Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cervical metastases of an unknown primary lesion accounts for 5%-10% of head and neck cancers. Tonsillar carcinoma is the third most common, with an incidence in the region of 18%-47% of unknown primaries, and the likelihood of synchronous tonsillar tumour of about 5%-10%. Current practice for investigating an unknown primary includes computed tomography (CT) with or without magnetic resonance imaging (MRI), and then, if necessary, 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET). This is followed by panendoscopy with biopsy from the potential primary sites and tonsillectomy. A five-year retrospective review of our database of metastatic squamous cell carcinomas from unknown primary sites identified patients with synchronous tonsillar tumours (n=5). All had clinically normal-looking tonsils; MRI was within normal limit and a PET-CT identified the ipsilateral tonsillar primary in three cases only. Bilateral tonsillectomy rather than a tonsillar biopsy in the search for an unknown primary has been standard practice in our unit. Identification of a second primary dictates planning for the primary site and in the long term, influences patients' survival. We therefore recommend that bilateral tonsillectomy should be standard in the investigation of patients who present with cervical metastases from an unknown primary in the head and neck region.
 ...
PMID:Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck. 1824 47

Tonsillar carcinoma metastasis to the myocardium is undermined with detection rate often occurring at autopsy or advance stage. A 60-year-old male with a 1-month history of right-sided facial pain and failed antibiotics therapy underwent head and neck CT scan that revealed a tonsillar mass. Tonsillar biopsy revealed squamous cell carcinoma, HPV-16 positive. PET-CT scan showed a significant activity in the right tonsillar mass along with prominent right level 2 lymph nodes and no distant disease. Definite surgery was deferred and he underwent 7 weeks of radiation therapy with concurrent weekly Cisplatin. PET scan 8 weeks later showed significant improvement in large right palatine tonsil mass; however, a new FDG-avid cardiac mass of right ventricle. An echocardiogram showed an ejection fraction of 59% and a large mass in the apical portion of the right ventricle. Cardiac MRI confirmed a 9 cm right ventricular mass. Complete resection of the cardiac mass was unsuccessful; a partial tumor debulking provided adequate sample for pathologic examination, which was consistent with metastatic squamous cell cancer, p16+, clinical-stage T4aN1M1. Surgical intervention was not performed; instead, he received a palliative radiation therapy to his right-sided cardiac mass with concurrent Keytruda immunotherapy. Unfortunately, the evening of successfully completing his last therapy, he was found unresponsive and subsequently expired. Although tonsillar carcinoma metastasis to the myocardium is rarely coupled with its atypical presentations, clinicians should consider early echocardiogram evaluation for possible metastatic disease so as to provide early interventions.
 ...
PMID:Tonsillar carcinoma as a rare cause of cardiac metastases. 3200 64