A rare case of Calcified Mediastinal Lymphadenopathy Due to anal Adenocarcinoma Metastasis.
Abstract: Introduction: Anal cancers constitute 1.5% of all gastrointestinal malignancies. Intrathoracic lymph nodal calcification is thought to
be sequelae of prior granulomatous diseases, however, it is a known predictor of metastasis from various primaries. We describe a case of anal
adenocarcinoma with multiple calcified metastatic mediastinal lymphadenopathies.
Case Details:A 43-year-old female presented with bleeding per rectum and chest pain for 1 month. Digital per rectal examination revealed
thickened anal wall. Contrast-enhanced computed tomography(CECT) of the pelvis showed irregular circumferential wall thickening in the anal
canal. CECT of the thorax showed multiple calcified mediastinal lymphadenopathies. Serum calcium level was normal. Proctoscopy-guided
biopsy from the anal canal was reported as adenocarcinoma. PET-CT (Positron Emission Tomography-computed tomography) showed uptake in
the proximal anal canal and mediastinal lymph nodes. Endobronchial ultrasound-guided fine needle aspiration was reported as metastatic
adenocarcinoma. Finally, it was found to be a case of well-differentiated adenocarcinoma of the anal canal with multiple calcified metastatic
mediastinal lymphadenopathies.
Discussion: Metastasis in anal carcinoma is seen only in 10% of cases, of which the most common is in the liver and lungs. Calcified
mediastinal lymph nodes are manifestations of previous granulomatous infection but are rarely due to metastasis from mucin-producing
adenocarcinomas. Interestingly in our case, after the biopsy confirmation of anal adenocarcinoma, PET-CT showed mediastinal nodal uptake
rather than other solid organs or pelvic or inguinal lymph nodes. There are very few reports of metastases of anal cancer to mediastinal nodes in
the literature. We did a thorough web search and as far as we know, this is the first case report on calcified metastatic mediastinal
lymphadenopathies from anal adenocarcinoma. CONCLUSION: If calcified mediastinal lymph nodes are found in the CECT thorax, apart from
benign conditions, metastasis from the lower gastrointestinal tract malignancies should be in the working differentials and hence pathological
examination of calcified nodes becomes mandatory.
be sequelae of prior granulomatous diseases, however, it is a known predictor of metastasis from various primaries. We describe a case of anal
adenocarcinoma with multiple calcified metastatic mediastinal lymphadenopathies.
Case Details:A 43-year-old female presented with bleeding per rectum and chest pain for 1 month. Digital per rectal examination revealed
thickened anal wall. Contrast-enhanced computed tomography(CECT) of the pelvis showed irregular circumferential wall thickening in the anal
canal. CECT of the thorax showed multiple calcified mediastinal lymphadenopathies. Serum calcium level was normal. Proctoscopy-guided
biopsy from the anal canal was reported as adenocarcinoma. PET-CT (Positron Emission Tomography-computed tomography) showed uptake in
the proximal anal canal and mediastinal lymph nodes. Endobronchial ultrasound-guided fine needle aspiration was reported as metastatic
adenocarcinoma. Finally, it was found to be a case of well-differentiated adenocarcinoma of the anal canal with multiple calcified metastatic
mediastinal lymphadenopathies.
Discussion: Metastasis in anal carcinoma is seen only in 10% of cases, of which the most common is in the liver and lungs. Calcified
mediastinal lymph nodes are manifestations of previous granulomatous infection but are rarely due to metastasis from mucin-producing
adenocarcinomas. Interestingly in our case, after the biopsy confirmation of anal adenocarcinoma, PET-CT showed mediastinal nodal uptake
rather than other solid organs or pelvic or inguinal lymph nodes. There are very few reports of metastases of anal cancer to mediastinal nodes in
the literature. We did a thorough web search and as far as we know, this is the first case report on calcified metastatic mediastinal
lymphadenopathies from anal adenocarcinoma. CONCLUSION: If calcified mediastinal lymph nodes are found in the CECT thorax, apart from
benign conditions, metastasis from the lower gastrointestinal tract malignancies should be in the working differentials and hence pathological
examination of calcified nodes becomes mandatory.