Malignant Cervical Adenopathies from Carcinomas of Unknown Origin

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Abstract
Lymph node metastases of epithelial tumors for which no primary cancer can be found at the time of treatment, despite a careful systematic search were studied. Excluded from consideration are those cervical adenopathies which constitute the initial presentation of superior aerodigestive system tumors, in which case the primary tumor is discovered by the specialist at the time of examination. Also excluded are lymphomatous adenopathies, malignant cervical tumors of nonlymph node structures (whether neurogenic origin, carotid body tumors or sarcomas) and malignant branchiomas described by Wolkmann and Veau, whose existence is currently disputed, and which, according to Micheau, consist of epithelial metastases of branchiogenic cysts. It is important to note in passing that the significance of cervical nodes as indicators of underlying disease in the superior aerodigestive system is ignored by many general surgeons, who may consider consultation with a specialist only after a cervical biopsy has revealed the histological nature of the adenopathy. The grave nature of such a biopsy, often performed under poor surgical conditions and with inadequate exposure limiting dissection must be emphasized. The biopsy often endangers the future of these patients, in whom the primary tumor should have been discovered preoperatively, by delaying treatment of the primary lesion and giving the patient a false sense of security in ameliorating the condition for which he sought medical advice.