中咽頭癌リンパ節転移が疑われたp16陽性鰓性癌例

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  • A Case of p16 Positive Branchiogenic Carcinoma Suspected as Lymph Node Metastasis from an Oropharyngeal Carcinoma
  • 臨床 中咽頭癌リンパ節転移が疑われたp16陽性鰓性癌例
  • リンショウ チュウ イントウガン リンパセツ テンイ ガ ウタガワレタ p16 ヨウセイシセイガンレイ

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Cases of branchiogenic carcinoma that strictly comply with the diagnostic criteria are rare. Human papillomavirus (HPV)-positive oropharyngeal carcinomas often manifest themselves as large and cystic lymph node metastases with a tiny primary lesion, mimicking branchiogenic carcinoma. We report herein on a case of branchiogenic carcinoma that was considered to be associated with HPV.<br> A 69-year-old man was referred to our department with a 2-week history of right-sided cervical swelling. Computed tomography revealed a multicystic mass measuring 35 mm in diameter in his right neck. The mass contained a small solid region, and a lymph node was seen anteroinferiorly to the cystic mass. Although a fine needle aspiration biopsy showed no malignancy, significant accumulation (SUVmax=5.3) was seen in the solid region of the mass on FDG-PET. We suspected lymph node metastasis, but failed to find a primary lesion with endoscopic and imaging examinations. The patient then underwent a biopsy of the lymph node, which turned out in frozen section analysis to be metastatic squamous cell carcinoma, suggesting cancer of an unknown primary. Conservative neck dissection (levels II-IV) was subsequently performed. The histopathological diagnosis was squamous cell carcinoma arising in a lateral cervical cyst. Immunohistochemically, the tumor was positive for p16, indicating the association with HPV. In order to examine for the presence of HPV-related cancer of the oropharynx, resection and histological examination of the palatine and lingual tonsils was performed, but no malignancy was detected. Under a definite diagnosis of branchiogenic carcinoma, the patient received postoperative concurrent chemoradiotherapy with carboplatin. He has been free from disease for 16 months after treatment.<br> To the best of our knowledge, this is the first case report on a p16-positive branchiogenic carcinoma. The relationship between the carcinogenesis of the lateral cervical cyst and HPV infection is unknown, and remains to be investigated.<br>

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