A case series of metastatic lateral cervical lymphadenopathy

Amit Narayan Pothare, Karuna Ilamkar


Background: Metastasis is a common cause of lymphadenopathy, seen mainly in patients above 40 years of age. Regional nodes entrap the tumor cells and setup complex immunological reactions within the nodes. The histological appearance of the nodes often suggests the primary tumor. The head and neck cancers spread to regional nodes via embolism and permeation. Primary site is evident most of times. The nodes are initially mobile but later may becomes fixed. The aim was to study the lateral cervical metastasis secondary to either lymphatic spread from distant primary or occult metastasis, their signs and symptoms, diagnostic procedure and treatment modalities.

Methods: The study was conducted from July 2012 to June 2015. All patients having cervical lymphadenopathy secondary to metastasis diagnosed by FNAC, are included in study. Patients are evaluated as a whole, starting with clinical history and examinations as per proforma. In cases of lympahdenopathy where the diagnosis was not established with FNAC, biopsy was performed and efficacy of FNAC has been calculated.

Results: Total 37 patients are studied. Most cases occurred in 5th decade of life, followed by 4th decade. More common in male 83.70% as compared to female 16.30% due to tobacco and smoking addiction more common in males. Change in voice is most common presentation in 46% of cases, followed by dysphagia in 35.13% of patients. Primary tumor was evident in 83.78% of cases and occult in 16.22%. Fixed nodes present in 54.05%, reduced mobility in 21.62% and mobile in 24.32%. FNAC was done in all the cases and positive results obtained in 91.8% with sensitivity of 90% and specificity of 98%. In patients treated by neoadjuvant chemotherapy followed by modified neck dissection, no recurrence occurred. Out of 10 patients treated by radical neck dissection only 2 patients had recurrence in follow up period and managed by radiotherapy. In 15 patients treated by radical radiotherapy, 5 patients had local recurrence and required selective neck dissection in follow up.

Conclusions: Cervical lymph node metastasis was major presentation of malignancies of head and neck region and also from distant site. Whenever presents, it should raise suspicion of metastatic origin. Early diagnosis of primary tumor followed by aggressive treatment via multimodal approach prolongs survival.


Cervical lymph node, Metastasis

Full Text:



Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga A. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787-803.

Basista H, Modwal A, Prasad B. Clinocopathological evaluation of neck masses. Scholars J Applied Med Sci. 2015;3(9):3235-41.

Danley P, Majarakis MD, Southwick HW. Clinical evaluation of swellings in neck. Surg Clin North Am. 1956;3:6-9.

Glesson M, Herbert A, Richards A. Management of lateral neck masses in adults. BMJ. 2000;320:1521-4.

Shah J. Pattern of cervical lymph node metastasis. Am J Surg. 1990;160:404-9.

Stell PM, Dalby JE, Singh SD. The fixed cervical nodes. Cancer. 1984;53:336-41.

Dolan RW, Vaushan CW. Symptoms in early head and neck cancers, an inadequate indicator. J Otolaryngology Head Neck Surg. 1998;119:463-7.

Morris J. Radiation therapy in management of lymph node metastasis from head and neck cancers. Head Neck Cancers. 1972;114(1):70-82.

Shah J. Epidermoid carcinoma of supraglottic larynx. Am J Surg. 1974;128:494-9.

Javant K. Quantification of role of smoking and chewing tobacco in oral, pharyngeal and oesophageal cancers. British J Cancer. 1997;35:232-34.

Nada A, Alwan, Hashmi. FNAC vrs histopathology in diagnosis of lymph node lesions of neck. Cytopathology. 1996;2(42):320-5.

Podar AK, Sahap. Cervical lymphadenopathy: comparative study of results of FNAC and histopathology. Indian J Tuberculosis. 1992;39(2):128.

Joseph R. Cervical lymph node metastasis of unknown origin. Am J Surg. 1970;120:466-70.

Differential diagnosis of neck masses. Available at Accessed on 14 July 2016.

Louis J. Cervical lymph nodes from an unknown primary. Am J Surg. 1990;160:35-9.

Richard H. Metaststic carcinoma in cervical nodes from unknown primary. Am J Surg. 1966;112:543-7.

Endicott JN, Cantrell RW, Kelly JH, Neel HB, Saskin GA, Zajtchuk JT. Head and neck surgery and cancer in aging patients. Otolaryngol Head Neck Surg. 1989;100(4):290-1.

Dowell KE, Armstrong DM, Aust JB, Cruz AB. Systemic chemotherapy of advanced head and neck malignencies. Cancer. 1975;35(4):1116-20.

Yves. Experience of Curie Institute in treatment of cancer of mobile tongue. Cancer. 1981;47:503-8.

Blady JV. Analysis of RND in treatment of cervical metastasis. Am J Surg. 1964;108:64-8.

Laurence. Collective review of RND and modified neck dissections. J Surg Gyne Obs. 1988;167:529-64.

Elliot E. Strong, preoperative radiation and radical neck dissection. Surg Clin North Am. 1969;49(2):271-6.