Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma

Abstract

Objectives: We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans. Patients and Methods: We retrospectively reviewed 410 patients 369 males, 41 females; 169 patients unilateral, 241 patients bilateral with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections. Results: Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients 2% , metastatic papillary thyroid carcinoma in three patients 0.7% , Warthin’s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin’s tumor since these patients did not continue their routine examinations. Conclusion: During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.

Keywords

• Head and neck neoplasms, neck dissection, squamous cell carcinoma

Primer baş ve boyun squamöz hücreli karsinomlarında boyun diseksiyonu örneklerinde beklenmedik bulgular

Abstract

Amaç: Primer baş-boyun yassı hücreli karsinomu nedeniyle yapılan boyun diseksiyonunda elde edilen örneklerin incelenmesi sırasında karşılaşılan beklenmedik patolojik bulguların ve görülme sıklığının, takip ve tedavi süreci üzerine etkileri ortaya kondu.Hastalar ve Yöntemler: Primer baş-boyun yerleşimli yassı hücreli karsinom nedeniyle 410 hastaya 369 erkek, 41 kadın; 169’u tek taraflı, 241’i iki taraflı yapılan toplam 651 boyun diseksiyonuna ait bilgiler hasta dosyalarında geriye dönük olarak incelendi.Bulgular: Olguların %3.2’sinde, boyun diseksiyonlarının ise %2’sinde beklenmedik patolojik bulgu saptandı. Beklenmedik bulgu olarak, sekiz olguda %2 granülomatöz iltihap tüberküloz ile uyumlu , üç olguda %0.7 papiller tiroid karsinomu yayılımı, birer olguda ise Warthin tümörü ve kistik higroma vardı. Tiroid papiller karsinomu saptanan olguların tümü tiroidektomi sonrası radyoaktif iyot tedavisi aldı. Bu olguların izlemlerinde primer tümör ve tiroid karsinomuyla ilgili sorun saptanmadı. Tüberküloz saptanan sekiz olgunun ikisi dışındakilere tüberküloz tedavisi verilmedi ve klinik takibe alındı. Bu hastaların hiçbirinde tüberküloz ile ilgili sorunla karşılaşılmadı. Kistik higroma ve Warthin tümörü saptanan olguların takiplere gelmemeleri nedeniyle uzun dönem takip sonuçları elde edilemedi.Sonuç: Primer baş-boyun yassı hücreli karsinomu nedeniyle yapılan boyun diseksiyonlarında ender de olsa beklenmedik bir başka patolojiye ait bulgular saptanabilir. Bu patolojiler içinde en sık rastlananları, tüberküloz lenfadenit ve tiroid papiller karsinom metastaz yayılımıdır. Ancak bu patolojilerin primer tümörün tedavi sürecini çok fazla etkilemediği düşünülmektedir

Keywords

• Baş-boyun kanseri, boyun diseksiyonu, yassı hücreli karsinom

References

1. Ansari-Lari MA, Westra WH. The prevalence and significance of clinically unsuspected neoplasms in cervical lymph nodes. Head Neck 2003;25:841-7.
2. Sheahan P, Hafidh M, Toner M, Timon C. Unexpected findings in neck dissection for squamous cell carcino- ma: incidence and implications. Head Neck 2005;27:28- 35.
3. León X, Sancho FJ, García J, Sañudo JR, Orşs C, Quer M. Incidence and significance of clinically unsus- pected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients. Laryngoscope 2005;115:470-4.
4. Coskun H, Erisen L, Tolunay S, Basut O, Onart S, Tezel I. Incidental association of thyroid carcinoma and squamous cell carcinoma of head and neck. Am J Otolaryngol 2002;23:228-32.
5. Jha BC, Dass A, Nagarkar NM, Gupta R, Singhal S. Cervical tuberculous lymphadenopathy: chang- ing clinical pattern and concepts in management. Postgrad Med J 2001;77:185-7.
6. Ammari FF, Bani Hani AH, Ghariebeh KI. Tuberculosis of the lymph glands of the neck: a limited role for sur- gery. Otolaryngol Head Neck Surg 2003;128:576-80.
7. Geldmacher H, Taube C, Kroeger C, Magnussen H, Kirsten DK. Assessment of lymph node tuberculo- sis in northern Germany: a clinical review. Chest 2002;121:1177-82.
8. Centkowski P, Sawczuk-Chabin J, Prochorec M, Warzocha K. Hodgkin’s lymphoma and tuberculosis coexistence in cervical lymph nodes. Leuk Lymphoma 2005;46:471-5.

9. Pandey U, Naraynan M, Karnik U, Sinha B. Carcinoma metastasis to unexpected synchronous lymphoprolif- erative disorder: report of three cases and review of literature. J Clin Pathol 2003;56:970-1.
10. Ratcliffe RJ, Soutar DS. Unexpected lymph node pathol- ogy in neck dissection for head and neck cancer. Head Neck 1990;12:244-6.
11. Burezq H, Williams B, Chitte SA. Management of cystic hygromas: 30 year experience. J Craniofac Surg 2006;17:815-8.
12. Charabi B, Bretlau P, Bille M, Holmelund M. Cystic hygroma of the head and neck--a long-term follow-up of 44 cases. Acta Otolaryngol Suppl 2000;543:248-50.
13. Emery PJ, Bailey CM, Evans JN. Cystic hygroma of the head and neck. A review of 37 cases. J Laryngol Otol 1984;98:613-9.
14. Demir Y, Aktepe F, Yílmaz MD, Altuntaş A. Warthin’s tumor of the cervical lymph node: an incidental find- ing. Ann Plast Surg 2002;48:110-1.
15. Snyderman C, Johnson JT, Barnes EL. Extraparotid Warthin’s tumor. Otolaryngol Head Neck Surg 1986;94:169-75.
16. Patterson JW, Wright ED, Camden S. Extraparotid Warthin’s tumor. J Am Acad Dermatol 1999;40:468-70.
17. Meyer JS, Steinberg LS. Microscopically benign thy- roid follicles in cervical lymph nodes. Serial section study of lymph node inclusions and entire thyroid gland in 5 cases. Cancer 1969;24:302-11.
18. Harach HR, Franssila KO, Wasenius VM. Occult pap- illary carcinoma of the thyroid. A “normal” find- ing in Finland. A systematic autopsy study. Cancer 1985;56:531-8.
19. Pacheco-Ojeda L, Micheau C, Luboinski B, Richard J, Travagli JP, Schwaab G, et al. Squamous cell carci- noma of the upper aerodigestive tract associated with well-differentiated carcinoma of the thyroid gland. Laryngoscope 1991;101:421-4.
20. Fliegelman LJ, Genden EM, Brandwein M, Mechanick J, Urken ML. Significance and management of thyroid lesions in lymph nodes as an incidental finding during neck dissection. Head Neck 2001;23:885-91.
21. Weiler Z, Nelly P, Baruchin AM, Oren S. Diagnosis and treatment of cervical tuberculous lymphadenitis. J Oral Maxillofac Surg 2000;58:477-81.
22. Manolidis S, Frenkiel S, Yoskovitch A, Black M. Mycobacterial infections of the head and neck. Otolaryngol Head Neck Surg 1993;109:427-33.
23. Oktay MF, Topcu I, Senyigit A, Bilici A, Arslan A, Cureoglu S, et al. Follow-up results in tuberculous cer- vical lymphadenitis. J Laryngol Otol 2006;120:129-32.