Head and neck surgeon Carole Fakhry, director of the Johns Hopkins Head and Neck Cancer Center, describes the case of an adult male patient with a neck mass mistaken for a branchial cleft cyst. Once pathology revealed HPV-positive squamous cell carcinoma, he was referred to Johns Hopkins for further management. The patient met with the center’s multidisciplinary team and elected to proceed with a robotic transoral resection of the oropharynx tumor and completion neck dissection with adjuvant radiation therapy.
Yeah. So this patient presented to us about five years ago. He had noticed a neck lump and saw an outside otolaryngologist who obtained a fine needle aspiration and a CT scan. The fine needle aspiration was indeterminant, and the CT scan was suggestive on his read of a bronchial cleft cyst. This is quite unusual. In a 60 to 70 year old male. He took him to the operating room to excise the neck mass, and it turned out to be a squamous cell carcinoma in a tree positive squamous cell carcinoma. At that time, he was referred to us for further management. Um, the patient had what appeared to be a small tumor in his glass of consular sulcus and, uh, no residual limb fadden apathy. On further imaging, he saw the radiation oncologist, medical oncologist, speech language pathologist and the rest of our team. Together, we all decided on, uh, proceeding with the trans oral reception of his, uh, or pharynx tumor and a completion neck dissection with the hope of giving him pageant radiation therapy. He also considered the option of chemo radiation therapy without surgery. Um, he elected to proceed with a robotic approach in the neck dissection. Um, he got negative margins, And, uh, there was one additional lymph node. Um, that was identified to be pathologic, um, after the next day section. So he ended up having a t two a and two b m zero squamous cell carcinoma. HBV positive t two n one. Um, issue positive squamous cell carcinoma using the eighth edition. Uh, a JCC staging. Um, he received adjuvant radiation therapy. Um, since he had one additional lymph node and had negative margins, um, but did not need any chemotherapy since he did not have any extra nodal extension. He's now five years out from treatment and doing well mhm.