Cystic Neck Mass Research Articles

Diagnostic Accuracy of Circulating Tumor HPV DNA Testing in Patients With a Lateral Neck Mass

The most frequent presenting symptom for patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a lateral neck mass. Circulating tumor tissue-modified viral (TTMV)-HPV DNA is a unique biomarker produced by the fragmentation of HPV DNA during the degradation of HPV-associated tumors, and its detection and quantitation are currently being used as an adjunct to imaging in monitoring for disease recurrence and may have utility for diagnosis. To measure the diagnostic characteristics of TTMV-HPV DNA compared with gold standard tissue biopsy for diagnosing HPV-OPSCC in patients presenting with an indeterminate lateral neck mass. This prospective diagnostic test study enrolled patients 18 years or older who presented with a lateral neck mass to a large urban tertiary health care system from December 2021 to June 2023. Participants underwent standard-of-care testing to obtain a tissue diagnosis and a single TTMV-HPV DNA measurement. The primary outcome of interest was sensitivity, while specificity, positive predictive value, and negative predictive value were secondary end points. A subset analysis was performed comparing test performance metrics between TTMV-HPV DNA testing and fine-needle aspiration. A total of 138 patients were included, of whom 80 (58.0%) were men, with median age of 57.5 years (IQR, 43.3-67.0 years). Of 138 patients, 87 (63.0%) had neck masses in level 2 and 47 (34.1%) had HPV-OPSCC. TTMV-HPV DNA testing exhibited a sensitivity of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), specificity of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]), positive predictive value of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), and negative predictive value of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]). In this diagnostic study of patients presenting with a lateral neck mass, circulating TTMV-HPV DNA demonstrated excellent diagnostic test characteristics for the detection of HPV-OPSCC. Such testing may have particular utility for patients in whom obtaining adequate tissue is problematic, as is often the case with cystic neck masses and unknown primary tumors.

A Rare Case of External Jugular Vein Aneurysm Mimicking Branchial Cyst in a Nigerian Child

Abstract Background: An aneurysm of the external jugular vein is exceptionally rare. Its occurrence in children could present diagnostic challenges due to numerous potential differential diagnoses, including anomalies such as branchial cysts. Objective: This study aims to emphasize the necessity of raising suspicion for jugular venous aneurysms in children with cystic neck masses. Case Summary: We report an 18-month-old boy with a left-sided neck swelling persisting for 10 months. The swelling was cystic and increased in size during straining or crying. A preoperative diagnosis of a branchial cyst was made but was inconsistent with intraoperative findings, where a venous aneurysm was diagnosed. Ligation and excision were performed without sequelae. Conclusion: External jugular venous aneurysms, though rare, should be considered as a potential differential diagnosis in case of lateral neck swellings, especially if they demonstrate compressibility with an increase in size on Valsalva maneuvers. Simple ligation and excision are curative measures.

Cervical cystic hygroma in adults: a case report

BackgroundsManifestation of cystic hygroma in adulthood is very rare. The rarity of cystic hygroma in adults has caused problems in its diagnosis and management and few studies have reported cystic hygroma in adults.Case presentationIn this study, we reported a rare case with cervical cystic hygroma in adults. We report a 20-year-old Iranian male (Iranian ethnicity) with a diagnosis of right-side neck cystic hygroma and discuss the presentation, diagnosis, and clinical, radiological, and operative aspects of it.ConclusionCystic hygromas are a rare occurrence in adults. They are typically asymptomatic, rarely complicated, and can be mistaken for a cystic neck mass. This study showed that in our case, surgical resection may be a safe and effective treatment for cystic hygroma, with minimal risk of complications during the procedure.

Metastatic Papillary Thyroid Microcarcinoma Presenting as a Branchial Cleft Cyst in Young Female.

