Abstract
PURPOSE: Computed tomography (CT) and magnetic resonance imaging (MRI) have contributed greatly to the ability to identify metastases in head and neck cancer. However the deficiencies in the assessment of lymphadenopathy still exist. The aim of this case report is to emphasize the importance of adequate knowledge of the patient's medical history, physical examination and a detailed analysis of imaging studies. METHODS: A 62-year-old man in whom the first manifestation of a metastatic lung adenocarcinoma was advanced severe and incapacitating neck pain of approximately 4 months of progression attributed to a degenerative disc disease of the cervical spine based in the cervical MRI results. During physical exploration showed no neurological deficit, just a pain in the back of the neck and limitation of the cervical spine motion. After detailed analysis of cervical MRI images, in which we observe the presence of a small nodule in the posterior cervical region surgery was recommended to get a sample, and then perform the corresponding histopathological study. RESULTS: After radical excision, the histopathological study has referred metastases in soft tissue of lung adenocarcinoma, infiltrating fibroadipose tissue and skeletal muscle. Immunohistochemically was positive for cytokeratin 7 (CK7+), thyroid transcription factor-1 (TTF-1+) and negative for cytokeratin 20 (CK20-). CONCLUSIONS: Don et al. (1995), in 36 neck dissections from patients with squamous cell cancer found a large number of malignant nodes having diameters of less than 10 mm. Since the current radiological criteria for assessing the status of the cervical lymph nodes are based largely on size, the findings indicate the major limitations in the detection capabilities of metastatic disease. For this reason it is important the history, the physical examination and a detailed analysis of imaging studies. Because, of this depends that patients receive an adequate treatment for their condition and needs.