Review of the literature discloses 76 cases of carcinoma metastatic to the palatine tonsil. Of these cases reported or mentioned, 51 were detailed sufficiently or occurred frequently enough to allow analysis. We add two new cases of hypernephroma, and also study the courses of patients with primaries of the stomach, breast, lung and melanoma and seminoma. Bilateral tonsilar involvement is found to be very common in melanoma and not uncommon in seminoma and adenocarcinomas of the stomach and breast. It is uncommon for bronchogenic carcinoma and hypernephroma to metastasize to both palatine tonsils. When laterality is present the left tonsil is more commonly involved than the right, except by melanoma. Regarding neoplastic involvement of the primary organ, the left side gives rise to malignancies more often than the right side. Only seminoma has a high incidence of other metastases. The mean time interval between development of the primary and the tonsillar secondary is one year or less in seminomas, bronchogenic carcinomas and adenocarcinomas of the stomach, but 2 1/2 years or more for adenocarcinomas of the breast and kidney and melanomas. The mean time of survival after appearance of the tonsillar metastasis is nine months or less, regardless of the cell type of the primary malignancy.
Summary--Forty-nine patients with cervical metastases from unknown primaries were treated during an 11-year period. Thirty-one (63%) of these patients were treated for cure rather than palliation. The three-year survival rate of these patients treated for cure was 39%. Although the treatment of these patients varied, a systematic mode of therapy has evolved: patients with histopathologic diagnosis of epidermoid carcinoma, or undifferentiated malignant tumor, metastatic to the neck from an unknown primary, are treated with full course radiation therapy (6000-7000 rads at 1000 rads per week). This is delivered to the nasopharynx, pyriform fossae, base of tongue, and the neck, and is followed by radical neck dissection in those patients in whom the neck nodes remain palpable. Six of the last 11 consecutive patients treated in this manner are long-term survivors. This paper describes the evaluation of patients with cervical metastases from unknown primaries as well as their therapy.
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