![]() ![]() There was no lymphorrhea from the juglosubclavian angle. The thoracic duct was also resected with the supraclavicular metastatic lymph nodes (Figure 4a). Some solid lymph nodes could be palpated between the left sternocleidomastoid muscle’s sternal head and clavicular head. A skin incision was made 2 cm above the left clavicle. ![]() Middle and lower jugular neck dissection was performed in 2011 on the grounds that volume reduction would contribute to the improvement of prognosis, and residual metastasis was only identified in the left supraclavicular lymph node. Positron emission tomography-computed tomography (PET-CT) revealed high uptake (SUVmax 6.0) in the left supraclavicular lymph node but no other metastatic lesions elsewhere (Figure 3). There was no clinical evidence of local or distant recurrence from either of the two malignancies at follow-up.įine needle aspiration biopsy of the left supraclavicular lymph node showed adenocarcinoma metastasis. Approximately 1 year later, the patient underwent para-aortic lymphadenectomy and additional chemotherapy for the recurrence in the para-aortic lymph node of endometrial adenocarcinoma. ![]() Subsequent to the operation, the patient received adjuvant chemotherapy. Figure 2 shows the changes of tumor markers (CA19-9, CA125, and CEA) from the time of diagnosis to the present. The patient’s past medical history includes the following: 7 years earlier she underwent rectal cancer treatment with low anterior resection and postoperative chemotherapy 4 years earlier she underwent a total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy for a stage IIIc endometrial adenocarcinoma (pT1cN1M0). In the findings, we detected a left supraclavicular lymph node suspected of metastasis (Figure 1). The objective of our report is to consider the most effective method of neck dissection for the treatment of supraclavicular lymph nodes from endometrial carcinoma in relation to our patient.Ī 74-year-old woman underwent computed tomography (CT) as a follow-up procedure following rectal cancer. ![]() Neck dissection for the treatment of metastasis from endometrial adenocarcinomas is not an established procedure. There have been no cases reported regarding the use of systematic neck dissection for the treatment of left supraclavicular lymph nodes suspected of being endometrial adenocarcinoma metastasis before surgery. Metastases of uterine carcinoma to the neck is reported to spread by way of the lymph flow from the pelvis up to the para-aortic nodes into the mediastinum, then into the thoracic duct. In such cases, palliative radiotherapy is the recommended treatment for relief of symptoms and improvement of the patient’s quality of life. Therefore, the prognosis of supraclavicular lymph node metastasis from uterine cervical cancer is considered significant. If supraclavicular lymph node metastases is detected from cervical cancer of the uterine, there is the possibility of further distant metastasis occurring. Supraclavicular lymph node metastasis from uterine carcinoma is rare and has been shown to negatively affect a patient’s prognosis. We have continued to monitor the patient closely over an extended period. Middle and lower jugular neck dissection was expected to improve the patient’s prognosis without impacting the patient’s active daily life. This surgery provided histological evidence that metastasis occurred from endometrial carcinoma. We determined that middle and lower jugular neck dissection was appropriate in treating this case based on the results of our preoperative FDG-PET and tumor markers. The patient’s past medical history included two prior cases of cancer: rectal cancer 7 years earlier and endometrial adenocarcinoma 4 years earlier. Our objective was to histologically determine the origin of the metastasis while simultaneously providing appropriate treatment. In this report, we describe the neck dissection procedure carried out on a 74-year-old woman with supraclavicular lymph node metastasis. To date, there have been no reported cases regarding systematic neck dissection as a salvage treatment. Supraclavicular lymph node metastasis from endometrial carcinoma is considerably rarer than metastasis from uterine cervical cancer. ![]()
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