Occult cancer with central lymph node metastasis: histologic profile of cervical lymph node and pan-endoscopic biopsies at University college hospital, Ibadan, Nigeria

Abstract

Background: Occult cervical lymph node metastasis is a relatively rare oncologic disease presenting as a neck lump without an obvious mucosal lesion. Most cases arise from the upper aerodigestive tract and affect all ages. It is often a diagnostic dilemma when there is no facility to carry out a thorough evaluation.
Methods: A prospective study of all patients with neck lump with unknown primary tumor site evaluated within the periods, January 2010 to December 2012 at the ENT/Head and Neck Department of University College Hospital, Ibadan. The patients went through clinical, radiological and endoscopic assessments. Fine Needle Aspirate and Cytology (FNAC) of neck node and random pan-endoscopic specimens obtained were cytological and histological analysed.
Results: The prevalence of cervical nodal metastasis with unknown primary site was 9.7%. We found no gender predilection in the study. Majority of the patients with occult cervical node metastases were in the third decade of life. The histological yield of pan-endoscopy biopsy specimen was 72%. Undifferentiated nasopharyngeal squamous (39%) cell carcinoma was the commonest diagnosis following random biopsy during pan-endoscopy.
Conclusion: Despite limitations arising from lack of FDG PET, the yield from pan-endoscopy biopsy specimen was appreciable. Inadequate immunohistological stains and lack of FDG PET scan may have diminished the histological yield of the blind pan-endoscopy biopsy specimens.

Keywords: Cervical nodal metastasis with unknown primary site, pan-endoscopy biopsy, occult cancer

Jos Journal of Medicine, Volume 7 No. 2