The utility of ultrasonographic surveillance in management of a presumed branchial cleft cyst later confirmed HPV-associated oropharyngeal cancer

Authors

Tatiana Ferraro, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA; Drexel University College of Medicine, Philadelphia, PA, USA. Electronic address: tferraro@mfa.gwu.edu.
Alisha R. Pershad, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA.
Shaleen Arora, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA.
Esther Lee, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA.
Arjun Joshi, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, 2300 M St NW, 4(th) Floor, Washington, DC 20037, USA.

Document Type

Journal Article

Publication Date

4-1-2024

Journal

Oral oncology

Volume

151

DOI

10.1016/j.oraloncology.2024.106743

Keywords

Branchial cleft cyst; Head and neck cancer; Human papillomavirus; Oropharyngeal cancer; Ultrasound

Abstract

While branchial cleft cysts are often considered benign pathologies, the literature discusses cases of squamous cell carcinoma (SCC) arising from these cystic lesions as either a primary or metastatic tumor. We illustrate our institutional experience and review the current literature to identify recommendations for best diagnostic, surveillance, and treatment guidelines for SCC identified in a branchial cleft cyst. A 61-year-old male presented with a right sided neck mass, with suspicion of a branchial cleft cyst due to benign findings on fine needle aspiration. Following surgical excision, a focus of SCC was found on surgical pathology. Despite PET/CT and flexible laryngoscopy, no primary tumor was identified prompting routine surveillance every 3 months with cervical ultrasonography and flexible nasolaryngoscopy. Two and a half years following his initial presentation, pathologic right level II lymphadenopathy was detected on ultrasound without evidence of primary tumor. Subsequent transoral robotic surgery with right tonsillectomy and partial pharyngectomy, with right lateral neck dissection revealed a diagnosis of pT1N1 HPV-HNSCC and he was referred for adjuvant chemotherapy and radiation. To our knowledge there are less than 10 cases of confirmed HPV-associated oropharyngeal SCC arising from a branchial cleft cyst. Here we demonstrate the utility of ultrasound as a surveillance tool and emphasize a higher index of suspicion for carcinoma in adult patients with cystic neck masses.

APA Citation

Ferraro, Tatiana; Pershad, Alisha R.; Arora, Shaleen; Lee, Esther; and Joshi, Arjun, "The utility of ultrasonographic surveillance in management of a presumed branchial cleft cyst later confirmed HPV-associated oropharyngeal cancer" (2024). GW Authored Works. Paper 4805.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4805

Department

Surgery