A 55-year-old non-smoker, non-drinker male presents with a cystic neck mass at level II. Fine needle aspiration cytology shows squamous cells. p16 immunohistochemistry is strongly positive. The most appropriate next investigation is:
- A Open neck exploration and excision biopsy
- B Repeat FNAC with ultrasound guidance
- C PET-CT scan followed by panendoscopy and directed biopsies ✓
- D MRI of the neck to exclude branchial cyst
Correct answer: C. PET-CT scan followed by panendoscopy and directed biopsies
Explanation
A cystic level II neck mass with p16-positive squamous cells in a non-smoker is highly characteristic of HPV-related oropharyngeal squamous cell carcinoma with cystic nodal metastasis. PET-CT is the preferred investigation to identify the occult primary (most often in base of tongue or tonsil) and to define extent of disease before definitive treatment. Open excision is avoided as it compromises the neck and may worsen prognosis. Panendoscopy with biopsies of high-risk oropharyngeal subsites follows imaging.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.