Cervical Lymph Node Metastases from Central Nervous System Tumors: A Systematic Review

Abstract

Introduction Lymph node metastasis (LNM) from primary tumors of the central nervous system (CNS) is an infrequent condition, and classically it was thought that CNS tumors could not spread via the lymphatic route. Recent discoveries about this route of dissemination make its knowledge necessary for surgeons and pathologists to avoid delays in diagnosis and unnecessary treatments. The aim of this paper is to review the literature and to discuss the relevant pathogenetic mechanism and the cytologic features along with recommendations for surgical treatment of these cervical LNM. Materials and Methods Using PRISMA guidelines, we conducted a systematic review of the literature published from 1944 to 2021, updating the comprehensive review published in 2010 by our group. Results Our review includes data of 143 articles obtaining 174 patients with LNM from a primary CNS tumor. The mean age of the patients was 31.9 years (range, 0.1–87) and there were 61 females (35.1%) and 103 males (59.2%), and in 10 cases (5.7%) the gender was not specified. The more frequent sites of distant metastasis were bones (23%), lungs (11.5%) and non-cervical lymph nodes (11%). Conclusion Cervical LNM from CNS tumors is infrequent. Pathologic diagnosis can be obtained by fine-needle aspiration cytology in most cases, giving surgeons the option to plan the appropriate surgical treatment. Given the poor prognosis of these cases, the most conservative possible cervical dissection is usually the treatment of choice.

Oligodendroglioma metastasizing to cervical lymph node: Rare entity diagnosed on fine‐needle aspiration cytology

“…One of the largest studies carried out by Coca‐Pelaz et al on cervical lymph node metastasis of CNS tumors consisted of 172 cases out of which 12 cases were of oligodendroglioma (including anaplastic oligodendroglioma) and all the cases had a previous history of CNS tumor 12 …”

“…One of the largest studies carried out by Coca-Pelaz et al on cervical lymph node metastasis of CNS tumors consisted of 172 cases out of which 12 cases were of oligodendroglioma (including anaplastic oligodendroglioma) and all the cases had a previous history of CNS tumor. 12 To date, the cytological features of oligodendroglioma or anaplastic oligodendroglioma have been described based on touch or squash smears of primary brain tumors. Watson and Hajdu first defined cytomorphologic findings of primary OG as uniform cells with round nuclei and prominent nucleoli on touch smears.…”

Glioblastoma: an organ-confined disease?

“…Extra-CNS metastases from GB more commonly occur in lymph nodes (LN), lungs, pleura, soft tissues, glands, liver, and bone (10). Coca-Pelaz et al (11), recently conducted a systematic review of the literature published in the period 1944-2021, finding 174 cases of LN metastases from primary CNS tumors, with 52.8% being of glial origin. In this series other sites of distant metastases were bones (23%), lungs (11.5%) and non-cervical LN (11%).…”

“…As this case and prior reports demonstrate, recurrent GB with extra-CNS metastases has very few treatment options. Exceptions to this rule are regional relapses such as those occurring in the dura and head and neck LN, or in oligometastatic bone metastases, which various reports have shown that may be subjected to local treatments achieving longer local and systemic controls (10,11,15,26). Considering that systemic therapy has not demonstrated to prolong OS in patients with recurrent GB, its management is even more complex in patients with extra-CNS metastases.…”