Carcinoma In Cervical Nodes Research Articles

Surgical management strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma

Objective: To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma. Methods: A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results: The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant(Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion: Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Clinicopathological features of incidentally detected metastatic thyroid papillary carcinoma in cervical lymph nodes of non-thyroid cancer patients: a retrospective analysis of 31cases

BackgroundThe incidental finding of thyroid inclusions in lymph nodes of neck dissections of non-thyroid cancer patients is an unusual event. It is still controversial for pathologists about whether this represents benign inclusions or metastatic papillary thyroid carcinoma (PTC). This study is to analyze clinicopathological features of such cases in an attempt to explore their clinical implications.MethodsPathological data were searched for incidentally detected PTC of cervical lymph nodes in non-thyroid cancer cases. Clinicopathological characteristics were reevaluated and recorded. BRAF V600E protein expression and sequencing analysis was then performed in cases with sufficient tissues.Results31 patients had an incidental finding of PTC in lymph nodes of patients with non-thyroid cancer. BRAF immunohistochemical staining were performed in 17 metastatic lymph nodes with sufficient tumor tissues, and 6 were positive. BRAF V600E point mutation was detected in 5 of 6 BRAF V600E positive cases. Subsequent imaging examinations of the thyroid showed no nodules or calcifications/benign nodules in 20 patients, and suspected malignant nodules in 5 patients. 12 patients underwent total thyroidectomy or ipsilateral lobectomy, and 6 showed PTC in postoperative pathological examinations. The remaining 19 patients without surgery were kept under active surveillance, and no one had recurrence of PTC.ConclusionIncidentally discovered PTC in lymph nodes has usually interpreted as metastasis from a clinical occult thyroid primary cancer, but primary PTC was not always detected. This suggests it could be double occult lesions. With regards to concurrence with highly malignant tumor, most patients could keep regular surveillance.

Diagnostic approaches to carcinoma of unknown primary of the head and neck.

Squamous cell carcinoma in cervical lymph nodes arising from an undetected primary tumour, termed carcinoma of unknown primary (SCCUP), is a well-recognized clinical presentation within head and neck oncology. SCCUP is a common presentation for patients with human papillomavirus-mediated oropharyngeal cancer (HPV+OPSCC), as patients with HPV+OPSCC often present with smaller primary tumours and early nodal metastasis. Meticulous work-up of the SCCUP patient is central to the management of these patients as identification of the primary site improves overall survival and allows for definitive oncologic resection or more focused radiation when indicated. This review summarizes the comprehensive diagnostic approach to the SCCUP patient, including history and physical examination, methods of biopsy of the cervical lymph node, imaging modalities and intraoperative methods to localize the unknown primary. Novel techniques such as transcervical ultrasound of the oropharynx, narrow band imaging and diagnostic transoral robotic surgery are also discussed.

Significance and management of incidentally diagnosed metastatic papillary thyroid carcinoma in cervical lymph nodes in neck dissection specimens.

The management of patients with incidentally discovered metastatic thyroid cancer in cervical lymph nodes in neck dissection specimens for other pathologies is unclear. Retrospective review of neck dissection specimens for nonthyroid malignancy during a 30-year period was undertaken to identify incidental metastatic papillary thyroid cancer (PTC). Twenty-six patients had an incidental finding of PTC in lymph node(s) in neck dissection specimens. Subsequent ultrasound of the thyroid showed nodules in 20 patients. Eleven (42%) underwent total thyroidectomy, 1 (4%) had a lobectomy, and 14 (54%) were kept under active surveillance only. At a median follow-up of 48 months (range 10-189 months), all patients who had undergone surgery and those under surveillance were free of PTC recurrence. Evaluation for detection of a primary thyroid tumor is essential in all patients with incidentally discovered metastatic PTC. Decision regarding surgery or surveillance is dependent on clinical and radiological tumor features and patient factors.

Clinical significance of cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma

The present study aims to analyze the expression of broad spectrum cytokeratin in the cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma and explore the metastasis of mandibular gingival squamous cell carcinoma in cervical lymph nodes. This study included 42 patients with mandibular gingival squamous cell carcinoma, which was staged according to the clinical staging criteria by International Union Against Cancer 2002 (UICC) and the Level staging method of cervical lymph node by American Academy of Otolaryngology-Head and Neck Surgery 1991. Monoclonal mouse anti-human cytokeratin (AE1/AE3) antibody was used in immunohistochemical examination and hematoxylin and eosin (H&E) staining. All positive sections by H&E staining were also positive by immunohistochemistry (IHC). The positive rate of routine H&E staining and serial-section H&E staining was 8.03 and 9.57%, respectively, the positive rate of IHC was 12.82%. The positive rate of IHC was significantly different with that of routine H&E staining (χ2=7.17, P<0.01), yet not significantly different with that of serial-section H&E staining (χ2=3.10, P>0.05). Lymph node metastasis was mainly in Level I, II and III, both serial-section H&E staining and IHC showed lymph node metastasis in Level IV for advanced patients. IHC showed 19 lymph node micrometastasis in 12 patients, while neither serial-section nor routine H&E staining showed micrometastasis. Lymph node dissection of hyoid bone (mainly in Level I, II and III) could be used for early patients, and the dissection could be expanded to Level IV for advanced patients.

Head and Neck Squamous Cell Carcinoma of Unknown Primary: Is There a Better Treatment?

Materials/Methods: Eleven patients with evidence of local and/or regional failure following curative-intent IMRT for nasopharyngeal carcinoma or cervical node carcinoma from unknown primary between 2004 and 2010 were retrospectively reviewed. Radiologic evident recurrent gross disease (rGTV) was manually delineated on the diagnostic CT scans documenting recurrence (rCT) and co-registered with the planning simulation CT (pCT) using validated atlas-based DIR software. Subsequently, deformation fields were applied to rGTV segmented on the rCT to convert them into deformed rGTV on the pCT. Evaluation of deformed rGTVs relative to original planning TVs and prescribed radiation dose was done using both volume overlap and focal methods. The focal method assumed the center of mass of deformed rGTV was the origin of the recurrence volume (rGTVorg) and its location was compared relative to planning TVs and dose. Rigid image registration (RIR) was also implemented to compare the spatial and dosimetric criteria of mapped rGTVs using both registration methods. Paired-samples Wilcoxon signed rank test was used to compare analysis metrics. Results: A total of thirteen rGTVs were identified. Using DIR, the focal method significantly assigned failures to more central TVs compared to the volume overlap method (p Z 0.009) where 12 (92.3%) rGTVorgs were located at GTV and one (7.7%) rGTVorg at CTV2 while the 95% volume of rGTV overlapped with GTV for 4 failures, CTV1 for 5 failures, and CTV2 for 4 failures. Moreover, failures mapped using DIR were assigned to more central TVs compared to RIR when compared using the volume overlap method (p Z 0.03) and the focal method (p Z 0.02). The dose to 95% failure volume was higher than the 95% prescribed dose for 12 out of 13 deformed rGTVs compared to 9 out of 13 for rGTVs mapped rigidly. Additionally, deformed rGTVs had significantly higher mean doses when compared to rGTVs mapped rigidly (70.93 vs 70.27 Gy, p Z 0.019). Conclusions: The vast majority of failures originated in the high dose target volumes and received full prescribed doses suggesting biological rather than technology-related causes of failure. Workflow methodology involving the use of validated DIR software allows more accurate evaluation of the patterns of failure compared to rigid registration and is recommended for large-scale future implementation. Author Disclosure: A.S. Mohamed: None. M. Awan: None. E. Kocak: None. B.M. Beadle: None. M.E. Kantor: None. G.B. Gunn: None. A.S. Garden: None. D.I. Rosenthal: None. C.D. Fuller: E. Research Grant; National Institutes of Health Cancer Center Support (Core) Grant CA016672 to The University of Texas MD Anderson Cancer Center. Dr. Fuller received/receives grant/funding support from the SWOG/Hope Fo.

