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Introduction:

Metastasis of squamous cell carcinoma to the neck with an occult primary is a recognised clinical and pathological entity. Despite well established diagnostic protocols, this condition still represents a management challenge.

Case report:

We report the case of a 46-year-old man who presented with metastatic cervical lymphadenopathy of unknown origin. He had undergone tonsillectomy as a child. The only abnormal finding was the presence of a tonsillar remnant, which harboured the primary carcinoma.

Conclusion:

According to our literature search, this is the only recorded case in which the index tumour was found in a tonsillar remnant. This case illustrates the importance of thorough clinical examination in patients with potential unknown primaries, and of the need, in previously tonsillectomised patients, to perform excisional biopsy of the tonsillar remnant.

We present the second case of primary synchronous bilateral tonsillar squamous cell carcinoma reported in the English literature and evaluate the role of fluoro-deoxyglucose positron emission tomography scanning in the search for the occult primary tumour in a patient presenting with metastatic nodal disease in the head and neck.

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Metastatic squamous cell carcinoma of occult primary: beware the tonsillar remnant

Synchronous bilateral tonsillar carcinoma: role of fluoro-deoxyglucose positron emission tomography scanning in detecting occult primary tumours in metastatic nodal disease of the head and neck

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Metastatic squamous cell carcinoma of occult primary: beware the tonsillar remnant

Synchronous bilateral tonsillar carcinoma: role of fluoro-deoxyglucose positron emission tomography scanning in detecting occult primary tumours in metastatic nodal disease of the head and neck