Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients

MOICS, a novel classier deciphering immune heterogeneity and aid precise management of clear cell renal cell carcinoma at multiomics level

Recent studies have indicated that the tumor immune microenvironment plays a pivotal role in the initiation and progression of clear cell renal cell carcinoma (ccRCC). However, the characteristics and heterogeneity of tumor immunity in ccRCC, particularly at the multiomics level, remain poorly understood. We analyzed immune multiomics datasets to perform a consensus cluster analysis and validate the clustering results across multiple internal and external ccRCC datasets; and identified two distinctive immune phenotypes of ccRCC, which we named multiomics immune-based cancer subtype 1 (MOICS1) and subtype 2 (MOICS2). The former, MOICS1, is characterized by an immune-hot phenotype with poor clinical outcomes, marked by significant proliferation of CD4+ and CD8+ T cells, fibroblasts, and high levels of immune inhibitory signatures; the latter, MOICS2, exhibits an immune-cold phenotype with favorable clinical characteristics, characterized by robust immune activity and high infiltration of endothelial cells and immune stimulatory signatures. Besides, a significant negative correlation between immune infiltration and angiogenesis were identified. We further explored the mechanisms underlying these differences, revealing that negatively regulated endopeptidase activity, activated cornification, and neutrophil degranulation may promote an immune-deficient phenotype, whereas enhanced monocyte recruitment could ameliorate this deficiency. Additionally, significant differences were observed in the genomic landscapes between the subtypes: MOICS1 exhibited mutations in TTN, BAP1, SETD2, MTOR, MUC16, CSMD3, and AKAP9, while MOICS2 was characterized by notable alterations in the TGF-β pathway. Overall, our work demonstrates that multi-immune omics remodeling analysis enhances the understanding of the immune heterogeneity in ccRCC and supports precise patient management.

Metastasis to the External Auditory Canal: A Systematic Review

OBJECTIVE

To systematically review the literature and understand the behavior, diagnosis, management, and mortality of metastasis to the external auditory canal (EAC).

DATABASES REVIEWED

PubMed/Medline, EMBASE, Web of Science.

METHODS

Studies from 1948 to June 2023 describing metastasis to the EAC were included. Non-English literature was excluded. Data extraction: Study design, age, sex, pathology, primary site, staging, additional sites of metastasis, time to EAC metastasis from diagnosis, time from diagnosis of EAC metastasis to death, symptoms, exam and imaging findings, and management.

RESULTS

Data were synthesized qualitatively with means calculated. Thirty-two studies met the criteria, totaling 37 patients with EAC metastasis. Mean age was 58 years; 73% were male. The most common pathologies were adenocarcinoma (37.8%), acute myelogenous leukemia (8.1%), and renal cell carcinoma (8.1%). Sites of primary malignancy were hematologic (10.8%), breast (8.1%), esophagus (8.1%), renal (8.1%), and prostate (8.1%). Within the temporal bone, 73% had isolated EAC metastasis. Median time to EAC metastasis from the diagnosis of primary malignancy was 18 months. Metastasis to the EAC was the first presentation of malignancy in 21.6% of patients. Median time to death was 4.5 months. Symptoms included hearing loss (59.5%), otalgia (27.0%), otorrhagia (24.3%), facial paralysis (21.6%), otorrhea (16.2%), and aural fullness (13.5%). On imaging, bony erosion was present in 50% of cases. Treatment was primarily palliative with excision and radiation.

CONCLUSIONS

EAC metastasis has a distinct presentation from other temporal bone subsites. Early biopsy to establish a diagnosis and intervene is critical.

Renal Cell Carcinoma Metastasizing to Oral Soft Tissues: Systematic Review

Background  Renal cancer metastasis to oral region is very rare. Studies have been published analyzing the cases of metastatic tumors to the oral cavity by many researchers. Very few research studies have been conducted till date to analyze the renal cancer metastasis as the sole primary source to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from renal cell carcinoma as the only primary source from 1911 to 2022. Materials and Methods  An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Renal cancer," or "Renal carcinoma" or "Renal cell cancer" or "Renal cell carcinoma"), and ("Metastasis" or "Metastases"), and ("Oral soft tissues" or "Tongue" or "Palate" or "Tonsil" or "Buccal mucosa" or "Salivary glands"). We also searched related journals manually and the reference lists. Results  Our research revealed a total of 226 relevant articles with 250 patients. Parotid glands and tongue were the most common sites of metastasis. 23% patients died with a survival time of 10 days to 4 years. Conclusions  Oral soft tissue metastasis from renal cell carcinoma has a bad prognosis. More cases need to be published in order to raise awareness of these lesions.

