原発不明頚部リンパ節転移癌の１例

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  • A case of cervical lymph node metastasis from an unknown primary cancer
  • ショウレイ ホウコク ゲンパツ フメイ ケイブ リンパセツ テンイガン ノ 1レイ

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We present a case of cervical lymph node metastasis from an unknown primary cancer in a 73-year-old woman. The patient was referred to our department for treatment of a submandibular swelling after extraction of a first molar. At the initial visit, a swelling measuring 22mm in diameter was detected in the left submandibular region. The mass was covered by normal skin and was elastic yet hard and immobile on palpation. The patient did not complain of pain or dysesthesia. Delayed healing was noted at the wound remaining after extraction of the first molar. The presence of a malignant disease such as malignant lymphoma or gingival carcinoma was suspected on the basis of the clinical findings and magnetic resonance and ultrasonographic images. Biopsy of the wound and resection of the cervical mass were performed under general anesthesia. Histopathological examination of the gingiva showed granulation tissue formation with inflammatory cell infiltration.The cervical mass proved to be a lymph node with metastasis from squamous cell carcinoma. Head, neck, and thoracic computed tomography, bronchoscopy, and other examinations were performed to locate the primary cancer, but its origin remained unknown. Left total neck dissection was combined with irradiation (total dose: 57.6Gy) of both sides of the neck and the upper, middle, and lower pharynx. The patient has been followed up for 1 year 5 months without any evidence of recurrence.

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