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RMJ. 2010; 35(2): 209-213

Role of panendoscopy and biopsy in cervical lymph node metastasis with unknown primary: a tertiary center experience

Azlan Iskandar Ishak, Mohd Razif Mohd Yunus, Mazita Ami, Primuharsa Putra.


To evaluate the role of panendoscopy and biopsy in diagnosing occult primary site of cancer in the head and neck region.
A retrospective review of patient clinical notes, radiological, histological and intra-operative reports who underwent panendoscopy and biopsy of the upper aerodigestive tract.
Out of 11 patients, six had undifferentiated carcinoma and five had squamous cell carcinoma (SCC) of the cervical lymph nodes. Nine underwent CT scan of the head and neck and one had a positron emission tomography scan. One patient had no radiological imaging. None of these studies were able to locate a primary tumor. Random biopsies from sites of possible origin of the primary tumor with tonsillectomies confirmed the primary site in 10 patients; three had nasopharyngeal carcinoma, four had SCC of the tonsils with three patients with unilateral and one with bilateral involvement, one each with SCC of the base of tongue, SCC of both vocal cord and non Hodgkin’s lymphoma of bilateral tonsils. In one patient, no site of origin of the primary tumor was identified in the head and neck region.
Panendoscopy and biopsies had significant role in arriving at a conclusive diagnosis as compared to imaging studies in cases of metastatic cervical lymph nodes with an occult primary. (Rawal Med J 2010;35: ).
Occult primary tumor, panendoscopy, head and neck cancer, aerodigestive tract
Cervical lymph node metastasis from unknown primary is a relatively rare event constituting 3-9% of all head and neck cancers.1 The most frequent histopathological diagnosis is squamous cell carcinoma (SCC) accounting for 65-76% of all cervical metastases from unknown primary, followed by undifferentiated carcinoma (14%), adenocarcinoma (13%) and nasopharyngeal-type undifferentiated carcinoma (8%).2 The occult primary tumor is eventually found in approximately 10-40% of patients during the follow-up and the upper aerodigestive tract is the most common site. Proper and directed treatment strategies can then be carried out, limiting the extent of the treatment and thus reduce the unwanted side-effects. The purpose of this study was to compare the diagnostic management in our institution with those previously published.
We retrospectively reviewed the clinical records of patient with cervical lymph nodes metastasis with an unknown primary, who underwent panendoscopy and biopsy of the upper aerodigestive tract over 3 years from March 2005 to July 2008 at Universiti Kebangsaan Malaysia medical center. Patients’ demographics data, clinical presentation, examination findings of the neck and initial neck biopsy result were collected. We also reviewed the radiological findings, final histology and the modality of treatment conducted on each patient.


A total of 11 patients who had cervical metastasis with unknown primary tumor were seen in our center during the stu

Key words: Occult primary tumor, panendoscopy, head and neck cancer, aerodigestive tract

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