Abstract
Rationale:Human papillomavirus (HPV)-related oropharyngeal cancer is becoming more common, the primary cancer AQ4 usually occult and appearing only as cystic cervical lymph node (LN) metastasis. Distinguishing between a benign cystic lesion and cystic LN metastasis is challenging given their similar radiologic and histologic appearances.Patient concerns:A 54-year-old man presented with a bulging cystic mass measuring 6.4cm on the right side of neck.Diagnoses:Postexcision diagnosis was second branchial cleft cyst. After 2 years, the cystic mass recurred, and HPV-related tonsillar squamous cell carcinoma with cystic metastatic LNs was confirmed after wide tonsillectomy and neck dissection. The previous cystic lesion proved to be a cystic metastatic LN from the same malignancy with additional p16 immunostain.Interventions:The patient was treated with adjuvant concurrent chemoradiation therapy.Outcomes:The patient was followed up in the outpatient department with no evidence of recurrence after 1 year.Lessons:When an adult has a cystic mass in the upper neck, we must rigorously exclude it as a cystic metastatic LN of occult HPV-related oropharyngeal cancer. Additional p16 staining might be helpful.
Highlights
Human papillomavirus (HPV)-related oropharyngeal cancer is a distinct disease that has increased in incidence over recent decades
We present a case of occult HPV-related oropharyngeal cancer and solitary cystic lymph node (LN) metastasis with clinical, radiological, and pathological findings that mimic second branchial cleft cyst
HPV-related oropharyngeal cancer is well known for its varying epidemiology, etiology, clinical presentation, and prognosis
Summary
Human papillomavirus (HPV)-related oropharyngeal cancer is a distinct disease that has increased in incidence over recent decades. Solitary cystic metastatic lymph node of occult human papillomavirus-related oropharyngeal cancer mimicking second branchial cleft cyst. Delayed diagnosis of the malignant disease is associated with a poor survival rate.[4] Here, we present a case of occult HPV-related oropharyngeal cancer and solitary cystic LN metastasis with clinical, radiological, and pathological findings that mimic second branchial cleft cyst. The cystic metastatic LN in our case is the largest cystic lesion reported in the literature
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