title: Cystic lymph node metastasis in patients with head and neck cancer: An HPV-associated phenomenon.
abstract: BACKGROUND
  : Cystic lymph node metastases have been associated with tonsil cancer. A subset of oropharyngeal cancers contain human papillomavirus (HPV) DNA. The clinical and virologic associations of cystic nodal metastasis in head and neck cancer (HNSCC) were investigated.
  
  
  METHODS
  : A retrospective review of patients undergoing neck dissection between 2002 and 2004 identified patients with cystic lymph node metastases. Clinical and pathologic information was recorded. The presence of HPV DNA was analyzed using in situ hybridization in a subset of patients.
  
  
  RESULTS
  : One hundred neck dissections were reviewed and 20 had cystic nodes. Seventeen of these patients had primary tumors arising in the palatine or lingual tonsil. Three were "unknown primary." HPV DNA was present in 11 of 13 patients with cystic metastases with tissue available for analysis (87%). No HPV DNA was identified in tumor from 21 patients with solid nodal metastasis (p <.0001).
  
  
  CONCLUSIONS
  : Cystic cervical lymph node metastasis is strongly associated with HPV-related tonsillar HNSCC: (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.
authors.affiliation: The Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Begum
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: Zubair
authors.initials: Z
authors.lastname: Khan
authors.forename: James
authors.initials: J
authors.lastname: Sciubba
authors.forename: Sara I
authors.initials: SI
authors.lastname: Pai
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Califano
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Koch
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000601:surgery / Q000821:virology*