title: Metastatic squamous cell carcinoma of occult primary: beware the tonsillar remnant.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK. ricard.simo@gstt.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Simo
authors.forename: M
authors.initials: M
authors.lastname: O'Connell
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000473:pathology* / Q000628:therapy; D014068:Tonsillectomy / Q000009:adverse effects