Objective: Branchiogenic carcinoma is a controversial entity. Some authors believe that the reported cases reflect cystic degeneration of metastatic lymph nodes rather than a primary tumor arising from cyst epithelium. In a previous study, we found evidence of normal epithelium within malignant cysts in 2 cases of possible branchiogenic carcinoma. In contrast, in the setting of a known primary tumor where cystic metastases are present, there is histologically highly dysplastic epithelium lining these degenerative cysts. Our goal was to analyze lymph nodes from patients with head and neck squamous cell carcinoma (SCC), with a documented primary focus, for the presence of normal epithelium within lymph nodes taken during neck dissection.