Bradley Paula T, Bradley Patrick J
Department of ORL-HNS, The Freeman Hospital, Newcastle-upon-Tyne, UK.
Curr Opin Otolaryngol Head Neck Surg. 2013 Apr;21(2):118-23. doi: 10.1097/MOO.0b013e32835cebde.
With the recent changes in the cause of head and neck cancer and the association of cystic metastatic neck squamous cell carcinoma with human papilloma virus (HPV), patients who are diagnosed with a cystic lesion in their upper neck need thorough investigation before commencing any treatment.
The differential diagnosis of a cystic mass in the upper neck of an adult over the age of 40 years is a branchial cleft cyst, cystic metastatic squamous cell carcinoma or a branchial cleft cyst carcinoma (BCCC). Investigation must include diagnostic imaging, biopsy or excision biopsy of likely primary sites, such as oropharyngeal sub-sites, and testing for HPV, Epstein-Barr virus immunological status.
The existence of BCCC is an exceptional diagnosis, with less than 40 cases considered proven. Consensus agreement has been proposed on making such a diagnosis. The diagnosis of a BCCC should be one of exclusion rather than presumption, after all other possible diagnoses have been considered and excluded.
鉴于近期头颈癌病因的变化以及囊性转移性颈部鳞状细胞癌与人乳头瘤病毒（HPV）的关联，对于上颈部诊断出囊性病变的患者，在开始任何治疗前都需要进行全面检查。
40岁以上成年人上颈部囊性肿块的鉴别诊断包括鳃裂囊肿、囊性转移性鳞状细胞癌或鳃裂囊肿癌（BCCC）。检查必须包括诊断性影像学检查、对可能的原发部位（如口咽亚部位）进行活检或切除活检，以及检测HPV、爱泼斯坦 - 巴尔病毒免疫状态。
BCCC的存在是一种罕见诊断，经证实的病例不到40例。对于做出此类诊断已提出了共识意见。BCCC的诊断应是排除性诊断，而非推测性诊断，需在考虑并排除所有其他可能诊断之后。
