Since lymphatic flow towards the left neck begins in the superior mediastinum, left supraclavicular lymph nodes receive lymphatic drainage from the thorax, abdomen and pelvis. In fact, incidence of neck node metastasis from distant primary site is accounting about 1%, including breast, lung, gastrointestinal tract, genitourinary tract and rarely central nervous system malignancies. Indeed, early prompt diagnosis evaluation of these patients will amend the prognosis to some extent. However, cervical nodal metastases, in absence of obvious clinical primary tumor of the head and neck area, should alarm clinicians to suspect distant primary cancer. Also, squamous cell carcinomas of the upper aero digestive tract, salivary glands malignancies, thyroid cancers and skin cancers of the head and neck region can also present cervical nodal metastasis. 5).Ĭervical lymph node metastases are most commonly developed from oral cavity malignancies. Thus, this analysis concluded to a lymph node metastasis of a neuroendocrine tumor of undetermined localization.Īs complement of investigation, the patient underwent Positron Emission Tomography (PET) scan coupled with CT scan, showing intense hyper metabolic lymph node involvement in cervical, mediastinal and abdomino-pelvic areas, in addition to hyper metabolic anal mass with a volume estimated to 19.36 cm3 associated to satellite lymphadenopathies, as well as hyper metabolic left pleural thickening of visceral and parietal layers ( Fig. The immunophenotyping showed that the tumor cells weakly express CK AE1AE and strongly express synaptophysin and chromogranin. Histological examination of the piece showed tumor proliferation. 1).Ĭervical CT scan examination showed multiple large left lymph nodes, located in the inferior level of the neck, the largest one measuring 38*24 cm and pushing forward the internal jugular vein and the SCM muscle.Īfter normal endoscopic examination of the rhinopharynx, total lymphadenectomy of the largest node was performed under local anesthesia. The patient had a performance status quoted to 4 and presented also a left facial palsy graded as 6 according to House-Brackmann classification secondary to her former parotid cancer ( Fig. The patient was admitted in our department for isolated chronic supraclavicular lymphadenopathy evolving since a year.Ĭlinical examination found a fixed left supraclavicular mass, firm and painless at palpation measuring approximately 4 cm. Then, the patient received 30 sessions of adjuvant radiotherapy. Pathological examination of the surgical piece showed myoepithelial carcinoma of the parotid gland with capsular invasion measuring 5 * 2 cm, 3 N + / 12 N lymph node metastasis and presence of vascular emboli. The patient had been operated in 2018 for malignant parotid tumor undergoing a total parotidectomy with lymph node dissection of the IIA and IIB levels. We report the case of an 80 year old female patient, under treatment for hypertension, hyperuricemia and moderate renal failure, operated 8 years ago for pacemaker implantation. These case reports supplement and support the literature exposing the necessity of careful and multiple investigations in order to establish an early diagnosis for adequate treatment We report two cases treated in our Otorhinolaryngology and Head and Neck department for chronic supraclavicular lymphadenopathies, for whom further investigations showed lymph node metastasis originating from distant tumors. In fact, about 1% of all head and neck malignancies are accounted for by metastases from a remote primary site, including mostly the breast, lung, gastrointestinal or genitourinary tracts, and, uncommonly, the central nervous system. Indeed, lymphoma and tuberculosis also manifest by cervical lymph nodes thereby, they always should be taken into consideration as a differential diagnosis. Apart from these last, thyroid cancers and skin cancers of the head and neck region may present as cervical nodal metastasis. Cervical lymph nodes are a common site of metastases for malignant tumors, most commonly developed from the upper aero digestive tract malignancies.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |