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known primary tumours found below the clavicle, the largest number are in the lungs, followed by the gastrointestinal tract.

In cases in which the primary tumour is not found, the most likely explanations are that either the primary lesion is so small that it is not visible or it has regressed spontaneously. The latter consideration is speculative, since spontaneous regression cannot be proved. Although the origin of a carcinoma in the wall of a bran-chiogenic cyst is possible, this remains entirely hypothetical. Few observers are willing to agree that primary squamous cell carcinoma (SCC) or other types of carcinoma arise in branchiogenic cysts. The most attractive hypothesis, therefore, is that the primary neoplasm is too small to be detected.

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