Mediastinoscopic Biopsy Research Articles

A confirmatory approach to diagnosing well-differentiated liposarcoma using limited biopsy tissue

Aim To demonstrate a confirmatory approach to diagnosing a well-differentiated liposarcoma using limited biopsy tissue. Methods A 66-year-old man presenting with pneumonia had an incidental CT finding of a 20 cm heterogeneous fat-density mass within the central mediastinum. The mass showed low PET FGD-avidity. The radiological characteristics and location suggested a liposarcoma. Mediastinoscopic biopsy yielded limited lesional tissue, further analysed by light microscopy on H&E and IPX stains, and FISH analysis for MDM2-gene amplification. Results Microscopically, the lesional tissue resembled an adipocytic lesion comprising mature adiopocytes with significant variability, nuclear atypia, with occasional lipoblasts, and fibromyxoid stroma. However, necrosis, mitosis and dedifferentiated areas were not identified. The lesional cells showed positive staining for MDM2 and negative staining for CD34, S-100, HMB45, cytokeratins and calretinin. FISH analysis revealed MDM2-gene amplification, confirming the diagnosis of a well-differentiated liposarcoma. Dedifferentiated areas were identified on subsequently resected tumour. Discussion The diagnosis of well-differentiated liposarcoma on biopsy is sometimes difficult with limited and poorly representative tissue. Whilst location and radiological appearance may be suggestive, a selective IPX panel and MDM2 FISH analysis can offer a definitive diagnosis.

Fibrosing Mediastinitis

A 38-year-old woman developed fibrosing mediastinitis after an initial episode of histoplasmosis. She had history of frequent bronchitis as a teenager and developed symptoms suggestive of pneumonia unresponsive to conventional antibiotics. In addition to right lung infiltrates, she developed mediastinal lymphadenopathy. After transbronchial biopsy confirmation of histoplasmosis, she received therapy with oral itraconazole. Three years after her initial therapy with itraconazole, she presented with worsening dyspnea on exertion. Echocardiography suggested new-onset pulmonary hypertension and moderate tricuspid regurgitation. Cross-sectional imaging of the chest demonstrated thickened pleura and pericardium; calcified, enlarged lymph nodes; and prominent fibrosis in the hilar region. Thorascopic and mediastinoscopic biopsies confirmed the diagnosis of fibrosing mediastinitis. She was treated with courses of antibiotics and pulsed steroids over the years for symptoms of dyspnea, hemoptysis, and pleuritic chest pain associated with radiological evidence of disease progression. Notably, the steroids did not …

G-CSF producing pleomorphic carcinoma with undetected origin: an autopsy case report

Pleomorphic carcinoma is an uncommon neoplasm that is known to arise in diverse sites, including the lung, breast, pancreas, gallbladder and prostate. We encountered a rare case of pleomorphic carcinoma of undetected origin associated with production of granulocyte-colony stimulating factor (G-CSF). The patient was a 62-year-old man who presented with cough and general fatigue. Chest computed tomography (CT) demonstrated a mass lesion in the mediastinum, so mediastinoscopic tumor biopsy was performed. However, making the diagnosis was difficult despite the suspected malignant potential. CT-supported positron emission tomography showed multiple uptake lesions in the small intestine, duodenum and right adrenal gland, in addition to the mediastinum. The patient subsequently presented with right-side weakness and sensory impairment. Brain CT showed multiple intracerebral lesions, indicating metastatic tumors. For the definitive diagnosis and to clarify options for chemotherapeutic management, the patient underwent surgical craniotomy. The resected specimen was considered to represent sarcomatoid carcinoma with positive immunoreactive staining for cytokeratin as an epithelial marker, indicating pleomorphic carcinoma. Furthermore, laboratory data showed leukocytosis without any infections and elevated serum G-CSF levels during hospitalization. The patient developed complications of occlusive intussusception in the small intestine caused by probably metastatic lesions and died from disease progression 82 days after initial admission. Although the presence of G-CSF-producing pleomorphic carcinoma was confirmed, the primary origin of this pleomorphic carcinoma could not be indentified clearly even at autopsy.

