Metastatic Carcinoma of the Neck of Unknown Primary Origin: Evolution and Efficacy of the Modern Workup

Waltonen, Joshua D.; Özer, Enver; Hall, N. C.; Schuller, D. E.; Agrawal, Amit

doi:10.1001/archoto.2009.145

Cited by 146 publications

(177 citation statements)

References 14 publications

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“…In the search for a primary tumor in the head and neck, a CT scan may be either complemented or supplanted by MRI with gadolinium contrast, which exhibits superior soft tissue resolution, particularly for the evaluation of the nasopharynx or oropharynx. The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% (3,18,19), rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (20). Over the last 2 decades, positron emission tomography (PET) has also been used in patients with CUP.…”

Section: Diagnostic Work-upmentioning

confidence: 99%

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Zhuang

et al. 2014

Molecular and Clinical Oncology

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Abstract. Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon found in ~3-9% of all head and neck cancers. It has not yet been determined whether CUP forms a distinct biological entity with specific genetic and phenotypic characteristics, or whether it is the clinical presentation of metastasis in patients with an undetected primary tumor and no visible clinical signs. The treatment of patients with cervical lymph node metastases from CUP remains controversial, due to the lack of randomized clinical trials comparing different treatment options. Consequently, treatment is currently based on non-randomized data and institutional policy. In the present review, the range and limitations of diagnostic procedures are summarized and an optimal diagnostic work-up is recommended. The initial preferred diagnostic procedures include fine-needle aspiration biopsy (FNAB) and imaging. Although neck dissection followed by postoperative radiotherapy is the the most generally accepted approach, other curative options may be used in certain patients, such as neck dissection alone, nodal excision followed by postoperative radiotherapy, or radiotherapy alone. There remains controversy regarding target radiation volumes, ranging from ipsilateral neck irradiation to prophylactic irradiation of all the potential mucosal sites and both sides of the neck. When no primary lesion is identified with imaging and endoscopy in patients without history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus and/or Epstein-Barr virus is required.

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Section: Diagnostic Work-upmentioning

confidence: 99%

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Zhuang

et al. 2014

Molecular and Clinical Oncology

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“…Although recent molecular studies showed promising results for identifying the primary site [18], the current standard HNSCCUP workup includes a combination of CT or MRI, positron emission tomography (PET), and panendoscopy (nasopharyngoscopy, laryngoscopy, bronchoscopy and esophagoscopy) with biopsies from several mucosal sites (base of tongue, nasopharynx, piriform sinus). The rate of success in identifying the primary tumor is variable, likely related to the diagnostic workup strategy, primary tumor size, radiological and pathological thoroughness, the quantity and quality of the tissue sampled and, even in recent studies, it was reported to be only 45-59% [19,20]. In both series, the most commonly identified tumors after complete workup were in oropharynx.…”

Section: Discussionmentioning

confidence: 90%

Small Lymphocytic Lymphoma Obscuring Microscopic Tonsillar Squamous Cell Carcinoma: an Unknown Occurrence with a Known Primary

Minca

Popat

Chadha³

et al. 2010

Head and Neck Pathol

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Head and neck squamous cell carcinoma (HNSCC) often presents with cervical lymph node metastases and at times the primary tumor cannot be identified despite extensive workup. Lymphoma is the second most common neoplasm in the head and neck region but is seldom synchronous with HNSCC and rarely involves regional mucosal sites. We report herein a rare occurrence of tonsillar involvement by small lymphocytic lymphoma (SLL) incidentally detected during the workup for a cervical lymph node SCC metastasis of a 52-year-old nonsmoker male. The microscopic human papillomaviruspositive SCC involving the tonsillar surface and crypts was obscured by SLL leading to the initial designation of 'unknown primary'. The occult HNSCC are likely explained by small tumor size, quality and quantity of sampling, thoroughness of endoscopic, radiological and pathological assessment or a combination of the above. The coexistence of another tumor such as lymphoma has not yet been reported as a confounding factor in the workup for cervical SCC metastasis. Since oropharyngeal SCC can be very small and Waldeyer's ring is a common site for lymphoma involvement, identification of such rare collision tumors requires pathologists' awareness, extensive sampling and occasionally ancillary studies for the accurate diagnosis and staging essential for the correct management.

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“…A quick, inexpensive, procedure with high spatial resolution is the contrast-enhanced CT-scan from the skull base to clavicles, complemented or substituted by a gadolinium contrast-enhanced MRI with superior soft tissue resolution [43]. In case of a cervical lymph node metastasis, the chance for CT, MRI or both to detect the primary site ranges from 9 to 23% [7,[47][48][49]. When suspicious findings on imaging are used to guide biopsy, the chance to find the primary tumor rises up to 60% [50].…”

Section: Imagingmentioning

confidence: 99%

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass

Kim¹,

Yoon²,

Kim³

et al. 2017

Korean J Otorhinolaryngol-Head Neck Surg

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Metastatic Carcinoma of the Neck of Unknown Primary Origin: Evolution and Efficacy of the Modern Workup

Abstract: Diagnostic workup including PET-CT, alongside panendoscopy with directed biopsies including bilateral tonsillectomy, offers the greatest likelihood of successfully identifying occult primary tumor location.

Cited by 146 publications

References 14 publications

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Small Lymphocytic Lymphoma Obscuring Microscopic Tonsillar Squamous Cell Carcinoma: an Unknown Occurrence with a Known Primary

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass

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