Renal cell carcinoma metastasizing to salivary glands: Systematic review

Distant metastasis to salivary glands is a very rare event. Renal cell carcinoma (RCC) has been known for its high propensity of metastasis to unusual locations and salivary glands are one among those sites. Approximately 0.1% of all salivary gland metastatic neoplasms originate from renal malignancies Literature has reported several studies analysing the metastatic tumors to the oral region. However, very little research work has been published to date to analyse solely the RCC metastasizing to the salivary glands. Thus, this review was conducted to examine the published cases of RCC metastasizing to salivary glands in the literature to date and to learn about their characteristics. An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ('Renal cancer', OR 'Renal carcinoma' OR 'Renal cell cancer' OR 'Renal cell carcinoma'), AND ('Metastasis' OR 'Metastases'), And ('Salivary glands' OR 'Parotid gland' OR 'Submandibular gland' OR 'Sublingual gland'). We also searched all related journals manually. The reference list of all articles was also checked. Our research revealed a total of 83 relevant papers (1965-2022) with 100 patients. Parotid was the most predominant gland affected. 8% of patients died with a mean survival time of 1.3 yr. From this research, it can be concluded that RCC metastasizing to salivary glands is a rare occurrence. Careful evaluation of these cases is needed in order to raise awareness of these lesions and gain a better understanding of their characteristics for clinical as well as global implications.

Top 10 Clear Cell Head and Neck Lesions to Contemplate

BACKGROUND

Optically clear cytoplasm may occur in neoplastic and non-neoplastic conditions, either as a characteristic feature of a disease entity or as a morphologic rarity, potentially creating diagnostic dilemmas in various organ systems. In the head and neck, clear cell change can occur in lesions of salivary, odontogenic, thyroid, parathyroid, or sinonasal/skull base origin, as well as in metastases to these regions.

METHODS

This review elaborates the top ten clear cell lesions in the head and neck, emphasizing their distinguishing histologic, immunohistochemical, and molecular attributes, and presents a rational approach to arriving at an accurate classification.

RESULTS

Cytoplasmic pallor or clearing may be caused by accumulations of glycogen, lipid, mucin, mucopolysaccharides, water, foreign material, hydropic organelles, or immature zymogen granules. Overlapping morphologic features may present a diagnostic challenge to the surgical pathologist. Similarity in immunohistochemical profiles, often due to common cell type, as well as rare non-neoplastic mimics, furthers the diagnostic conundrum.

CONCLUSIONS

The top ten lesions reviewed in this article are as follows: (1) clear cell carcinoma (salivary and odontogenic), (2) mucoepidermoid carcinoma, (3) myoepithelial and epithelial-myoepithelial carcinoma, (4) oncocytic salivary gland lesions, (5) squamous cell carcinoma, (6) parathyroid water clear cell adenoma, (7) metastatic renal cell carcinoma (especially in comparison to clear cell thyroid neoplasms), (8) sinonasal renal cell-like adenocarcinoma, (9) chordoma, and (10) rhinoscleroma.

Use of Immune Checkpoint Inhibitors in Elderly Patients With Chronic Kidney Disease and Renal Cell Carcinoma Metastasis of the Parotid Gland: Case Report and Review of the Literature

Renal cell carcinoma metastasis of the parotid gland is extremely rare, and the present literature review found only 23 cases reported in the last two decades. We present a case of a 75-year-old woman with a colon cancer history who had parotid gland metastasis as the first manifestation of second primary kidney cancer. The presence of multiple comorbidities affected medical decision-making. Therefore the patient was treated primarily with immunotherapy. After four cycles of dual immune checkpoint blockade, this advanced patient still benefited and was changed to nivolumab monotherapy as maintenance therapy.

