title: Neck lymph node metastases from unknown primary.
abstract: Metastatic cervical carcinoma from unknown primary is a metastatic disease in the lymph nodes of the neck without any evidence of a primary tumour after appropriate investigation. The condition is rare and definite evidence is lacking for both diagnosis and treatment. In this review of the literature, we tried to draw some clinical indications based on the few available studies. We ultimately came to the following conclusions: (1) a thorough and accurate diagnostic work-up should be systematically offered. It includes accurate inspection with fibroscopy, CT or MRI, fine needle aspiration, panendoscopy and positron emission tomography, (2) Patients with low-volume neck disease, N1 and N2a stage and without extracapsular extension on histopathological examination should receive single modality treatment. Radiotherapy and surgery may be similarly effective but, if possible, surgery (excisional biopsy, neck dissection and tonsillectomy) should be favoured because it consents a more precise staging, (3) patients with more advanced conditions require combined treatment in the form of either resection followed by adjuvant radiation (±chemotherapy) or primary chemoradiation (±post-therapy neck dissection).
authors.affiliation: Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Alberto Daniele
authors.initials: AD
authors.lastname: Arosio
authors.affiliation: Department of Otorhinolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pignataro
authors.affiliation: Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Renato Maria
authors.initials: RM
authors.lastname: Gaini
authors.affiliation: Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy. Electronic address: werner.garavello@unimib.it.
authors.forename: Werner
authors.initials: W
authors.lastname: Garavello
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D037981:Neck Dissection; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000473:pathology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D014068:Tonsillectomy
chemical_list: D000970:Antineoplastic Agents
keywords: Diagnosis; Metastatic cervical carcinoma from unknown primary; Radiotherapy; Surgery