Metastatic adenocarcinoma in the cervical lymph nodes from an occult primary

Investigation strategy in the management of metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy

CONCLUSION

Computed tomography (CT) of the neck, chest, abdomen and pelvis is the most appropriate initial investigation following a fine needle aspiration cytology (FNAC) diagnosis of metastatic adenocarcinoma in cervical lymph nodes with unknown primary. PET-CT should be considered as the next step if the initial CT fails to identify the primary site, but its true value is yet to be determined.

OBJECTIVE

To review investigation strategies for metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy, and to develop a management algorithm.

METHODS

This was a retrospective case note study from two regional head and neck cancer centres in the UK. Adult patients with FNAC diagnosis of metastatic adenocarcinoma in cervical lymph nodes between 1998 and 2008, with a minimum 5-year follow-up, were included. Patients with a clinically obvious primary tumour or a previous history of adenocarcinoma were excluded.

RESULTS

This study examined 41 cases. CT of the neck, chest, abdomen and pelvis was the most useful initial investigation. It identified the primary tumour site in 16/28 cases (57%), detected the primary tumour and led to revision of the FNAC diagnosis in 1 case (2.4%), and was necessary for the final diagnosis of true unknown primary in 12 cases (29.3%). Targeted imaging was not helpful.

Metastatic choriocarcinoma: a rare presentation as a neck mass

Testicular carcinoma metastatic to the neck is rare. Even more rare is a finding of choriocarcinoma as a neck mass without any sign of a primary testicular tumor, as only a few cases have been reported in the literature. We describe a new case that occurred in a 29-year-old man who presented with a neck mass. Fine-needle aspiration biopsy identified the tumor as a malignant epithelial neoplasm. Radiologic findings indicated the presence of a systemic metastasis of a tumor to the chest and abdomen, as well as the neck. Findings on an incisional biopsy of the neck mass were consistent with a choriocarcinoma. The testicles were normal on palpation and ultrasonography. The patient was diagnosed with metastatic choriocarcinoma with an unknown primary, and he was started on chemotherapy. On the second day of treatment, which was 25 days after his referral to our clinic, he died of respiratory insufficiency.

Head and neck metastases from occult abdominal primary site: a case report and literature review

OBJECTIVES

A very rare case of cervical lymph node metastasis from the liver is reported. The clinical findings and the diagnosis of a metastasis to the head and neck from the isolated silent abdominal cancer are discussed.

MATERIAL AND METHODS

The clinical and histopathological findings of a 56-year-old woman with a metastatic cervical lymph node of unknown origin are presented, together with a literature review of metastases from an occult abdominal primary.

RESULTS

The primary site was identified as an undifferentiated cholangiolocellular carcinoma using immunostaining for anti-cytokeratin subclasses after autopsy. Fifty-two cases of head and neck metastases from an abdominal primary cancer were found and separately summarized according to the metastatic routes.

CONCLUSIONS

When a metastatic neck cancer of unknown origin is diagnosed, it is very important to consider the possibility of a metastasis from an abdominal organ. Recognition of metastatic routes and their characteristics is helpful in the search for the occult abdominal primary site. Immunohistochemistry of the metastatic cancer may provide important information for identifying the primary site in cases of metastasis of an undifferentiated carcinoma.

Treatment of cervical lymph node metastasis from an unknown primary tumor, with a review of the literature

BACKGROUND

The results of treatment at the Free University Hospital of 44 patients with cervical lymph node metastasis of an unknown primary tumor were reviewed in order to establish an optimal treatment policy and to look for prognostic parameters. These results were compared with results of other treatment policies known from the literature.

PATIENTS AND METHOD

Thirty-three out of the 44 patients received a treatment with curative intent; 22 cases received a unilateral neck dissection and postoperative radiotherapy, 7 were irradiated after an excisional biopsy and 4 received radical radiotherapy alone.

RESULTS

For the whole group 5- and 10-year overall survival was 50% and 44%, respectively, and for the group treated with curative intent 68% and 56%, respectively. Disease-free survival at 5 and 10 years after treatment for the whole group was 48% and 32%, respectively, and for the group treated with curative intent 63% and 37%, respectively.

CONCLUSIONS

Multivariate analysis showed only treatment with intent and histology as significant independent prognostic factors for the whole group. For the patients treated with curative intent no significant influences of variables were found.

Adenocarcinoma from an unknown primary presenting in women with an axillary mass

Adenocarcinoma from an unknown primary is generally associated with a poor prognosis. This is not the case with women who present with disease confined to one axilla, when the primary, despite negative investigations, is often found to lie in the ipsilateral breast. Twenty such patients presented to our department between 1977 and 1989 and were generally treated by radical radiotherapy to the breast and peripheral lymphatics. Local control was achieved in the axilla in 17 of the 20 patients (85%). No primary has appeared in the breast, although one patient has died of a carcinoma of the colon. The 5-year actuarial survival of the group is 66%, similar to stage II breast carcinoma patients. The value of radiological and histopathological investigations is discussed. The cosmetic results are good and in view of the excellent local control achieved by irradiation we feel mastectomy is unnecessary in this rare presentation of breast cancer.