Cervical lymph node metastasis from occult tonsillar squamous cell carcinoma with incidental ectopic parathyroid tissue: a case report

Parathyroid glands originate from the third and fourth branchial pouches, and alterations in their embryological migration may result in ectopic parathyroid tissue, a rare finding, particularly within cervical lymph nodes. We describe the case of a 74-year-old man presenting with neck swelling, weight loss, dysphagia, and respiratory symptoms. Clinical examination revealed a firm cervical mass, while ultrasound, fine needle aspiration, and computed tomography imaging were inconclusive. Surgical excision and histopathological evaluation revealed metastatic squamous cell carcinoma and incidental ectopic parathyroid tissue within a cervical lymph node. A tonsillar carcinoma was subsequently identified as the primary tumor, and the patient was treated with radio-chemotherapy. This case highlights the rarity of ectopic parathyroid tissue in lymph nodes, especially in the absence of calcium metabolism disorders, and emphasizes the importance of accurate differential diagnosis to avoid misinterpretation and inappropriate management.