A case of primary lung cancer developing 9 years after surgery for metastatic mediastinal lymph node carcinoma

The patient was a 63-year-old male who had high levels of CEA in 1997. In 2002, CT revealed a swelling of the right upper mediastinal lymph node. Although metastatic carcinoma was diagnosed by biopsy, the primary lesion remained unknown. We performed a dissection of the mediastinal lymph node by VATS. The CEA levels normalized for 9 years. However, in 2011, the levels increased, and CT revealed bronchial wall thickening at the right superior bronchus. Class V diagnosis was achieved by cytology; therefore, right upper lobectomy was performed. Large cell carcinoma was diagnosed resembling that of the mediastinal lymph node. The CEA levels normalized, and he has remained recurrence-free for 3 years.