Azlan Iskandar Ishak, Mohd Razif Mohd Yunus, Mazita Ami, Primuharsa Putra.
Role of panendoscopy and biopsy in cervical lymph node metastasis with unknown primary: a tertiary center experience.
Rawal Med J Jan ;35(2):209-13.

Objective: To evaluate the role of panendoscopy and biopsy in diagnosing occult primary site of cancer in the head and neck region. MethoDS: A retrospective review of patient clinical notes, radiological, histological and intra-operative reports who underwent panendoscopy and biopsy of the upper aerodigestive tract. Results: Out of 11 patients, six had undifferentiated carcinoma and five had squamous cell carcinoma (SCC) of the cervical lymph nodes. Nine underwent CT scan of the head and neck and one had a positron emission tomography scan. One patient had no radiological imaging. None of these studies were able to locate a primary tumor. Random biopsies from sites of possible origin of the primary tumor with tonsillectomies confirmed the primary site in 10 patients; three had nasopharyngeal carcinoma, four had SCC of the tonsils with three patients with unilateral and one with bilateral involvement, one each with SCC of the base of tongue, SCC of both vocal cord and non Hodgkin`s lymphoma of bilateral tonsils. In one patient, no site of origin of the primary tumor was identified in the head and neck region. Conclusions: Panendoscopy and biopsies had significant role in arriving at a conclusive diagnosis as compared to imaging studies in cases of metastatic cervical lymph nodes with an occult primary. (Rawal Med J 2010;35:209-213).

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