Histopathologic Diagnosis

The histopathologic type of metastatic cervical lymphadenopa-thy for which a primary cannot be identified is squamous cell carcinoma in about 80% of the cases.2 The remainder are adenocarcinomas, melanomas, undifferentiated carcinomas, and small cell carcinomas.6 The diagnosis can usually be reliably established in most cases with a fine-needle aspiration biopsy (FNAB), particularly with metastatic squamous cell carcinoma. Certain instances in which the aspiration biopsy is indeterminate or suggestive of lymphoma require an open cervical lymph node biopsy.

The histopathology of the metastasis provides information that can aid in the search for a primary site and that is used for appropriate management decisions. Adenocarcinoma in low cervical lymph nodes only is strongly suggestive of an infraclavicular primary lesion. In such cases, further exhaustive evaluation of the upper aerodigestive tract is not warranted. The diagnostic evaluation would shift to focus on the organs being the most likely sources of the metastasis. The potential primary sites in decreasing order of frequency for an infraclavicular adenocarcinoma are lung, gastrointestinal tract, breast, pancreas, prostate, and ovary. Adenocarcinoma from an infraclavicular site manifesting as cervical adenopathy represents distant metastatic disease and, as might be expected, has a very poor prognosis.7 By contrast, metastatic adenocarcinomas presenting in the upper neck often arise from salivary tissue in the major or minor salivary glands. Metastatic differentiated or medullary thyroid carcinoma must be considered for adenocarcinoma metastatic to cervical lymph nodes in any location. Immuno-histochemical stains specific for these malignancies are useful in establishing a diagnosis. Obviously, histopathologic findings consistent with melanoma require a systematic evaluation of all cutaneous sites, as well as a thorough aerodigestive tract examination to rule out a rare mucosal primary. Finally, small cell or undifferentiated carcinoma may elude detection if evaluation of the salivary glands and paranasal sinuses is omitted from the routine evaluation of the aerodigestive tract and the potential infraclavicular sites.

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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