LETTER

Hippokratia 2016, 20(3):253

Krasic D1, Trajkovic M1, Zivkovic N2
1
Department of Maxillofacial Surgery, 2Department of Pathology, Faculty of Medicine, University of Niš, Niš, Serbia

 

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Key words: Metastatic tumors, head and neck, differential diagnosis, surgical treatment

Corresponding author: Asist.dr Nikola Zivkovic, MD, PhD, Institute of Pathology, Medical Faculty, University of Niš, Blvd. dr Zoran Djindjic 81, 18000 Niš, Serbia, tel: +381631045645, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Dear Editor,

Metastatic tumors of the head and neck represent an exceptionally rare pathological entity which constitutes 1 % of the total number of malignant tumors in the region1. The most common primary tumors that metastasize in the head and neck region are the lungs cancer in men and breast cancer in women2.

We retrospectively studied all patients treated in our department with head and neck cancer from 2000 until 2015. Out of the 2,834 patients with histopathologically confirmed malignant head and neck tumors, 18 patients (0.6 %) had metastatic mass from a distant primary tumor. In these patients (mean age 67.5 years, 6 women, 12 men), we recorded the site and histopathology of the primary tumor, as well as the biopsy confirmation of the histopathology of the metastatic tumor mass and absence of other primary malignancy in the head and neck region following thorough clinical and imaging examination. We excluded from the study patients with metastatic carcinoma of an unknown primary tumor, patients with known distant primary (confirmed pathohistology) whose general medical condition contraindicated a biopsy confirmation of the head and neck metastatic tumor, as well as patients with histopathologically diagnosed myeloma, lymphoma, and leukemia. Demographic data of the 18 patients, including the site of the primary tumor, site of metastasis, time of metastasis after initial diagnosis, status on the last follow-up, and treatment, are shown in Table 1.

In spite of their low incidence, metastatic tumors of the head and neck represent a particular clinical challenge for head and neck surgeons and pathologists. Most patients are diagnosed in an advanced stage of the disease, and therefore, the prognosis is very poor, with survival ranging from 4-38 months. A detailed anamnesis, along with comprehensive clinical examination, appropriate imaging, and tissue biopsy for confirmation of both primary and metastasis are crucial in setting the correct diagnosis, and provide appropriate treatment.

Conflict of interest

Authors declare no conflict of interest.

References

1. Zhu LJ, Wang SQ, Jiang S, Wang QP, Feng H, Ye YK, et al. Retrospective review of patients with metastatic tumours in oral and maxillofacial region. Int J Oral Maxillofac Surg. 2017; 46 Suppl 1: 140.
2. Hirshberg A, Berger R, Allon I, Kaplan I. Metastatic tumors to the jaws and mouth. Head Neck Pathol. 2014; 8: 463-474.