Cystic cervical metastasis: A diagnostic dilemma

Metastasis of head neck squamous cell carcinoma to regional deep cervical nodes is a common and usually are bony hard, solid. But sometimes they may present as a cystic mass which makes it a diagnostic challenge, in absence of evident primary, for the treating doctor. Previously they have been labeled as cancers of branchial cleft cysts which have undergone malignant degeneration. With the advancement in understanding of tumor pathophysiology most researchers now have concluded that these are tumors from tissue of waldeyer’s ring which have the potential of producing cystic cervical metastasis. : A 57-year-old male presented to our department with a right side slow growing neck swelling for 2 years. The rest of ear, nose, throat examination was normal. The fine needle aspiration cytology revealed clear fluid. The diagnosis of branchial cleft cyst was made and patient counselled for surgery for benign lesion. After a period of one month the patient presented with change in voice, difficulty in swallowing and another swelling on left side of the neck. FNAC from the left side swelling revealed metastatic squamous cell carcinoma and PET-CT revealed a tongue base growth. Patient underwent an excision of growth from tongue base and neck dissection on both sides. Even for cystic neck swelling in an adult over 40 years of age, the possibility of malignancy should be kept, until proven otherwise.