Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma

We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans.

We retrospectively reviewed 410 patients (369 males, 41 females; 169 patients unilateral, 241 patients bilateral) with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections.

Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients (2%), metastatic papillary thyroid carcinoma in three patients (0.7%), Warthin,s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin,s tumor since these patients did not continue their routine examinations.

During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.