The clinical importance of cystic squamous cell carcinomas in the neck

Abstract

In most cases of prominently cystic squamous cell carcinomas in the upper neck, the origin of the primary site will be in faucial or lingual tonsillar crypt epithelium. Knowledge of the probable site of origin allows for more tailored therapy in which the patients can be treated relatively conservatively with surgical excision and subsequent field-limited radiation therapy only, with 77% survival at 5 years. None of the cases reviewed in this study was a branchiogenic carcinoma.

Cystic lymph node metastases of squamous cell carcinoma of Waldeyer’s ring origin

“…in malignant melanoma (Clark et al, 1989;Barr, 1994) or head and neck tumours (Sessions and Hudkins, 1993). Partial or complete immunological regression (disappearance of the primary tumour) could serve as a plausible explanation for some so-called 'branchiogenic' carcinomas without a detectable primary SCC even after many years of follow-up (Martin et al, 1950;Thompson and Heffner, 1998).…”

“…For patients with an isolated finding of SCC in a neck LN, a search for a primary carcinoma in the upper aerodigestive tract is mandatory, including US, MRI and CT, as well as extensive biopsies of the base of tongue, nasopharynx and tonsillectomies in the case of clinically occult tumours (Spiro et al, 1983;Flanagan et al, 1994). This clinical practice has provided overwhelming evidence in recent years that isolated cystic SCC in neck LN are metastases from primary SCC of the palatine tonsils, the base of the tongue and the nasopharynx, tissues also collectively referred to as the Waldeyer's ring (Micheau et al, 1974(Micheau et al, , 1990Flanagan et al, 1994;Thompson and Heffner, 1998). Although this explanation has been slow to gain wide recognition and claims of the first true 'branchiogenic carcinoma' have been made rather recently (Micheau et al, 1974;Jones et al, 1993), cystic SCC in cervical LN is now regarded as a typical presentation of metastatic SCC arising in the oro/nasopharynx.…”

“…Although this explanation has been slow to gain wide recognition and claims of the first true 'branchiogenic carcinoma' have been made rather recently (Micheau et al, 1974;Jones et al, 1993), cystic SCC in cervical LN is now regarded as a typical presentation of metastatic SCC arising in the oro/nasopharynx. At the same time, the idea of a primary branchiogenic carcinoma has become a vanishing concept (Thompson and Heffner, 1998). Despite the body of literature about this topic, there is little information regarding the frequency of cystic LN metastases from SCC of the Waldeyer's ring.…”

Second Branchial Cleft Cyst

“…Nasopharyngeal carcinoma presenting clinically as a cystic lateral neck swelling as the initial presentation has been reported and could be misinterpreted as a second branchial cleft cyst. In one study of 136 cases, 8 % of cystic metastases in the lateral neck were of nasopharyngeal origin [13]. Using in situ hybridization PET-CT shows FDG uptake in the primary left palatine tonsil mass and contralateral node, but no FDG uptake in the predominately cystic node.…”

Cancer in branchial cleft cyst

“…Thompson i Heffner przeanalizowali 136 przypadków pod kątem wyżej wymienionych kryteriów i żaden nie okazał się prawdziwym rakiem w torbieli tylko przerzutem nowotworu do zmienionego torbielowato węzła chłon-nego szyi. Guz pierwotny był najczęściej zlokalizowany w obrębie migdał-ków podniebiennych i pierścienia chłonnego Waldeyera (63% -87 pacjentów), u 22 pacjentów wywodził się z nosowej części gardła, krtani, zatok przynosowych lub podniebienia, natomiast u pozostałych 27 osób nie można było zidentyfikować pierwotnej lokalizacji nowotworu [5].…”