A case series of metastatic lateral cervical lymphadenopathy

Abstract

Background: Metastasis is a common cause of lymphadenopathy, seen mainly in patients above 40 years of age. Regional nodes entrap the tumor cells and setup complex immunological reactions within the nodes. The histological appearance of the nodes often suggests the primary tumor. The head and neck cancers spread to regional nodes via embolism and permeation. Primary site is evident most of times. The nodes are initially mobile but later may becomes fixed. The aim was to study the lateral cervical metastasis secondary to either lymphatic spread from distant primary or occult metastasis, their signs and symptoms, diagnostic procedure and treatment modalities.Methods: The study was conducted from July 2012 to June 2015. All patients having cervical lymphadenopathy secondary to metastasis diagnosed by FNAC, are included in study. Patients are evaluated as a whole, starting with clinical history and examinations as per proforma. In cases of lympahdenopathy where the diagnosis was not established with FNAC, biopsy was performed and efficacy of FNAC has been calculated. Results: Total 37 patients are studied. Most cases occurred in 5th decade of life, followed by 4th decade. More common in male 83.70% as compared to female 16.30% due to tobacco and smoking addiction more common in males. Change in voice is most common presentation in 46% of cases, followed by dysphagia in 35.13% of patients. Primary tumor was evident in 83.78% of cases and occult in 16.22%. Fixed nodes present in 54.05%, reduced mobility in 21.62% and mobile in 24.32%. FNAC was done in all the cases and positive results obtained in 91.8% with sensitivity of 90% and specificity of 98%. In patients treated by neoadjuvant chemotherapy followed by modified neck dissection, no recurrence occurred. Out of 10 patients treated by radical neck dissection only 2 patients had recurrence in follow up period and managed by radiotherapy. In 15 patients treated by radical radiotherapy, 5 patients had local recurrence and required selective neck dissection in follow up.Conclusions: Cervical lymph node metastasis was major presentation of malignancies of head and neck region and also from distant site. Whenever presents, it should raise suspicion of metastatic origin. Early diagnosis of primary tumor followed by aggressive treatment via multimodal approach prolongs survival.