Distant Primary Tumor Research Articles

Utility of Positron Emission Tomography in Radiotherapy Practice with Emphasis on Head and Neck Cancer

SummarySeveral issues related to functional imaging in treatment planning and response assessment in head and neck cancer exist. In the pre‐radiotherapy setting, integrated positron emission tomography (PET)‐computed tomography (CT) provides more accurate delineation of disease extent in head and neck cancer than does PET or CT alone, while fluorodeoxyglucose (FDG)‐PET shows promise in detecting distant metastases and/or primary tumour after a negative work‐up. Incorporating FDG‐PET data during the radiotherapy planning stage may significantly alter the gross tumour volume as well as identify primary tumour sites. Given sufficient time following radiation therapy (RT), FDG‐PET is valuable in identifying residual tumours where CT and/or magnetic resonance imaging are unable to. While FDG‐PET and PET‐CT show great potential, challenges exist in successfully integrating the data into radiotherapy planning. No integrated system is used throughout the planning and treatment delivery process, leading to difficulty in reconciling imaged data with accurate radiotherapy delivery. This is particularly true when attempting to accurately delineate the tumour boundary. Although the several discussed methods yield good results, target volume definition remains elusive and uncertain. By identifying targets using mathematical thresholding techniques some of this uncertainty is removed.

Breast Adenocarcinoma Mimicking Temporomandibular Disorders: A Case Report

The aim of this report is to present a case of a metastatic lesion in the mandible originating from a breast adenocarcinoma that was initially diagnosed as temporomandibular disorder (TMD). The role of the dental practitioner in the diagnostic phases is also discussed. It is not uncommon to see a patient who complains of what seems to be a TMD but who in reality suffers from a systematic disease, dental infection, or neoplasia. Although metastases to the head and neck are uncommon, it should always be considered among the differential diagnoses of lesions. A 42-year-old female presented with pain and swelling in the right temporomandibular joint (TMJ) previously diagnosed as TMD. Further clinical, radiological, and histological examinations coupled with a history of adenocarcinoma of the breast lead to a final diagnosis of a metastatic lesion in the right TMJ region. In most patients who present with an oral metastasis the distant primary tumor has already been diagnosed and treated. Occasionally the discovery of an oral metastasis leads to the detection of an occult primary malignancy elsewhere in the body. Thus the dentist should be able to perform an adequate diagnosis and play an important role in the diagnostic phase of care that can lead to a useful palliation and an enhanced quality of the patient's life. In order to avoid the pitfalls so common in evaluating patients with TMJ pain, the clinician must perform a complete and critical review of the medical history along with a comprehensive examination. The challenge is to know and evaluate the differential diagnosis. Failure to do so can result in a misdiagnosis which may lead to unnecessary care, long-term therapy without clinical resolution, or potentionally death.

Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma

We report the results of radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma (HCC). From 1998 to 2004, 45 cases were treated with radiotherapy (RT), with a dose between 30 and 55 Gy. The radiation response, overall survival, prognostic factors, and complications were evaluated. Thirty-nine cases were able to be evaluated for response: 10 cases showed complete response; 21 cases showed a partial response; and 8 cases showed stable disease. The overall response rate was 79.5%. The response rate was 87.5% for patients receiving >or=40 Gy(10) (biologically effective dose, alpha/beta = 10) and 42.9% for patients receiving <40 Gy(10) (P = 0.02). The median survival time was 10 months for responders and 6 months for nonresponders (P = 0.01). The absence of other concurrent distant metastasis and controllable primary HCC were significant prognostic factors. RT induced gastric or duodenal ulcer development in nine patients. All of these patients had received more than 50 Gy(10), and these complications were not detected among patients receiving <50 Gy(10) (0% vs 37.5%, P < 0.01). RT was an effective treatment modality, and the absence of concurrent distant metastasis and controllable primary tumor were significant prognostic factors. However, considering the high rate of RT-induced morbidity, 40 Gy(10) to 50 Gy(10) might be the optimal RT dose.

Primary Squamous Cell Carcinoma of the Breast: Value of Positron Emission Tomography Scanning in Confirming the Diagnosis

Pure primary squamous cell carcinoma of the breast is rare. Controversy exists as to whether a pure form exists or whether described cases represent extreme squamous metaplasia within an adenocarcinoma. We present a case of pure primary squamous cell carcinoma of the breast confirmed histopathologically with the absence of a distant primary tumor excluded using positron emission tomography. Because of the paucity of guidelines in the literature for this rare tumor, it is difficult to draw firm conclusions regarding the optimal treatment modality or the overall prognosis.

