Head and Neck Metastases From Infraclavicular Primary Tumors: Analysis of 136 Cases

Distant metastases in the head and neck region are rare, often posing challenges for ENT specialists and being of crucial importance in the management of infraclavicular primary tumors.

The case series presented here aims to outline the relevant aetiologies and clinical presentation in the head and neck region. Aspects of diagnostics, differential diagnostics, therapy, and prognosis are discussed. A total of 136 cases (7.8%) from 1735 patients recorded in our tumor database between 2000 and 2023 were included. All cases represent patients consecutively operated on during this period.

The metastases of the patients (58 women, 78 men, median 64 years) were predominantly located in the cervical lymph nodes (86.8%). Organ metastases mainly affected the parotid gland (38.9%). Histologically, adenocarcinomas were most frequently diagnosed (40.4%). The primary tumors were mainly lung carcinomas (33.1%), followed by mammary and renal cell carcinomas. The clinical manifestation was indolent swelling in most cases. In 91 cases (66.9%), head and neck metastases were the first manifestation of the primary tumor. Only 7 of the cases presented with an isolated cervical metastasis.

Localizing a metastasis in the supraclavicular neck region and/or a histological finding other than squamous cell carcinoma indicates a remote primary tumor. The considerable relevance of cervical metastases in the (initial) primary tumor diagnosis is due to their early clinical manifestation and easy biopsy accessibility. In most cases, distant cervical metastasis is an indication of advanced tumor disease.