Cystic Metastatic Nasopharyngeal Carcinoma Presenting as Branchial Cleft Cyst: Report of Two Cases and Review of the Literature

Zhang, Guo Zhi; Liu, Zi Long; Gong, Jun; Cheng, Zhi Qiang; Ke, ChaoYang

doi:10.1016/j.joms.2014.05.020

Cited by 7 publications

(5 citation statements)

References 47 publications

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“…91 It should be noted that, similar to oropharyngeal SCC, NPC may also present with cystic lymph node metastasis in the neck. 92 Thompson and Heffner reported that of 136 cystic neck metastases, 8% were derived from the nasopharynx 93 and the corresponding figure in another study was 1.8%. 94 In addition to what has been mentioned above regarding very early and subclinical disease when endoscopic examination of the posterior nasal space (PNS) most commonly is normal, a normal-appearing nasopharynx may be encountered in clinically advanced/symptomatic patients.…”

Section: Clinical Featuresmentioning

confidence: 90%

Nasopharyngeal carcinoma: A review

Petersson

2015

Seminars in Diagnostic Pathology

173

146

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Section: Clinical Featuresmentioning

confidence: 90%

Nasopharyngeal carcinoma: A review

Petersson

2015

Seminars in Diagnostic Pathology

173

146

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“…While the nodal metastatic lesion will be irregular, with peripheral contrast enhancement, invasion of adjacent structures, internal vascularization, heterogeneous center and internal septations. 4 PET-CT, as in our case is helpful to identify unknown primary and also rule out chest metastasis, in patients presenting with secondaries, but negative clinical and radiological work-up. 11…”

Section: Discussionmentioning

confidence: 57%

Cystic cervical metastasis: A diagnostic dilemma

Singh

Gupta

Kaur³

et al. 2021

IJOAS

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Metastasis of head neck squamous cell carcinoma to regional deep cervical nodes is a common and usually are bony hard, solid. But sometimes they may present as a cystic mass which makes it a diagnostic challenge, in absence of evident primary, for the treating doctor. Previously they have been labeled as cancers of branchial cleft cysts which have undergone malignant degeneration. With the advancement in understanding of tumor pathophysiology most researchers now have concluded that these are tumors from tissue of waldeyer’s ring which have the potential of producing cystic cervical metastasis. : A 57-year-old male presented to our department with a right side slow growing neck swelling for 2 years. The rest of ear, nose, throat examination was normal. The fine needle aspiration cytology revealed clear fluid. The diagnosis of branchial cleft cyst was made and patient counselled for surgery for benign lesion. After a period of one month the patient presented with change in voice, difficulty in swallowing and another swelling on left side of the neck. FNAC from the left side swelling revealed metastatic squamous cell carcinoma and PET-CT revealed a tongue base growth. Patient underwent an excision of growth from tongue base and neck dissection on both sides. Even for cystic neck swelling in an adult over 40 years of age, the possibility of malignancy should be kept, until proven otherwise.

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“…It has been reported that 72–90% of cervical squamous cell carcinoma metastases are from Waldeyer’s ring (base of tongue, palatine tonsils and nasopharynx) [ 18 , 36 , 37 ], and other sites, including the larynx, hard palatine, and thyroid gland, are rare [ 10 ]. Zhang et al [ 8 ] reported two cases with cervical cystic masses, which were diagnosed as malignant after surgical excision. The final diagnosis was nasopharyngeal carcinoma with neck metastasis determined by biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical cystic masses are associated with a number of conditions that often present similar symptoms, including branchial cleft cysts (BCC), branchiogenic carcinomas (BC) and cervical cystic CUP [ 7 – 9 ]. However, these conditions are difficult to differentiate from each other by fine-needle aspiration (FNA), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) [ 8 ]. Among these lesions, BCC is the most common, which results from the incomplete obliteration of the embryonal branchial apparatus and is lined by stratified squamous epithelium histologically [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Small cancerous lesions may remain unidentified using 18F 2-fluoro-2-deoxy-D-glucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) [ 17 ] and hence limit its role in the differentiation between cervical cystic CUP and BC. Therefore, cervical cystic CUP may easily be misdiagnosed as BC [ 8 ] or BCC, preoperatively [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cervical metastasis of gingival carcinoma misdiagnosed as branchiogenic carcinoma, a rare entity - report of a case and review of literature

Sun¹,

Chen²,

Sun³

et al. 2017

BMC Oral Health

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BackgroundA cervical cystic mass is associated with a number of pathologies that present with similar symptoms. These conditions are difficult to differentiate using fine-needle aspiration (FNA), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Another dilemma in the differential diagnosis of cervical cystic masses is due to the controversies associated with the existence of branchiogenic carcinoma (BC). BC is an extremely rare disease that must be differentiated from other conditions presenting with cervical cystic masses, especially cystic metastasis from occult primary lesions.Case presentationWe present a case report of a right cervical cystic metastasis from a significantly small squamous cell carcinoma primary gingival lesion misdiagnosed as BC by histopathology. A 62-year-old female presented with a painless progressively enlarging cervical mass at the anterior edge of the sternocleidomastoid muscle in the right submandibular region. Preoperative MRI and US revealed a well-defined cystic round mass. Postoperative histological examination indicated BC. Positron emission tomography/computed tomography (PET/CT) revealed high 18F–FDG (18F 2-fluoro-2-deoxy-D-glucose) uptake in surgical regions with a SUV (standard uptake value) max 4.0 and ipsilateral nasopharynx with a SUVmax 4.4, without any distant metastasis. Pathologic results revealed nasopharyngeal lymphadenosis. Considering the low incidence of BC and the limitation of diagnosis in one institution, the patient was referred to another hospital. Physical examination detected a significantly small neoplasm (~3 mm diameter) in the right lower gingiva. Histopathological examination of the neoplasm revealed a well-differentiated squamous cell carcinoma. Surgery, including a partial mandibulectomy and modified neck dissection (neck level I–V and submental lymph nodes) were undertaken. Postoperative histopathological results revealed a well-differentiated squamous cell carcinoma of right lower gingiva and two metastatic lymph nodes in the 18 lymph nodes of level II. A month later, recurrence occurred in the right cervical level II. The patient was placed on postoperative concurrent chemo-radiotherapy and supportive care. The patient suffered from cachexia and survived for only six months after surgery.ConclusionsIn cases of cervical cystic masses that appear after the age of 40, clinicians should bear in mind that occult primary lesions should be excluded and examination of the gingiva should be undertaken. PET/CT has a limited role in identifying small occult primary lesions and a comprehensive physical examination must be carefully performed.

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Cystic Metastatic Nasopharyngeal Carcinoma Presenting as Branchial Cleft Cyst: Report of Two Cases and Review of the Literature

Cited by 7 publications

References 47 publications

Nasopharyngeal carcinoma: A review

Nasopharyngeal carcinoma: A review

Cystic cervical metastasis: A diagnostic dilemma

Cervical metastasis of gingival carcinoma misdiagnosed as branchiogenic carcinoma, a rare entity - report of a case and review of literature

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