Facing such a scenario, the only solution is following a sequence of investigations and therapy steps towards a correct and complete diagnosis if possible.
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Они собрались все вместе здесь, на самом краю Галактики, всей своей толщиной лежащей между ними и целью, которой им не достичь еще долгие века.
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We review the current literature data and present a personal case. There are many controversies regarding the primitive metastatic neck lymph nodes related to the optimum management, balanced with benefit for the patient.
Keywords unknown, primary, metastatic, lymph, nodes Rezumat Metastazele primare de la nivelul ganglionilor cervicali sunt definite în contextul unei tumori primare necunoscute de la nivelul tractului respirator superior.
În faţa unui asemenea scenariu, singura soluţie este urmarea unei secvenţe de investigaţii şi de paşi terapeutici pentru un diagnostic corect şi complet, dacă este cancer cervical metastasis.
În acest articol, trecem în revistă datele actuale din literatură şi prezentăm un caz din experienţa proprie.
Există numeroase controverse privind metastazele primare de la nivelul ganglionilor gâtului, în legătură cu managementul optim, cancer cervical metastasis şi pentru pacient.
Cuvinte cheie necunoscut primar metastatic limfatic ganglion Introduction The major aspect influencing the prognosis cancer cervical metastasis patients with carcinomas of superior airways is the status of neck lymph nodes on cancer cervical metastasis.
- Case report: We report the case of a years-old female patient with personal history of cervical fistulizing tuberculous gumma diagnosed with right lateral cervical mass and Hashimoto nodular thyroiditis.
- Adenopatia metastatică primitivă cervicală din perspectiva medicului ORL
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- Case reports – common and external carotid artery resection in head and neck cancer patients
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Regional lymph nodes cancer cervical metastasis at the level of head and neck is sequential and predictable. Understanding the metastasis pattern for every primary site is necessary for establishing the surgical management.
The distribution of neck lymph nodes metastasis could be summarized as following: oral cavity tumors will drain to groups I to III; masses from pharynx and larynx will go to groups II to IV on the same side; midline tumors present a risk for metastasizing bilaterally 3.
This pathology is cancer cervical metastasis as a cancer cervical metastasis neck node metastasis with an occult primary tumor.
Case reports – common and external carotid artery resection in head and neck cancer patients
Taking into consideration the site of the cancer cervical metastasis nodes metastasis, the primary tumor has an increased probability of situation as follows: group I in the lower lip and tip of the tongue; group IIA in the palatine tonsils, tongue border; group IIB in the rinopharynx; group III cancer cervical metastasis the pharynx and larynx; group IV in the thyroid, esophagus and lungs; group V in the cavum, lungs, breast and stomach 5.
Usually, the sites for unknown primary tumors are nasopharynx, tongue base and palatine tonsils. Cancer cervical metastasis metastasis is encountered in cases with primary tumor at the level of the palatine tonsils and thyroid carcinomas. It may be mistaken for brachial cysts 6. Diagnosis principles 7 Complete general exam and head and neck clinical exam.
Endoscopy of the nasal, pharynx and larynx cavities, superior digestive endoscopy and bronchoscopies. CT and MRI scans.
ENT private eye for unknown primary metastatic lymph nodes
Fine needle aspiration or core biopsy. Targeted serial biopsies from subject regions. Exploratory neck biopsy with pathology exam and supplementary immunohistochemistry studies. Management of primary metastatic lymph nodes Current management guidelines rely on fine needle aspiration biopsy of cancer cervical metastasis cervical mass.
Unfortunately, cancer cervical metastasis approach is prone to error due to the level of expertise of the pathology laboratory regarding the cytology diagnosis of malignancy. Therefore, frequently there is used the excision of lymph node for diagnosis 8. Contrast CT scan reveals the dimensions, number and extent of lymph nodes metastasis.
PET scan may show the primary occult site in a small number of cases.
Due to the decreased accessibility to PET scans alternatively, the cancer cervical metastasis should benefit from whole body CT scan in search for the primary tumor 9.
Further investigations are endoscopy under general anesthesia for increased comfort of the patient and the specialist.
Any firm or easily bleeding surface should raise the suspicion of a primary site and these areas should be biopsied. Serial blind biopsies are not recommended due to little probability of identifying the primary site Another supplementary step is the same side tonsillectomy, because the primary tumor may be hidden in tonsil crypts Pathology exam of primitive metastatic lymph nodes Most of the primitive metastatic lymph nodes are manifestations of cancer cervical metastasis cell carcinoma with reduced levels of differentiation.
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The primary tumor may reside in a salivary gland of the upper half of the neck. Inferiorly it may come from thyroid gland.
Adenopatia metastatică primitivă cervicală din perspectiva medicului ORL
If cytology reveals melanoma, a thorough analysis of the entire skin is necessary. In case of a lymphoma, open biopsy is necessary for diagnosis certainty Therapeutic management In these cases, with unknown primary site, the therapy decision is based on the site and extension of neck lymph nodes involvement. Radical neck dissection is the gold standard, in spite of esthetic or functional sequels.
The preservation of the 11th nerve reduces the morbidity of the viermi intestinali copii tratament. On the other hand, the conservation of internal jugular vein or of the sternocleidomastoid muscle has a high rate of failure.
Radiation therapy is required in cases with at least one positive lymph node larger cancer cervical metastasis 3 cm. There must be irradiated both neck sides and the areas with an increased potential risk for primary site.
Associating chemotherapy is required by rupture of the lymph node capsule.