Neck Metastasis From Burned-Out Tumor of the Testis: Diagnostic Pitfall for the Head and Neck Surgeon

Giancarlo Tirelli, Francesca Boscolo Nata, Nicoletta Gardenal
2019 Ear, nose, & throat journal  
Thirty-seven-year-old man came to our attention with a 2-month history of painless right neck mass and fatigue. Neck ultrasound showed a 2.5-cm wide solid mass in supraclavicular right fossa and multiple enlarged lymph nodes at right neck levels III to IV. Otolaryngological examination, even with narrowband imaging, was negative except for the neck mass. Fine-needle aspiration cytology (FNAC) revealed high-grade epithelial malignancy. Total body computed tomography (CT) evidenced multiple right
more » ... nced multiple right cervical enlarged lymph nodes at levels Ib to II, a 5-cm wide packet at levels IV to V and few enlarged lymph nodes in mediastinum ( Figure 1) . Abdomen, retroperitoneum, and central nervous system were negative. A positron emission tomography was performed in the hypothesis of nodal metastases from unknown primary. It showed elevated radioactivity in the neck and mild activity in mediastinum and right oropharyngeal tonsil. Intraoperative frozen section on Figure 1. Coronal (A) and axial (B) computed tomography images showing a 5-cm packet at levels IV and V of the right neck. Figure 2. Ultrasound images of the left testicle showing macrocalcification under the tunica albuginea.
doi:10.1177/0145561319881229 pmid:31597533 fatcat:s6y7o5v3sjaunkbyxcnagsf6vq