Unexpected findings in neck dissection for squamous cell carcinoma: Incidence and implications

Abstract

Background. During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. These pathologic findings may simulate malignant disease and/or have implications on the already complicated management of patients with head and neck cancer.Methods. We retrospectively reviewed 202 consecutive patients with a preoperative diagnosis of squamous cell carcinoma (SCC), who underwent 307 neck dissections performed by a single surgeon and examined by a single pathologist.Results. Ten patients had an unexpected finding. These included metastatic papillary thyroid carcinoma, leukemia, lymphoma, Warthin's tumor, and tuberculosis. Two of three patients with benign-appearing thyroid tissue within lymph nodes received no further treatment, and both remained well beyond 6 years. Four patients succumbed to SCC; none died from the incidentally discovered pathologic findings.Conclusions. Unexpected pathologic findings may be present in more than 3% of neck dissections. Although this is usually indolent, with the underlying SCC remaining the main prognostic determinate, it may significantly complicate postoperative management.

Paediatric thyroid carcinoma in disguise: papillary thyroid carcinoma presenting with thyrotoxicosis and diffuse goiter

“…The presence of thyroid tissue within lymph nodes is the most common incidental finding in neck dissection specimens [5]. Benign causes, e.g.…”

Incidental thyroid carcinoma found during surgery for laryngeal carcinoma: a case report

“…İleri evre larenks karsinomlu olgularda primer larenkse yönelik cerrahi yaklaşımda tiroid bezine yönelik farklı yaklaşımlar bulunsa da [12] biz, geniş-letilmiş cerrahi yaklaşımını önermekteyiz. Bu olgularda ikinci bir tiroid kanseri olasılığı ya da tiroid bezine larenks kanseri yayılımı açısından ameliyat öncesi tiroid bezi yakından incelenmelidir.…”

“…Bu sayede olgu ikinci bir ameliyattan kurtarılmış olacaktır. [12][13][14] Mevcut inceleme ve klinik değerlendirmeye rağmen ameliyat sonrası histopatolojik incelemede tiroid karsinomu ile karşılaşabileceğimizi ve tamamlayıcı bir cerrahiye gidilebileceğini her zaman aklımızda bulundurmak gerekmektedir. Larenks karsinomu tanısıyla cerrahi planlanan olguların detaylı ve özenli klinik incelemelerinin yanı sıra, ikinci primer olarak olası tiroid kanserleri açısından tiroid bezi ve boyun görüntüleme incelemelerinde ek hassasiyet gösterilmelidir.…”

Warthin’s Tumor at the Brazilian National Cancer Institute: Additional Evidence of Homogeneous Sex Prevalence and Association with Other Neoplasms

“…This was further confirmed by the microscopic absence of normal salivary gland tissue adjacent to the neoplasms. Other authors reported up to 8% of WT in cervical lymph nodes [4,26] . In addition, we also identified 1 patient with a WT of the inferior lip.…”

“…In a small subset, WT was accidentally discovered in the assessment of other primary lesions (6.2%). Parotid and extraparotid WT have been included among the possible unexpected surgical or pathological findings in neck dissection for malignancies of the head and neck [25,26] . WT has been considered an indolent benign neoplasm, with very few recurrences after surgical treatment [3,11] .…”