Compound C Inhibits Renca Renal Epithelial Carcinoma Growth in Syngeneic Mouse Models by Blocking Cell Cycle Progression, Adhesion and Invasion

Compound C (CompC), an inhibitor of AMP-activated protein kinase, reduces the viability of various renal carcinoma cells. The molecular mechanism underlying anti-proliferative effect was investigated by flow cytometry and western blot analysis in Renca cells. Its effect on the growth of Renca xenografts was also examined in a syngeneic BALB/c mouse model. Subsequent results demonstrated that CompC reduced platelet-derived growth factor receptor signaling pathways and increased ERK1/2 activation as well as reactive oxygen species (ROS) production. CompC also increased the level of active Wee1 tyrosine kinase (P-Ser⁶⁴²-Wee1) and the inactive form of Cdk1 (P-Tyr¹⁵-Cdk1) while reducing the level of active histone H3 (P-Ser¹⁰-H3). ROS-dependent ERK1/2 activation and sequential alterations in Wee1, Cdk1, and histone H3 might be responsible for the CompC-induced G2/M cell cycle arrest and cell viability reduction. In addition, CompC reduced the adhesion, migration, and invasion of Renca cells in the in vitro cell systems, and growth of Renca xenografts in the BALB/c mouse model. Taken together, the inhibition of in vivo tumor growth by CompC may be attributed to the blockage of cell cycle progression, adhesion, migration, and invasion of tumor cells. These findings suggest the therapeutic potential of CompC against tumor development and progression.

Use of Circular RNAs in Diagnosis, Prognosis and Therapeutics of Renal Cell Carcinoma

Renal cell carcinoma is the most common type of kidney cancer, representing 90% of kidney cancer diagnoses, and the deadliest urological cancer. While the incidence and mortality rates by renal cell carcinoma are higher in men compared to women, in both sexes the clinical characteristics are the same, and usually unspecific, thereby hindering and delaying the diagnostic process and increasing the metastatic potential. Regarding treatment, surgical resection remains the main therapeutic strategy. However, even after radical nephrectomy, metastasis may still occur in some patients, with most metastatic renal cell carcinomas being resistant to chemotherapy and radiotherapy. Therefore, the identification of new biomarkers to help clinicians in the early detection, and treatment of renal cell carcinoma is essential. In this review, we describe circRNAs related to renal cell carcinoma processes reported to date and propose the use of some in therapeutic strategies for renal cell carcinoma treatment.

Exophytic Mass Around the Tip of the Nose: Unusual Presentation of Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) has a predilection for metastatic spread, aggressive behavior. RCC is known for recurrence even after years of presentation. RCC has been linked to uncommon metastatic locations and unusual presenting symptoms from the disseminated illness. Common sites of metastasis include the lungs, liver, bones, brain, and adrenal glands, and many case reports are explaining the ability of RCCs to occur almost anywhere in the body. This case report states the unusual site of recurrence of RCC metastatic spread around the tip of the nose as exophytic growth years following nephrectomy. No such case is reported in the literature. We submit this case to report its occurrence, emphasize the rarity, presentation, diagnostic and therapeutic challenges, as well as a review of the literature. Renal cell carcinoma is the third most common cause of distant head and neck metastases and should be considered in the differential diagnosis of rapidly growing head and neck lesions.

Construction and Verification of a Combined Hypoxia and Immune Index for Clear Cell Renal Cell Carcinoma

Clear cell renal cell carcinoma (ccRCC) is one of the most aggressive malignancies in humans. Hypoxia-related genes are now recognized as a reflection of poor prognosis in cancer patients with cancer. Meanwhile, immune-related genes play an important role in the occurrence and progression of ccRCC. Nevertheless, reliable prognostic indicators based on hypoxia and immune status have not been well established in ccRCC. The aims of this study were to develop a new gene signature model using bioinformatics and open databases and to validate its prognostic value in ccRCC. The data used for the model structure can be accessed from The Cancer Genome Atlas database. Univariate, least absolute shrinkage and selection operator (LASSO), and multivariate Cox regression analyses were used to identify the hypoxia- and immune-related genes associated with prognostic risk, which were used to develop a characteristic model of prognostic risk. Kaplan-Meier and receiver-operating characteristic curve analyses were performed as well as independent prognostic factor analyses and correlation analyses of clinical characteristics in both the training and validation cohorts. In addition, differences in tumor immune cell infiltrates were compared between the high and low risk groups. Overall, 30 hypoxia- and immune-related genes were identified, and five hypoxia- and immune-related genes (EPO, PLAUR, TEK, TGFA, TGFB1) were ultimately selected. Survival analysis showed that the high-risk score on the hypoxia- and immune-related gene signature was significantly associated with adverse survival outcomes. Furthermore, clinical ccRCC samples from our medical center were used to validate the differential expression of the five genes in tumor tissue compared to normal tissue through quantitative real-time polymerase chain reaction (qRT-PCR). However, more clinical trials are needed to confirm these results, and future experimental studies must verify the potential mechanism behind the predictive value of the hypoxia- and immune-related gene signature.