Thymomas with prominent glandular differentiation: a clinicopathologic and immunohistochemical study of 12 cases

Twelve cases of thymomas with prominent glandular differentiation are presented. The patients were 7 men and 5 women aged between 45 and 68 years (average, 56.5 years). Clinically, the patients presented with nonspecific symptoms of chest pain, cough, and fatigue. None of the patients had a history of myasthenia gravis or other autoimmune syndrome. Thymectomy was performed in all patients. The tumor size ranged from 4 to 7 cm in greatest diameter. Macroscopically, the tumors were described as firm and light tan without areas of necrosis, hemorrhage, or cystic change. Histologically, 7 tumors were classified as spindle cell (World Health Organization type A), 2 as mixed spindle cell and conventional (A+B1), 2 as conventional (B1), and 1 as atypical thymoma (B3). In 4 cases, the tumors showed invasion into periadipose thymic tissue. All cases showed the typical growth patterns of their particular subtypes. In addition, a distinct glandular component was present in all cases showing mucinous differentiation in 4 of them. Immunohistochemical studies showed tumor cells positive for CAM5.2, cytokeratin 5/6, and Pax8 and negative for carcinoembryonic antigen, thyroid transcription factor 1, and epithelial membrane antigen. Calretinin showed focal weak staining in the nonmucinous glandular components in 3 cases. Follow-up information obtained in 8 patients showed that all were alive and well in a period ranging from 2 to 5 years. The possibility of a glandular component in thymomas should be kept in mind in the assessment of mediastinoscopic biopsies to avoid misdiagnosis for other neoplasms that may require different treatment modalities.

The additive importance of combination of mediastinoscopic tissue biopsy and fine needle aspiration cytology to targetted therapies for non-small cell lung cancer

The additive importance of combination of mediastinoscopic tissue biopsy and fine needle aspiration cytology to targetted therapies for non-small cell lung cancer

Rescue of hemodynamic compromise in superior vena cava syndrome with transesophageal echocardiography

The anesthetic management of patients with an anterior mediastinal mass is very challenging due to the potential risk of hemodynamic and respiratory compromise. A specialized anesthetic plan should be developed for in patients with an anterior mediastinal mass based on the preoperative clinical symptoms as well as, radiographic, computed tomographic, spirometric, and echocardiographic data [1,2]. A 31-year-old man (height 173.5 cm, weight 70.4 kg) came to our emergency department with right-sided chest discom fort, dry cough, progressive dyspnea, and orthopnea for the previous 4 weeks. The initial chest X-ray evaluation revealed a large amount of right side pleural effusion and a bulky mediastinal mass. Multi directional computed tomography revealed a 12.3 cm homogenous soft tissue mass in the anterior mediastinum compressing the superior vena cava and dis placing the ascending aorta. The trachea and both main bronchi were patent, but a cross-sectional area of the right upper lobe bronchus (7.21 mm) was reduced 44% relative to the left upper lobe bronchus (12.97 mm). Right loculated pleural effusion, totally collapsed right lower lobe and subsegmental atelectasis in the right middle lobe were noted. A therapeutic and diagnostic thoracentesis was done under local anesthesia, and 1,600 ml of pleural fluid was removed. Cytology of pleural fluid revealed many lymphocytes and mesothelial cells, but these were negative for malignancy. However, because dyspnea persisted and pleural effusion was increased after admission, a mediastinoscopic biopsy and pleural decortication were performed under general anesthesia. In the operating room, the CAPIOX emergency bypass system (CAPIOX Ⓡ EBS TM , Terumo Corporation, Tokyo, Japan) was prepared in the event of cardiopulmonary collapse. Before the induction of general anesthesia, a 20-guage catheter was placed in the right radial artery for continuous blood pressure monitoring. The patient was placed in the Semi-Fowler’s position with the head elevated 30 degrees to relieve the discomfort of the supine position. Initial vital signs were blood pressure 105/65 mmHg, heart rate 100 beats/min, respiration 25 breaths/min, and O2 saturation 96%. Preoxygenation with 100% O2 was administered using a face mask, and anesthesia was induced with a continuous infusion of propofol (effect-site concentration 4.0-5.0 μg/ml and remifentanil (effect- site concentration 3.0 5.0 ng/ml using a target-controlled infusion pump (Orchestra Ⓡ Base Primea, Fresenius Vial, Brezins, France) and a bolus dose of rocuronium 50 mg via a preexisting 16-guage IV catheter in the vein on the medial surface of the right leg. Intubation was successfully achieved using the left-sided Robert-Shaw double lumen bronchial tube in the supine position. Breath sounds were heard on both sides of the chest. Mechanical ventilation was maintained with a tidal volume, respiratory rate and partial pressure of end-tidal carbon dioxide of 500 ml, 15 breaths/min, and 28-32 mmHg, respectively. After induction, the arterial blood pressure began to drop to 60/35 mmHg and the heart rate increased to 110 beats/min. Ephedrine 10 mg were administered intravenously, but the vital signs were not improved. A transesophageal echocardiography (TEE) was performed for evaluation of hemodynamic instability. It showed that a large mass compressed the right atrium

