Head and neck carcinoma of unknown primary

Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3):185-192. doi: 10.1016/j.anorl.2019.04.002. Epub 2019 Apr 17.


In adult cervicofacial pathology, carcinoma of unknown primary is defined as lymph-node metastasis the anatomic origin of which is not known at the time of initial management. It constitutes up to 5% of head and neck cancers. Presentation may suggest benign pathology, delaying and confusing oncologic treatment. Diagnostic strategy in cervical lymph node with suspicion of neoplasia requires exhaustive work-up to diagnose malignancy and, in 45% to 80% of cases, depending on the series, to identify the primary site. Histologic types comprise squamous cell carcinoma, thyroid carcinoma, adenocarcinoma, neuroendocrine carcinoma and undifferentiated carcinoma. Association is sometimes found with human papilloma virus or Epstein Barr virus, guiding treatment. The objective of the present study was to provide clinicians with the necessary diagnostic tools, based on the current state of clinical, imaging and pathologic knowledge, and to detail treatment options.

Keywords: Head and neck tumor; Lymph-node metastasis; Metastasis of unknown primary.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / secondary*
  • Adenocarcinoma / virology
  • Adult
  • Carcinoma, Neuroendocrine / pathology
  • Carcinoma, Neuroendocrine / secondary
  • Carcinoma, Neuroendocrine / virology
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / virology
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / secondary*
  • Head and Neck Neoplasms / virology
  • Herpesvirus 4, Human
  • Humans
  • Lymphatic Metastasis
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / virology
  • Neck
  • Neoplasms, Unknown Primary / pathology*
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / virology
  • Papillomaviridae
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / virology