Case Report: Rare Case of Synchronous Neck Metastasis From Metachronous Bilateral Renal Cell Carcinoma

Renal cell carcinoma (RCC) is a malignant tumor that can metastasize easily. Hence, many patients have already developed metastasis when they are diagnosed. It is also one of the most common tumors that metastasize to the head and neck through extranodal disease. Herein, we reported a case of a 53-year-old man with cervical metastasis from bilateral RCC. Interestingly, whole exome sequencing (WES) and clonal evolution analysis revealed that bilateral renal tumor lesions and neck metastases (squamous cell carcinoma) share the same subclones and a large number of gene variants, while the pathological morphology is different (left nephrotic foci, a mixed pattern of mucinous tubular and spindle cell carcinoma (MTSCC) with papillary adenoma; right renal foci, papillary renal cell carcinoma (PRCC)). This was first reported in RCCs to the best of our knowledge. This case suggests that genotype analysis can be a powerful supplementary examination for clinical histopathological diagnosis. Gene detection has great significance for the accurate diagnosis and treatment of RCC metastasis or multiple lesions.

PAPP-A functions as a tumor suppressor and is downregulated in renal cell carcinoma

Pregnancy‐associated plasma protein A (PAPP‐A) is a proteolytic enzyme produced by the placenta. The expression and role of PAPP‐A in renal cell carcinoma (RCC) remain elusive. The aim of this study was to investigate the role and the molecular mechanisms of PAPP‐A in RCC. Initially, we evaluated the expression of PAPP‐A in samples from patients with RCC and cell lines by quantitative PCR, western blot and immunohistochemical staining, and examined the role of PAPP‐A in RCC cells by cell viability, colony formation and Transwell assays. Next, we investigated the molecular mechanisms regulating the tumor suppressor function of PAPP‐A. Our results demonstrated that PAPP‐A is expressed at low levels in RCC tissues and cells. Clinical data analysis revealed a significant correlation between PAPP‐A expression and RCC‐related death (P < 0.0115). Overexpression of PAPP‐A inhibited viability, proliferation, migration and invasion of RCC cells. Furthermore, PAPP‐A overexpression significantly increased phosphorylation of c‐Jun N‐terminal kinase and decreased the expression of cyclin D1, phosphorylated glycogen synthase kinase‐3β and β‐catenin. This study is the first to report that downregulation of PAPP‐A is associated with poor prognosis in patients with RCC. In conclusion, PAPP‐A may serve as a novel prognostic marker and potentially as a therapeutic target in patients with RCC.

Renal Cell Carcinoma in the Head and Neck: Case Presentation of a Patient With a Rare Metastatic Pattern

Renal cell carcinoma is known for its metastatic potential, however, metastasis to the head and neck are rare. We present a 71-year-old man who presented with a palpable tongue mass. The positron-emission tomographic-computed tomographic scan revealed enhancements in the left tongue base, left thyroid, left shoulder musculature, right upper thigh, and right paratracheal mediastinal lymph nodes. Subsequent tongue and trapezius muscle biopsies had immunochemical stains consistent with renal cell carcinoma metastasis. This article discusses an uncommon metastatic pattern of renal cell carcinoma to the tongue and what is the second reported metastasis of renal cell carcinoma to the trapezius muscle.

