The clinical significance of radiographically detected pulmonary neoplastic lesions in patients with head and neck cancer.

The histopathologic features of pulmonary lesions found in 36 patients with head and neck cancer ( HNC ) whose chest radiograms had abnormalities suggestive of a neoplasm were reviewed. Ten patients (28%) had benign lesions but cancer was diagnosed in 26 patients (72%) by lung biopsy or at autopsy. Second primary lung cancer was found in 19 (53%) and metastatic HNC in seven (19%) of the 36 patients examined. The second lung primaries occurred in seven (100%) patients with HNC in stage I or II and in 12 (63%) of those in stage III or IV. The histologic examination revealed squamous cell carcinoma of the lung in eight (42%) of 19 patients, small cell carcinoma in six (31.5%), adenocarcinoma in three (16%), and large-cell carcinoma in two (10.5%). These findings indicate that a prompt histologic examination of radiographically detected neoplastic pulmonary lesions in patients who have, or have had HNC is mandatory because a second primary cancer of the lung may be found and cured with early treatment. Furthermore, a substantial number of the patients in this retrospective analysis had small-cell carcinoma of the lung and could benefit from current therapeutic advances for this type of tumor.

Prolonged survival of patients with extrapulmonary small cell carcinoma arising in the neck.

Two patients with extrapulmonary small cell carcinoma localized in the neck survived for more than two years without systemic therapy. This suggests that there may be a subset of small cell carcinomas characterized by slow growth, resulting in an indolent clinical course. By light and electron microscopy, we were unable to identify features of this indolent form which differ from those of the aggressive form of pulmonary or extrapulmonary small cell carcinoma.