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

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.

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.

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.