Occurrence of contralateral lymph neck node metastasis in patients with squamous cell carcinoma of the oral cavity.

Introduction: Squamous cell carcinoma represents about 90% of malignancies of the mouth and about 38% of the head and neck tumors. The behavior of the cancer is very aggressive, presenting early cervical metastasis and, often contralateral ranging from 0.9 to 36%. Objectives: This study aims to analyze clinical and pathological factors that may influence metastasis of squamous cell carcinoma in cervical lymph nodes and relate this occurrence in the contralateral primary tumor, with disease prognosis and the interference of this type of metastasis in the survival rate of patients with this pathology. Material and Metohds: It was conducted a retrospective study from medical records of patients with Squamous Cell Carcinomas with homolateral lymph node metastasis and contralateral attended at the clinic of Head and neck surgery of Hospital São Vicente de Paulo in Passo Fundo – RS - Brazil, from 2000 to 2008. Results: Analyzing the charts of patients with metastatic and metastatic contralateral side it was observed that patients with initial stage presented a higher survival with statistical significance (p=0,035). Conclusions: The occurrence of metastases in lymph nodes of contralateral position to the primary lesion was not the main fator that influenced the survival of the group. Key words:Squamous cell carcinoma, oral cavity, contralateral, death rate, lymphatic metastasis, prognosis.

Occult Multifocal Papillary Thyroid Microcarcinoma Presenting as a Supraclavicular Mass Containing Anaplastic Thyroid Carcinoma

There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with evidence of only papillary carcinoma in the thyroid gland. There have been no cases of this clinical scenario with only papillary microcarcinoma in the thyroid gland. We describe the case of a 60-year-old man who initially presented with an enlarged right, level 5, supraclavicular lymph node. Initial fine-needle aspiration demonstrated evidence of papillary thyroid carcinoma. The final pathologic finding in the thyroid gland showed only multiple foci of papillary thyroid microcarcinoma. The index neck mass showed evidence of anaplastic thyroid carcinoma. This is the first instance in the literature in which anaplastic thyroid carcinoma has appeared in metastatic cervical lymph nodes with only a focus of papillary microcarcinoma in the thyroid gland. With this case, we hope to build awareness of this rare finding.

Histologic Identification of Human Papillomavirus (HPV)-Related Squamous Cell Carcinoma in Cervical Lymph Nodes: A Reliable Predictor of the Site of an Occult Head and Neck Primary Carcinoma

Patients with head and neck squamous cell carcinoma (SCC) often present with cervical lymph node metastasis. Occasionally the primary tumor site remains unknown even after thorough investigation. Management of such cases is problematic and may result in over-treatment and consequent increased morbidity. High risk HPV has been advocated recently as an important etiologic factor for a subset of head and neck SCC. These are believed to have a special predilection for the oropharyngeal tonsils and are characterized by nonkeratinizing basaloid morphology, and a strong reactivity to p16 immunostain. Identifying HPV-related SCC in the lymph nodes may thus provide a means for localizing the primary tumor site. Ninety-three cases of SCC metastatic to the neck from known primary tumors were classified morphologically into conventional keratinizing SCC (KSCC) and non-keratinizing SCC (NKCa). In situ hybridization (ISH) for high risk HPV as well as immunostaining for p16 were performed on all metastsatic and primary tumors. Of the 93 cases of metastatic carcinomas 32 were oropharyngeal, 35 oral, and 26 arose in the laryx/hypopharynx. Twenty-three cases were found to be HPV+ by ISH, of which 22/23 had oropharyngeal origin (P < 0.0001), with 95.7% sensitivity and 85.7% specificity. Twenty-one of these HPV+ oropharyngeal tumors were NKCa (P < 0.0001). The remaining case showed overlapping NKCa/KSCC hybrid morphology. All NKCa were HPV+ and stained diffusely and strongly with p16 antibodies. We have demonstrated that HPV status of the lymph node metastasis can be assessed not only by ISH and p16 immunoreactivity but also histomorphologically. In addition, a positive microscopic identification of HPV-related carcinoma is a reliable predictor of oropharyngeal origin.

