Open AccessLarge neck metastasis with unknown primary tumor: A case report
Author(s) -
Mirjana Dimitrijević,
Bojana Bukurov,
Ana Jotić
Publication year - 2022
Publication title -
vojnosanitetski pregled
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.123
H-Index - 19
eISSN - 2406-0720
pISSN - 0042-8450
DOI - 10.2298/vsp201104037d
Subject(s) - medicine , neck dissection , radiology , histopathology , neck mass , primary tumor , biopsy , metastasis , cervical lymph nodes , metastatic carcinoma , head and neck squamous cell carcinoma , radiation therapy , malignancy , carcinoma , surgery , head and neck cancer , pathology , cancer
. Metastatic head and neck carcinoma from an unknown primary tumor is defined as a metastatic disease in the neck?s lymph nodes without evidence of a primary tumor after appropriate investigation. Multiple national guidelines recommend that essential steps in diagnostic protocols involve a detailed clinical exam with radiological imaging, fine-needle aspiration (FNA) biopsy of the cervical tumor, panendoscopy with palatine and lingual tonsillectomy, immunohistochemical staining, and human papillomavirus (HPV) detection. Treatment of head and neck carcinomas of unknown primary (CUPs) origin involves surgery (neck dissection) with radiotherapy, while some authors recommend chemo-radiotherapy in cases of the advanced regional disease. Case report. A 44-year old male was referred to the tertiary medical center because of a large ulcero-infiltrative cervical mass on the right side. Examination of the head and neck and flexible nasopharyngolaryngeal endoscopy was conducted, followed by computed tomography (CT) of the head, neck, and thorax with intravenous contrast. The primary localization of the tumor was not confirmed by these diagnostic methods. Open biopsy of the neck mass confirmed histopathology diagnosis of metastatic squamous cell carcinoma. Results of panendoscopy with biopsies and bilateral tonsillectomy were negative for malignancy. Treatment included extended radical neck dissection with reconstruction and postoperative ipsilateral radiotherapy. Five years after the first surgery, the patient presented with an extensive pharyngolaryngeal tumor. Biopsy with histopathology examination confirmed the diagnosis of squamous cell carcinoma. Conclusion. A structured step-by-step diagnostic approach in identifying the primary site of the metastatic head and neck carcinoma is mandatory. Substantial advances in diagnostics and operative techniques have increased the likelihood of primary tumor identification, as well as detection of regional and systemic spread of the disease. Purpose of adherence to guidelines results in higher overall-survival and longer regional disease-free survival in these patients.