Figure 2

Hilar lymph node metastases appeared 6 years after initial treatment of the primary tumor. A) A contrast-enhanced computed tomography image of the patient’s chest performed in July 2003. The arrow indicates a contrast-enhancing enlarged lymph node. Serum tumor markers are elevated as follows: carcinoembryonic antigen was 43.8ng/mL, carbohydrate antigen 19–9 was 151U/mL, and carbohydrate antigen 125 was 343U/mL in June 2003. B) The lymph node (arrow) decreased to 65% of its peak volume in June 2005, 2 years after the recurrence. Serum tumor markers were decreased as follows: carcinoembryonic antigen was 27.1ng/mL, carbohydrate antigen 19–9 was 27U/mL, and carbohydrate antigen 125 was 188U/mL.