Sarcoidosis Presenting as Löfgren’s Syndrome with Myopathy

A 34-year-old female patient, who had proximal muscle weakness for 8 months, presented with erythema nodosum lesions on the pretibial region in addition to pain, swelling, and movement restriction in both ankles for the last one month. Thoracic CT demonstrated hilar and mediastinal lymphadenopathy. She underwent mediastinoscopic lymph node biopsy; biopsy result was consistent with noncaseating granuloma. Serum angiotensin converting enzyme level and muscle enzymes have been elevated. Muscular MRI and EMG findings were consistent with myositis. Muscle biopsy was done, and myopathy was found. The patient was diagnosed with sarcoidosis, Löfgren's syndrome, and sarcoid myopathy. The patient displayed remarkable clinical and radiological regression after 6-month corticosteroid and MTX therapy.

Mediastinal mass and pericardial tamponade in a renal transplant recipient: A rare case of nocardia infection

Patient: Female, 30Final Diagnosis: NocardiosisSymptoms: Cardiac tamponade • cough • dyspnea • hoarseness • mediastinal mass • pericardial effusion • short of breathMedication: —Clinical Procedure: —Specialty: TransplantologyObjective:Rare diseaseBackground:Nocardia infections can complicate solid organ transplantation. The usual clinical presentations include pulmonary infiltrates with or without cavitation and subcutaneous and brain abscesses. We report an unusual case of nocardia infection in a kidney transplant recipient that presented as mediastinal mass and was associated with pericardial tamponade.Case Report:A 30 year old African American renal transplant recipient presented with cough, hoarseness and shortness of breath nine months after kidney transplantation. She received basiliximab perioperatively and her maintenance immunosuppression included tacrolimus, mycophenolate mofetil and prednisone. Computed tomography (CT) showed a large mediastinal mass with a large pericardial effusion. An echocardiogram revealed collapse of the right ventricle consistent with tamponade. We performed emergent pericardiocentesis to treat the tamponade. A mediastinoscopic biopsy of the mediastinal mass was done to establish a diagnosis. The mediastinal biopsy confirmed the growth of Nocardia. After 2 weeks of imipenem and 6 weeks of linezolid, there was marked radiographic improvement in the size of the mediastinal mass.Conclusions:We report a rare case of a large mediastinal mass associated with pericardial tamponade from nocardia infection in a renal transplant recipient. An invasive approach may be necessary to obtain tissue diagnosis to direct treatment in these cases. Prompt and appropriate medical therapy leads to marked radiographic improvement.

