Screening unilateral tonsillectomy in the unknown primary

Righi, Paul D.; Sofferman, Robert A.

doi:10.1288/00005537-199505000-00021

Cited by 61 publications

(46 citation statements)

References 10 publications

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“…Although panendoscopy is standard in HNSCCUP workup, there is no general consensus on the sampling modality of the palatine tonsils. Recent studies provide compelling support for unilateral [21] or even bilateral [22] tonsillectomy, which, in the experience of several groups, provided a significantly higher yield in detecting occult tumors than deep tonsillar biopsy [2,16,23,24]. The morphologic findings in our case further support this clinical approach: the few microscopic SCC foci might have been missed, had only tonsillar biopsies been obtained.…”

Section: Discussionsupporting

confidence: 68%

Small Lymphocytic Lymphoma Obscuring Microscopic Tonsillar Squamous Cell Carcinoma: an Unknown Occurrence with a Known Primary

Minca

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Chadha³

et al. 2010

Head and Neck Pathol

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Head and neck squamous cell carcinoma (HNSCC) often presents with cervical lymph node metastases and at times the primary tumor cannot be identified despite extensive workup. Lymphoma is the second most common neoplasm in the head and neck region but is seldom synchronous with HNSCC and rarely involves regional mucosal sites. We report herein a rare occurrence of tonsillar involvement by small lymphocytic lymphoma (SLL) incidentally detected during the workup for a cervical lymph node SCC metastasis of a 52-year-old nonsmoker male. The microscopic human papillomaviruspositive SCC involving the tonsillar surface and crypts was obscured by SLL leading to the initial designation of 'unknown primary'. The occult HNSCC are likely explained by small tumor size, quality and quantity of sampling, thoroughness of endoscopic, radiological and pathological assessment or a combination of the above. The coexistence of another tumor such as lymphoma has not yet been reported as a confounding factor in the workup for cervical SCC metastasis. Since oropharyngeal SCC can be very small and Waldeyer's ring is a common site for lymphoma involvement, identification of such rare collision tumors requires pathologists' awareness, extensive sampling and occasionally ancillary studies for the accurate diagnosis and staging essential for the correct management.

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Section: Discussionsupporting

confidence: 68%

Small Lymphocytic Lymphoma Obscuring Microscopic Tonsillar Squamous Cell Carcinoma: an Unknown Occurrence with a Known Primary

Minca

Popat

Chadha³

et al. 2010

Head and Neck Pathol

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“…Ipsilateral or bilateral tonsillectomy is recommended as part of the diagnostic work-up in patients with unknown primary site who have adequate lymphoid tissue in their tonsillar fossae, particularly in those with a single node involving the subdigastric (level II), mid-jugular (level III) or submandibular (level Ib) areas, or in patients presenting with bilateral subdigastric adenopathy [29,30]. In a study of 87 patients who underwent tonsillectomy as a part of the work-up for cervical node metastases presenting as an unknown primary cancer, 26% had a tonsillar primary [31].…”

Section: Answers To the Questions Proposedmentioning

confidence: 99%

Unknown primary cancer of the head and neck: a multidisciplinary approach

2011

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The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.

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“…In studies where tonsillectomy is routinely performed in identification and treatment of unknown primaries, the rates of occult tonsillar SCCA can be as high as 40%. 7,11,12 …”

Section: Unknown Primarymentioning

confidence: 99%