Occult primary head and neck carcinoma

Abstract

Unknown primary carcinoma presenting as cervical lymph node metastasis accounts for approximately 5% of all head and neck malignancies. The typical presentation involves a middle-aged man with a painless neck mass that has been present for several months. Over 90% of these malignancies represent squamous cell carcinoma originating within Waldeyer's ring (lymphoid tissue of the nasopharynx, tonsil, and base of tongue). The remainder are comprised of adenocarcinoma, melanoma, and other rare histologic variants. The ability to identify the occult primary tumor is imperative because identification allows site-specific therapy and avoidance of wide-field radiation side effects. Following confirmation of metastatic cervical disease with fine-needle aspiration, all patients presenting with an unknown primary carcinoma require a thorough head and neck history and physical examination, radiographic imaging, panendoscopy with directed biopsies of Waldeyer's ring, and bilateral tonsillectomy. Positron emission tomography has proved helpful in identifying occult primary tumors of the head and neck region.

Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis

“…3 The lack of a clinically identifiable primary tumor usually leads to more aggressive therapy, which can result in higher morbidity. 3 Because FNA biopsies often are the first diagnostic procedure performed in patients who present with a neck mass, it is important to assess the applicability of various …”

“…3 Even after extensive diagnostic workup, including various imaging modalities and panendoscopy with targeted biopsies, only 1 in 3 primary tumors is identified. [4][5][6][7][8] When the primary tumor remains unknown, wide-field irradiation that includes the entire pharyngeal axis and larynx usually is applied, resulting in increased morbidity.…”

Improved survival of head and neck cancer patients in Greenland

“…Patients with a Greenlandic CRS number combined with an ICD-10 code for carcinoma in the pharynx, larynx, oral cavity, nasal cavity and sinuses, salivary gland and thyroid gland were included. Patients with cervical lymph node metastases but an unknown primary tumour were included because over 90% of these represent malignancies within Waldeyer’s ring in the pharynx [15]. The diagnoses were validated using the Danish Pathology Registry.…”

Primary Branchiogenic Carcinoma

“…OPC is finally dia gnosed in up to 70% of cases. From the HPV point of view, an interesting case of HPV-associated BC was reported by Maeda [11][12][13][14][15]. …”