A lesion of contralateral neck lymph nodes in oral tongue cancer with clinically negative neck lymph nodes (clinical case)

The objective is to present a clinical case of combined treatment of cancer of the tongue and its progression to the contralateral lymph nodes of the neck using data on individual lymphatic outflow from the primary tumor of the tongue.

Clinical case. Clinical, laboratory, radiological and pathomorphological data of a 50-year-old patient with a diagnosis of squamous human papillomavirus-negative cancer of the free part of the tongue and clinically negative lymph nodes of the neck with cT2N0M0. The patient underwent radical surgical treatment in the amount of hemiglossectomy and ipsilateral selective cervical lymphadenectomy after two courses of polychemotherapy according to the cisplatin + 5-fluorocracil regimen with partial regression and adjuvant treatment in the amount of conformal remote radiation therapy combined with chemotherapy. 9 months after the end of treatment, progression to the lymph nodes of the neck of the contralateral side was revealed, which accumulated a radiopharmaceutical before treatment.

Conclusion. The described clinical case shows the importance of studying the lymphatic outflow from the primary tumor of the tongue to the regional lymph nodes in order to plan surgical treatment on the regional lymphatic collector in patients with squamous cell carcinoma of the free part of the tongue.

1. Alkureishi L.W., Burak Z., Alvarez J.A. et al. Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/ oropharyngeal squamous cell carcinoma. Ann Surg Oncol 2009;16(11):3190–210. DOI: 10.1245/s10434-009-0726-8.

2. Schilling C., Stoeckli S.J., Vigili M.G. et al. Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 2019;41(8):2655–64. DOI: 10.1002/hed.25739.

3. D’Cruz A.K., Vaish R., Kapre N. et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 2015;373(6):521–9. DOI: 10.1056/NEJMoa1506007.

4. Fan S.F., Zeng Z.Y., Peng H.W. et al. Sentinel lymph node biopsy versus elective neck dissection in patients with cT1–2N0 oral tongue squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117(2):186–90. DOI: 10.1016/j.oooo.2013.09.012.

5. Flach G.B., Bloemena E., Klop W.M. et al. Sentinel lymph node biopsy in clinically N0 T1–T2 staged oral cancer: the Dutch multicenter trial. Oral Oncol 2014;50(10):1020–4. DOI: 10.1016/j.oraloncology.2014.07.020.

6. Hassan O., Taha M., El Mehairy H. Sentinel lymph node biopsy versus elective neck dissection in evaluation of cN0 neck in patients with oral and oropharyngeal squamous cell carcinoma. Systematic review and meta-analysis study. Egypt J Ear Nose Throat Allied Sci 2015;16(1):25–34.

7. Schilling C., Stoeckli S.J., Haerle S.K. et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51(18):2777–84. DOI: 10.1016/j.ejca.2015.08.023.

8. Kanaev S.V., Novikov S.N., Krzhivitckiy P.I. et al. SPECT-CT visualization of sentinel lymph nodes and lymph flow from tongue cancer. Voprosy onkologii = Problems in Oncology 2019;65(2):250–5. (In Russ.)