Case history/examination
An 89-year-old Japanese man presented to our department with gallbladder cancer. He had been suffering from left upper lobe (S1+2) lung cancer (papillary adenocarcinoma, pT3N2M0, pStage ⅢB). Left upper lobectomy with regional lymphadenectomy. Left mediastinal lymphadenectomy had been performed three years prior, but was followed by mediastinal lymph node metastases and an intrapulmonary metastasis in the right lobe two years before. The patient received chemoradiotherapy which stabilized the metastases. Follow-up PET-CT revealed that18F-fluorodeoxyglucose (FDG) had accumulated in the fundus of the gallbladder (Standard Uptake Value (SUV) max:4.2) and the hepatoduodenal lymph nodes (SUVmax:3.2) as well as in mediastinum lymph nodes (right carina lymph node SUVmax:11.0, para-aorta lymph node SUVmax:6.1). A tumor in the gallbladder and those in the hepatoduodenal lymph nodes had diameters of 15 mm and 12 mm, respectively. No significant change was observed in lung tumor size (Figure 1). The patient’s medical comorbidities included left internal carotid artery stenosis, early colorectal cancer, early bladder cancer, hypertension, and hyperuricemia Physical examinations of the thorax and abdomen showed almost normal findings. He did not have any disability or any signs of cognitive dysfunction.