Though aetiology of lateral neck masses is complex, branchial cleft cyst is the second most common congenital lesions of the neck next only to thyroglossal duct cysts. Rarely ectopic thyroid tissue within a branchial cleft cyst may develop into primary papillary carcinoma, and even more rarely it may harbour metastases of primary thyroid papillary carcinoma. We report a rare case of lateral cystic neck mass in a 24-year-old female patient diagnosed as metastatic PTC. The patient was diagnosed after she underwent surgical excision of branchial cleft cyst. Later prospectively the patient underwent total thyroidectomy which revealed papillary thyroid micro invasive carcinoma.

Malignancy and "Violated Neck" Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass-Lessons Learned and Recommendations for Clinical Practice Guidelines.

The neck region is a common site for solitary cystic neck mass (SCNM) of various etiologies, including congenital, inflammatory, and neoplastic. In adults, the primary focus is excluding malignancy. The objective of this study was to retrospectively analyze the accuracy of available diagnostic technologies for the differentiation of benign and malignant SCNM in adult patients. The study aimed to develop new clinical practice guidelines for evaluating and managing SCNM. The primary predictive variables were the diagnostic utilities of fine-needle aspiration cytology (FNAC), ultrasound (U/S), multislice computed tomography, and magnetic resonance imaging. The study's endpoint was the overall diagnostic accuracy in differentiating between benign and malignant SCNM. The final diagnosis was based on histopathology. The study included 79 adult patients: 55 (69.62%) male and 24 (30.38%) female ( P <0.05). The mean age at presentation was 42.1 years (range: 18-84 years). Solitary cystic neck mass was distributed in the anterior neck region in 30 (37.97%) patients and the posterolateral neck regions in 49 (62.03%) patients ( P <0.05). The posterolateral neck regions had a significantly higher rate of malignant SCNM than the anterior neck region [19/49 (38.78%) versus 1/30 (3.33%)] ( P <0.05). There was no statistically significant difference between the U/S+FNAC and U/S+FNAC+multislice computed tomography and/or magnetic resonance imaging groups in differentiating benign and malignant SCNM (40/42 versus 36/37, P >0.05). "Violated neck" was recorded in 2 cases. A systematic investigation protocol should be applied to evaluate adult patients with SCNM.

Metastatic papillary thyroid carcinoma masquerading as lymphangioma: A rare case report and review of literature

ABSTRACT Papillary thyroid carcinoma coexisting with lymphangioma is a rare presentation of a cystic neck mass. Here, we report a case of papillary thyroid carcinoma masquerading as lymphangioma in the neck clinically and radiologically. Our patient was a 31-year-old man who presented with swelling on the left side of the neck for four months. A detailed history and investigation are summarized, and a review of published literature on similar cases is obtained. The initial computed tomography (CT) scan reported it as lymphangioma, and the fine-needle aspiration cytology (FNAC) reported it as a cystic lesion. However, the excision biopsy showed a picture of metastatic papillary carcinoma of the thyroid with cystic changes and associated lymphangioma. The patient finally underwent total thyroidectomy, which again revealed multifocal papillary thyroid carcinoma with capsular invasion and lymph node metastasis on histopathological examination (HPE). Primary occult carcinoma of the thyroid with metastatic deposits presenting as lymphangioma is a very rare presentation of a cystic neck mass, and very few cases have been reported in the English language literature.

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review.

