Oropharyngeal metastatic squamous cell carcinoma masquerading as suppurative lymphadenitis.

Abstract

Background Metastatic oropharyngeal squamous cell carcinoma (SCC) often present with palpable, painless cervical lymphadenopathy. The incidence of this presenting as suppurative lymphadenitis is rare. We describe a rare presentation of oropharyngeal SCC presenting as suppuratives lymphadenitis. Case Report A 58-year-old non-smoker presented with a three-week history of a persisting upper respiratory tract infection, a one-week history of a gradually enlarging left neck mass, fevers and otalgia. The patient was otherwise well, with no significant travel or medical history. Clinically the patient was febrile, with mild trismus and tender left upper cervical lymphadenopathy, with normal findings on intraoral examination and flexible nasoendoscopy. The inflammatory markers were raised. Methods/Results The patient underwent CT and MRI of the head and neck that revealed extensive left cervical and retropharyngeal lymphadenopathy with significant fat stranding. Two fine needle aspirates were performed, revealing necrotic debris, poorly preserved cells, and cultures grew Streptococcus anginosus. A core biopsy revealed features in keeping with metastatic SCC. He was treated with appropriate antimicrobials, and repeat imaging confirmed improvement but not resolution of lymphadenopathy. Tonsillectomy confirmed a right tonsillar p16 positive moderate to poorly differentiated SCC. Conclusions Cervical lymphadenopathy is not uncommon following infections of various head and neck regions. A high index of suspicion for malignancy should be maintained to avoid a delayed or missed diagnosis.