Desmoplastic spindle cell thymomas: a clinicopathologic and immunohistochemical study of 14 cases

Fourteen cases of spindle cell thymoma with prominent desmoplastic changes are presented. The patients are 9 women and 5 men between the ages of 46 and 79 years. Clinically, the patients presented with symptoms of chest pain, shortness of breath, and dyspnea. Radiographic imaging showed the presence of an anterior mediastinal mass, and surgical resection of the tumor mass was accomplished in all of the cases. Grossly, all the tumors were described as ovoid tumor masses measuring between 4 and 9 cm in greatest dimension. At cut surface, the tumors were described as solid and light tan-brown in color. Necrosis and hemorrhage were not recorded in any of the cases. Histologically, 8 cases were invasive, and 6 were encapsulated tumors. Extensive areas of young fibrocollagen and a prominent fibroblastic proliferation characterized the tumors. Scattered areas of more conventional spindle cell thymoma were present in all cases but mitotic activity, necrosis, and/or hemorrhage were not identified. Immunohistochemical stains were performed in 9 cases, showing tumor cells positive for pancytokeratin, cytokeratin 5/6, Bcl-2, Pax8, and vimentin. Clinical follow-up in 8 patients showed that all are alive and well 1 to 8 years after diagnosis. The current growth pattern of spindle cell thymomas is unusual and should be kept in mind when evaluating mediastinoscopic biopsies.

Both Native and Ectopically Transplanted Hearts Shown on FDG PET/CT in a PTLD Patient

Posttransplant lymphoproliferative disorder (PTLD) is one of the unfortunate complications of immunosuppression after allograft transplantation. 18F-FDG PET/CT plays an important role in the diagnosis and management of PTLD. The authors report a PET/CT scan of a young woman who received a heterotopic cardiac transplant, demonstrating 2 functional hearts in the thorax. The scan also demonstrates a small-volume mediastinal lymphadenopathy caused by the PTLD/B-cell lymphoma, subsequently proven by mediastinoscopic biopsy.

Peripheral Tuberculous Lymphadenitis Masquerading as Metastatic Gastric Carcinoma on F-18 FDG Dual Time Point PET/CT.

A 59-year-old woman was hospitalized with weight loss, anorexia, and low grade fever for 2 weeks. She had undergone a total gastrectomy followed by adjuvant chemotherapy 10 years prior due to advanced gastric cancer. To evaluate recurrence, fluorine-18 fluorodeoxyglucose (FDG) dual time point positron emission tomography/computed tomography (DTPP) was conducted with a Gemini GXL 6 PET/CT system (Philips, Hamburg, Germany). FDG DTPP was performed twice, with an early scan 60 min after FDG injection and a delayed scan 150 min after FDG injection (Fig. 1a). The early scan showed that multiple hypermetabolic lesions were located along left supraclavicular, mediastinal (1R, 2R, 3, 4R and 7) and left paraaortic (retroperitoneal) nodal stations (Fig. 1b). The delayed scan showed that all the above mentioned lesions revealed a more increased maximal standard uptake value (SUVmax) than was detected in the early scan. Both scans did not show intrapulmonary lesion. For example, the left supraclavicular lymph node, 2R and retroperitoneal lymph node were observed with early and delayed SUV maxes of 4.5/7.7/3.6 and 6.7/10.7/4.4, respectively. To confirm diagnosis and establish a treatment plan, a mediastinoscopic biopsy of one of the mediastinal lymph nodes (4R) was subsequently performed and tuberculosis was ultimately diagnosed. Then, the patient started an antituberculosis treatment instead of antichemotherapy (Fig. 1c). A follow-up FDG PET/CT performed 12 months later showed disappeared FDG uptake and significant decreased change of multiple peripheral tuberculous lymphadenitis. Fig. 1 F-18 FDG dual time point PET/CT maximum intensity projection (MIP) images with (a) early scan and (b) delayed scan for ruling out recurrence, showing multiple systemic hypermetabolic lymph nodes. (c) Second MIP after antituberculosis treatment, demonstrating ... Whole-body FDG PET/CT has widespread use in diagnosing and staging variable malignancies, and plays an important role in detection of gastric cancer recurrence [1]. However, FDG is not cancer-specific and some inflammatory diseases have shown higher FDG uptake on PET imaging [2]. Infection, inflammation, and granulomatosis are also known to cause false positive FDG PET scans because activated inflammatory cells show avidity for FDG [3, 4]. So, for alternative measure differentiating malignancy from benign disease [5], early standard FDG PET/CT and delayed scan after early scan, namely FDG DTPP, has been introduced and often performed worldwide. FDG DTPP used the phenomenon that with time, FDG uptake in tumor tissues increases, while FDG uptake in normal or benign tissues decreases [5, 6]. Although FDG DTPP has been not accepted routinely, the retention index inferred from FDG DTPP predicted patient prognosis in lung cancer [7]. We had considered multiple hypermetabolic lymph nodes as metastasis rather than benign lymphadenopathies because of increased FDG uptake on the delayed scan versus the early scan, before pathologic results were confirmed. It is presumed that FDG DTPP could not help differentiate malignancy from benign diseases in cases of active infectious disease such as ongoing tuberculosis. Peripheral tuberculous lymphadenitis (PTL) is a common manifestation of extrapulmonary tuberculosis and remains an important cause of adenopathy globally [8, 9]. It was difficult for those lesions to be directly considered as PTL, because PTL manifestation mainly involves cervical chains and the supraclavicular region [8]. We demonstrate a rare FDG DTPP case showing PTL mimicking metastatic lymphadenopathies originated from advanced gastric cancer. Even if FDG DTPP showed increased FDG uptake on the delayed scan to be considered as suspicious metastasis, the possibility of active tuberculosis should always be kept in mind, especially in areas with epidemic granulomatous diseases.

