[Latero-cervical adenopathies due to occult tumors: clinical experience and considerations on the therapeutic treatment].

The treatment of patients with occult primary tumors presenting cervical metastases is still controversial. Thus the treatment of 10 patients with cervical metastases from unknown primary sites observed from 1978 to 1987 is reviewed. The average age of these patients was 56 years with a male: female ratio of 9:1. Any patients previously treated for cephalic or extracephalic neoplasms were excluded from the study as were those with lymphomas. According to TNM classification (1978) 7 cases (70%) were N1, one (10%) was N2 and two (20%) were N3. Only in one case were the cervical metastases multiple and unilateral, in one case (N2) they were bilateral. Histopathological diagnosis was performed with open biopsy in all cases prior to radical or conservative neck dissection. Five patients (50%) had metastases from epidermoid carcinoma, two (20%) from undifferentiated carcinoma (non nasopharyngeal), one (10%) from a papillary thyroid carcinoma, one (10%) from undifferentiated nasopharyngeal carcinoma and one (10%) from adenocarcinoma. The neck locations of the metastases were as follows: 3 (30%) at the upper cervical nodes (as was the N2 case), 3 (30%) at the mid-jugular nodes, 1 (10%) at the lower cervical nodes, 1 (10%) at the supra-clavicular nodes and 1 (10%) at the jugulo-digastric node. In the only case of multiple and unilateral nodes (10%) a contemporary involvement of the mid-jugular and lower cervical nodes was observed. A complete history was taken and a general physical and E.N.T. examination, X-ray, radioisotope and endoscopic studies were performed for all patients. In all cases treatment was: surgery on N + radiation therapy on the most common sites of unknown primary tumors. In particular, 7 conservative neck dissections (bilateral in one case), 2 radical neck dissections and 1 modified radical neck dissection were performed. The survival rate was 60% at 3 years and 40% at 5 years; it may be due to the radical treatment and to the high number of N1 and epidermoid carcinomas. In conclusion some considerations about the treatment of this pathology were reported.