Cystic lymph node metastases of head and neck squamous cell carcinoma: pitfalls and controversies.
ABSTRACT Lymph node metastases of squamous cell carcinomas in the neck can appear cystic. Without a clinically apparent primary tumour they can classically be considered to originate in a branchial cleft. We report two cases of cystic squamous cell carcinoma with histopathologic criteria of branchial cleft carcinoma. After a review of the literature, diagnostic strategies, histopathologic features, and therapeutic options for this very controversial clinical situation are discussed. We conclude by suggesting that Martin's criteria, largely used to differentiate between a cystic metastasis of a squamous cell carcinoma and a very theoretical branchial cleft carcinoma should be abandoned for lack of applicability.
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ABSTRACT: PURPOSE OF REVIEW: With the recent changes in the cause of head and neck cancer and the association of cystic metastatic neck squamous cell carcinoma with human papilloma virus (HPV), patients who are diagnosed with a cystic lesion in their upper neck need thorough investigation before commencing any treatment. RECENT FINDINGS: The differential diagnosis of a cystic mass in the upper neck of an adult over the age of 40 years is a branchial cleft cyst, cystic metastatic squamous cell carcinoma or a branchial cleft cyst carcinoma (BCCC). Investigation must include diagnostic imaging, biopsy or excision biopsy of likely primary sites, such as oropharyngeal sub-sites, and testing for HPV, Epstein-Barr virus immunological status. SUMMARY: The existence of BCCC is an exceptional diagnosis, with less than 40 cases considered proven. Consensus agreement has been proposed on making such a diagnosis. The diagnosis of a BCCC should be one of exclusion rather than presumption, after all other possible diagnoses have been considered and excluded.Current opinion in otolaryngology & head and neck surgery 01/2013;
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ABSTRACT: We report the case of a 66-year-old man with a cervical neck mass located behind the left sternocleidomastoid muscle. To exclude malignancy, a full workup, including clinical, radiological, and cytological examination, was performed but failed to provide a definitive diagnosis. Histological analysis following excisional biopsy revealed a benign epithelial cyst, consistent with an atypically located branchial cyst. We describe an approach to the management of these neck masses and discuss several theories of the etiology of branchial cysts and how they may come to be abnormally located.Case reports in otolaryngology. 01/2014; 2014:912347.
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ABSTRACT: A case of squamous cell carcinoma of the base of tongue presenting initially as a cystic metastasis in the contralateral neck is described. The patient complained of a painless mass in the left neck, which was removed and histologically diagnosed as cystic malignancy. One year and seven months after the removal, a squamous cell carcinoma of the right tongue base and cystic metastases of the right neck were discovered. The histologic similarity among these three lesions strongly indicated the cystic metastases in the bilateral neck were from the squamous cell carcinoma of the tongue base.Oral Oncology Extra 01/2006; 42(2):56-59.