A 55-year-old man with a 30 pack-year smoking history presents with a 2 cm right level II neck mass. Contrast-enhanced CT shows a well-defined, round, hypodense necrotic lymph node. Fine needle aspiration reveals squamous cell carcinoma. The most likely primary site is:

• A Larynx
• B Nasopharynx
• C Hypopharynx
• D Oropharynx (base of tongue/tonsil) ✓

Explanation

In adults, a necrotic level II lymph node with squamous cell carcinoma metastasis in a smoker most commonly originates from the oropharynx, particularly HPV-related tonsillar or base of tongue carcinoma, which is rising in incidence. While laryngeal and hypopharyngeal primaries can present with nodal metastases, oropharyngeal primaries are the most common cause of occult primary with necrotic cervical nodes in this demographic.

Reference: Cummings Otolaryngology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.