Case history/examination
An 89-year-old Japanese man presented to our department with gallbladder
cancer. He had been suffering from left upper lobe (S1+2) lung cancer
(papillary adenocarcinoma, pT3N2M0, pStage ⅢB). Left upper lobectomy
with regional lymphadenectomy. Left mediastinal lymphadenectomy had been
performed three years prior, but was followed by mediastinal lymph node
metastases and an intrapulmonary metastasis in the right lobe two years
before. The patient received chemoradiotherapy which stabilized the
metastases. Follow-up PET-CT revealed that18F-fluorodeoxyglucose (FDG) had accumulated in the
fundus of the gallbladder (Standard Uptake Value (SUV) max:4.2) and the
hepatoduodenal lymph nodes (SUVmax:3.2) as well as in mediastinum lymph
nodes (right carina lymph node SUVmax:11.0, para-aorta lymph node
SUVmax:6.1). A tumor in the gallbladder and those in the hepatoduodenal
lymph nodes had diameters of 15 mm and 12 mm, respectively. No
significant change was observed in lung tumor size (Figure 1). The
patient’s medical comorbidities included left internal carotid artery
stenosis, early colorectal cancer, early bladder cancer, hypertension,
and hyperuricemia Physical examinations of the thorax and abdomen showed
almost normal findings. He did not have any disability or any signs of
cognitive dysfunction.