Carcinoma of Unknown Primary with Positive Cervical Lymph Node- a Case Report (original) (raw)
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Head & Neck, 1998
The purpose of this study was to evaluate the efficacy of the modern diagnostic evaluation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. One hundred thirty patients were evaluated between June 1983 and June 1997. All underwent head and neck examinations, head and neck computed tomography (CT), and/or magnetic resonance imaging (MRI) scans, panendoscopies, and biopsies of head and neck mucosal sites. Twenty-four patients underwent 2-[fluorine-18]-2-deoxy-D-glucose (FDG) single photon emission computed tomography (SPECT); 34 patients underwent tonsillectomy. The primary site was identified in 56 patients (43%); the likelihood was increased in patients with suggestive findings on physical examination and/or radiographic evaluation. Eighty-three percent of the lesions were located in the tonsillar fossa and base of tongue. Results of FDG-SPECT scans were positive in 20 patients (83%); the primary tumor was detected in 7 patients (35%). Twelve (35%) of 34 patients who underwent tonsillectomy had a primary tumor discovered in the tonsillar fossa. Multivariate analysis of successful primary site detection revealed that suggestive findings on physical examination (p= .0225) and suggestive findings on CT and/or MRI (p = .0013) were significantly related to this end point. The primary lesion will be detected in over 40% of patients with physical examination of the head and neck and CT and/or MRI followed by panendoscopy and biopsies. Limited data pertaining to FDG-SPECT suggest that this provides additional useful information in a small subset of patients. Tonsillectomy is useful for those with suggestive findings on physical examination and/or radiographic evaluation.
Cervical lymph node metastasis of squamous cell carcinoma from unknown primary tumor
The first aim of the study was to determine the survival rate of the patients with Carcinoma of the Unknown Primary (CUP) in relation to lymph node status and eventual later identification of the primary tumor. To second one was to investigate the impact of PET-CT on identification of the primary tumor. We studied 97 patients sent to our University Medical Center with diagnosis of metastasis of unknown primary tumor between 1.1.1997 and 1.9.2009. All patients had panendoscopy and some had PET-CT at later period. All susceptible patients had a surgery and postoperative radiation therapy. After the completed their treatment they were followed up at ENT department. With preoperative examinations we discovered 48 primary tumors. Only in one case of 13 the PET-CT detected the primary tumor not confirmed with other examination methods. After the treatment we found primary tumors in 10 patients. In 39 patients we didn't discover any primary tumor. The 2-year overall survival for 10 patients with found tumor was 80.0%, the 2-year overall survival for the 39 patients without discovered tumor was 73.8%. The 2-year disease-specific survival for 10 patients with found tumor was 90.0%, the 2-year disease-specific survival for 39 patients without discovered tumor was 81.6%. The 2-year overall survival for high neck level lymph node metastasis group (N=36) was 80.1%, the 2-year overall survival for low neck level lymph node group (N=13) was 61.5%. PET-CT method was not particularly useful in detecting primary tumors in patients with metastasis with unknown primary. Patients with high neck level lymph node metastasis had statistically significant better survival.
Diagnosis and management of neck metastases from an unknown primary
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2005
Neck lymph node metastases from occult primary constitute about 5%-10% of all patients with carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography scan, and magnetic resonance. The most frequent histological finding is Squamous Cell Carcinoma, particularly when the upper neck is involved. In these cases, a systematic tonsillectomy in the absence of suspicious lesions is discussed since up to 25% of primary tumours can be detected in this site. Thoracic, and abdominal primaries (especially from lung, oesophagus, stomach, ovary or pancreas) should be ...
Evaluation and management of malignant cervical lymphadenopathy with an unknown primary tumor
Otolaryngologic Clinics of North America, 2005
Periodically physicians involved in the management of head and neck cancer encounter a patient with biopsy-demonstrated carcinoma within a cervical lymph node but with no clinically detectable primary tumor site within the upper aerodigestive tract. Presumed metastatic carcinoma within cervical lymph nodes with an unknown primary site is relatively rare, representing only 3% to 5% of all head and neck cancers [1]. Explanations for this phenomenon are speculative, and although the roles of panendoscopy (directed laryngoscopy, esophagoscopy, bronchoscopy) and directed biopsies are generally accepted, many questions about how to employ and interpret new radiographic technologies and about appropriate management remain unanswered. This article reviews current information regarding the diagnostic evaluation of the patient with malignant cervical disease with an unknown primary tumor site, prognostic indicators for these patients, and treatment strategies. Etiology Carcinoma metastatic to the neck with an unknown primary tumor site accounts for approximately 3% to 5% of all head and neck cancers. Most patients with metastatic cervical adenopathy have squamous cell carcinoma
East African Scholars Journal of Medical Sciences, 2022
Introduction: Squamous cell carcinoma is the most common cancer of the upper aerodigestive tract, accounting for more than 90% of cancers. Its method of spread is through lymphatic channels, with a high propensity toward deposition in the regional lymph nodes. Objective: To determine the pattern of metastesis of squamous cell carcinoma in cervical lymph node in patients with occult primary. Methods: This was an observational cross sectional study which was carried out in the Dept. of ENT, Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2017 to June-2019. A Total 31 patients were selected according to selection criteria and level of involved lymph node and nodal staging was determined by careful clinical examination, biopsy of all suspicious site, CT scan, MRI, USG and X-ray. Results: Thirty One patients with metastatic neck node in whom the primary tumour was not found despite of extensive diagnostic procedure were studied in this series. Patients distri...
Metastatic neck node with unknown primary
Bangladesh Journal of Otorhinolaryngology, 2014
Objective: To find out the clinical presentation of metastatic neck node with unknown primary. Methods: A cross-sectional study done on the admitted patient from four tertiary level hospitals in Dhaka city from January 2010 to September 2010. Results: Most of the cases were squamous cell carcinoma (68.75%). the next common was adenocarcinoma (15.62%) and undifferentiated carcinoma (12.5%). Melanoma was a rare condition (3.13%). The commonest age group was 6th decade (40.63%) which was followed by 5th decade (28%). None of the case was found bellow the age of 30 years. The male to female ratio was 2:1. Commonest metastatic group of lymph node was Level II (50%), followed by Level- III (22%) Level- IV (19%), Level- V (6%) and Level- I (3%). Staging of lymph nodes were N2A (35%), N1 (31%), N2B (16%), N3 (12.5%) and N2C (6.25%) in decreasing order of frequency. About 72% cases are smoker. Conclusion: Metastatic carcinoma with unknown primary tumour commonly present in elderly age group ...