In rare situations, neonates may present with respiratory distress and neck swelling from a piriform fossa sinus tract (PFST) lesion. Open surgical excision of PFST may be associated with higher complication rates, especially in neonates. Endoscopic treatment has been shown to have high success rates in older children, but neonatal outcomes appear to be less promising. The objective of this study was to review the existing literature on endoscopic treatment of PFST in neonates. PRISMA-ScR guidelines for scoping reviews were employed. Medline and Embase databases were searched in accordance with a detailed search strategy. Nine studies met criteria for inclusion. A total of 21 neonates with PFST treated endoscopically were reviewed. Mean age at onset of symptoms was 11.6 days. Neck swelling was the most common presenting symptom (20/21, 95%), followed by respiratory distress (6/9, 66.6%). Success rate after initial endoscopic treatment was 57% (12/21); among those, seven patients required additional concurrent treatments such as neck/pharyngeal swelling decompression or sclerotherapy. Nine patients underwent a second intervention (43%) and three patients (14%) required three interventions. Notably, 90% of patients (19/21) achieved success with only minimally invasive approaches. Two patients underwent open salvage surgical excision after recurrence following initial endoscopic treatment. Neonates with PFST and cystic neck masses are prone to recurrence after initial minimally invasive endoscopic treatment; however, high success rate may be achieved after repeat interventions. Adjunctive measures to optimize outcome may include swelling decompression w/wo sclerotherapy to cause fibrosis and postoperative nasogastric tube feeding. NA Laryngoscope, 134:2585-2591, 2024.

Metastatic micropapillary cervical adenocarcinoma presenting as a cystic neck mass: a diagnostic pitfall that can be mistaken with metastatic papillary thyroid carcinoma

Abstract Introduction/Objective Micropapillary endocervical adenocarcinoma is a rare aggressive variant of cervical adenocarcinoma with a high propensity for lymphovascular spread and poor outcomes. A 69-year-old woman presented with bilateral neck masses for 6 months. Imaging showed multiple multilocular cystic lateral neck masses. Fine needle aspiration was non-diagnostic. A core biopsy showed a papillary adenocarcinoma positive for TTF-1, Napsin-A, and PAX-8 immunostains, and negative for thyroglobulin, interpreted as metastatic papillary carcinoma of possible lung or thyroid origin. Further imaging of the head, neck, and thorax did not reveal a clear primary, but there was extensive involvement of the neck and mediastinal lymph nodes. Given the disease distribution and prominent cystic change in the nodal metastases, the patient underwent total thyroidectomy, bilateral neck, and mediastinal dissections for a presumed thyroid primary. No tumor was found in the thyroid gland. On follow-up the patient was noted to have normal serum thyroglobulin and retroperitoneal lymphadenopathy on PET/CT scan, prompting the search for a pelvic source. Additional immunostains performed in existing samples showed strong estrogen and progesterone receptor expression suggesting a gynecologic primary. At reevaluation, it was found that the patient had postmenopausal bleeding for a year. The colposcopy examination was normal, but a pap smear showed adenocarcinoma. An endocervical biopsy confirmed a micropapillary variant of endocervical adenocarcinoma. Methods/Case Report case report Results (if a Case Study enter NA) NA Conclusion Micropapillary carcinomas occur at multiple sites and are associated with the prominent lymphovascular spread and poor outcomes. The association of prominent neck and mediastinal lymphadenopathy, papillary architecture, cystic metastases, and coexpression of TTF-1, Napsin-A, and PAX-8 led to an erroneous presumption of a thyroid primary. This case highlights how overlapping immunomorphological features between thyroid and gynecologic tumors with papillary architecture, anchoring and confirmation biases, and suboptimal anamnesis can lead to an erroneous diagnosis.

Cervical thymic cyst ? A Rare Neck Swelling in an Adolescent.

Cystic neck masses in adolescents pose a diagnostic challenge as they be neoplastic or non-neoplastic, congenital, inflammatory, or infectious. Detailed history and examination, anatomical location of the lesion may help narrow down the differential diagnosis of such masses. Cervical thymic cysts contribute to less than 1% cystic lesions in the neck. We present one such case and our management strategy.

Congenital Cystic Neck Masses.

Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.

