A survey of metastatic central nervous system tumors to cervical lymph nodes

Abstract

In the realm of head and neck diseases, one particularly common clinical presentation is that of the patient with a cervical mass. In children, neck masses often prove to be developmental cysts; in adults, the recent onset of a neck mass can signal a metastasis from a head and neck squamous carcinoma. Less often, both adults and children may present with cervical masses caused by either non-Hodgkin's lymphoma or Hodgkin's disease. There are, of course, less frequently encountered differential diagnostic possibilities; one of the most uncommon of all is the possibility of metastasis from an intracranial tumor. Intracranial tumors rarely give rise to cervical node metastases. The present review examines the published experience with 128 tumors that gave rise to cervical node metastases in both adult and in pediatric patients. While it is presumed that the blood-brain barrier blocks the spread of most tumors beyond the intracranial locale, this is speculative. Although many of the cervical node metastases reported here arose after craniotomy (and, presumably, after breaching of the blood-brain barrier), some arose in the absence of any preceding surgical procedure. Cervical node metastases may arise from glial tumors (including glioblastoma multiforme, in both adult and pediatric patients) and non-glial tumors (such as medulloblastoma in pediatric patients). The history of a previous intracranial lesion is often the key to correct diagnosis, since, without prompting, neither the pathologist nor the radiologist is likely to think of a cervical node metastasis from a brain tumor when assessing a cervical mass of unknown etiology.

Supratentorial extraventricular anaplastic ependymoma with extracranial metastasis

“…There are several hypotheses regarding the metastatic spread of intracranial tumors, including surgical manipulation with breach of anatomic barriers, hematogeneous spread after tumor invasion of the dural veins, via the ventricular system (drop or retrograde metastases), via ventriculoperitoneal shunts, and via hematogeneous or lymphatic spread after tumor invasion of the skull and extracranial tissues [7]. Three other patients in addition to ours had metastatic spread after a surgical procedure; manipulation of the tumor site and seeding during the invasive procedure may have a role in the development of metastasis (Table 1) [8-10].…”

“…It is possible that tumor growth may breach the normal anatomical site and spread tumor cells into the general circulation [7]. Primary brain tumors often have a poor response to chemotherapy due to the poor blood–brain barrier penetration [8].…”

The Microenvironmental Landscape of Brain Tumors

“…However, challenging this dogma was the observation that the brain is subject to immune surveillance under normal homeostatic conditions, particularly within the meninges (Ransohoff and Engelhardt, 2012; Shechter et al, 2013). Furthermore, detection of lymphocyte and tumor cell trafficking from the brain to the cervical lymph nodes suggests that there could be a direct route of passage into the lymphatic system (Goldmann et al, 2006; Mondin et al, 2010). …”

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

“…The patient usually presents with a painless, unilateral cervical mass. Affliction of the levels 1-3 indicates the primary site to be located in the head and neck region, whereas a mass in levels 4-5 suggests the primary tumor situated at the lower neck (e.g., thyroid gland) or below the clavicles [31][32][33] (Fig. 1).…”

“…When node metastases are found in levels 1-3, the primary site is suspected to be in the head and neck region. Upon affliction of the levels 4-5, the primary tumor most likely is located below the clavicles [31][32][33]. The time interval between noting the cervical mass and final diagnosis of HNCUP ranges from 2 to 5 months [6,8,34].…”