with 100 patients, the most common histological diagnosis was adenocarcinoma second common histologic type was SCC. has published that majority of supraclavicular lymphadenopathy was SCC and next common histological diagnosis was lymphoma, followed by adenocarcinoma and undifferentiated carcinoma ( 7). Predominant histopathologic subtype of tumors metastasizing to supraclavicular region has differed according to authors. Whereas SCC metastasis were primarily from cervix, mediastinum, esophagus, lung and head and neck region ( 6). Histopathological investigation of supraclavicular lymphadenopathy has shown that adenocarcinomas were mostly from pimaries of the breast, lung, prostate, stomach, pancreas and endometrium. It has occured mainly on the left side such as in our study ( 3, 5). From these, majority (65% - 90%) were metastatic carcinomas from infraclavicular region. Supraclavicular lymphadenopathy would often be (58% - 83%) malignant. Malignancies which have shown tendency to metastasize to supraclavicular region have mentioned as: lung, head and neck (mostly hypopharynx, tonsil and nasopharynx), breast, esophageal, gastric, pancreatic, gynecologic and prostate cancers ( 1).ĭifferential diagnosis of supraclavicular lymphadenopathy was broad and it has included benign lymphadenopathy, congenital cysts and tumors, specific infections, nonspecific inflammation, primary and metastatic malignancies ( 4). The supraclavicular area is the final common pathway of the lymphatic system from infraclavicular sites as it joined to central venous system. Number of 18 Patients According to Distant Metastatic SiteĪbbreviations: NET, neuroendocrine tumor SCC, squamous cell carcinoma. Distant metastatic sites have summarized in Figure 1. Excisional biopsies from supraclavicular region have administered to all of them.ĭistant metastatic sites: From 18 patients, 10 patients (55.5 %) of them were lung in origin, two patients (11%) were breast cancer, one patient (5.5%) was pleural mesothelioma, one patient (5.5%) was prostate carcinoma, one patient (5.5%) was pancreas, one patient (5.5 %) was cervix carcinoma, one patient (5.5%) was urinary bladder urothelial carcinoma metastasis, one patient (5,5%) was gastric carcinoma metastasis. In this study we have retrospectively investigated excisional biopsy results of 18 patients with supraclavicular lymphadenopathy the origin sites and histopathological types have discussed in the light of current literature.ġ8 patients (10 male, 8 female patients with ages between 42 to 78 and median age of 54) with supraclavicular lymphadenopathy for whom FNAB results were non-diagnostic or suspicious of malignancy have retrospectively analysed from years 2010 to 2014. But when FNAB does not give enough diagnostic material, excisional biopsy should be planned. It would be simple, safe and cost effective. Utility of fine needle aspration biopsy (FNAB), as a first line of investigation for lymph nodes, has assumed highly importance during the recent years ( 3). Infraclavicular region tumors, mostly lung, could also metastasize to supraclavicular region ( 2). Primary metastatic sites from the head and neck region were usually hypopharynx, tonsil and nasopharynx. Metastasis to supraclavicular fossa could originate from head and neck or infraclavicular tumors. Supraclavicular lymph node area lies above the manubrium, laterally to medial edge of common carotid artery, and medially to the clavicula and lateral rib margin ( 1). Supraclavicular Metastasis Infraclavicular Excisional Biopsy 1. Excisional biopsy should be performed promptly when fine needle aspiration biopsy was not diagnostic. Early diagnosis would be critical because supraclavicular metastasis indicates poor prognosis with decreased survival. Lung has been the most common origin site. Supraclavicular neck masses should be evaluated carefully, since they were mostly malignant in origin.
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