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Neck Node Squamous Cell Metastasis from Unknown Primary and Mutagen Sensitivity: A Case Series.

Botond Bukovszky1,2,3, János Fodor3, Gábor Székely3

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|December 20, 2023
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Summary

Cancer of unknown primary (CUP) neck node metastases, often human papillomavirus (HPV)-related squamous cell carcinomas (SCCs), show good outcomes with elevated mutagen sensitivity (MS). This suggests MS may predict prognosis in HPV+ or cystic head and neck SCC from CUP.

Keywords:
HPV+ or cystic squamous cell cancerMutagen sensitivityNeck node metastasisUnknown primary carcinoma

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Area of Science:

  • Oncology
  • Pathology

Background:

  • Cancer of unknown primary (CUP) frequently presents as neck node metastases, predominantly squamous cell carcinomas (SCCs).
  • Many of these SCCs are human papillomavirus (HPV)-related and may originate from Waldeyer's ring, often exhibiting cystic morphology.

Observation:

  • This study reports four cases of neck node SCC metastases from CUP in patients under 50 years old.
  • All four patients had undergone pretreatment mutagen sensitivity (MS) assay and exhibited elevated MS levels (>1.0 chromatid break/cell).

Findings:

  • One male patient died within 3 years, while three female patients survived over 15 years post-treatment.
  • The survivors had HPV-positive (two) or cystic (one) SCC. Two survivors developed metachronous primary cancers at distant sites.
  • Elevated MS in HPV-positive or cystic head and neck SCC (HNSCC) from CUP appears to correlate with a favorable prognosis.

Implications:

  • Elevated MS may serve as a predictive biomarker for good outcomes in specific subtypes of CUP neck node metastases.
  • The development of metachronous cancers of different histologic types in survivors warrants further investigation beyond the field cancerization hypothesis.
  • Further research is needed to elucidate the clinical significance of elevated MS in CUP neck node SCC metastasis.