SAT542 TDC or Not TDC: Isolated Ectopic Papillary Carcinoma in the Midline Neck with a Benign Native Thyroid

Abstract Disclosure: M. Fasen: None. L. Kosmiski: None. Background: Thyroglossal duct carcinoma is a rare entity, occurring in about 1% of all thyroglossal duct cysts (TDC). Several cases have reported PTC within a thyroglossal duct cyst. Initially thought to be a TDC, we present an unusual case of a midline ectopic papillary thyroid carcinoma with absence of features characteristic of a TDC in the context of benign native thyroid tissue. Clinical Case: A 19 year old female presents to the clinic with a progressively growing midline neck mass over the past five years associated with mild dysphagia. Physical exam was notable for 2 x 2 cm mobile nontender midline mass. Neck ultrasound demonstrated a complex cystic lesion measuring 3.8 x 3.4 x 2.5 cm with partial calcification and mildly vascular. The thyroid itself had no nodules. She underwent a Sistrunk procedure with follow-up pathology revealing 1.6 cm classical PTC that extended into surrounding soft tissue and focal invasion into skeletal muscle without a definitive remnant thyroglossal duct lining despite cystic architecture. The differential included PTC completely replacing the thyroglossal duct cyst, PTC arising from ectopic thyroid tissue or metastatic PTC. Due to the unclear origin of the PTC, decision was made to perform total thyroidectomy. Pathology of the thyroid and four lymph nodes were negative for malignancy confirming a PTC origin from an extra-thyroidal remnant. The patient’s course was complicated by post-operative hypocalcemia resolved with calcitriol and calcium carbonate. She is pending discussion with endocrinology regarding adjuvant radioactive iodine. Conclusion: Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Sistrunk surgery should be performed in all cases for tumor removal. Thyroidectomy in individuals with normal thyroid can be considered due to the probability of concomitant intraglandular thyroid cancer and enables management with adjuvant radio-iodine if needed. In this particular case, PTC was found without evidence of a TDC and suggests PTC arose from ectopic thyroid tissue. Ectopic thyroid tissue can undergo malignant transformation along with the native thyroid gland. There are only a few other reports of isolated ectopic thyroid tissue malignancy with a benign thyroid gland. Presentation Date: Saturday, June 17, 2023

Papillary Thyroid Carcinoma within a Thyroglossal Cyst: A Rare Case Report with Review of Literature.

Thyroglossal cyst (TGC) is the most common congenital anomaly of the thyroid gland and is found in approximately 7% of general population. It represents cystic degeneration of a remnant of the thyroglossal duct that failed to involute during gestation. Malignancy occurring in TGC is rare entity, accounting only for 1% of all thyroglossal cysts. We are presenting such a rare case of papillary thyroid carcinoma arising in a thyroglossal cyst.30-year-old female presented with a painless, gradually progressive swelling below the chin extending to left side. On examination, swelling was noted in submental region and measuring 4 × 3 × 1cm, firm in consistency and moves with deglutition and movement of tongue.On radiological investigations, lobulated cystic lesion in midline with thin septations was seen, suggestive of thyroglossal cyst. The thyroid of the patient was normal. Patient underwent Sistrunk procedure. On histopathology, papillary thyroid carcinoma in thyroglossal cyst was seen and it was invading cyst wall and superficial skeletal muscle.The 1st case of thyroglossal duct carcinoma was reported by Brentano in 1911. Till now 300 cases have been reported in literature. Carcinomas occurring in thyroglossal cyst are extremely rare, (< 1% cases). The most frequent histological type is papillary pattern followed by mixed(papillary and follicular), squamous cell, Hürthle cell, follicular and anaplastic variety. The etiology of thyroglossal duct carcinoma is unknown and neither good clinical history nor examination can lead to a preoperative diagnosis. Diagnosis is often incidental on histopathology as in present case.Thyroglossal duct carcinoma is a rare condition that comes as a surprise to both the patient and surgeon and should be considered in patients presenting with cystic midline neck masses.

