Iqbal Hussain, Gulzar A Shaikh, Azam Yousfani.
Diagnosis of occult primary in the head & neck cancer.
Pak J Otolaryngol Jan ;21(3):53-5.

Occult primary is a diagnostic dilemma, which can only be resolved by adopting a systemic approach. A case control study of 44 patients presented with metastatic neck masses with unknown primary at ENT department, Peoples Medical College Hospital, Nawabshah and ENT department, Chandka Medical College, Larkana, during July 1994 to September 2002. Malignant nature of these nodes were confirmed by FNAC (63.7%) & open biopsy in remaining cases. In 41% cases, the primary source was located by panendoscopy. Male with advanced age (45.3%) N3 (31.8%), level I (2.27%), level II (38.64%), level III (31.81%), level IV (13.64%), level V (9.10%), level VI (4.54%). Commonest site of origin was hypopharynx (18.1%) followed by supra glottic larynx (13.6%) & nasopharynx. Histology proved to be squamous cell carcinoma (50%), undifferentiated carcinoma (45%) & lymphoepithelioma (4.6%). FNAC & panendoscopy were the most effective tools in devising, cost effective protocol. Open biopsy should be reserved as last resort. Imag ing techniques are useful supports preferably prior to panendoscopy.

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