Circular RNAs in renal cell carcinoma: implications for tumorigenesis, diagnosis, and therapy

Renal cell carcinoma (RCC) is the most common malignant kidney tumor and has a high incidence rate. Circular RNAs (circRNAs) are noncoding RNAs with widespread distribution and diverse cellular functions. They are highly stable and have organ- and tissue-specific expression patterns. CircRNAs have essential functions as microRNA sponges, RNA-binding protein- and transcriptional regulators, and protein translation templates. Recent reports have shown that circRNAs are abnormally expressed in RCC and act as important regulators of RCC carcinogenesis and progression. Moreover, circRNAs have emerged as potential biomarkers for RCC diagnosis and prognosis and targets for developing new treatments. However, further studies are needed to better understand the functions of circRNAs in RCC. In this review, we summarize and discuss the recent research progress on RCC-associated circRNAs, with a focus on their potential for RCC diagnosis and targeted therapy.

Metastatic renal cell carcinoma to the oral cavity as first sign of disease: A case report

Renal cell carcinoma metastasis to the oral cavity is rare. Significantly, the oral lesion in this case was the first indication of a malignant disease in the patient. This case underscores the importance of detailed history taking, interpretation of clinical finding, and high index of suspicion for metastatic disease to the oral cavity.

Renal Cell Carcinoma Metastases to the Oral Cavity: Report of 2 Cases and Review of Literature

The localization of renal cell carcinoma (RCC) metastases in the oral cavity has been reported, accounting for about 15% of patients with metastasizing renal disease. In this work, we report 2 cases of oral metastases of renal carcinoma and provide a review of the current literature on the occurrence of oral metastases of renal origin. The first patient (a 61-year-old man) presented with a tumefaction of the body of the tongue. The second patient (a 71-year-old man) showed a large mass localized in the buccal mucosa. In both patients, incisional biopsy was performed to better characterize the nature of the lesions. Histologic evaluation showed the metastatic origin of the 2 lesions, which were distant metastases of clear cell RCC. After systemic evaluation, a second surgical procedure was performed to obtain a wider resection of the mass to reduce the development of complications and improve the patients' quality-of-life. After the second surgical treatment, both patients showed an improvement in symptoms, and no further complications and/or signs of recurrence were detected. At present, 132 cases of oral metastases of RCC have been described in the literature. This article reviews and discusses the clinical, diagnostic, and pathologic features and the treatment options reported in the literature. Localization of renal metastases to the tongue was the most frequently described localization in the literature. In general, surgical treatment appears to be effective in controlling metastasis development and associated symptoms. Although relatively rare, renal metastases to the oral cavity should be taken into account when creating the differential diagnosis of oral lesions of unknown origin.

Metastatic disease in head & neck oncology

The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.

Current Concepts of Non-Coding RNAs in the Pathogenesis of Non-Clear Cell Renal Cell Carcinoma

Renal cell carcinoma (RCC) is a relatively rare malignancy of the urinary tract system. RCC is a heterogenous disease in terms of underlying histology and its associated underlying pathobiology, prognosis and treatment schedule. The most prevalent histological RCC subtype is clear-cell renal cell carcinoma (ccRCC), accounting for about 70-80% of all RCCs. Though the pathobiology and treatment schedule for ccRCC are well-established, non-ccRCC subtypes account for 20%-30% of RCC altogether, and their underlying molecular biology and treatment options are poorly defined. The class of non-coding RNAs-molecules that are generally not translated into proteins-are new cancer drivers and suppressors in all types of cancer. Of these, small non-coding microRNAs (miRNAs) contribute to carcinogenesis by regulating posttranscriptional gene silencing. Additionally, a growing body of evidence supports the role of long non-coding RNAs (lncRNAs) in cancer development and progression. Most studies on non-coding RNAs in RCC focus on clear-cell histology, and there is a relatively limited number of studies on non-ccRCC subtypes. The aim of this review is to give an overview of the current knowledge regarding the role of non-coding RNAs (including short and long non-coding RNAs) in non-ccRCC and to highlight possible implications as diagnostic, prognostic and predictive biomarkers.

Rare Case of Clear Cell Renal Cell Carcinoma Metastasizing to Contralateral Kidney and Ipsilateral Parotid more than five Years following Nephrectomy

Backgroung/Aim: Salivary gland malignancies are rare, with only a fraction due to metastases. We report a rare case of the Clear Cell Renal Cell Carcinoma (CCRCC), a subtype of the Renal Cell Carcinoma (RCC), metastasizing to the parotid gland more than five years following nephrectomy.