Fibrosing mediastinitis mimicking bronchogenic carcinoma.

Fibrosing mediastinitis is a rare but benign disorder characterized by an excessive fibrotic reaction in the mediastinum which can result in compromise of airways, great vessels, and other mediastinal structures. In this paper we presented a patient with fibrosing mediastinitis mimicking bronchogenic carcinoma. The patient was a 32-year-old diabetic male admitting with cough and hemoptysis. There was a right hilar mass and multiple mediastinal conglomerated lymph nodes on chest computed tomography. Positron emission tomography with computed tomography (PET/CT) scan demonstrated increased fluorodeoxyglucose (FDG) uptake at the right hilar mass lesion and mediastinal lymph nodes. Fiberoptic bronchoscopy showed mucosal distortion of right upper lobe. Pathologic examination of the mucosal biopsy revealed inflammation. Endobronchial ultrasound guided transbronchial needle and cervical mediastinoscopic lymph node biopsies were undiagnostic. Diagnostic thoracotomy confirmed the diagnosis fibrosing mediastinitis. Administration of six months of systemic corticosteroid and antituberculous therapy was not beneficial. In conclusion, despite being a rare clinical entity, fibrosing mediastinitis should be kept in mind in the differential diagnosis of mediastinal mass lesions of unknown etiology. The diagnosis is exceptionally difficult in the presence of atypical radiological findings. The treatment is particularly challenging without any proven effective therapy.

Sarcoidosis with uveitis occurring in Taiwanese sisters

Sarcoidosis is a multisystem granulomatous inflammatory disease, and uveitis is the most common ocular manifestation. Herein we report a female sibling pair both having sarcoidosis with uveitis. A 59-year-old woman presented with chronic panuveitis in both eyes lasting for one year. Enlarged mediastinal lymph nodes were demonstrated on computed tomography, and mediastinoscopic biopsy revealed chronic non-caseating granulomatous inflammation. Sarcoidosis was diagnosed. Eight months later, her younger sister developed bilateral anterior and intermediate uveitis. She was also diagnosed with sarcoidosis confirmed by intrathoracic lymph node biopsy. This is the first report of familial sarcoidosis presented with uveitis in Taiwan.

