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Metastatic squamous cell carcinoma of occult primary: beware the tonsillar remnant

Published online by Cambridge University Press:  11 June 2007

R Simo  and
M O'Connell
R Simo*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
M O'Connell
Affiliation:
Department of Radiotherapy and Clinical Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
*
Address for correspondence: Mr Ricard Simo, Department of Otorhinolaryngology, Head and Neck Surgery, 3rd Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK. Fax: 020 7188 2206 E-mail: ricard.simo@gstt.nhs.uk
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Abstract

Introduction:

Metastasis of squamous cell carcinoma to the neck with an occult primary is a recognised clinical and pathological entity. Despite well established diagnostic protocols, this condition still represents a management challenge.

Case report:

We report the case of a 46-year-old man who presented with metastatic cervical lymphadenopathy of unknown origin. He had undergone tonsillectomy as a child. The only abnormal finding was the presence of a tonsillar remnant, which harboured the primary carcinoma.

Conclusion:

According to our literature search, this is the only recorded case in which the index tumour was found in a tonsillar remnant. This case illustrates the importance of thorough clinical examination in patients with potential unknown primaries, and of the need, in previously tonsillectomised patients, to perform excisional biopsy of the tonsillar remnant.

Keywords

Head and Neck NeoplasmsNeoplasms, Occult PrimaryTonsil
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 6 , June 2008 , pp. 641 - 643
Copyright
Copyright © JLO (1984) Limited 2007

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