Isolated spread of hepatic metastatic disease to a mediastinal lymph node - Report of a case and review of pertinent anatomy and literature

The lymphatic system is an important route of spread of hepatic metastatic disease to extrahepatic sites. Although portal and celiac nodes are commonly evaluated both pre- and intraoperatively in patients considered for resection, cephalad sites of drainage of the liver represent a more occult pitfall. We report a case of colon cancer metastatic to the right lobe with an isolated extrahepatic deposit in a mediastinal lymph node. This preoperative diagnosis was confirmed at a subsequent operation, leading to a change in treatment plan. We believe that such occurrences may be unrecognized rather than rare. Careful evaluation of the mediastinum prior to proceeding with hepatic resection may improve patient selection, and hence the outcome, of this procedure.