Lymphnodal metastases from unknown primary tumors

Prognosis and adequate therapy of lymphnodal metastases from unknown tumors are still uncertain. At the Milan Cancer Institute 71 patients with neoplastic adenopathies of unknown origin were hospitalized between 1965 and 1979. Men were 45 and women 26 with a M/F ratio of 1.7: 1. Most of patients were aged 51-70 years. Laterocervical adenopathies were the more frequent, followed by supraclavicular, axillary, inguinal, submandibular and retroperitoneal ones. In 11 cases the primary tumor was subsequently found (3 cases in tongue, 3 in rhinopharynx. 2 in lung. 2 in breast and 1 in thyroid). Of the remaining 60 cases, only histologic diagnosis of the metastasis was available and the primary tumor has never been found. Squamous cell carcinoma was the most frequent histologic type, followed by adenocarcinoma, undifferentiated carcinoma and malignant melanoma. No significant relationship between histologic types and lymphnodal sites could be demonstrated. In different cases treated with all possible combined therapies (surgery, chemotherapy and radiotherapy), no correlation between survival and therapy was possible. 35 patients (58.3%) were dead 18 months after diagnosis. No significant correlation between survival and histology was either shown. The natural history of these tumors remains unclear and any specific therapy cannot be proposed to be scheduled in such cases.