原発不明頚部転移癌１２例の臨床的検討

Between January 1992 and January 2002, we treated 12 patients with metastatic carcinoma in cervical lymph nodes from an unknown primary tumor. Of 12 patients, the histological diagnosis was squamous cell carcinoma in 10 and adenocarcinoma in 2. Three patients were in clinical stage N3, 8 patients were in N2 and 1 patient was in N1. Among them, 6 patients with resectable lymph nodes were treated mainly with surgery, and 6 patients with unresectable lymph nodes or distant metastasis were treated with radiotherapy and/or chemotherapy. After these treatments, a primary lesion appeared in only one patient, who was diagnosed as having nasopharyngeal carcinoma. The loco-regional control rate in all patients was 75%. The control rate in the patients treated with surgery was 100%, and that in patients treated with radiotherapy and/or chemotherapy was 50%. Distant metastasis after treatment appeared more often in open-biopsy cases than in those receiving fine-needle aspiration (FNA) or open-biopsy with simultaneous radical neck dissection.According to these results, radical neck dissection appeared to be effective in controlling neck disease. For initial pathological diagnosis, FNA is recommended, while open biopsy should be avoided, if possible.

Cytologic Features of Metastatic Papillary Thyroid Carcinoma in Cervical Lymph Nodes

To elucidate the cytologic characteristics of metastatic papillary thyroid carcinoma (PTC) in cervical lymph nodes and the differences in cervical lymph nodes from those of stage I (intrathyroidal) PTC. Forty-seven cases of papillary thyroid carcinoma with cervical lymph node metastasis (group A) and 38 cases of intrathyroidal papillary carcinoma (group B) were included in this study. Preoperative fine needle aspiration cytology (FNAC) examination was performed on enlarged cervical lymph nodes (47 cases, group A) and enlarged thyroid nodules (13 cases, group A, and 38 cases, group B). All the cases were surgically excised and pathologically verified. The cytologic smears were reviewed and analyzed. The cytologic characteristics of metastatic PTC in cervical lymph nodes displayed a higher frequency of foamy macrophages (51.1% vs. 26.3%) and a lower frequency of distinct cell borders (38.3% vs. 71.1%) than those of stage I PTC. Metastatic PTC in cervical lymph nodes also had a higher frequency of cystic degeneration (44.7% vs. 5.3%) than intrathyroidal lesions. In 1 of the 47 cases with lymph node metastasis, the aspirate contained macrophages but no tumor cells. FNAC was useful in the diagnosis of metastatic PTC in cervical lymph nodes. However, because cystic degeneration appeared frequently, FNAC combined with thyroid ultrasonography to find the primary lesion is necessary in this situation.

Microvessel density predicts the radiosensitivity of metastatic head and neck squamous cell carcinoma in cervical lymph nodes.

Cervical lymph node metastasis is the most common recurrence pattern of head and neck squamous cell carcinoma (HNSCC), and it is usually treated with radiation therapy and/or neck dissection. There has long been a desire for markers useful in predicting radiosensitivity to enable assignment of patients with recurrent head and neck cancer to clinical trials to improve their survival rates and quality of life. A total of 43 cases of HNSCC treated with whole or elective neck irradiation (total dose, 26-70 Gy; median, 60 Gy) for recurrent metastatic SCC in neck lymph nodes after neck dissection between 1992 and 1999 were the subject of this study. The relationship between radiosensitivity and clinicopathological and histopathological factors, including the Ki-67-labeling index for cell proliferation, p53 immunoreactivity and microvessel density (MVD), in surgical neck lymph node specimens were investigated by univariate and multivariate analysis. Of the 43 patients, 31 had recurrent tumors in neck lymph nodes after radiotherapy. Univariate analysis revealed significant associations between radiosensitivity and both high grade of keratinization (p=0.033) and low MVD (p=0.004), and marginally significant associations between radiosensitivity and grade of differentiation of the cancer in the lymph nodes (p=0.070). Multivariate analysis showed that only MVD had predictive value (p=0.016). Tumors with a high MVD possessed a significantly better neck control rate than tumors with a low MVD (p=0.004) by Kaplan-Meier analysis. MVD can be used as a good predictive marker for radiosensitivity of metastatic HNSCCs in cervical lymph nodes after neck dissection.

