gms | German Medical Science

76th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

04.05. - 08.05.2005, Erfurt

Status of tonsillectomy within CUP-syndrome showing metastases in cervical lymph nodes and negative PET

Meeting Abstract

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  • corresponding author Jan-Hendrik Krömer - HNO-Klinik des Universitätsklinikums Münster
  • Wolfgang Stoll - HNO-Klinik des Universitätsklinikums Münster
  • Frank Schmäl - HNO-Klinik des Universitätsklinikums Münster

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 76. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. Erfurt, 04.-08.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05hno057

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2005

© 2005 Krömer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Within CUP-syndrome detection of the primary tumor is obligatory before an operative treatment. In past years special meaning refers to PET (Positronen-Emissions-Tomographie) in this framework. Most studies showed PET was superior conventional picture-giving diagnostics and a primary tumor let itself localize in 25 to 50 percent. Disadvantage of this diagnostic tool is a low sensitivity within relatively small primary tumors (< 1 cm). This study reports several patients with a CUP-syndrome, inconspicuous PET within investigations of a possibly primary tumor and both-inspection was done carefully and palpates of inconspicuous tonsils as well- with which however itself after tonsillectomy a squamous cell carcinoma (PEC) had proved. All patients showed on lymph node positive side a malignant tonsillar tumor, up to a diameter > 2 cm; in one case diameter of tonsillar tumor was only 0,3 cm. On basis of these not rare results however following concept of CUP-syndrome had proved: with proof of a cervical lymph nodes (metastases) PET should be executed, a sonographic demonstration of abdominal structures as well as a neck-chest-CI with inconspicuous ENT investigations. With negative result, a panendoscopy with palpates of the tongue as well as a bilateral tonsillectomy is executed afterwards. A neck dissection needs to be done as well. Represented results substantiate out extraordinary status of tonsillectomy with inconspicuous mirror-results and negative PET regarding the prognosis. The overall 5-year survival is up to 100 percent on the basis of the minimal local tumor-expansion with additionally executed postoperative radiotherapy.