Delayed Hematogenous Metastasis Versus Second Primary Squamous Cell Carcinoma of the Neck in a Patient With Previous Cancer of the Cervix

Squamous cell carcinoma (SCC) of the uterine cervix commonly spreads through direct infiltration and disseminates by lymphatic or hematogenous pathways. The most frequent locations for metastasis are lungs, liver, and bone. Other distant metastatic sites are rare, with only 1 reported case of neck metastasis. We present here a 73-year-old female with a prior human papillomavirus (HPV) + SCC of the cervix that had metastasized to her peri-aortic lymph nodes. Eight years after diagnosis and treatment, she returned with a hypermetabolic supraclavicular lymph node and new left-sided neck mass. Biopsy of the neck mass revealed invasive SCC positive for high-risk HPV genotype. The presence of high-risk HPV genotypes in both the cervix and supraclavicular lymph node, without evidence of second primary tumor, implies that the neck mass is a delayed metastasis of the patient’s previous cervical cancer. This marks the second recorded case of neck metastasis from a SCC of the cervix.

Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.

Factors favoring neck metastasis in patients underwent laryngectomy for laryngeal cancer

Background One third of all head and neck cancers are caused by laryngeal cancer. However, the incidence and prevalence rates have decreased over the past 3 decades. Neck metastasis from cancer larynx is important to be addressed as its presence greatly reduces the probability of survival. However, quality of life should be taken into consideration. Hence, it was important to analyze factors related to neck metastasis from primary laryngeal cancer to detect any change of tumor behavior with time. Results One hundred thirty-eight patients underwent concomitant neck dissection with laryngectomy (total or partial). Supraglottic tumors had the greatest share in the neck metastasis with a count of 11 (of 26 neck metastasis), representing 42% and a total value of 11 (of 30 total supraglottic cancer) representing a tendency of spread in 37% of the total case number. Tumor midline crossing was present in 77% cases (20 of 26) with positive nodes, representing a P value 0.05. Conclusion This study investigated different factors related to lymph node metastasis from primary laryngeal tumor. The most important factors were the site of the tumor and its relation to the midline.

Comparison of Long-Term Outcomes Between Ipsilateral and Bilateral Central Neck Dissection in Occult Contralateral Central Lymph Metastasis in Papillary Thyroid Carcinoma With Unilateral Lateral Neck Metastasis Using Propensity Score Matching

This study aimed to evaluate long-term prognosis of contralateral central neck dissection in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We aimed to produce clinical evidence to help determine the extent of central neck dissection (CND) focusing on the separation between the ipsilateral and contralateral sides. A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection (LND) were retrospectively included between January 1997 and December 2015 at a single institution. The median follow-up time was 89.7 months, the mean age was 44.7 years and the mean tumor size was 1.5 cm. Among the study population, 507 were female (71.5%) and 201 (28.5%) were male. Locoregional recurrence (LRR) was observed in 26 (7.9%) patients and 30 (7.9%) patients in the ipsilateral and bilateral CND groups, respectively. There were 6 (1.8%) contralateral recurrence cases in the ipsilateral CND group and 5 (1.3%) cases in the bilateral CND group. Male sex (adjusted HR = 1.857, p = 0.034), larger tumor size (adjusted HR = 4.298, p = 0.006), and more metastatic ipsilateral central lymph nodes (adjusted HR = 1.078, p = 0.014) significantly increased the risk of LRR. Ipsilateral CND only did not significantly increase the risk of LRR (adjusted HR = 1.110, p = 0.712). There were no significant differences in recurrence according to contralateral central neck dissection status after propensity score matching (p = 0.424), either. The incidence of hypocalcemia (p = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Surgeons may consider performing contralateral CND only for therapeutic purposes to reduce unnecessary complications.