Tumour-mediated upregulation of chemoattractants and recruitment of myeloid cells predetermines lung metastasis

Primary tumours influence the environment in the lungs before metastasis. However, the mechanism of metastasis is not well understood. Here, we show that the inflammatory chemoattractants S100A8 and S100A9, whose expression is induced by distant primary tumours, attract Mac 1 (macrophage antigen 1)(+)-myeloid cells in the premetastatic lung. In addition, tumour cells use this mechanism, through activation of the mitogen-activated protein kinase (MAPK) p38, to acquire migration activity with pseudopodia for invasion (invadopodia). The expression of S100A8 and S100A9 was eliminated in lung Mac 1(+)-myeloid cells and endothelial cells deprived of soluble factors, such as vascular endothelial growth factor A (VEGF-A), tumour necrosis factor alpha (TNFalpha) and transforming growth factor beta (TGFbeta) both in vitro and in vivo. Neutralizing anti-S100A8 and anti-S100A9 antibodies blocked the morphological changes and migration of tumour cells and Mac 1(+)-myeloid cells. Thus, the S100A8 and S100A9 pathway may be common to both myeloid cell recruitment and tumour-cell invasion.

Sensibilitätsstörung und pathologische Unterkieferfraktur als Erstsymptome bei metastasiertem Prostatakarzinom

Distant metastases of solid tumors account for about 1% of all malign neoplasms. In about 30% of all patients who present with an oral metastasis, the distant primary tumour has not been diagnosed yet. We report the case of a 71-year-old man who clinically demonstrated unilateral mental neuropathy as well as pathologic fracture of the mandible. Prostate carcinoma was identified as a primary tumor. Clinically, there was significant hypesthesia of the skin area innervated by the left inferior alveolar nerve. X-ray examination revealed an osteolytic lesion of the ascending ramus of the mandible as well as a pathologic fracture of the mandible. Further imaging showed an extensive neoplasm of the mandible and adjacent soft tissues and significant supraclavicular lymph node enlargement. The diagnosis of metastatic carcinoma of the prostate was histopathologically confirmed. Mental neuropathy without a dental focus indicates screening for an osseous metastasis. In cases of left-sided supraclavicular lymph node enlargement in men over 45 years, metastatic prostate carcinoma must be excluded.

Scalp Ulcer as First Sign of Cholangiocarcinoma

Metastases from distant primary tumors are rarely the first indicators of cancer. However, cutaneous metastases are not uncommon in cases of internal malignancy. This article describes the case of a 65-year-old man with cutaneous metastasis of cholangiocarcinoma who presented with a scalp ulcer as the only initial sign. This is only the third reported case of cholangiocarcinoma with distant cutaneous metastasis.

Metástasis en la glándula parótida

IntroductionMetastatic disease in the parotid gland has been observed and reported in the literature, and its treatment is controversial Material and methodsWe review 48 patients with parotid tumors that underwent surgery during 1997-2004. The clinical and histogical features are reviewed ResultsAmong these 48, there were 12 cases of metastatic tumors to the parotid (25%). The pathohistological analysis of these tumors revealed that 8 were epidermoid carcinoma (66%), 1 patient was a melanoma (8%), 2 lymphomas below clavicules (16%) and 1 patient with a metastasis of a primary renal cancer. All patients underwent parotidectomy and 10 also cervical neck dissection (6 cases showed cervical metastases). 8 patients received radiotherapy after surgery ConclusionsIn our study parotid metastases are relatively common in patients submitted for parotid surgery. Often the site of origin of the primary tumor is the facial skin, and the primary tumors most commonly are melanomas or squamous-cell carcinomas, but it is possible distant primary tumors below clavicules

