Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site

Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic; restricted to confirming the metastatic process, because of too numerous and disseminated or unresectabte lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients. (C) 2013 Published by Elsevier Masson SAS.