MALIGNIZED BRANCHIAL CYST OR CERVICAL METASTATIC ADENOPATHY WITH PRIMARY TUMOR IN A TONSILLAR HIDDEN CARCINOMA?

• Main Authors: Daniela Vrînceanu, M. Dumitru, Carmen Maria Ardeleanu
• Format: Article
• Language: English
• Published: Editura Universitara Carol Davila 2020-01-01
• Series: Journal of Surgical Sciences
• Subjects: primitive metastatic adenopathy; tonsil; surgery; adjuvant radiotherapy
• Online Access: http://journalofsurgicalsciences.com/index.php/jss/article/view/306

Cancer of occult origin is defined as a group of primary tumors with metastatic determinations, most commonly lymph nodes for which diagnostic algorithms fail to identify the place of origin of the primary tumor at the time of positive metastasis diagnosis. Squamous cell carcinoma with a truly unknown primary office is a relatively rare entity in the region of the head and neck. Retrospective studies suggest that it accounts for 1-3% of new cases of squamous cell carcinoma of the head and neck. We will present the clinical case of a 76-year-old patient with metastatic left-cervical cystic metastatic adenopathy, initially interpreted as a malignant branchial cyst. Discrepancies in histopathological examination, imaging and clinical examination delayed the performance of adjuvant radiotherapy. We will present details of diagnosis and evolution of the case. The results of the systematic literature review suggest that palatal tonsillectomy has a high overall rate of detection of subclinical primary tumors. Given the significant number of bilateral / contralateral occult tonsil tumors reported in the specialty literature, bilateral tonsillectomy should be considered in determining the diagnosis of squamous cell carcinoma patients of unknown primary origin in the head and neck. Cervical lymph node metastasis with unknown primary tumor remains a difficult topic for head and neck oncology. Most diagnostic and treatment protocols recommend unilateral or bilateral tonsillectomy, with an increased chance of finding an occult tumor in the palatine, unilateral or bilateral tonsils. In the presence of a cystic cervical lymph node metastasis, the first location should be considered as the primary tumor site must be the palatine tonsil.