Carcinomas of the oro/nasopharynx often present with regional lymph node (LN) metastases before the primary tumour is discovered. Some of the cervical LN metastases feature prominent cyst formation. Solitary cystic LN metastases have often been mistaken for primary squamous cell carcinomas (SCC) originating within a branchiogenic lateral neck cyst (LNC), resulting in the commonly used terms 'branchioma' and 'branchiogenic carcinoma ' (von Volkmann, 1882;Wolff et al, 1979;Khafif et al, 1989;Parks and Karmody, 1992;Carroll et al, 1993;Hall and Dexter, 1993;Flanagan et al, 1994;Knobber et al, 1995). 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. 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. Our goal was to establish the frequency of cystic LN metastases in our series of 123 patients with SCC of Waldeyer's ring origin who had been treated primarily surgically along with neck dissections. Furthermore, we discuss the morphological features and clues for establishing a diagnosis of cystic LN metastases rather than 'branchiogenic carcinoma'. 1984 and 1997, 108 patients with biopsy-proven SCC of Waldeyer's ring origin underwent neck dissections at the ORL Department of the University Hospital in Graz, Austria. Fifteen patients were treated at the Elisabethinen Hospital, Graz, Austria, between 1992 and 1997. Archival formalin-fixed, paraffinembedded haematoxylin and eosin (HE) stained sections of all primary SCC and their corresponding neck dissections were reviewed. SCC were separated into (1) tonsillar origin (palatine tonsil), (2) base of tongue origin and (3) nasopharyngeal origin. Extensive tumours involving the entire oropharynx, and multiple or synchronous intraoral carcinomas were not included in this study, because we were not able to determine the exact origin of the SCC in these cases. Initial diagnosis was established by biopsy and fol...

The use of rigid endoscopes in paranasal sinuses, nasopharynx and skull base surgery has extended and diversified, specifically for the treatment of malignant lesions of the nose and paranasal sinuses. We have endoscopically treated 33 patients with tumours of the skull base, paranasal sinuses and nasopharynx during the last 8 years (five patients with juvenile nasopharyngeal angiofibromas and 28 patients with various malignant tumours and T-classification). Endoscopic tumour surgery can be performed in patients of all age groups, even in the first days of life, using endoscopes of different diameters. Cosmetic results are excellent; there is no disfiguration of the face. Functional results are also excellent in terms of: organ preservation, minimal morbidity and rapid postoperative recovery and short hospitalisation. All these factors are essential for the patient's quality of life. Limitations of this technique, however, are found at the anatomical borders of the paranasal sinuses, when a tumour extensively infiltrates the orbit, the surrounding soft-tissue and skull base. However, very aggressive and extensive endoscopic surgery can be performed, e.g. removal of bone and dura of the anterior skull base, as well as resection of the periorbit and lateral nasal wall with the turbinates. Our results, with only a few recurrences after endoscopic endonasal tumour surgery, encourage us to use this procedure in selected cases as a reliable alternative to other techniques.

Summary A significant decrease in %IgG1 accompanied by an increase in %IgG2 in total serum IgG has been previously reported as a highly sensitive marker for detecting early stages of carcinomas of various localizations. Here we investigated the question as to whether this phenomenon is also observed in sera of patients with squamous cell carcinoma of the head-neck region (SCC-HN), and to evaluate its diagnostic performance in the post-operative monitoring. Using quantitative affinity chromatography, serum concentrations of IgG1, IgG2 and total IgG were determined in 81 patients with different stages of primary and untreated SCC-HN, in 51 SCC-HN patients in post-therapeutical follow up, and in 33 patients with organ matched benign diseases. The data were compared with a total of 174 healthy controls. It was found that (i) 105 SCC-HN patients exhibited a mean value of 56.0 ± 0.7% IgG1, which likewise differed from healthy controls (63.2 ± 0.5) and benign diseases (61.5 ± 1.0) with P < 0.0005, (ii) sensitivities and specificities for discriminating primary malignancies from healthy controls were 70 and 74% respectively, and from benign diseases 65 and 76%, (iii) highest sensitivities and specificities were observed with posttherapeutic cases suffering from tumour recurrence (88% and 75%) or patients with distant metastases (87% and 86%), (iv) apparently tumour-free post-therapeutic patients showed a mean %IgG1 not different from the normal value. The decrease in %IgG1 accompanied by increased %IgG2 is an efficient, sensitive and early marker of SCC-HN, which appears particularly useful for the post-therapeutic monitoring.

The shift in %IgG1/%IgG2 exhibited diagnostic sensitivities and specificities comparable to, or--particularly at early tumour stages--by far higher than conventional serological tumour markers. Whereas conventional serological markers directly correspond to tumourogenically derived products, the shift in %IgG1/IgG2 represents an indirect marker, consisting of a change of the host's immune system due to the presence of malignant tumours.

No abstract