Cinberg J Z, Silver C E, Molnar J J, Vogl S E
Laryngoscope. 1982 Jan;92(1):27-30. doi: 10.1288/00005537-198201000-00006.
A cystic neck mass can be either malignant or benign; 22% of patients (4/18) admitted with the tentative diagnosis of branchial cyst in a recent 2-year period (1977-1979) had metastatic carcinoma: epidermoid, thyroid or salivary gland. Preoperative fine needle aspiration was diagnostic in 1 instance and unhelpful in 2. Frozen section analysis of the gross specimen invariably provided the correct diagnosis. All patients with malignancies had subclinical primary disease and in 1 instance random biopsies identified its origin. The prudent surgeon will avoid untoward results if he approaches a neck cyst in an adult as if it were malignant. Guidelines he can follow to prevent the inadvertent removal of a metastasis under the misapprehension that it is a benign neck cyst include: 1. Prior to operation, perform a thorough head and neck examination to identify a primary carcinoma; 2. Do a fine needle aspiration of the mass for cytology. A negative report must be considered inconclusive; 3. Make a gross examination in the operating room of the opened cyst and frozen section processing of suspicious areas; 4. Follow with a panendoscopy and random biopsies of appropriate areas and complete the neck dissection on the involved side, after a metastatic deposit has been recognized. The preoperative procurement of contingency consent for these procedures is understood.
颈部囊性肿物可能是恶性的，也可能是良性的；在最近两年（1977 - 1979年）因初步诊断为鳃裂囊肿而入院的患者中，22%（4/18）患有转移性癌：表皮样癌、甲状腺癌或唾液腺癌。术前细针穿刺在1例中具有诊断价值，在2例中无帮助。大体标本的冰冻切片分析总能提供正确的诊断。所有患有恶性肿瘤的患者都有亚临床原发性疾病，在1例中随机活检确定了其起源。如果成年外科医生在处理颈部囊肿时将其视为恶性，就可以避免不良后果。他可以遵循的防止在误以为是良性颈部囊肿的情况下误切转移灶的指导原则包括：1. 手术前，对头颈部进行全面检查以确定原发性癌；2. 对肿物进行细针穿刺做细胞学检查。阴性报告必须视为不确定；3. 在手术室对切开的囊肿进行大体检查，并对可疑区域进行冰冻切片处理；4. 在识别出转移灶后，进行全腔镜检查并对适当区域进行随机活检，然后完成患侧的颈部清扫术。术前应就这些操作获取应急同意书。
