Unexpected findings in neck dissection for squamous cell carcinoma: incidence and implications.
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.
Sheahan
Patrick
P
Department of Otolaryngology, St. James Hospital, 17 Hampton Square, Navan Road, Dublin 7, Ireland. sheahanp@eircom.net
Hafidh
Maky
M
Toner
Mary
M
Timon
Conrad
C
D000235:Adenolymphoma / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000473:pathology / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003413:Cricoid Cartilage / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology / Q000628:therapy; D008207:Lymphatic Metastasis; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery; D013965:Thyroidectomy; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy / Q000473:pathology