The Thorax by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030272333
Publisher: Springer International Publishing

Also the azygos vein, the esophagus, the phrenic nerves, and the recurrent laryngeal nerve can be involved. Pericardial spread is relatively common, manifesting as pericardial effusion and/or irregular thickening of the pericardium. Even compression or direct extension to the heart may be seen, particularly to the left atrium [9, 81].

5.4.6 Pathway of Diffusion: Distant Metastatic Spread

Once the tumor reaches access to the mediastinum, there are pathways of spread downward into the abdomen via the aortic and esophageal hiatus, both through lymphatic vessels and direct diffusion. This can result in intra-abdominal lymphadenopathies primarily along the celiac vessels resulting in celiac, periportal, peripancreatic, and para-aortic lymph node metastases. Disease may also reach the gastrohepatic ligament either by spread along vascular planes or through the esophageal hiatus.

SCLC can also directly spread upward via the cervicothoracic hiatus, resulting in supraclavicular and, less commonly, lower neck adenopathies and possible involvement of the lower neck structure (cervical esophagus, hypopharynx, thyroid, etc.) [86].

Metastatic spread to distant organs is also frequent in SCLC. The most common metastatic sites at diagnosis are bone (19–38%), liver (17–34%), adrenal glands (10–17%), and brain (up to 14%, whose 10–15% in neurologically asymptomatic patients) [9]. Particularly, SCLC has been associated with an increased metastatic potential to liver and brain with respect to NSCLC [87].

Nodules or masses in the contralateral lung can be also found as well as other uncommon metastatic sites, such as pancreas, prostate, spinal cord, and oropharynx [81]. Lastly, metastatic involvement of bone marrow has been detected in 10–15% of patients. However, less than 5% of these patients have bone marrow as isolate distant metastatic site [88].

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