Úvod: Metastáza (MTS) do lymfatických uzlín (LU) na krku pri neznámom primárnom tumore sa diagnostikuje u 5 % pacientov s malígnym nádorom hlavy a krku. V manažmente pacientov s MTS do LU na krku je vždy potrebné komplexné pátranie po okultnom nádore. Detekcia origa umožňuje cielenú špecifickú liečbu, čo výrazne zlepšuje prognózu choroby. Materiál a metodika: Retrospektívna analýza pacientov, ktorí boli hospitalizovaní na Klinike otorinolaryngológie a chirurgie hlavy a krku UK JLF a UNM v Martine od januára 2012 do septembra 2017 pre MTS do LU krku pri neznámom primárnom tumore. Zamerali sme sa na diagnostický postup a úspešnosť detekcie primárneho tumoru. Výsledky: V súbore bolo 40 pacientov, priemerný vek 59,4 ± 1,5 rokov (35-78 rokov). CT vyšetrenie aj panendoskopické vyšetrenie v celkovej anestézii sa vykonalo u všetkých pacientov. Ipsilaterálna tonzilektómia (TE) sa realizovala u 34 (80 %). U zvyšných 6 sa TE neindikovala - u 2 sa zistilo origo pri panendoskopickom vyšetrení a u 4 bola vykonaná TE v minulosti. Odber slepých vzoriek z nosohltana, koreňa jazyka a piriformného recesu na histopatologické vyšetrenie sa vykonalo u 38 pacientov (95 %). PET/CT vyšetrenie sa indikovalo u 12 pacientov (30 %). Primárny nádor sa nezobrazil ani u jedného z nich. Po realizovaných vyšetreniach sa origo diagnostikovalo u 21 (52,5 %). U 16 (40 %) sa primárny nádor našiel v hornom aerodigestívom trakte, u 5 (12,5 %) sa primárny nádor nachádzal mimo ORL oblasť. U 19 (47,5 %) sa nepodarilo origo identifikovať. Záver: Aj napriek využitiu dostupných zobrazovacích a endoskopických metód nie je možné primárny tumor vždy identifikovať.

Introduction: Carcinoma of unknown primary (CUP) in head and neck region is diagnosed in 5% of patients with malignant tumour of head and neck. In the management of patients with CUP, complex investigation to diagnose the occult tumour is always necessary. Detection of origin allows targeted specific treatment that significantly improves the prognosis of the disease. Material and methods: Retrospective analysis of patients treated at the Department of Otorhinolaryngology and Head and Neck Surgery of the UK JLF and UNM in Martin between January 2012 until September 2017 for CUP in head and neck region. Diagnostic procedure and success of primary tumour detection were evaluated. Results: In study group, there were 40 patients with average age 59.4 ± 1.5 years (35-78 years). CT scan and panendoscopic examination in general anaesthesia were performed in all patients. Ipsilateral tonsillectomy (TE) was performed in 34 patients (80%). For the remaining 6 patients, TE was not indicated - 2 found originally in the panendoscopic examination and in 4 TE was performed in the past. Blinded samples from the nasopharynx, the base of the tongue and the pyriform recess were taken in 38 patients (95%). PET/CT screening was indicated in 12 patients (30%). The primary tumour did not detect the primary tumour in any of them. Primary tumour was diagnosed in 21 cases (52.5%). In 16 patients (40%), the primary tumour was found in the upper aerodigestive tract, in 5 patients (12.5%) the primary tumour was located outside the ENT region. The primary tumour was not identified in 19 cases (47.5%). Conclusion: Despite the modern imaging and endoscopic methods, the primary tumour cannot always be identified.

Klinika otorinolaryngológie a chirurgie hlavy a krku UK JLF a UNM Martin

Oddelenie otorinolaryngológie FNsP FD Roosevelta Banská Bystrica

Carcinoma of unknown primary in head and neck region

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