Primary papillary carcinoma in a thyroglossal duct cyst: A case report

Background: Thyroglossal duct cyst(TDC)is the most common congenital disorder of the thyroid gland. Seventy five percent of midline neck masses in children are (TDC). Occurrence of malignancy in (TDC) is very rare event, and include 1% of all cases of (TDC). Here in this report, we describe a rare case of primary papillary carcinoma which arises in a (TDC). Case report: Our case is a 42-year-old woman who presented with a hard painless solid and cystic mass in front of the neck above of thyroid cartilage. After initial physical examination and ultrasonography, the mass identified. Radiologist performed a core needle biopsy of the cyst and mass which show a papillary cell carcinoma. The patient underwent near total thyroidectomy, excision of lymph node and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which showed a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, cervical lymph node was not involved. Conclusions: Primary papillary carcinoma of thyroglossal duct cyst is a rare disease which presents in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management with radioactive iodine therapy which improve the survival.

Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy.

Management of lateral cystic neck masses with no apparent upper aerodigestive tract primary tumour in adults is controversial. Imaging modalities and fine needle aspiration cytology often struggle to distinguish the presence of malignancy. This study entailed a multicentre retrospective review of all patients with isolated lateral cystic neck masses from 2012 to 2018 in three Welsh health boards, utilising demographic data and first-line investigations (ultrasound scanning and fine needle aspiration cytology) to develop an evidence-based predictive tool for risk of malignancy. It was found that 29.1 per cent of cystic lesions were malignant on final histology. Age, male gender, non-benign ultrasound scan findings and fine needle aspiration cytology were significant risk factors on univariate analysis. The final multivariate analysis predicted a risk of malignancy ranging from 2.1 to 65.0 per cent depending on the covariate pattern. Smoking status was non-significant. A rigorous, risk-stratified approach to the management of these patients should aid the clinician in minimising morbidity and optimising resources.

Clinicopathologic Study of Thyroglossal Duct Cyst: An Institutional Experience

Background: Thyroglossal duct (TGD) is a developmental anomaly in which a remnant of the thyroid anlage is left in the neck throughout its descent from the foramen cecum of tongue to ultimate peritracheal position. A persistent duct can lead to thyroglossal duct cyst (TGDC). Histologically, TGDC brings an epithelial lining of squamous or pseudostratified ciliated columnar epithelium and ectopic thyroid gland tissue in the duct wall. TGD-associated malignancy is rare, and the majority is papillary thyroid carcinoma (PTC). Objectives: The aim of the study is to assess the clinicopathologic features of thyroglossal duct cyst. Methods: This is an observational study. The study was carried out among the admitted patients of National Institute of ENT, Dhaka, Bangladesh from January 2019 to September 2022. Statistical analysis of the data was carried out using SPSS-24. Results: This study shows that according to age distribution, 30(58.8%) were &lt;20, 8(15.7%) were 21-30, 10(19.6%) were 31-40, 2(3.9%) were 41-50, none in the 51-60 and 1(2.0%) was ≥61 years age group. And according to gender (47.1%) were Male and (52.9%) were Female. According to diagnosis, 45(88.2%) were Thyroglossal Duct Cyst, 1(2%) was multinodular goiter and 5(9.8%) were Papillary thyroid carcinoma. Conclusion: TGDCs are common pathologic lesion affecting the neck. Thyroglossal duct cyst carcinomas, most commonly papillary thyroid carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery is the main treatment and multidisciplinary consultation is required to improve survival. The diagnosis of malignancy is made postoperatively.

Cystic Posterior Neck Mass in a Premature Newborn

Congenital dermal sinus is a type of occult spinal dysraphism. It is a result of incomplete separation of the cutaneous ectoderm from neural ectoderm. MRI can aid in identifying the subtype of spinal dysraphism however, surgery is always recommended to dissect the intradural component.

Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck

Cystic masses of the lateral neck are mostly benign. However, the incidence of metastatic squamous cell carcinoma (SCC) in cervical cystic masses initially diagnosed as benign is quite high in patients older than 40 years. The aim of this study was to compare the diagnostic accuracy of preoperative cytology and intraoperative frozen section (FS) in detecting malignancy in cystic masses of the neck. We reviewed 61 patients who underwent preoperative ultrasound-guided fine-needle aspiration cytology (FNAC) and neck biopsy of a cystic neck mass, and analysed the concordance between FNAC and intraoperative FS with respect to definitive histology. HPV status was also tested. Of 49 eligible cases, the accuracy of preoperative FNAC was 70.5% (weighted kappa 0.53), meaning moderate agreement between cytology and final diagnosis. Intraoperative FS consultations detected 16 cases of SCC metastasis while the remaining 33 cases were negative for SCC, showing perfect agreement with histology. Since FS results were useful in evaluating cystic neck masses, despite a moderate accuracy of cytology, we suggest intraoperative FS analysis for all cystic neck masses. This technique can allow us to switch to therapeutic neck dissection, multiple upper aerodigestive tract biopsies, tongue base mucosectomy, and bilateral tonsillectomy in the same surgical setting.

Secondary syphilis of the oropharynx and cervical lymph nodes: a case report.

Secondary syphilis rarely affects the head and neck including the oropharynx and cervical lymph nodes. These patients present with throat pain, cystic/necrotic lymphadenopathy, and mucosal swelling. Sometimes this constellation of symptoms can be mistaken for head and neck cancer. We report a case of an enlarging throat and painless cystic neck mass in a transgender woman in her forties who was initially suspected to have oropharyngeal squamous cell carcinoma. A subsequent workup revealed the presence of spirochetes without cellular atypia consistent with secondary syphilis. We include the ultrasonography images as well as an endoscopic photograph of the oropharyngeal manifestation in this report.

Large non-functioning substernal parathyroid cyst: A case report and review of the literature.

ObjectivesParathyroid cysts are rare benign lesions of the head and neck that account for less than 1% of cystic neck masses. We present a rare case of a large 6 cm substernal parathyroid cyst.Presentation of caseAn otherwise healthy 65 year-old female presented to the otolaryngology clinic for evaluation of an anterior, midline neck mass. On physical exam, she was noted to have a fullness in the anterior neck extending to the sternal notch. CT demonstrated an enlarged thyroid with a cyst extending to the aortic arch. Initial evaluation suggested a bilateral goiter with substernal extension. The cyst was managed with drainage and observation. After two years of continued growth, the patient underwent a left thyroid lobectomy and mediastinal mass resection via the cervical approach. Final pathology was consistent with a parathyroid cyst.ConclusionsParathyroid cysts are a rare cause of neck mass in an adult, and a 6 cm substernal parathyroid cyst represents an unusual site and size for these cysts. Parathyroid cysts are not often considered on the differential of neck and mediastinal cystic lesions. However, appropriate steps should be taken to ensure a proper diagnosis for any cystic lesion in the neck.

Lateral cystic neck masses in adults: a ten-year series and comparative analysis of diagnostic modalities.

In adults, the solitary lateral cystic neck mass remains a diagnostic challenge with little solid material to target for cytology and few clues on imaging modalities to suggest underlying malignancy. This study was a retrospective review of patients presenting with a lateral cystic neck mass to a tertiary academic head and neck centre over a 10-year period. A total of 25 of 157 cystic lesions were subsequently malignant on paraffin section histopathology, with the youngest patient being 42 years. In the age cohort over 40 years, 30 per cent of males and 10 per cent of females were diagnosed with malignancy. The ipsilateral palatine tonsil was the most common primary site (50 per cent). A total of 85 per cent of cases demonstrated integrated human papillomavirus infection. Age, male sex and alcohol were significant risk factors on univariate analysis. Ultrasound-guided fine needle aspiration cytology and magnetic resonance imaging represented the most accurate pre-open biopsy tests. The authors of this study advocate for a risk-stratified, evidence-based workup in patients with solitary lateral cystic neck mass in order to optimise timely diagnosis.