A case of primary signet-ring cell carcinoma of the lung whose neck lymph node metastasis progressed rapidly

Abstract

Background. Primary signet-ring cell carcinoma (SRCC) of the lung is rare, and carcinoma which has ≥50% SRCC component is considered to have poor prognosis. Case. A 59-year-old man presented to our pulmonary medicine department complaining of chest and back pain, cough, and anorexia. Neck and thoracic computed tomography (CT) showed left supraclavicular and upper mediastinal lymph node enlargement on both sides of the neck, and nodules in the subpleural region of the apical lung. He was given a diagnosis of adenocarcinoma consisting almost completely of signet-ring cells based on biopsy results from a lower left jaw lymph node and transbronchial lung biopsy. Immunohistochemically, the tumor cells were positive for thyroid transcription factor-1 (TTF-1) and cytokeratin-7 (CK7), but negative for cytokeratin-20 (CK20). Consequently, the tumor was diagnosed as primary SRCC of the lung, stage IV (cT1N3M1, Lung Cancer Classification 6th Edition). We scheduled cisplatin (CDDP) + TS-1® therapy. However, on post-treatment day 4, the patient experienced rapid enlargement of a neck lymph node, and we carried out tracheotomy to maintain the airway. The patient subsequently died of respiratory failure due to the progression of SRCC with pneumonia on day 25. Conclusion. We report a patient with primary SRCC of the lung with rapidly progressing neck lymph node metastasis. © 2011 The Japan Lung Cancer Society.