Les tumeurs malignes secondaires de la parotide

Secondary malignant tumors of the parotid gland are uncommon. They arise from primary tumors located in the head and neck or from distant primary tumors. The formers are dominated by squamous cell carcinomas and melanomas, the latters by renal and lung cancers. Distinction between malignant primary tumors and metastasis of other primary tumors to the parotid gland is very important to appreciate, because the result of this will change therapeutic procedure and the evaluation of prognosis.A series of 23 patients with tumors metastatic to the parotid gland are reported. All clinical and pathological data were reviewed. The management of secondary tumors of the parotid gland and the results were analyzed in order to try to identify common features and implications for management.The most frequent histologic types were squamous cell carcinoma and melanoma. Most primary tumors occurred in the head and neck. Metastasis to the parotid gland presented with a median time of 18 months after diagnosis of the primary tumor. All the patients had a parotid mass. No patient had facial nerve weakness. Parotid metastases were treated by superficial parotidectomy with preservation of the facial nerve in all cases, associated in 14 cases with a homolateral selective neck dissection and in 6 cases with a homolateral radical neck dissection. Twenty-one patients were submitted to radiation therapy. Seven patients died after the treatment: in 3 cases, death was due to a local recurrence with cervical relapse; 4 patients presented cervical and metastatic lesions.This retrospective review confirmed that patients with involvement of cervical nodes and metastatic parotid tumors have a worse prognosis than those without involvement of cervical nodes. The addition of postoperative radiotherapy provides no additional benefit.

Deleted in colon cancer protein expression in colorectal cancer metastases: a major predictor of survival in patients with unresectable metastatic disease receiving palliative fluorouracil-based chemotherapy.

To determine whether deleted in colon cancer (DCC) protein expression in colorectal cancer (CRC) metastases could predict outcome to palliative fluorouracil (FU)-based chemotherapy and to assess whether it is similar to that observed in the corresponding primary tumors. DCC protein expression was assessed immunohistochemically on archival specimens of CRC metastases from 42 patients homogeneously treated by methotrexate-modulated bolus FU alternated to 6-S-leucovorin-modulated infused FU and was retrospectively correlated with patient characteristics and clinical outcome. In a subset analysis, DCC immunoreactivity was compared between metastatic CRC and the corresponding primary tumors and regional lymph node metastases. Positive immunoreactivity for DCC was found in 45% of patients. Eighteen (78%) of 23 patients for whom multiple samples were available displayed a similar pattern of expression in distant metastases and primary tumors. The median survival time was 14.3 months in patients without DCC expression and 21.4 months in patients with DCC-positive tumors (log-rank test, P =.04); the 2-year survival rates were 8.5% and 42.5%, respectively. Response rates to chemotherapy were not significantly different between the two groups. By multivariate analysis, DCC protein expression maintained its prognostic value and showed to be the single best predictor of survival, with a relative risk of 2.16. Our results indicate that expression of the DCC protein in CRC metastases is similar to that observed in the corresponding primary tumors and represents a dominant predictor of survival in patients with unresectable, advanced CRC who are undergoing palliative FU-based chemotherapy.

Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: a clinicopathologic study of five new cases

The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or, more rarely, de novo. Diagnostic criteria of PIOC require absence of initial connection with the overlying mucosa or skin and exclusion of metastasis from a distant primary tumor by physical and radiographic examination during at least a 6-month follow-up. We report 5 patients with PIOC treated at the University of Maryland, Baltimore, during the period from 1997 to 2004. Three of the patients were female and 2 were male. Their age ranged from 18 to 84 years with a mean age of 52.8 years. One case involved the anterior maxilla, and 4 cases occurred in the mandible, 3 of them being located posteriorly. One patient complained of pain and paresthesia, and the remaining patients were asymptomatic. The typical radiographic presentation of our cases was that of a radiolucent lesion with well defined or irregular margins. Histopathologically, 4 cases were diagnosed as PIOC arising from previous odontogenic cysts (including 2 odontogenic keratocysts and 2 periapical cysts); all 4 were well differentiated keratinizing carcinomas. The remaining case, a poorly differentiated nonkeratinizing squamous cell carcinoma, was not associated with a cystic component and appeared to have arisen de novo. Four patients underwent surgical removal with postoperative radiotherapy, and 1 patient was treated with surgery only. Lymph node involvement and distance metastasis were not present in any of our patients at the time of diagnosis and did not develop during a follow-up period ranging from 15 to 77 months. To date, all patients are alive and free of disease. Knowledge of the clinical, radiographic, and histopathologic features of PIOC will allow accurate diagnosis and appropriate treatment of this rare malignancy. The term primary intraosseous odontogenic carcinoma (PIOC) has been primarily used to describe a squamous cell carcinoma within the jaws arising either from a previous odontogenic cyst or, more rarely, de novo. Diagnostic criteria of PIOC require absence of initial connection with the overlying mucosa or skin and exclusion of metastasis from a distant primary tumor by physical and radiographic examination during at least a 6-month follow-up. We report 5 patients with PIOC treated at the University of Maryland, Baltimore, during the period from 1997 to 2004. Three of the patients were female and 2 were male. Their age ranged from 18 to 84 years with a mean age of 52.8 years. One case involved the anterior maxilla, and 4 cases occurred in the mandible, 3 of them being located posteriorly. One patient complained of pain and paresthesia, and the remaining patients were asymptomatic. The typical radiographic presentation of our cases was that of a radiolucent lesion with well defined or irregular margins. Histopathologically, 4 cases were diagnosed as PIOC arising from previous odontogenic cysts (including 2 odontogenic keratocysts and 2 periapical cysts); all 4 were well differentiated keratinizing carcinomas. The remaining case, a poorly differentiated nonkeratinizing squamous cell carcinoma, was not associated with a cystic component and appeared to have arisen de novo. Four patients underwent surgical removal with postoperative radiotherapy, and 1 patient was treated with surgery only. Lymph node involvement and distance metastasis were not present in any of our patients at the time of diagnosis and did not develop during a follow-up period ranging from 15 to 77 months. To date, all patients are alive and free of disease. Knowledge of the clinical, radiographic, and histopathologic features of PIOC will allow accurate diagnosis and appropriate treatment of this rare malignancy.

