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Most of the neck node metastases from cancer of unknown primary (CUP) are squamous cell carcinomas (SCCs). The majority of which are human papillomavirus (HPV)-related, frequently show cystic morphology referring to Waldeyer’s ring origin. Here, we report four cases of neck node SCCs metastases from CUP. In our institute, 432 patients with head and neck (HN) SCC underwent pretreatment mutagen sensitivity (MS) assay between 1996 and 2006. Among them, 4 patients ≤50 years of age had metastatic cervical nodes from CUP. The primary treatment was cervical node dissection ± radiotherapy. All patients had elevated (>1.0 chromatid break/cell) MS. One male patient died of progressive neck metastasis within 3 years and the 3 female patients are still alive more than 15 years after initial treatment of HPV+ (two) or cystic (one) SCC. Two female patients developed second and third distant site metachronous primary cancers. HPV+ or cystic HNSCC from CUP with elevated MS indicates good outcome. Distant site metachronous cancers of different histologic origins cannot be explained by field cancerization. The clinical significance of elevated MS in neck node SCC metastasis from CUP requires further investigation.

Aims: The present study examines the role of demographic and pathological features of primary tumours in predicting neck metastasis in early oral cavity cancers, which has been a matter of debate. Methods: A single-centre, retrospective, institution review was conducted of all the patients presented to our centre from January 2014 to December 2021. Patient characteristics were compared between the two lymph node groups (lymph node positive and lymph node negative) and significant prognostic factors were determined. Results: A total of 462 oral squamous cell carcinoma (OSCC) patients were included, 407 male and 55 female. Tobacco chewing (59.2%) was a major habit with buccal mucosa (49.5%) and tongue (44.8%) as primary sites. The majority of the patient's histology was of SCC (96.8%) with grade II (moderately differentiated, 74.5%). Univariate logistic regression analysis to predict lymph node metastasis showed pT size (< 0.001), LVI (< 0.001), and PNI (< 0.001) as significant tumor characteristics. On multivariate, pT size (OR-1.58, P – 0.0001) and LVI (OR-19.70, P – 0.0001) were reported to be statistically significant to predict lymph node metastasis. Conclusion: Reporting and studying the clinico-pathological features of primary tumors can give vital information in predicting the neck node metastasis in OSCC patients. [ABSTRACT FROM AUTHOR]

Most of the neck node metastases from cancer of unknown primary (CUP) are squamous cell carcinomas (SCCs). The majority of which are human papillomavirus (HPV)-related, frequently show cystic morphology referring to Waldeyer's ring origin. Here, we report four cases of neck node SCCs metastases from CUP. In our institute, 432 patients with head and neck (HN) SCC underwent pretreatment mutagen sensitivity (MS) assay between 1996 and 2006. Among them, 4 patients ≤50 years of age had metastatic cervical nodes from CUP. The primary treatment was cervical node dissection ± radiotherapy. All patients had elevated (>1.0 chromatid break/cell) MS. One male patient died of progressive neck metastasis within 3 years and the 3 female patients are still alive more than 15 years after initial treatment of HPV+ (two) or cystic (one) SCC. Two female patients developed second and third distant site metachronous primary cancers. HPV+ or cystic HNSCC from CUP with elevated MS indicates good outcome. Distant site metachronous cancers of different histologic origins cannot be explained by field cancerization. The clinical significance of elevated MS in neck node SCC metastasis from CUP requires further investigation. [ABSTRACT FROM AUTHOR]

Carotid artery involvement in head and neck cancer is challenging for surgeons and oncologists, particularly in recurrence or residual disease following multiple treatments. However, carotid artery resection and reconstruction can be safely performed in a carefully selected patient with local and regional control benefits despite the potential morbidity and high-risk complications. We presented a case of primary laryngeal cancer treated with chemoradiotherapy, modified radical neck dissection type I for residual neck node disease, and further chemotherapy. Although the primary laryngeal cancer showed a complete response, the residual neck tumor was still unresolved and even involved the carotid artery. Therefore, carotid resection with a combined saphenous vein graft and free flap reconstruction was the treatment of choice for this patient. It is effective and safe, and the risk of morbidity has been accepted. [ABSTRACT FROM AUTHOR]

