Abstract
We encountered a patient with a cystic neck metastasis from oropharyngeal carcinoma, which was detected after extraction of a cystic neck mass under the diagnosis of a lateral cervical cyst. The patient was a 64-year-old woman with a one-month history of swelling in the left side of the neck. The swelling was diagnosed preoperatively as a lateral cervical cyst, however, histopathological examination of the resected specimen revealed the diagnosis of squamous cell carcinoma (SCC). One year and ten months later, when the patient presented with a new swelling in the left-upper-neck region, she was referred to another medical institution for further examination and treatment. Transoral endoscopic examination with NBI revealed the primary lesion in the left palatine tonsil; biopsy revealed SCC and the specimen was positive for p16. Reexamination of the previous cystic specimen suggested that it might have been a p16-positive lymph node metastasis from the overlooked tonsillar cancer.
Lymph node metastases from HPV-positive oropharyngeal cancer tend to show cystic degeneration, and sometimes appear as neck metastases from cancer of unknown primary origin. Care must be taken when examining the cystic mass, with the possibility of oropharyngeal cancer borne in mind.