The molecular biology of mucosal field cancerization of the head and neck.

Field cancerization was first described in 1953 as histologically altered epithelium surrounding tumor samples taken from the upper aerodigestive tract. Since then, the term has been used to describe multiple patches of pre-malignant disease, a higher-than-expected prevalence of multiple local second primary tumors, and the presence of synchronous distant tumors within the upper aerodigestive tract. Molecular techniques such as karyotype analysis, microsatellite analysis, p53 mutation screening, and X-chromosome inactivation studies have further refined the relationship among these lesions. While there are differences in the techniques used to identify the clonal origins of the lesions, these studies indicate that there is often lateral clonal spread of pre-malignant or malignant disease, and a significant portion of local second primary tumors are in fact genetically related. Distant second primary tumors found in the esophagus are often not related to concurrent head and neck cancer, whereas synchronous squamous lung tumors with a head and neck primary are often, in fact, metastases, rather than independently arising malignancies. These observations help to explain the high incidence of recurrent disease, despite excision or other therapy--pre-malignant or malignant clones often have the ability to migrate and persist outside of the field of treatment. Therefore, alternative means of prevention or therapy that can affect the entire head and neck region may be of benefit to such patients. Future studies will further refine the relationship among these lesions and perhaps identify key molecular alterations to be used as targets for gene therapy.

MMP9 induction by vascular endothelial growth factor receptor-1 is involved in lung-specific metastasis.

The molecular mechanism of tissue-specific metastasis in tumors endogenously expressing members of the vascular endothelial growth factor (VEGF) family is not yet clear. Here we demonstrate that MMP9 is specifically induced in premetastatic lung endothelial cells and macrophages by distant primary tumors via VEGFR-1/Flt-1 tyrosine kinase (TK) and that it significantly promotes lung metastasis. In a genetic approach using mice, suppression of MMP9 induction by deletion of either VEGFR-1TK or MMP9 markedly reduced lung metastasis. Furthermore, the MMP9 levels in endothelial cells of normal lung lobes from patients carrying distant tumors were significantly elevated as compared with those from patients without tumors. Thus, a block of MMP9 induction via VEGFR-1 inhibition could be useful for the prevention of tumor metastasis in lung.

Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases

Malignant esophageal stricture secondary to invasion from a tumor arising in a contiguous organ is a relatively rare finding; even more uncommon is a direct metastasis to the esophagus from a distant primary carcinoma. We present six cases, the largest current series, of esophageal strictures secondary to metastases from a separate primary cancer. We reviewed the records of 20 patients treated at Virginia Mason Medical Center between 1972 and 2000 with a diagnosis of malignant esophageal stricture secondary to an extraesophageal primary carcinoma. Patients whose stricture appeared to be secondary to esophageal invasion or compression from a contiguous tumor or lymph nodes were excluded. The remaining six patients who had metastases to the esophagus itself were reviewed with respect to the nature of the primary tumor, presentation, radiologic and endoscopic findings, and treatment. Among the 20 patients reviewed, 14 were excluded owing to either contiguous involvement from a nearby primary malignancy, regional nodal involvement, or complications of external beam radiation treatment. Six patients were considered to have direct metastasis to the esophagus from distant primary malignancies. The mean age of these patients was 72 years (range 68-74). Two of the primary lesions were lung carcinoma, while four primaries were breast cancers. The average time interval from the diagnosis of a primary tumor to esophageal involvement was 7 years in patients with breast cancer and 5 months in patients with lung cancer. Three patients were palliated with endoscopic dilation and stent placement. The other three patients have died secondary to upper gastrointestinal bleeding. Metastatic cancer to the esophagus is a rare occurrence. The process is usually submucosal and can be difficult to diagnose. The diagnosis should be considered when a patient presents with malignant dysphagia and has a background of distant carcinoma.

