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Title: [Analysis of cases of cervical cystic lymph node metastasis with an unknown primary misdiagnosed as branchial cleft carcinoma].
Author: Liu Q, Luo JW.
Journal: Zhonghua Zhong Liu Za Zhi; 2024 Jun 23; 46(6):583-589. PubMed ID: 38880737.
Abstract:
Objectives: To analyze the location, discovery time and possible causes of cases of cervical cystic lymph node metastasis with an unknown primary misdiagnosed as branchial cleft carcinoma. Methods: A retrospective analysis was performed on clinical and pathological data of 15 patients misdiagnosed as branchiogenic carcinoma at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2000 and December 2020. Results: Among the 15 patients, 6 were nasopharyngeal squamous cell carcinoma, 4 tonsil squamous cell carcinoma, 2 tongue root squamous cell carcinoma, 2 hypopharyngeal squamous cell carcinoma and 1 thyroid papillary carcinoma. The median time from the diagnosis of branchial cleft carcinoma to the discovery of primary lesions was 3.58 months (0-76 months). The causes of misdiagnosis might be the lack of experience in the diagnosis and treatment of branchial cleft carcinoma, and not enough attention to comprehensive examination and close follow-up. Conclusions: Different from oropharyngeal cancer reported internationally, the proportion of misdiagnosed cases with nasopharyngeal carcinoma as the primary site in the current article is higher. As a country with a high incidence of nasopharyngeal carcinoma, the examination of nasopharynx should not be taken lightly. Most hidden cases can be found in the comprehensive examination in a short time, while a few cases need long-term follow-up. Finding the primary sites should not rely too much on imaging examination, and we cannot ignore the importance of clinical physical examination. 目的： 探讨鳃裂癌的原发灶发生部位、发现时间及可能的误诊原因，为临床诊治提供经验。 方法： 回顾性收集2000年1月至2020年12月中国医学科学院肿瘤医院收治的经病理诊断为鳃裂癌患者的临床病理资料，对15例误诊为鳃裂癌患者的临床资料以及临床诊疗进行回顾性分析。 结果： 15例误诊患者中，鼻咽鳞状细胞癌6例，扁桃体鳞状细胞癌4例，舌根鳞状细胞癌2例，下咽鳞状细胞癌2例，甲状腺乳头状癌1例。从诊断鳃裂癌到发现原发灶的中位时间为3.58个月（0～76个月）。误诊原因可能是对于鳃裂癌及发生囊性变的颈部淋巴结转移癌的诊治经验不足以及没有重视全面检查及密切随诊。 结论： 以鼻咽癌为原发灶的病例误诊为鳃裂癌的占比较高，作为鼻咽癌高发国家，一定要重视鼻咽部位的检查。多数隐匿患者能够于术后完善检查中发现原发灶，少数患者需长期随访观察。寻找原发灶不应过度依赖影像学检查，临床查体的重要性不可忽视。.

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