Mycobacterium kansasii pericarditis in a kidney transplant recipient: a case report and comprehensive review of the literature

Mycobacterium kansasii is the second most common non-tuberculous mycobacteria in kidney transplant recipients (KTRs) and has been reported to cause disseminated infection in KTRs. We report the first case to our knowledge of M. kansasii pericarditis after kidney transplantation in a 54-year-old man. The patient was admitted with a 2-month history of intermittent fever and myalgia, treated with oral prednisolone and mycophenolate mofetil prior to admission. Chest computed tomography showed enlarged mediastinal lymph node and small amount of pericardial effusion. Mediastinoscopic biopsy of mediastinal lymph node revealed reactive hyperplasia, without evidence of granuloma, but acid-fast bacilli stain of pericardial fluid reported positive finding and pericardial fluid culture identified M. kansasii. The patient has been treated successfully with rifabutin-based combination therapy. All available cases of M. kansasii infection in kidney transplant patients and M. kansasii pericarditis in human immunodeficiency virus-infected patients are comprehensively reviewed.

Encéphalite limbique paranéoplasique révélant un cancer bronchique non à petites cellules. Place de l’échographie endobronchique dans le diagnostic étiologique

Limbic encephalitis is a rare neurological paraneoplastic syndrome, characterized by anterograde amnesia, epilepsy and confusion. Diagnosis of the underlying cancer is essential for treatment.A 55-year-old heavy smoker was admitted on account of general physical deterioration and neurological symptoms. The diagnosis of limbic encephalitis was based on rapidly progressive symptoms, inflammatory cerebrospinal fluid, increased signal intensity in the temporal lobes on magnetic resonance imaging and the presence of anti-neuronal anti-Ma2 antibodies. The initial work-up, including positron emission tomography, did not reveal any cancer. Four months later, sub-carenal lymphadenopathy was detected. Echo-guided transbronchial and mediastinoscopic biopsies revealed bronchial adenocarcinoma (TxN2M0). Neurological and general physical deterioration followed despite radio-chemotherapy giving total control of the tumour macroscopically. The patient died two months after the end of his treatment as a result of staphylococcal septic shock.The neurological prognosis is poor. The search for bronchial cancer, when suspected, should include positron emission tomography, to be repeated if necessary, and sampling of the mediastinal lymph nodes using endobronchial ultrasound.

Airway obstruction after biopsy by cervical mediastinoscopy in a patient with a mediastinal mass -A case report-

Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression.

Primary intrathoracic goiter: Incidental diagnosis on 99m-Tc pertechnetate radioisotope thyroid scan

Primary intrathoracic goiter: Incidental diagnosis on 99m-Tc pertechnetate radioisotope thyroid scan

Sarcoidosis Presenting with Massive Pleural Effusion and Elevated Serum and Pleural Fluid Carbohydrate Antigen-125 Levels

A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.

A Case of Human Herpes Virus-8 Unrelated Primary Effusion Lymphoma-Like Lymphoma Presented as Pleural Effusion

Primary effusion lymphoma (PEL) is a rare type of lymphoma that arises in the body cavity without detectable masses. It is associated with human herpes virus-8 (HHV-8), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). Recently, PEL unrelated to viral infection has been reported and it has been termed HHV-8 unrelated primary effusion lymphoma-like lymphoma (HHV-8 unrelated PEL-like lymphoma). Here, we report a case of HHV-8 unrelated PEL-like lymphoma in an 80-year-old woman. Chest X-ray and computed tomography revealed left-sided pleural effusion. Pleural effusion analysis and mediastinoscopic biopsy showed atypical cells that had originated from the B cells. The cells were positive for CD20 and bcl-2, but negative for CD3, CD5, CD21, CD30, CD138, epithelial membrane antigen, and HHV-8. Serological tests for HIV and EBV were negative. Considering the patient's age, further treatments were not performed. She has shown good prognosis without chemotherapy for more than 18 months.

A case of mediastinal lymph node carcinoma of unknown primary site treated with docetaxel and cisplatin with concurrent thoracic radiation therapy.

Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5 × 8.2 cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset.