Neck nodal metastases from unknown primary: case series.

Background: Neck nodal metastases from occult primary constitute about 5%-10% of all hosts harboring carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-IV-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography (CT) scan, and magnetic resonance radiology (MRI). The most frequent histological finding is squamous cell carcinoma, particularly when the upper neck is involved.

Settings: We report three cases of patients presented with nodal metastases of the neck from unknown primary site and we also describe the diagnostic and therapeutic approach employed in each one.

Results: One patient harbored a neuroendocrine metastatic deposit, the second patient a poorly differentiated carcinoma and the third one a malignant melanoma.

Conclusions: Diagnostic procedures should be aimed at clarifying the histology of the nodal metastases and detecting the primary tumor site.