Lege Artis Medicinae

[PRIMARY TUMOURS OF UNKNOWN ORIGIN WITH CERVICAL LYMPH NODE METASTASES - A RETROSPECTIVE STUDY]

GARAI Tibor, NÉMETH Zsuzsanna, TOMPOS Tamás, ZEMPLÉN Béla

APRIL 22, 2008

Lege Artis Medicinae - 2008;18(04)

[ITRODUCTION - Primary tumours are defined unknown if, despite of the presence of histologically verified metastases, the site of origin cannot be revealed even with complex investigations. On average, 5% of patients with cervical lymph node metastases belong to this group. The incidence of cervical lymph node tumours increases with age, with more than 60% arising from malignancies in patients over 40. PATIENT AND METHODS - In this retrospective study, the authors review the history of 29 patients treated or examined in their department between January 2002 and November 2006 with the starting diagnosis of cervical lymph node metastasis from a primary tumour of unknown origin. All patients had a thorough physical examination, indirect upper respiratory tract endoscopy, and aspiration cytology. In the search for the primary tumour the use of both traditional X-ray studies and modern imaging techniques are justified. RESULTS - Of the 29 patients, five did not present after surgery, and one patient died. The location of the primary tumour could be determined in 12 of the remaining 23 patients during the follow-up period. These included the palatine tonsil in four cases, the lung in three patients, the lower pharynx in two patients, and one case each of the lingual radix, the larynx and the nasal pharynx. The histology of the metastases was mostly squamous cell carcinoma and they were located in the upper parajugular region. The investigation of the remaining patients is continued. CONCLUSION - In cases of cervical lymph node metastases that histologically turn out to be squamous cell carcinoma, the primary tumour should first be searched for in the head-and-neck region, followed by the lungs. On the other hand, high-grade nasopharyngeal carcinomas warrant the search in the Waldeyer ring. The authors emphasize the importance to keep the proper order of the diagnostic and therapeutic steps and to manage these patients in experienced institutions.]

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