Unexpected findings in neck dissection for squamous cell carcinoma: Incidence and implications

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Abstract
Background. During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. These pathologic findings may simulate malignant disease and/or have implications on the already complicated management of patients with head and neck cancer. Methods. We retrospectively reviewed 202 consecutive patients with a preoperative diagnosis of squamous cell carcinoma (SCC), who underwent 307 neck dissections performed by a single surgeon and examined by a single pathologist. Results. Ten patients had an unexpected finding. These included metastatic papillary thyroid carcinoma, leukemia, lymphoma, Warthin's tumor, and tuberculosis. Two of three patients with benign‐appearing thyroid tissue within lymph nodes received no further treatment, and both remained well beyond 6 years. Four patients succumbed to SCC; none died from the incidentally discovered pathologic findings. Conclusions. Unexpected pathologic findings may be present in more than 3% of neck dissections. Although this is usually indolent, with the underlying SCC remaining the main prognostic determinate, it may significantly complicate postoperative management. © 2004 Wiley Periodicals, Inc. Head Neck27: 28–35, 2005

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