Background: Cancer continues to be a major health problem despite advances in medical technology for its diagnosis and treatment. Cancer of the larynx is the eleventh most common cancer in the world. Carcinoma larynx is a multifactorial disease. Smoking, betel-nut, betel-leaf chewing habit and drinking alcohol are the most important factors associated with carcinoma larynx. Objective: To find out the patterns of neck node metastases in laryngeal carcinoma. Methods: Observational cross-sectional study was carried out in the Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital (DMCH) from January' 2018 to December' 2019. Total 100 patients diagnosed as laryngeal carcinoma with neck metastases were included in this study. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: The mean age was found 57.8±12.7 years with range from 37 to 79 years. Males were predominant (76.0%) and females were (24.0%). Male: female ratio was 3.17:1. More than two third (68.0%) patients had supraglottis, 26.0% had glottis and 6.0% had subglottis. Supraglottic was found in 68 patients among them 27(39.7%) were T3, 18(26.5%) were T3. Glottic was found in 26 patients among them 16(61.5%) were T3, 6(23.1%) were T2, 4(15.4%) were T4a. Subglottic was found in 6 patients among them 4(66.7%) were T3 and 2(33.3%) was T2. Supraglottic was found in 68 patients among them 34(50.0%) were N1, 28(41.1%) were N2 and 6(8.8%) were N3. Glottic was found in 26 patients among them 20(76.9%) were N1 and 6(23.1%) were N2. Subglottic was found in 6 patients among them 4(66.7%) were N1 and 2(33.3%) was N2. supraglottic was found in 68 patients, among them majority 17(50.0%) patients were found in level II of neck nodes. Glottis was found in 26 patients, among them 16(61.5%) patients were found in level III of neck nodes. Subglottic found in 6 patients, among them 4(66.7%) patient was found in level IV of neck nodes. Unilateral neck node metastasis was more common 9(96.0%) than bilateral neck node metastasis 4(4.0%), out of them single neck node metastasis 84(84.0%) is more than multiple neck node metastasis 16(16.0%). Majority 46(46.0%) patients had stage III, 38(38.0%) had stage II, 10(10.0%) had stage I and 6(6.0%) had stage IV. Results: The mean age was found 57.8±12.7 years with range from 37 to 79 years. Males were predominant (76.0%) and females were (24.0%). Male: female ratio was 3.17:1. More than two third (68.0%) patients had supraglottis, 26.0% had glottis and 6.0% had subglottis. Supraglottic was found in 68 patients among them 27(39.7%) were T3, 18(26.5%) were T3. Glottic was found in 26 patients among them 16(61.5%) were T3, 6(23.1%) were T2, 4(15.4%) were T4a. Subglottic was found in 6 patients among them 4(66.7%) were T3 and 2(33.3%) was T2. Supraglottic was found in 68 patients among them 34(50.0%) were N1, 28(41.1%) were N2 and 6(8.8%) were N3. Glottic was found in 26 patients among them 20(76.9%) were N1 and 6(23.1%) were N2. Subglottic was found in 6 patients among them 4(66.7%) were N1 and 2(33.3%) was N2. supraglottic was found in 68 patients, among them majority 17(50.0%) patients were found in level II of neck nodes. Glottis was found in 26 patients, among them 16(61.5%) patients were found in level III of neck nodes. Subglottic found in 6 patients, among them 4(66.7%) patient was found in level IV of neck nodes. Unilateral neck node metastasis was more common 9(96.0%) than bilateral neck node metastasis 4(4.0%), out of them single neck node metastasis 84(84.0%) is more than multiple neck node metastasis 16(16.0%). Majority 46(46.0%) patients had stage III, 38(38.0%) had stage II, 10(10.0%) had stage I and 6(6.0%) had stage IV. [ABSTRACT FROM AUTHOR]

