Velike metastaze u vratu sa nepoznatim primarnim tumorom
Sažetak
Uvod. Metastaze u glavi i vratu karcinoma (HNC) nepoznatog primarnog tumora definišu se kao metastatska bolest u limfnim čvorovima vrata bez dokaza o postojanju primarnog tumora nakon sprovedene dijagnostike. Više nacionalnih vodiča preporučuje da dijagnostički protokoli obavezno uključe detaljan klinički pregled sa radiološkom dijagnostikom, iglenu aspiracionu biopsiju (FNA) tumorskih promena na vratu, ezofagogastroduodenoskopiju (EGD) sa tonzilektomijom palatinalnih i lingvalnih tonzila, imunohistohemijska bojenja preparata i detekciju humanog papiloma virusa (HPV). Terapija metastaza HNC nepoznatih primarnih tumora podrazumeva hirurško lečenje (disekciju vrata) i primenu radioterapije (RT), dok neki autori preporučuju hemoradioterapiju u slučajevima uznapredovale regionalne bolesti. Prikaz bolesnika. Bolesnik star 44 godine je, zbog pojave ulceroinfiltrativne mase na vratu sa desne strane, upućen u tercijarnu medicinsku ustanovu. Učinjen je pregled glave i vrata i fiberoptička nazofaringolaringoskopija, a potom i kompjuterizovana tomografija (CT) glave, vrata i grudnog koša sa intravenskim kontrastom. Primarna lokalizacija tumora nije utvrđena tim dijagnostičkim metodama. Otvorenom biopsijom tumorske promene na vratu postavljena je histopatološka dijagnoza metastaze skvamocelularnog karcinoma (SCC). Bolesniku je potom urađena EGD sa slepim biopsijama, čiji su rezultati bili negativni na malignitet. Lečen je hirurški, proširenom radikalnom disekcijom vrata sa rekonstrukcijom i postoperativnom ipsilateralnom RT. Pet godina nakon operativnog lečenja, bolesnik se javio na pregled sa manifestacijama masivnog faringolaringealnog tumora. Biopsijom i histopatološkim ispitivanjem potvrđena je dijagnoza SCC. Zaključak. U slučaju metastaze HNC nepoznatog primarnog tumora, obavezan je dijagnostički postupak „korak po korak“ za identifikaciju lokalizacije primarnog tumora. Značajan napredak u dijagnostici i operativnim tehnikama uticao je na povećanje verovatnoće utvrđivanja porekla primarnog tumora, kao i detekciju regionalnog i sistemskog širenja bolesti. Krajnji cilj je poboljšanje ukupnog preživljavanja i produženje intervala bez regionalnih recidiva kod tih bolesnika.
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