Unknown primary of the head and neck: A long-term follow-up

Lanzer, Martin; Bachna-Rotter, Sophie; Graupp, Matthias; Bredell, Marius; Rücker, Martin; Huber, Gerhard; Reinisch, Sabine; Schumann, Paul

doi:10.1016/j.jcms.2015.03.004

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…A carcinoma of unknown primary (CUP) is a rare disease, defined as a lymph node metastasis of an unknown primary tumor . The diagnosis of a CUP poses a great challenge to patients and treating physicians due to the unknown localization of the primary tumor and the patient's fear of relapse . Although the lymph node metastasis is the only indication of the disease, TNM status, localization, and histology of lymph node metastasis play an important prognostic role.…”

Section: Introductionmentioning

confidence: 99%

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Janik

Simmel

et al. 2019

Head & Neck

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Background The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck. Methods Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy. Results At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy. Conclusion As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

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Section: Introductionmentioning

confidence: 99%

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Janik

Simmel

et al. 2019

Head & Neck

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“…As in all H&N malignancies, squamous cell carcinoma presents the most common entity, with the tonsil being the most frequent localization for an occult primary. Patients with a CUP disease have a decreased overall survival rate compared to other head and neck squamous cell carcinoma (HNSCC) patients [2]. …”

Section: Introductionmentioning

confidence: 99%

Synchronous bilateral tonsil carcinoma: case presentation and review of the literature

Theodoraki¹,

Veit²,

Hoffmann³

et al. 2017

Infect Agents Cancer

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BackgroundThe incidence of synchronous bilateral tonsil carcinoma seems to be underreported. For adequate oncologic treatment, it is mandatory to remove all primaries to prevent recurrence or metachronic disease. The purpose of this manuscript is to provide a comprehensive review on this topic and to emphasize the need of bilateral tonsillectomy in cases of cancer of unknown primary (CUP) as well as in the case of a unilateral tonsillar carcinoma.Material and methodsA systematic review of the literature was performed for “bilateral tonsillar neoplasm”, “synchronous cancer of the oropharynx” and “cancer of unknown primary in head and neck”.ResultsWe present a clinical case with bilateral tonsillar carcinoma in initially suggested cancer of unknown primary. Clinically, both tonsillar sites were unsuspicious, but in PET/CT an ipsilateral enhancement of the tonsil area was detected. The pathological work up of bilateral tonsillectomy specimens revealed bilateral squamous cell carcinoma with HPV-type 16 positivity. The review of the literature revealed 29 cases of bilateral tonsil cancer.ConclusionThe handling of tonsillar tissue in the frame of panendoscopy in the case of CUP is still controversial. We recommend a bilateral tonsillectomy as a routine procedure for cancer of unknown primary as well as unilateral tonsillar carcinoma. Herewith the detrimental consequences of occult metachronous contralateral tonsillar carcinoma can be prevented.

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“…Sagheb et al reported that CUPs accounted for more than 20% of metastatic cancers in the HN region (HNCUPs) [23]. Overgaard et al and Lanzer et al found that 1.5 and 8.9% of CUPs were located in HN regions, respectively [24, 25]. Balaker et al reported that survival outcomes of patients with HNCUPs were most significantly influenced by clinical stage at the time of diagnosis and that treatment modalities did not affect the survival outcomes [26].…”

Section: Discussionmentioning

confidence: 99%

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

Abe¹,

Watanabe²,

Shinozaki‐Ushiku³

et al. 2019

BMC Cancer

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BackgroundCancers of unknown primary origin (CUPs) are reported to be the 3-4th most common causes of cancer death. Recent years have seen advances in mutational analysis and genomics profiling. These advances could improve accuracy of diagnosis of CUPs and might improve the prognosis of patients with CUPs.Case presentationA 76-year old male with an adenocarcinoma of unknown primary origin in the lung presented with another tumor of the palate mucosa. The tumor cells in the pleural effusion were all negative for immunohistochemical markers (TTF-1 and Napsin A) and lung-specific oncogenic driver alterations (EGFR mutation and ALK translocation). The tumor of the palate mucosa was likewise identified as an adenocarcinoma, and the cells showed cytological similarities with the tumor cells in the pleural effusion; TTF-1, Napsin A, EGFR mutation and ALK translocation were all negative. This result suggested that origins of the tumors of the palate mucosa and in the lung were the same, even though the origin had not yet been determined. Next, we addressed whether the tumor of the palate mucosa was a primary tumor or not. Secretory carcinoma (SC), which is a common type of minor salivary gland tumor (MSGT), was suspected; however, mammaglobin was negative and ETV6-NTRK3 (EN) fusion was not observed. Other MSGTs were excluded based on histological and immunohistochemical findings. Furthermore, an additional examination demonstrated an oncogenic KRAS mutation at codon 12 (p.G12D) in both palate tumor and in pleural effusion. KRAS mutation is known to exist in one-third of lung adenocarcinomas (LUADs), but quite rare in MSGTs. The possibility of metastasis from other organs was considered unlikely from the results of endoscopic and imaging studies. This result indicated that the primary site of the CUP was indeed the lung, and that the tumor of the palate mucosa was a metastasis of the LUAD.ConclusionsA tumor of the palate mucosa that showed diagnostic difficulties was determined to be a metastatic LUAD by genomic alterations and histopathological findings.Electronic supplementary materialThe online version of this article (10.1186/s12885-019-5277-1) contains supplementary material, which is available to authorized users.

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Unknown primary of the head and neck: A long-term follow-up

Cited by 11 publications

References 34 publications

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Synchronous bilateral tonsil carcinoma: case presentation and review of the literature

Identification of a metastatic lung adenocarcinoma of the palate mucosa through genetic and histopathological analysis: a rare case report and literature review

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