Oncologic rationale for bilateral tonsillectomy in head and neck squamous cell carcinoma of unknown primary source.
OBJECTIVE
To demonstrate an oncologic basis for the recommendation to perform bilateral tonsillectomy as a routine measure in the search for a primary mucosal lesion in patients presenting with cervical nodal metastasis of squamous cell carcinoma (SCC).


METHODS
A case series of individuals selected from a 3-year period is reported.


METHODS
Academic medical center.


RESULTS
Each individual presented with metastatic squamous cell carcinoma in a cervical lymph node from an unknown primary source. In each case, the primary source was identified in a tonsillectomy specimen, either located contralateral to the node, or in both tonsils.


CONCLUSIONS
The rate of contralateral spread of metastatic cancer from occult tonsil lesions appears to approach 10%. For this reason, bilateral tonsillectomy is recommended as a routine step in the search for the occult primary in patients presenting with cervical metastasis of SCC and palatine tonsils intact.
Johns Hopkins University, Department of Otolaryngology-Head and Neck Surgery.
W M
WM
Koch
N
N
Bhatti
M F
MF
Williams
D W
DW
Eisele
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000556:secondary*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000601:surgery*; D014067:Tonsillar Neoplasms / Q000601:surgery; D014068:Tonsillectomy / Q000379:methods*