The Pattern of Cervical Lymph Nodes Metastases and its Relation to the Histopathology of the Primary Lesion

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Harb,Khalid Ahmad
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The presence of clinically palpable lymph nodes in a patient with oral and maxillofacial cancer should be considered metastatic until proven otherwise. Surgery provides comprehensive clearance of enlarged lymph nodes and offers accurate histological information on lymph nodes at risk of having metastases in the clinically negative neck. In a series of 18 patients with advanced oral and maxilofacial cancer comprehensive neck dissection was performed. The lymph nodes specimens were examined for the presence of metastasis and the order of involvement, while the primary lesion was examined for the degree of pattern and depth of stromal invasion. The results showed that metastases was evident in 41% of the cases. Of the latter an orderly progressive overflow was seen in 88% of the cases. Skipping of the anatomic levels II and III was seen in only 12% of the cases. Type III pattern of invasion was seen in 6 cases, 71% of them showed lymph nodes involvement. Fifty seven per cent of VIII cases of stromal invasion of more than 8mm showed positive lymph node involvement. In summary, 41 % of patients with oral cancer have neck metastses, and a strong relation was seen between such metastases and the pattern as well as the depth of invasion
the depth of stromal invasion in the primary