Thompson L D, Heffner D K
Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Cancer. 1998 Mar 1;82(5):944-56. doi: 10.1002/(sici)1097-0142(19980301)82:5<944::aid-cncr21>3.0.co;2-#.
Predominantly cystic squamous cell carcinomas in the neck often present without a clinically apparent primary and therefore are frequently considered to be of branchial cleft origin. It is the authors' hypothesis that the anatomic site of the primary carcinoma that produced the neck metastasis can often be predicted on the basis of the histologic features.
Cases of cystic squamous cell carcinoma in the neck diagnosed between 1971 and 1991 were retrieved from the Otorhinolaryngic Pathology Registry of the Armed Forces Institute of Pathology. Histologic features were reviewed and patient follow-up was obtained and analyzed.
In cases wherein the primary site was discovered subsequently, 64% of the primaries were in the lingual or faucial tonsil. An additional 8% of cases were in nasopharyngeal tonsillar tissue. The cases that did not originate in Waldeyer's tonsillar ring generally differed in histologic appearance from the tonsillar cases. The tonsillar primaries were discovered within an average of 12.4 months, but many were not discovered for years (up to 11 years). Most were small, indicating a slower growth of the primary than is usually expected for squamous cell carcinoma. Patients with such carcinomas had a much better prognosis than patients with metastatic squamous cell carcinomas of other upper airway mucosal sites.
In most cases of prominently cystic squamous cell carcinomas in the upper neck, the origin of the primary site will be in faucial or lingual tonsillar crypt epithelium. Knowledge of the probable site of origin allows for more tailored therapy in which the patients can be treated relatively conservatively with surgical excision and subsequent field-limited radiation therapy only, with 77% survival at 5 years. None of the cases reviewed in this study was a branchiogenic carcinoma.
颈部以囊性为主的鳞状细胞癌通常在临床上没有明显的原发灶，因此常被认为起源于鳃裂。作者的假设是，根据组织学特征通常可以预测产生颈部转移瘤的原发癌的解剖部位。
从武装部队病理研究所的耳鼻咽喉病理学登记处检索1971年至1991年间诊断的颈部囊性鳞状细胞癌病例。回顾组织学特征并获得患者随访资料并进行分析。
在随后发现原发部位的病例中，64%的原发灶位于舌扁桃体或腭扁桃体。另外8%的病例位于鼻咽扁桃体组织。并非起源于瓦尔代尔扁桃体环的病例在组织学外观上通常与扁桃体病例不同。扁桃体原发灶平均在12.4个月内被发现，但许多病例多年（长达11年）未被发现。大多数原发灶较小，表明其生长速度比通常预期的鳞状细胞癌要慢。患有此类癌症的患者的预后比其他上呼吸道黏膜部位的转移性鳞状细胞癌患者要好得多。
在上颈部以囊性为主的鳞状细胞癌的大多数病例中，原发部位将起源于腭扁桃体或舌扁桃体隐窝上皮。了解可能的起源部位有助于采用更有针对性的治疗方法，即仅对患者进行相对保守的手术切除和随后的局部放疗，5年生存率为77%。本研究中回顾的病例均不是鳃源性癌。
