2021 Volume 72 Issue 1 Pages 30-37
Late one October, a 54-year-old woman experienced swelling and reddening in the left neck after taking cold medication. The following month, she underwent a check-up at our hospital by the ENT physician who had treated her previously. Although there was no typical focal oral and throat inflammation, she was diagnosed with left deep neck abscess based on clinical and computed tomography (CT) findings. An operation for abscess drainage was performed immediately. One month after reduction in inflammation, a lesion was suspected. A lateral cervical lesion was revealed on the CT scan taken during the first surgery. This lesion was removed in a second surgery the following month. It was a solid tumor with a film coating. Based on histopathological diagnosis, it was identified as lymph node metastasis comprising p16 positive squamous cell carcinoma. As her primary lesion was not identified in a positron emission tomography-CT scan, she was finally diagnosed with human papillomavirus (HPV) -associated oropharyngeal carcinoma based on the diagnostic criteria of the Union for International Cancer Control (8th edition). Six months after the first medical examination, she underwent left neck dissection and chemoradiotherapy. Based on our therapeutic experience and previous reports, we recommend that the possibility of occurrence of malignant lesions in cases of deep neck infections should not be ignored, even in the absence of typical focal oral and throat inflammation. Especially, if there is a single lesion in the cervical area, we should consider the presence of malignant tumors such as HPV-associated oropharyngeal carcinoma. Although clinical examination did not confirm the lesion as malignant, in this case, we administered treatment considering the lesion a malignant tumor.
