Incidental malignancy in internal thoracic artery lymph nodes

The incidental finding of malignant internal thoracic lymph nodes while mob ilizing the internal thoracic artery (ITA) for coronary bypass grafting has not to our knowledge been previously reported. The cases of 3 male patient s who underwent surgery between January 1990 and January 1993 and in whom m alignant lymph nodes were found in the ITA pedicle are reviewed. One indivi dual was found to have metastatic carcinoma of the breast, whereas the othe r 2 were discovered to have previously undiagnosed lymphomas. After undergo ing further relevant investigation and treatment, all 3 patients remain fre e of recurrent disease 6.8 to 9.8 years after their original cardiac surger y. Primary or metastatic malignancy may be encountered in the course of ITA mobilization for grafting. Abnormally enlarged internal thoracic lymph nod es should be sent for pathologic examination. (C) 2001 by The Society of Th oracic Surgeons.