S diagnózou metastázy zhubného nádoru do krčných lymfatických uzlín z neznámehoprimárneho ložiska sme v intervale 11 rokov vyšetrili a liečili 70 pacientov. 55 malo metastázuepidermoidného karcinómu, 14 iného karcinómu a jeden malígneho melanómu. Najčastejší spôsobliečby bola kombinácia chirurgickej a radiačnej terapie. Chemoterapia sa podávala najmä u pa-cientov s rozsahom N3. U pacientov s metastázou epidermoidného karcinómu sa zistil v priebehuliečby alebo po ukončení liečby primárny karcinóm v ORL oblasti u 18 %. Päťročné prežitie u vše-tkých pacientov sa dosiahlo len v 9 %. Autori stanovujú diagnostický a liečebný postup u pacientovs potvrdenou metastázou do krčných lymfatických uzlín.

From 1989 to 1999 seventy patients with the diagnosis of cervical lymph node metastases from an unknown primary site were examined and treated at the Department of Otorinolaryngology in Bratislava. 55 suffered from metastatic epidermoid carcinoma, 14 had a me- tastasis of different carcinoma and on had a metastasis of a malignant melanoma. Diagnostic procedures include fibroscopy, rigid panendoscopy, excision from the epipharynx, tonsillectomy and “blind” biopsy from suspicious tissue. Fine needle biopsy of the cervical lymph nodes is the recommended initial biopsy technique. Open biopsy has to be reserved after search for a head and neck primary tumour is completed. In patients with no identified primary tumour site, the prognosis depends on the site and extent of neck involvement. The neck stage before any treatment was unknown in 5 patients, N1 in 7 patients, N2a in 22 patients, N2b in 3 patients N2c in 5 patients and N3 in 28 patients. Combination of neck dissection and radiotherapy was the most frequent treatment (27 patients). Radiotherapy was limited to the cervical lymphatic system and and was not applied to all mucosal surfaces in the head and neck region. Chemotherapy was used in N3 cases with palliative intention. The presumed primary site was detected in 18% cases during or after therapy. The 5-year survival rate was poor - only 9%. In N3 cases mortality was 100% within one year. Diagnostic and therapeutic guidelines for patients with confirmed metastases in cervical lymph nodes from unknown primary tumours are discussed.

1 ORL klinika LF UK FN a SPAM Bratislava

Metastases of an epidermoid carcinoma into cervical lymph nodes with an unknown primary tumour

Metastázy epidermoidného karcinómu do krčných lymfatických uzlín pri neznámom primárnom ložisku = Metastases of an epidermoid carcinoma into cervical lymph nodes with an unknown primary tumour /

Lit: 28

Souhrn: eng