Metastatic squamous cell carcinoma of the gingiva appearing as a solitary branchial cyst carcinoma: diagnostic role of PET/CT.
We herein present a case of a left cervical cystic mass, for which the initial pathological diagnosis was branchial cleft cyst carcinoma (following complete mass excision). Thorough postoperative examinations, including with FDG positron emission tomography/computed tomography (PET/CT), revealed a primary tumor in the retromolar region of the left mandible. A 52-year-old female presented with a 2-month history of a painless, progressively enlarged left-sided neck mass. Fine-needle aspiration biopsy suggested a branchial cleft cyst. Physical examination revealed a 3 × 3-cm smooth, tender mass in the upper-left neck and anterior border of the sternocleidomastoid muscle. Examination using nasendoscopy and a strobolaryngoscope revealed no abnormalities of the nasal cavity, nasopharynx, oropharynx, hypopharynx or larynx. MRI of the neck revealed a solitary, round, cystic mass under the left parotid gland. The mass was excised completely. Pathologic results indicated a branchial cleft cyst carcinoma. According to the diagnostic criteria for a branchial cleft cystic carcinoma, PET/CT was performed to detect the occult primary site. PET/CT revealed high FDG uptake in the tooth root of the left mandible. Frozen sections of the mass were indicative of moderate, differentiated squamous cell carcinoma. The carcinoma in the retromolar region of the left mandible was locally excised under general anesthesia. A partial left maxillectomy, partial mandibulectomy, and left radical neck dissection were performed. The patient received postoperative concurrent chemoradiotherapy, and was disease-free at the 8-month follow-up. True branchial cleft cyst carcinoma is rare: once diagnosed, it should be distinguished from metastatic cystic cervical lymph and occult primary carcinoma. FDG PET/CT is useful in the identification of occult primary tumor.
Department of Anesthesiology The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Xiong-Xin
XX
Zhang
Department of PET/CT Center The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Kui
K
Zhao
Department of Otolaryngology The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Shui-Hong
SH
Zhou
Department of Otolaryngology The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Qin-Ying
QY
Wang
Department of Stomatology The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Jian-Hua
JH
Liu
Department of Radiotherapy, The First Affiliated Hospital, College of Medicine, Zhejiang University Zhejiang 310003, China.
Zhong-Jie
ZJ
Lu
D044963:Biopsy, Fine-Needle; D001935:Branchioma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D003937:Diagnosis, Differential; D005260:Female; D005887:Gingival Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D037981:Neck Dissection; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Branchial cleft cyst carcinoma; carcinoma of unknown primary site; metastatic cystic cervical lymph node; positron emission tomography/computed tomography