Detection of pancreatic metastases by EUS-guided fine-needle aspiration

Background: Metastases to the pancreas are usually found incidentally. Tissue diagnosis is imperative because imaging alone is incapable of differentiating them from primary pancreatic tumors. This study tested whether it is possible to differentiate metastases from other focal pancreatic lesions by using EUS-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis. Methods: One hundred fourteen consecutive patients (mean age 61 years) with focal pancreatic masses, detected on CT, underwent EUS-FNA by using a linear-array echoendoscope and 22-gauge needles. Results: Adequate specimens were obtained from 112 lesions. Carcinomas were identified in 68 cases (60.7%), 56 (50%) of pancreatic origin and 12 (10.7%) from distant primary tumors. The metastases were all located in the head and body of the pancreas and measured 1.8 to 4.0 cm. The echo-texture was heterogeneous or hypoechoic in all cases and resembled that of primary tumors. Six of the 12 patients with metastatic disease had a prior diagnosis of cancer (breast, 3; renal cell, 2; salivary gland, 1), 4 of them with a recurrence and 2 with a second carcinoma metastasizing to the pancreas. Six patients without a prior diagnosis of cancer had metastases from renal cell, colonic, ovarian, and esophageal carcinomas; one metastasis was from an unknown primary and another was from a malignant lymphoma. These findings influenced the therapeutic strategy in 8 patients who underwent nonsurgical palliation. There were no complications. Conclusions: Pancreatic metastasis is an important cause of focal pancreatic lesions, but the EUS features are not diagnostic. Simultaneous EUS-FNA allows cytodiagnosis and can have a decisive influence on the selection of appropriate therapeutic strategies. (Gastrointest Endosc 2001;53:65-70.)

Primary Leiomyosarcoma of the Adrenal Gland

We report a rare case of a primary leiomyosarcoma of the adrenal gland. A 73-year-old woman presented with an inferior vena cava syndrome. MR imaging was suggestive of a large tumour originating from the right adrenal gland. Angiography revealed a tumour vascularised by the right adrenal artery. At explorative laparotomy a tumour of 27 cm in diameter was found which was completely fixed to the liver; the tumour was therefore considered unresectable. As a consequence of the mechanical problems caused by this large tumour, the patient died 3 weeks after the operation. Autopsy revealed no distant metastases or other primary tumour site.

Testicular and paratesticular involvement by metastatic neuroblastoma.

Testicular and paratesticular involvement is a less familiar feature in neuroblastoma and its prognostic impact is unclear. The records of 1076 male patients in the German cooperative neuroblastoma treatment trials were searched for patients with testicular or paratesticular involvement. The authors found 11 children with paratesticular or testicular involvement at the time of manifestation of the disease, 3 children with testicular involvement at the time of relapse, and 1 infant with testicular involvement at the time of progression of neuroblastoma from International Neuroblastoma Staging System (INSS) Stage 4S to Stage 4. In de novo disease, the age of manifestation did not exceed 12 months. Two children had paratesticular involvement per continuitatem by growth of a primary tumor through the inguinal channel. All others had distant primary tumor. Prognosis appeared more favorable for infants (3 of 9 died) than for older children (5 of 6 died), for children with involvement of testes and < 10% involvement of bone marrow (2 of 8 died) than for children with other distant metastasis (6 of 7 died), and for children with intrascrotal involvement at first diagnosis (4 of 11 died) than for children with intrascrotal involvement during relapse of the disease (all 4 children died). Paratesticular or testicular metastasis does not per se indicate unfavorable outcome and is compatible with INSS Stage 4S in infants. The age at diagnosis and the time of manifestation during disease contributed to the prognosis in those patients.

