Abstract
Purpose
One of the most striking qualities of cancer is its spread throughout the body. The location of a metastatic mass may help to identify the primary tumor. Metastases to head and neck area can occur either from local structures or from distant organs.
Materials and methods
This study was a retrospective review of patients from a University Hospital in Tehran, Iran, during the period 1992 to 2008. The data were analyzed for sex, age, primary site of tumors, metastatic site, and histology of the tumors. The tumors were classified into 2 groups: intraoral and extraoral.
Results
A total of 191 cases were found; of these, 118 (62%) were men and 73 (38%) were women. The most common intraoral primary site was tongue (anterior and posterior parts). Thyroid gland was the most frequent primary extraoral site. The most frequent metastatic site was the lymph node, and level II most commonly involved lymph nodes, followed by level I.
Conclusion
Metastases are an infrequent finding in head and neck region and they may represent the initial manifestation of the disease. Diagnostic evaluation of metastatic lesion will detect the primary tumor.
1
Introduction
One of the most striking qualities of cancer is its spread throughout the body. The location of a metastatic mass may help to identify the primary tumor. Previous studies have demonstrated that all malignant cervical tumors are metastatic, except for lymphoma. In addition, asymmetric enlargement of one or more cervical lymph nodes in an adult is almost always cancerous and is usually due to metastasis from a primary lesion in the mouth or pharynx . Metastases to head and neck area can occur either from local structures or from distant organs. In most cases, the head and neck region is the primary site for metastasis , but metastases may arise from outside of the head and neck region, including the lung, liver, bone, brain, and lymph nodes. Most metastases in the head and neck target the neck lymph nodes .
Metastatic tumors of the oral cavity are rare, representing about 1% of oral tumors. They affect the jaws much more frequently than soft tissues . Metastasis to the mandible makes up more than 70% of all malignant metastatic tumors in the oral cavity . To determine the frequency of metastasis to head and neck area, a retrospective study was conducted. The clinical and pathological data are reported here.
2
Materials and methods
This study was a retrospective review of patients from a University Hospital in Tehran, Iran. During the period 1992 to 2008, records from the Department of Pathology were reviewed with attention to metastatic tumors in head and neck area. Histological confirmation of the metastatic lesion was obtained in 191 cases. The data were analyzed for sex, age, primary site of tumors, metastatic site, and histology of the tumors. For better detailed analysis, the tumors were classified into 2 groups: intraoral and extraoral.
2
Materials and methods
This study was a retrospective review of patients from a University Hospital in Tehran, Iran. During the period 1992 to 2008, records from the Department of Pathology were reviewed with attention to metastatic tumors in head and neck area. Histological confirmation of the metastatic lesion was obtained in 191 cases. The data were analyzed for sex, age, primary site of tumors, metastatic site, and histology of the tumors. For better detailed analysis, the tumors were classified into 2 groups: intraoral and extraoral.
3
Results
Within the 16-year period of study, a total of 191 cases were found; of these, 118 (62%) were males, and 73 (38%) were females ( Table 1 ). Average age for men was 57.2 years (range, 45–83 years), and for women, 30 years (range, 12–49 years).
| Variable (191 patients) | No. of patients |
|---|---|
| Sex | |
| Male | 118 |
| Female | 73 |
| Age | |
| <15 | 3 |
| 16-40 | 56 |
| >40 | 132 |
| Tumor primary site | |
| Intraoral site | 33 |
| Extraoral site | 158 |
| Lymph node metastases | 180 |
| Extranodal metastases | 11 |
As shown in Table 2 the most common intraoral primary site was tongue (anterior and posterior parts) with 19 cases (9%). According to Table 3 , thyroid gland was the most frequent primary extraoral site (n = 59; 30%). The most frequent metastatic site was the lymph node with 180 cases (94%), and level II was the most commonly involved in lymph nodes with 129 cases (67%), followed by level I with 21 cases (10%). Supraclavicular lymph node involvement was detected in 10 cases (5%). Histologically, there was a predominance of squamous cell carcinoma (SCC) (55 cases, 28%) of which 23 cases (12%) developed in oral cavity. Papillary carcinoma with 49 cases (25%) formed the second largest group. The 2 most frequent primary sites histologically diagnosed as SCC were the tongue with 18 cases (9%) and the larynx with 10 cases (5%). Salivary gland metastases developed in 23 cases (12%), of which one was distant metastasis to the brain. Among the salivary glands, submandibular gland was the most commonly found primary site in 12 cases (12%). Lymph node metastases from lesions of salivary glands occurred in 22 cases (11.5%). Metastases to the parotid lymph nodes occurred in 15 cases (7.8%).The dominant histologic type for salivary gland tumors was mucoepidermoid carcinoma (n = 13; 6.8%). Cutaneous metastases occurred in 10 cases (5%). Metastases to the parotid gland (n = 2; 1%) were associated with cutaneous primary malignancies in the head and neck area. Among patients with SCC, level II was the most frequently involved in lymph nodes (n = 39; 20%). The breast, with 4 cases (2%), was the most common primary site with distant metastases, followed by the stomach with 3 cases (1%). The bladder, with 2 cases (1%), was the most frequent site metastasizing to oral cavity, both to buccal mucosa. There was one unknown primary tumor.
| Primary site | Metastatic site | Type of tumor | Number |
|---|---|---|---|
| Posterior tongue | Level II | SCC | 13 |
| Level II | Spindle cell tumor | 1 | |
| Anterior tongue | Level I | SCC | 5 |
| Floor of mouth | Level I | SCC | 5 |
| Level I | Undifferentiated carcinoma | 1 | |
| Buccal mucosa | Level I | SCC | 2 |
| Level I | Undifferentiated carcinoma | 1 | |
| Maxillary alveolus | Level I | SCC | 2 |
| Level II | SCC | 1 | |
| Palate | Level II | Mucoepidermoid carcinoma | 1 |
| Mandible | Level II | Ameloblastic carcinoma | 1 |
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