A Clinicopathological Study Of Cervical Metastatic Tumors Of Unknown Primary

[Objective] To explore the value of clinicopathology looking for the primary tumor of cervical lymph node metastatic tumors of unknown primary. The feasibility to hint the possible primary tumor by routine HE technology together with immunohistochemisty integrated mode detection was analyzed and the pathological diagnosis template to find the primary tumor of cervical lymph node metastatic tumors was initially investigated.[Methods] A retrospective study was performed to analyze the pathological data of patients in pathological department in the First Affiliated Hospital of Kunming Medical University between January of2000and December of2010. The distribution of malignant tumor, metastatic tumor, cervical metastatic tumor and neck metastatic tumor from an unknown primary site were recorded and analyzed. The cervical lymph node samples from surgical ablation as unknown primary tumors which have integrated clinical data were chose as investigate objects. Histopathological and immunohistochemisty technology were used to investigate the pathological diagnosis template of cervical lymph node metastatic tumors unknown primary[Results]:In First Affiliated Hospital of Kunming Medical University, Department of Pathology, the total number of cases has136.038. cancer accounted for12.81%of the total tumor; Metastatic tumors account for8.62%of the malignant tumor disease cases (1503/17435); cervical metastatic tumor accounted for49.10%of metastatic tumor disease cases (738/1503); The cervical metastatic tumors accounted for49.10%of the number of cases of metastatic tumors (738/1503); cervical unknown primary tumor metastatic tumors accounted for38.21%(282/738) of the neck metastatic tumors number of cases; cervical unknown primary tumor metastatic tumors accounted for1.61%of the number of cases of malignant tumors(282/136038). By clinical examination and pathological diagnosis of the patient prior to discharge primary tumor has been a clear diagnosis of the patients had456cases. But there are still282cases of primary tumor is not clear. Now through the HE and immunohistochemistry combined mode for pathological diagnosis. Cases from456cases, selected64cases of squamous cell carcinoma and72cases of sexual HE staining and immunohistochemical detection combined mode validation, the results suggested a primary tumor or a highly probable primary site were consistent with the pathological referral.Finally in the primary sites of high possibility finfding by this study, there were61cases coincident with the final pathological diagnosis prior to discharge, including thyroid cancer:16cases, lung adenocarcinoma:25cases, adenocarcinoma of the esophagus:4cases, colon adenocarcinoma:2cases, bile duct cancer:2cases, nest serous adenocarcinoma:2cases, breast cancer:5cases. And72cases of squamous cell carcinoma. However3cases didn’t match including1case of adenocarcinoma of the esophagus, colon adenocarcinoma and bile duct cancer respectively. Press the inclusion criteria for the selected72cases of squamous cell carcinoma were detected CK10&13, CK15positive rate is high and consistent,no significant difference. Which CK5, CK18. CK.14positive expression rate differences (lung squamous cell carcinoma:39cases, esophageal squamous cell carcinoma:18cases and laryngeal squamous cell carcinoma:15cases) were detected. In lung squamous cell carcinoma, squamous cell carcinoma of the esophagus.and laryngeal squamous cell carcinoma group, the expression of CK5was89.74%(35/39),88.89%(16/18),86.67%(13/15), normal lymph nodesgroup did not express; Four groups CK5expression is not exactly accordant, the difference was statistically significant (P <0.05). In lung squamous cell carcinoma, squamous cell carcinoma of the esophagus, and laryngeal squamous cell carcinoma group, the expression of CK18was5.10%(2/39),5.56%(1/18)、60.0%(9/15),normal lymph nodesgroup did not express; Four groups CK18expression is not exactly accordant, the difference was statistically significant (P<0.05). In lung squamous cell carcinoma, squamous cell carcinoma of the esophagus, and laryngeal squamous cell carcinoma group, the expression of CK14was97.43%(38/39),88.89%(16/18),86.67%(13/15). Four groups’CK14expression were not exactly accordant, the difference was statistically significant (P<0.05). CK5in squamous cell carcinomas of the sensitivity of89.74%and a specificity of45.28%; esophageal squamous cell carcinoma in a sensitivity of88.89%and a specificity of 45.28%;in laryngeal squamous cell sensitivity of86.67%and a specificity of33.77%. CK18in squamous cell carcinomas of the sensitivity of5.10%and a specificity of88.67%; esophageal squamous cell carcinoma in a sensitivity of5.56%and a specificity of90.54%; in laryngeal squamous cell sensitivity33.3%. specificity was96.10%. CK14in squamous cell carcinomas of the sensitivity was97.4%, specificity of45.28%; esophageal squamous cell carcinoma in a sensitivity of88.89%and a specificity of31.08%; in laryngeal squamous cell sensitivity of86.67%and a specificity of29.87%.[Conclusion]1. Neck metastatic tumors of unknown primary tumor and neck metastatic tumors accounted for38.21%of cases, the incidence rate is higher, to bring great difficulties in clinical diagnosis and treatment, should be actively pursued on the neck of unknown primary tumor metastatic malignant basic and clinical cancer research.2. Pathological examination combined with routine HE and immunohistochemical diagnostic mode combination, can greatly improve the neck metastatic tumors of unknown primary tumor detection rate of the primary site.3. Immunohistochemical CK5, CK18and CK14monoclonal antibodies against cervical metastatic squamous cell carcinoma of unknown primary tumor, a better sensitivity and a certain relative specificity.