Introduction: Occult neck node metastasis in head and neck squamous cell carcinoma (HNSCC) in the form of micrometastasis and isolated tumour cell (ITC) often goes unnoticed in the routine pathological examination. This limitation can be overcome by using serial sectioning and immunohistochemistry for detection of micrometastasis and ITC in clinically and pathologically node-negative neck. The primary objective was to determine the incidence of micrometastasis and ITC in the selective neck dissection specimen, whereas to determine the levels of lymph nodes involved, depending upon the site of primary tumour, was the secondary objective. Materials and Methods: Lymph nodes from selective neck dissection specimen were subjected to serial sectioning and immunohistochemistry with pan-cytokeratin marker. Incidence of micrometastasis and ITC, site and stage of primary tumours and level of lymph nodes involved were determined. Results: In total, 8.8% patients in the study got upstaged after serial sectioning and immunohistochemistry. Tongue and lower alveolar primaries showed the presence of micrometastasis and ITC in neck nodes. All the primary tumours were of pT1 stage. Level IB and II lymph nodes were primarily involved. Conclusion: Micrometastasis and isolated tumour cells are found in approximately 9% of cases of early-stage oral cavity squamous cell carcinoma. The predictive factors and clinical significance are still unknown. More prospective trials are required to solve this evolving aspect of HNSCC. [ABSTRACT FROM AUTHOR]

Objective To generate a nomogram for predicting the risk of neck node metastasis in pathologically node-negative patients using a combination of variables comprising of protein expression, ultrastructural alterations and clinicopathological parameters. Materials and Methods Surgically removed oral tumours ( n = 103) were analysed for the expression of desmosomal and hemidesmosomal assembly proteins by immunohistochemistry and ultrastructural alterations by transmission electron microscopy ( TEM). Protein expression, ultrastructural alterations and clinicopathological variables were used to construct nomogram from the training set in 75 patients. Clinical utility of the nomogram was validated in a discrete set of 28 patients. Results Univariate and multivariate analyses were performed on the training set, and obtained significant variables comprising of integrin β4 expression ( p = .027), number of hemidesmosomes ( p = .027)/desmosomes ( p = .046), tumour differentiation grade ( p = .033) and tumour thickness ( p = .024) were used for construction of the nomogram. The area under the curve was calculated for both training 0.821 (95% CI 0.725-0.918) and validation sets 0.880 (95% CI 0.743-1.000). The nomogram demonstrated a predictive accuracy of 73.3% and 78.6% with the sensitivity of 81.4% and 83.3% in the training and validation sets, respectively. Conclusions The nomogram constructed on postsurgical tumour samples will be a value addition to histopathology for the detection of neck node metastasis in pathologically node-negative patients. [ABSTRACT FROM AUTHOR]

Objectives: One of the main changes in the 8th edition of the TNM Classification for head and neck tumors is the inclusion of extracapsular spread (ECS) as a criterion for evaluating the regional extension, both clinical (cN) and pathological (pN). The objective of our study is to evaluate the prognostic capacity derived from the inclusion of the ECS in the pathological classification of head and neck squamous cell carcinoma (HNSCC) patients treated with a neck dissection, as established by the 8th edition TNM Classification.Materials and Methods: Retrospective study of 1188 patients with HNSCC treated with a neck dissection between1990 and 2013.Results: There were lymph node metastasis in 50.1% of the neck dissections. The pathological record revealed ECS in 50.5% of the positive neck dissections. The implementation of the changes of the 8th edition TNM classification produced the upstaging of 20.9% of the patients classified as pN1 with the 7th edition TNM classification to pN2a¸ and the upstaging of 58.4% of the patients classified as pN2 with the 7th edition TNM classification to pN3b. We conducted an objective comparison of the quality of both classifications. The 8th TNM classification edition achieved better results regarding both the discrimination in cause-specific survival between pN categories and in the distribution in the number of cases between categories than the 7th edition TNM classification.Conclusion: The inclusion of ECS in the pathological classification (pN) of the neck nodes improves the prognostic capacity of the 8th TNM Classification edition. [ABSTRACT FROM AUTHOR]

A new system for the histological grading of malignancy was ultilized in 91 cases of squamous cell carcinomas of the anterior 2/3 of the tongue which were treated initially by radiotherapy at Osaka University Hospital from 1967 to 1980. Three different morphological parameters were evaluated with respect to the tumor, cell population estimated in terms of a four-point scale. A correlation was found between the degree of histological malignancy and the incidence of neck node metastasis. Furthermore, a statistical significance was valid on the survival rates between the group according to the histological grading. At present, prophylactic neck dissection is encouraged, especially for the highly malignant cases. [ABSTRACT FROM AUTHOR]

Background and Objective: Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection., Material and Methods: Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available., Results: 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours., Conclusions: Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)