二次性側頭骨悪性腫瘍による顔面神経麻痺

Shun-ichi Imamura, Kaori Hashimoto, Mayumi Imamura, Izuru Nozawa, Ken-ichi Hisamatsu and Yoshihiko Murakami (Yamanashi Medical University)Peripheral facial palsy caused by secondary malignant tumors of the temporal bone from distant or adjacent primary tumors is thought to be rare. We encountered nine patients with facial palsy resulting from secondary neoplastic invasion to the temporal bone from various primary sites (liver, lung, breast, eyelid, hypopharynx, maxillary sinus, renal pelvis, and leukemia) during a period of approximately 10 years (between 1983 and 1992). The incidence of this type of etiology accounted for 5.2% (9/173) of all patients with facial palsy who were treated at our institution during that period.We also performed histopathologic studies of the temporal bones acquired from five patients who had presented facial palsy of varying degrees before death due to secondary malignant tumors and the correlation between their clinical and histological findings was investigated.The results obtained in the present study were summarized as follows:1) The present study and our comprehensive review of the literature indicated that the most common clinical symptom in patients with secondary malignant tumors of the temporal bone was facial palsy, followed by hearing loss, otalgia, etc.2) It also became apparent that there were three basic routes of tumor invasion from primary tumors to the intratemporal portion of the facial nerve: 1. hematogenous dissemination of neoplastic cells to the bone marrow or pneumatized area of the temporal bone destroying the Fallopian canal,2. direct extension of malignant tumors adjacent to the temporal bone involving the Fallopian canal,3. leptomeningeal metastatic carcinomatosis involving the internal auditory meatus and destroying the facial nerve trunk directly. Clinical otologic features including facial palsy tended to differ depending on the extension route of the malignancy to the temporal bone and facial nerve.3) Although metastatic or secondary temporal bone malignancies are rare and the clinical symptoms usually appear late in the course of disease, otologists should be aware of existence of this disease entity, since otologic symptoms such as that for facial palsy or hearing loss may be the only initial sign of tumor in selected patients.

Non-squamous malignancy in lymph nodes: the occult primary.

The present study presents 105 patients seen at a head and neck specialist clinic with a neck gland which subsequently proved to be a non-squamous malignancy. Of the 105 patients, 50 patients were eventually found to have a tumour in the head and neck region, 30 to have a distant primary and in 25 no primary site was ever found. The majority of patients were diagnosed in the clinic after careful examination and most of the remainder were diagnosed during endoscopy/biopsy. Chest radiography was the most useful investigation for diagnosing primary tumours of the lung. The 5-year-survival for the whole group of 105 patients was 28% (95% CI 17-39). The 5-year-survival for the head and neck primary tumour group was 44% (95% CI 25-60). The median survival of patients with a distant primary tumour was only a 6 months, there was one 5-year-survivor. The median survival for those in whom the primary was never discovered was 18 months. However, a reasonable proportion of these patients survived, five being alive at 5 years. The difference between survival for the three groups was statistically significant (P < 0.001). The most common histological type was undifferentiated/anaplastic tumours (37 out of 105) and this was followed by adenocarcinoma (33 out of 105). There was a significant difference in the survival between these two groups (chi 2 = 2.02, d.f. = 1, P = NS). Multi-variate analysis suggested that survival was better in the older age group and was affected by histology (P = 0.0093, P = 0.0332 respectively). The present study suggests that the treatment of patients in whom the primary site is eventually found to be in the head and neck region is rewarding with the same survival as a similar group of patients with squamous cell carcinoma. Sixty of the group of 105 patients had excision biopsies of the neck node and this did not affect survival.

すい癌のへん桃・舌根部転移例

Metastatic tumors to the head and neck from distant primary tumors are rare. Very few cases of metastatic tonsillar tumor have been reported in the literature, and most of them originated in the lung, kidney, skin, or stomach. We treated a patient with pancreatic cancer which had metastasized to the palatine and lingual tonsils. A 57-year-old male complained of sore throat and a feeling of foreign body in the pharynx after treatment for a lung tumor. The right palatine and lingual tonsils were coated with a dirty furlike covering. Biopsy showed an undifferentiated carcinoma. The tumor disappeared completely after radiation treatment, but he developed liver damage and obstructive jaundice caused by para-aortic lymph node swelling. Jaundice disappeared after PTCD (percutaneous transhepatic cholangio drainage) and radiation to the abdomen, but he died 2 months later of peritonitis carcinomatosa. Autopsy revealed primary pancreatic undifferentiated carcinoma which had metastasized to the lung and tonsils.As far as we are aware, this is the first report in Japan of metastasis to the tonsils from a primary pancreatic tumor. The clinical aspects of metastatic tonsillar tumor and a possible mechanism of the metastatic processes are discussed.