Surgical treatment for patients with solitary metastasis in the mediastinal lymph node from renal cell carcinoma.

We performed surgical treatment on two patients, each with a solitary metastasis in a mediastinal lymph node from a renal cell carcinoma (RCC). The first case was a 58-year-old male with a chief complaint of chest discomfort due to pretracheal mediastinal lymph node (#3) swelling. He had undergone a right nephrectomy for RCC 13 years previously. Because of difficulty in establishing the diagnosis, a mini-thoracotomy was performed, and this lymphadenopathy was judged to be metastasis from the RCC. The pretracheal lymph nodes were completely resected, and he has experienced no recurrence for two years postoperatively. The second case was a 60-year-old female who had undergone a left nephrectomy for RCC two years previously. Because of the Botallo's lymph node (#5) swelling, a mini-thoracotomy was performed. This swollen lymph node was resected, and it was finally diagnosed to be metastasis from the RCC. Unfortunately, the tumor recurred in the mediastinal lymph nodes with multiple lung metastases five years later. A solitary metastasis in a mediastinal lymph node from a RCC is an unusual event, particularly in the absence of lung metastasis. The diagnostic and clinicopathological problems associated with this unique disease are herein discussed.