The diagnosis of primary malignant epithelial cervical nodes is applied to patients having epithelial metastatic ganglions where, despite complete and careful examinations of all systems, it was not possible to discover the primary cancerous focus. Many clinicians think that these tumors arise from epithelial degeneration of bronchial embryonic remnants in the latero-cervical region and group, without any anatomo-pathological proof, the total of these formations under the title of malignant branchioma. While some remnants may exceptionally degenerate, it still remains that the great majority of what one calls malignant branchioma, are nothing more than metastatic ganglions of the neck. This conception based on anatomo-pathological research is so close to reality that some practioners even doubt the existence of malignant branchiomas. During the last 15 years (1954–1969) 558 patients suffering from carcinoma of the oto-rhino-laryngological sphere have been hospitalized and regularly followed by the Geneva oto-rhino-laryngological clinic and polyclinic. Of this important material which we have studied with care, 12 cases (2.1%) of malignant cervical epithelial adenopathies, seemingly primary, were observed. The anatomopathological examination of these cervical tumors revealed in each case the picture of a metastatic invasion of the ganglion. In no case were we able to put in evidence kysts, or embryonic inclusions with or without degeneration. On the other hand, in studying the anatomo-pathological report of branchiogenic or thyreoglossal kysts operated in our clinic during the past 10 years, we found no trace of malignant transformation. Among our 12 patients, 3 (25%) died 8–12 months after the appearance of the first symptoms without having received any treatment. At the autopsy of 2 of them the primary tumor was found once at the level of the cavum, and once at the level of the parotid. The 3 other patients (25%) who received a partial treatment (removal of ganglions or cobalt therapy) died 6–16 months later, and at the autopsy we discovered in 2 cases the primary tumor (tonsil and parotid) while in the 3rd case all research remained in vain. Of the 6 other patients who received a complete treatment (surgery and radiotherapy over large areas), 4 (33%) are alive and present no further symptoms, 2 (17%) died, 1–3½ years after the first symptoms. The primary tumors in the 2 latter patients were found in the thyroid gland and in the bronches. The appearance of the primary tumor during the lifetime of the patienfs as well after the end of the treatment was observed in 2 of our patients. In 1 case it was found at the level of the piriform sinus 1½ years after the first symptoms, and in the other case at the level of the bronchi 3 years after their appearance.

Keywords:
Branchiogenic carcinoma, Cervical lymphnodes, Metastases
© 1971 S. Karger AG, Basel
1971
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