Case report: A 75-year-old female presented with a unilateral left parotid mass that was growing over the period of 18 months. After clinical and laboratory examinations, the patient underwent left partial superficial parotidectomy with preservation of the facial nerve. The significance of the patient’s history of the CCRCC was pivotal to the histopathological diagnosis of a metastatic CCRCC to the parotid.

Conclusions: The unpredictable nature of the RCC results in the need for a long period of follow-up, as well as having a high degree of suspicion of metastasis in a patient presenting with a medical history of the RCC and a parotid mass.

Unusual metastasis of papillary renal cell carcinoma to the pyriform sinus: Case report

Renal cell carcinoma is the third most common cause of distant metastasis to the head and neck. Renal cell carcinoma metastasis should be considered in differential diagnosis when patients with a clinical history of renal cell carcinoma show a head and neck mass.

Skull Base Metastasis From Occult Renal Cell Carcinoma

Skull base metastases are extremely rare. The authors report a case of a 65-year-old man who presented with a headache and diplopia secondary to a skull base metastasis from occult renal cell carcinoma. Since there were no other systemic metastases, radical nephrectomy and radiotherapy of the unresectable skull base location were performed. He subsequently received immunotherapy with sunitinib, everolimus, and sorafenib with local and systemic control of the disease after 53 months from surgery. When metastasis is unresectable radical nephrectomy and radiotherapy aimed at the metastasis may be of benefit improving quality of life. Immunotherapy may provide alternative treatment strategies improving the outcomes of patients affected by this rare pathology with historically poor prognosis.

Lingual metastasis as an initial presentation of renal cell carcinoma: a case report

BACKGROUND

Renal cell carcinoma is the third most common tumor that metastasizes to the head and neck, after breast and lung carcinomas. Tongue metastasis as an initial presentation of renal cell carcinoma is extremely rare, and very few cases have been reported. The prognosis is poor. We present a rare case of metastatic renal cell carcinoma that initially presented as a tongue lesion.

CASE PRESENTATION

We report the case of a 55-year-old white man who presented with a large exophytic lesion on his tongue. A biopsy was taken, and pathologic examination showed a poorly differentiated carcinoma including a sarcomatoid component. Subtotal glossectomy with neck dissection were planned, but a positron emission tomographic-computed tomography scan showed a left kidney mass. Immunohistochemical evaluation of the tongue lesion was performed, and it was compatible with metastasis from primary renal cell carcinoma. The biopsy of the renal lesion showed a high-grade unclassified renal cell carcinoma. Although our patient underwent systemic therapy, he died of hemorrhagic complications 3 months after the initiation of therapy.

CONCLUSION

Tongue lesions require a complete assessment to distinguish a metastasis from a primary cancer in order to give the appropriate treatment.

Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa

OBJECTIVE

Patients presenting with a cervical mass are common for head and neck specialists and present a diagnostic challenge against the backdrop of a wide variety of etiologies. The objective of the present study was to evaluate the significance of a mass in the supraclavicular fossa for etiology, diagnostic procedure, and therapy.

STUDY DESIGN

Individual retrospective cohort study.

METHODS

We reviewed the data of 211 consecutive cases (116 male, 95 female) with excisional biopsy or tumor removal of a supraclavicular mass.

RESULTS

In 202 of 211 cases, a biopsy was taken from a lymph node. In 182 biopsies, a malignant lymphadenopathy was found (117 metastases, 65 malignant lymphoma). The histologic findings of metastatic diseases were adenocarcinoma (48), followed by squamous cell carcinoma (22). The majority of primary carcinomas were located below the clavicle (94), in the lung (32), in the breast (29), and in the head and neck region (18). In the left supraclavicular fossa, only metastases of the genitourinary tract were significantly more frequent (16 of 17). In nonmalignant tumors (29), tuberculosis (11) was most prevalent. In 79% of biopsies, the neck mass was the first manifestation of the disease.

CONCLUSION

The location of a cervical mass in the supraclavicular fossa provides a strong indication of malignancy. A biopsy is mandatory in the majority of patients presenting with a supraclavicular mass. In cases of metastatic disease, the location of a cervical mass helps identify the primary site. Histologic findings are essential for further diagnostic steps, therapy, and prognosis.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:646-650, 2018.