Cervical lymph node metastasis from an unknown primary tumor

Between June/1986 and June/1999, we treated 18 cases of previously untreated metastatic carcinoma in cervical lymph nodes from an unknown primary tumor. Among them, 15 cases were squamous cell carcinoma, 2 were adenocarcinoma, and one was undifferentiated carcinoma. The dose of radiotherapy, which was planned only for the cervical lymph nodes, was 60-70 Gy at the metastatic sites. Preventive radiotherapy at possible primary sites was performed only in one case. After these treatments, a primary lesion appeared in only two cases: in one case a tumor was found in the hypopharynx, and the other, which had been diagnosed as undifferentiated carcinoma, proved to be malignant lymphoma. Outcomes were analyzed except for these two cases. The five-year survival rate was 31%. The loco-regional control rate was 57% after radiation treatment limited to the affected cervical lymph nodes. Distant metastasis appeared more often in open-biopsy cases than in those receiving fine-needle aspirations (FNA). According to these results, treatment of possible primary sites may not be necessary, and for initial pathological diagnosis, FNA is recommended, while open biopsy should be avoided, if possible.

The Management of Metastatic Squamous Cell Carcinoma in Cervical Lymph Nodes From an Unknown Primary

A patient is diagnosed with an unknown primary of the head and neck when metastatic disease is present in the cervical lymph node or nodes and no primary lesion is detected by thorough physical examination, directed biopsies of suspicious or most likely primary sites, and imaging studies. The optimal management of patients who have this syndrome is still unclear and controversial. We report our results and analysis of the management of 24 patients with this syndrome. From 1976 through 1992, 24 patients who had metastatic squamous cell carcinoma in the cervical lymph nodes were seen in our medical center. A thorough search did not detect a primary lesion in any of them. Patients underwent radical neck dissection of the involved neck; 23 had unilateral and I had bilateral neck disease. Postoperative radiotherapy was delivered to both sides of the neck and to the potential primary mucosal and submucosal sites. The relation between clinical N stage, histologic findings of numerous involved lymph nodes, presence of extracapsular tumor extension, and survival were statistically analyzed. The Kaplan-Meier method was used for the survival analysis. The p values of log-rank test for the comparison of the two groups 1) N1 and N2 versus N3, and 2) presence of extracapsular tumor extension versus its absence are less than 0.005, with extracapsular tumor extension versus nonextracapsular tumor extension slightly smaller. The 5- and 10-year disease-free survival rate for the entire group was 54.2% (70.5% for N1 and N2, and 14.2% for N3). Three patients had locoregional failure, two in the primary sites, one in the nasopharynx, and the other in the oropharynx (the latter also had recurrent disease in the undissected neck). In 8 patients, distant metastases developed 7 to 38 months after radiotherapy. All 11 patients (45.8%) who had recurrent disease had advanced clinical N stage, microscopic findings of numerous involved lymph nodes, and prominent extracapsular tumor extension to the surrounding soft tissue and blood vessels. The high incidence of distant metastases shortly after treatment suggests a hematogenous spread before treatment in patients who had extensive nodal and extranodal disease. Our long-term disease-free survival beyond ten years seems to indicate combined treatment modalities, including radical neck dissection with postoperative radiotherapy of the neck, and the potential primary site in patients with N2 and N3 disease (our N1 group is too small for analysis). Further improvement of cure rate can be expected in the future with early detection and treatment.

Metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary tumour: prognostic factors.

The aim of this retrospective review is the study of the prognostic factors related to cervical metastases of squamous cell carcinoma from an unknown primary tumour. Sixty-seven patients were selected and surgery and postoperative radiotherapy was the treatment used. Nineteen tumours were subsequently found (27%). The 5-year actuarial survival rate of all patients was 22%. Survival rates were significantly related to lymph node stages and to the histological degree of differentiation. Nevertheless, actuarial survival rates were not related to the appearance of the primary tumour (P = 0.07). In our series, the single most important prognostic factor was the neck stage. The value close to statistical significance observed when the primary tumour subsequently appeared (P = 0.07), suggests that this could worsen the prognosis.

