Carcinoma cervical metastático com tumor primário oculto

Introducao: A metastase cervical de origem desconhecidae um problema raro, cuja gestao continua a ser um desafiodiagnostico e terapeutico. Objetivo: Nosso objetivo e analisarretrospectivamente os resultados e fatores prognosticos nestegrupo de pacientes. Metodo: Um total de 22 pacientes foiretrospectivamente estudado. Foram considerados genero,idade, habitos de tabagismo e etilismo, nivel cervical da doenca,estadio segundo o TNM, sintomas, tempo das queixas, achadoshistologicos, dose de radioterapia, incidencia da recidiva dotumor e a evolucao da doenca. Foram realizados esvaziamentocervical radical modificado e radioterapia adjuvante. Resultados:A idade media foi 62.5 anos, e a proporcao homem: mulher foi10:1. Doze pacientes foram estadiados como N2a. O nivel II foia unica regiao com linfonodos metastaticos em 17 pacientes.Foi detectado carcinoma espinocelular em 18 casos. Durantea cirurgia foi encontrada invasao extracapsular grosseira em 9pacientes, enquanto invasao extracapsular microscopica foiencontrada em 10 amostras de exames anatomopatologicos.Todos os pacientes foram submetidos a radioterapia adjuvante.O sitio do tumor primario foi encontrado durante o seguimento em3 pacientes. Cinco pacientes desenvolveram metastase cervicalrecorrente e seis pacientes apresentaram metastases a distância.Dois pacientes desenvolveram segundo tumor primario. A taxa desobrevida global em 5 anos foi de 22,7% e a sobrevida especificada doenca foi de 36,4%. Introduction: Cervical metastasis of unknown origin is a rareproblem whose management remains a diagnostic and therapeuticchallenge. Objective: Our aim is to analyse retrospectively theresults and prognostic factors in such a group of patients. Method:A total of 22 patients were retrospectively studied. Gender, age,smoking and drinking habits, cervical level of disease, stageaccording to TNM, symptoms, time of complaints, histologicalfindings, radiation therapy dose, incidence of tumor recurrence,and course of the disease were considered. Radical modifiedneck dissection and adjuvant radiation therapy were performed.Results: The mean age was 62.5, and the men:women ratio was10:1. Twelve patients were staged as N2a. Level II was the onlyregion of metastatic node in 17 patients. Squamous cell carcinomawas detected in 18 cases. Gross extracapsular invasion of thelymph node was found in 9 patients during the surgery, whilemicroscopic extracapsular invasion was found in 10 pathologicalspecimens. All the patients underwent adjuvant radiation therapy.The site of the primary tumors was found during the follow-up in3 patients. Five patients developed recurrent cervical metastasisand 6 patients presented distant metastasis. Two patientsdeveloped second primary tumor. The overall 5-year survival ratewas 22.7% and the disease specific survival was 36.4%.