Cervical Lymph Node Metastases from Unknown Primary Tumor

Vladimir Milosev

doi:10.26332/seemedj.v8i2.340

Vladimir Milosev Faculty of Medical Sciences, Goce Delcev University, Stip; Department of Maxillofacial Surgery, Clinical Hospital, Stip, North Macedonia

DOI: https://doi.org/10.26332/seemedj.v8i2.340

Abstract

Introduction: Metastases of the lymph nodes of the neck originating from cancers of an unknown primary site represent a diagnostic and therapeutic challenge. Metastatic carcinomas of unknown primary site (CUPS) account for about 3-5% of all malignant disease diagnoses. Planocellular carcinomas account for 90% of cancers of unknown site, while the remaining 10% are poorly differentiated and adenocarcinomas.

Materials and methods: This paper presents three case reports of patients with surgical treatment at the Department of Maxillofacial Surgery, Clinical Hospital, Stip, who had metastases of the lymph nodes of the neck with the unknown primary tumor site.

Results: We fallow diagnostic protocols which include a detailed clinical examination, radiological diagnostics, fine needle biopsy (FNAB) of the tumor change in the neck, esophagogastroduodenoscopy, detailed examination of the naso, oro and hypo pharynx, evaluation of the laryngeal structures. In all patients, after the clinical evaluation, ultrasonography, otorhinolaryngological examination, neck CT and fine needle biopsy were performed. FNAB findings showed metastatic deposits from squamous cell carcinomas. The therapy of metastases from CUPS includes surgical treatment (neck dissection) and the use of radiotherapy (RT), and some authors also recommend chemoradiotherapy, in cases with advanced regional disease.

Conclusion: Significant advances in diagnostic and operative techniques have increased the probability of identifying the primary tumor, as well as its regional and systemic spread. If CT or MRI does not identify a primary site, PET/CT scans should be performed before surgical biopsy. Although high-quality data on treatment protocols are lacking, patients with more advanced stages of regional disease require combined treatment that includes neck dissection, and postoperative radiotherapy with or without chemotherapy.

KEYWORDS : Carcinoma, unknown primary origin site (CUPS), metastases, lymph nodes, neck