Cystic metastases in the neck revealing occult carcinoma of the tonsil.A report of six cases

Abstract

This study deals with a peculiar aspect of lymph node metastases observed in 6 patients with carcinoma of the tonsil. These metastases preceded the occurrence of the primary tumor. The metastases were solitary and consisted of a cystic, ovoid, and regular mass in the upper part of the neck. They exhibited the usual appearance of branchial cysts. The microscopic examination revealed in every case poorly differentiated carcinomas with the pattern of an amygdaloid cyst. As a result, the neck tumor was misinterpreted in five cases and the diagnoses were branchial cyst, amygdaloid cyst, cyst with carcinomatous change, and epidermoid cyst. For the sixth patient, the occult tonsillar carcinoma was discovered from the peculiar appearance of the neck metastasis. The authors discuss the clinical and pathologic features of these metastases.