Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: Outcomes and patterns of failure.

Context: Management of cervical lymph nodes metastases of squamous cell carcinoma (SCC) from primary of unknown origin (PUO) is contentious and there is insignificant data from India on this subject. Aims: To present experience of management of these patients treated with curative intent at a single institution. Settings and Design: Retrospective study of patients treated between 1989-1994 in a tertiary referral cancer centre. Materials and Methods: Eighty-nine patients were evaluated in the study period and their survival compared with patients with common sites of primary in the head and neck with comparable node stage. Statistical analysis used: Kaplan-Meier method. Results: The clinical stage of the neck nodes at presentation was N1 in 11%, N2a in 28.5%, N2b in 22.5%, N3 in 35% and Nx in 3.4% patients. All patients underwent surgery and 70 patients received more than 40Gy postoperative radiotherapy. Twenty-nine (32.6%) patients had relapse of which 19 (21%) were in the neck. Postoperative radiotherapy did not influence the neck relapse (p=0.72). Primary was detected in 13 patients (14.6%) on subsequent follow up. The overall five and eight-years survival was 55% and 51% respectively. The overall five-year survival was better compared to patients with known primary with comparable node stage. Conclusions: Patients with cervical lymph nodes metastases of SCC from PUO have reasonable survival and low rate of development of subsequent primary when treated with surgery and radiotherapy. The overall survival is comparable to that of patients with known primary and hence an attempt at cure should always be made.

Metastasis of osteosarcoma to the maxilla--a case report.

Secondary osteosarcomas of the maxilla/premaxilla are extremely rare. We describe a case of a 24-year-old man with a metastasis of osteosarcoma to the premaxilla. The patient had undergone hip disarticulation followed by adria based chemotherapy for chondroblastic osteosarcoma of the proximal right femur ten years ago. The metastatic work up did not show liver or lung metastasis. The patient underwent premaxillectomy in February 1999. The histopathology revealed a chondroblatic osteosarcoma consistent with metastasis in the clinical setting. The patient was disease free at the end of five months.

Undifferentiated embryonal sarcoma of the liver in childhood.

Primary undifferentiated embryonal of the liver in children is a rare neoplasm with dismal prognosis. Surgery is the treatment of choice. Adjuvant chemotherapy may prove useful in improving the prognosis of these tumours. We report two cases of Primary undifferentiated embryonal sarcoma of the liver.

Primary germ cell tumours of the mediastinum.

Twenty nine cases of primary mediastinal germ cell tumours (MGCT) were seen at the Tata Memorial Hospital over a 16--year period (1974-1989). There were 5 benign MGCT occurring predominantly in females (80%), with these patients having an excellent result after surgery with all patients disease free at an median follow-up of 27 months. Malignant MGCT occurred only in males and demonstrated wide variation in response to treatment depending upon whether the tumour was seminomatous or non-seminomatous. There were 11 Seminomas, 5 Embryonal carcinomas, 5 Endodermal sinus tumours and 3 Teratocarcinomas. The diagnosis was established by surgical exploration or by biopsy of a lymph node or chest wall nodule in 20 patients. Four patients had needle biopsy. Seminomatous MGCT received radiotherapy as their main treatment modality and did well with 75% of the patients alive without disease at an average follow up of 33 months. The non-seminomatous MGCT could be divided into two groups. The mean survival for patients receiving cisplatinum based chemotherapy was 14 months as compared to the group not receiving such therapy where the survival was only 5.3 months. However, because of the advanced disease at presentation even in the group receiving cisplatinum chemotherapy, a long term complete response rate of only 20% could be achieved.