Metastatic cervical lymph nodes with occult primary carcinomas

Metastatic carcinoma in cervical lymph nodes is relatively common in patients with head and neck cancer. Usually, a careful search will reveal the primary tumor in the skin or mucosal surfaces of the head and neck or, rarely, in an area below the clavicles, such as the lungs. In approximately 3% to 11 % of cases, however, the primary tumor remains elusive. Controversy exists about which treatment regimens give the best results in patients in whom the primary cancer is not found. This review discusses current concepts in diagnosis, therapeutic options, and prognostic factors. Emphasis is given to recent advances in diagnosis, treatment (including radiation and chemotherapy), and prognosis.

The occult head and neck primary: to treat or not to treat?

In patients with cervical node metastases from an unknown primary malignancy, there is unresolved controversy regarding the utility of elective irradiation of putative pharyngeal primary sites as part of the management plan. We analysed the experience of the Peter MacCallum Cancer Institute to assess the risk of withholding mucosal irradiation in relation to the diagnostic algorithm used to exclude a primary lesion at the time of initial presentation. Between 1983 and 1992, 69 patients were seen with metastatic squamous or undifferentiated carcinoma in cervical nodes from an unknown primary site. Neck nodal stage was NX or N1 13%; N2 52%; N3 35%. Nodal disease was bilateral in 12% of patients. Investigations included examination under anaesthesia, with or without random biopsies, in 84%, and CT scanning of the head and neck in 55%. Treatment was by surgery alone in four patients, by radiotherapy alone in 23, and by combined modalities in 40. Two patients received no treatment. Seventeen were treated with palliative intent. The radiotherapy fields provided comprehensive coverage of the pharynx in only eight patients and partial coverage in five. The estimated overall 5-year survival was 36%. Eleven primary tumours were detected between 7 months and 7 years after the initial treatment, of which nine were in head and neck sites. This yielded an estimated incidence of 30% at 10 years, which is similar to the risk of the development of a second primary after the successful treatment of a known head and neck cancer. Only three patients (none of whom had a CT scan as part of their initial evaluation) manifested a primary in an unirradiated pharyngeal site within 2 years of treatment. As the accuracy of imaging improves, the risk of missing an occult primary lesion will decrease further. We conclude that the use of standardized diagnostic investigations incorporating modern imaging substantially eliminates the indication for comprehensive elective mucosal irradiation with its consequent morbidity. The overriding priority in patients who present with advanced neck disease is to secure regional control.

Extracapsular spread and the perineural extension of squamous cell cancer in the cervical plexus.

Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.

Metastatic prostatic carcinoma presenting as left-sided cervical lymphadenopathy: a series of 11 cases.

Eleven cases of metastatic prostatic carcinoma in cervical lymph nodes as a primary presenting sign were identified in a survey of 250 cervical lymph node biopsies from men. The diagnosis was clinically unsuspected in all cases. All occurred on the left side of the neck. These 11 cases represented 11% of all metastatic carcinomas in the neck and 20% of those with left-sided involvement. The diagnosis was readily confirmed by immunostaining for prostate specific antigen and prostate specific acid phosphatase. Six patients are alive and well at an average of 25.8 months and five others survived for an average of 34.4 months, the combined survival being 29.7 months. This contrasts with the dismal fate of patients with metastatic adenocarcinoma from other sites who all died at an average of 2 months from diagnosis. Prostatic carcinoma should always be considered in the differential diagnosis of metastatic carcinoma in cervical lymph nodes in elderly men, as appropriate treatment results in worthwhile prolongation of life.

Metastatic carcinoma in cervical lymph nodes from unknown primary: A failure analysis of 144 cases following radical radiotherapy

Metastatic carcinoma in cervical lymph nodes from unknown primary: A failure analysis of 144 cases following radical radiotherapy