Cervical node metastases presenting with features of branchial cysts

Abstract

For many years it has been recognized that seemingly benign neck cysts may contain carcinoma. The true incidence is unknown. This paper investigated nine out of 270 patients presenting with a neck mass — which proved to contain a squamous carcinoma. Records (from a 30-year period) of over 3400 patients with squamous carcinoma of the head and neck, were examined. The histology slides were reviewed, the number of cystic lesions was noted and also the clinical outcome. Out of the 270 patients nine presented with a cystic lesion and these were studied. Six cystic lesions were originally diagnosed as branchial cysts although the youngest age was 39 years. All patients underwent a simple excision.In six cases the tonsil was the primary site, in one the primary was in the base of tongue and in two the primary remained occult. One-third of the patients had died of their disease by the time this report was written and the maximum follow-up time for the remaining patients was 18 months. Therefore 16 per cent of branchial cysts in this series represented metastases from squamous cell carcinoma.At the Royal Liverpool University Hospital only 25 patients had branchial cysts excised between 1988 and 1993: out of these only four contained squamous carcinoma.In patients over 40 years of age panendoscopy and ipsilateral tonsillectomy is mandatory prior to cyst excision.

The role of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary

“…18-FDG PET should precede panendoscopy, to target lesions for endoscopic biopsy and avoid artifactual uptake caused by mucosal trauma, especially at the biopsy site. Lymph node metastasis in the form of cystic adenopathy has been widely reported since the 1970s [2,[8][9][10]. Gourin and Johnson [11], in a series of 121 patients with cervical cystic adenopathy, found a 23.5% rate of metastatic adenopathy in over-40-year-olds.…”

Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management

“…Both SCC (most frequently of the tonsil) and papillary carcinoma of the thyroid may mimic a branchial cleft cyst. [9][10][11][12] To our knowledge, the positive predictive value of a pre-operative diagnosis of branchial cleft anomaly has not previously been assessed. Gourin and Johnson reported an incidence of malignancy of 9.9 per cent among patients presenting with a solitary lateral cervical cyst; however, all patients with a non-SCC histological diagnosis had been excluded from their study.…”

Mechanisms of cyst formation in metastatic lymph nodes of head and neck squamous cell carcinoma

“…In these cases, 72-90% of primary tumors, when detected, are located in Waldeyer's ring (base of the tongue, palatine tonsils, and nasopharynx) [2,3]. Larynx, hard palate, thyroid gland, salivary glands, sinuses [2,4], lung, uterine cervix [5] and esophagus [6] are the other probable sites but reported cases are rare.…”