Clinical manifestations: complaints relating to the primary tumor. Symptoms may be caused by mass effects such as superior and inferior vena cava syndrome
Diagnosis: sonography; FNAB: cytology aids in locating the primary tumor. Other
modalities that can aid the search for an occult primary tumor are chest radiography and fluoroscopy, thoracic and/or abdominal CT, pelvic CT, and endoscopy.
Sonographic findings: Round lesions of varying echogenicity, depending on the
primary tumor; in the CDS tumor vascularisation
Accuracy of sonographic diagnosis: Sonography alone cannot positively distinguish a benign lymph node from a metastasis. Suggestive criteria are illustrated
Lymph node metastasis: large tumor mass in the left inguinal region; metastasis from an ovarial carcinoma. May be confused with a
hernia. The punctate vascularization in the CDS suggests the tumor genesis