Cystic Neck Research Articles

Ultrasound of Neck Masses in Pediatrics

US plays an important role in the evaluation of palpable neck masses in pediatric patients. The superficially located structures are easily examined and exquisitely displayed by US using a high-frequency linear array transducer. In most of the cases, US can differentiate cystic from solid lesions. For the cystic lesions, the imaging diagnosis is based on location. The midline or paramedian location of cystic neck masses in pediatrics mostly are thyroglossal duct cyst and dermoid/epidermoid when locating between hyoid bone and thyroid gland, ranula or plunging ranula when locating in sublingual or submandibular spaces, and dermoid/epidermoid again when locating at suprasternal notch. Epiglottic cyst can also be detected in its typical location when there is no intervening air. The laterally-located cystic lesions are branchial cleft cyst, venolymphatic malformation, and phlebectasia of the jugular vein. Lymphatic malformation has its typical location in posterior triangle of the neck. Contents within cystic neck masses in many cases are not echo-free and may appear as pseudo-solid lesions on US. For the solid neck masses in pediatrics, US usually can tell whether it is an enlarged lymph node or not. Like in adult, US may depict the suspicious lymph node for biopsy. The imaging diagnosis of the solid neck masses other than enlarged lymph nodes in many cases are nonspecific and need histological diagnosis. However, there are some typical solid lesions that the diagnosis could be provided, e.g., fibromatosis colli, infantile hemangioma, ectopic thymus, and ectopic thyroid.

A parathyroid cyst; Often neglected in the differential diagnosis of cystic neck swellings: A case report

A parathyroid cyst; Often neglected in the differential diagnosis of cystic neck swellings: A case report

A Decade of Experience of Management of Thyroglossal Duct Cyst in a Tertiary Care Hospital: Differentiation Between Children and Adults.

Variations in thyroglossal duct cysts (TGDCs) between children and adult are mentioned very little in literature. The lesion mostly found in children but adult population also possesses this anomaly. The aim of this study was to determine the differences in clinical presentations and surgical outcomes of TGDC between children and adults. A retrospective chart review of all patients with TGDCs managed in our hospital from July 2004 to June 2014. All records were reviewed for age, sex, location of cyst in neck and with relation to hyoid bone, size, postoperative complication and recurrence rates. Differences between children and adults were assessed. A total of 39 patients (21 children and 18 adults) were treated for TGDC. Of the pediatric group, 71.4% were male and 28.5% were female, whereas 72.2% of the adults were male and 27.7% were female. Adults were more likely to develop other complaints like neck pain, dysphagia and dyspnea. Position was almost similar in both age groups with midline and infrahyoid location while laterality was seen in adult only. Size of Cyst was found to be larger in adults. The recurrence and post operative complication rates between children and adults were not significantly different. TGDC has male predominance. Clinical presentations were almost similar in both age groups. Although lateral deviation, increase size of cyst and recurrences were seen in adults only, Sistrunk procedure is recommended as a safe and standard surgical treatment in both age groups.

18F-FDG PET/CT to differentiate malignant necrotic lymph node from benign cystic lesions in the neck.

Patients presenting with cystic lesions in the neck without obvious signs of malignancy constitute a diagnostic challenge since fine needle aspiration is often insufficient and a diagnosis may not be reached until surgical resection/biopsy is performed. The differential diagnosis of a cystic cervical mass comprises a variety of benign conditions, but malignancy must be ruled out. We examined the diagnostic performance of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT to identify malignancy. We retrospectively included consecutive patients referred from the Department of ENT Head and Neck Surgery for 18F-FDG PET/CT-scans because of a solitary neck cyst. Scan results were compared to histopathology and follow-up. The study comprised 58 patients. Twenty patients (34%) were diagnosed with cancer during follow-up. PET/CT suggested malignancy in 34 patients (19 true positive, 15 false positive) and showed no malignancy in 24 (23 true negative, 1 false negative). The sensitivity, specificity, accuracy, positive and negative predictive values were 95% (76-99%), 61% (45-74%), 72% (60-82%), 56% (39-71%), and 96% (80-99%), respectively (95% confidence intervals in brackets).The primary tumor was identified in 14 out of the 20 patients with confirmed cancer. Increased metabolism, as evaluated by PET, was the only imaging characteristic among several others, which associated independently with malignancy in the cystic neck lesions, odds ratio 1.27 (1.07-1.50), p=0.006. 18F-FDG PET/CT could reliably rule out malignancy (NPV 96%), albeit with a high frequency of false positive scans, requiring further diagnostic work-up. Increased metabolism was the best imaging parameter to differentiate between malignant and benign lesions.

Fine Configuration of Thoracic Type II Meningeal Cysts: Macro- and Microscopic Cadaveric Study Using Epoxy Sheet Plastination.

A cadaveric study OBJECTIVE.: The aim of this study was to analyze the in situ macro- and microscopic configuration of the type II cyst and its anatomic relationship with surrounding structures. The lack of consensus of surgical strategy to manage symptomatic type II meningeal cysts (Tarlov cysts) is because our knowledge of type II cyst anatomy remains incomplete. It has been assumed that the cyst communicates with the subarachnoid space via microconnections. Till date, however, no direct evidence demonstrates the existence of the microconnections, although delayed contrast filling of type II cysts is commonly observed in CT myelography. Three type II meningeal cysts analyzed in this study were incidentally found in one of 16 plastinated spines. The spine was from an 89-year-old female cadaver and plastinated as a set of 164 transverse sections with a thickness of 2.5 mm. The sections were examined under a stereomicroscope. Three type II cysts were in the thoracic spine and had a common feature that a clearly identifiable cyst neck connected the cyst body to the subarachnoid space. The dorsal root of the spinal nerve was centered in the cyst neck but spread over the cyst body or traversed the cyst cavity. The meningeal opening of the cyst was located above the inferior border of the vertebral pedicle, thus, the cyst neck hugged around the pedicle and sharply turned inferolaterally into the intervertebral foramen. The cyst body was halted by the dorsal ganglion. This study reveals in situ macro- and microscopic configuration of the type II cyst and its relationship with the structures and suggests that it may be feasible to localize and ligate the cyst neck for surgical management of type II cysts. 3.

Significance of the size of fetal anterolateral neck cysts in early gestation

Purpose: To recognize the association between the size of fetal anterolateral neck cysts and nuchal translucency, chromosomal aberration and fetal malformations.

Branchial Cleft Cyst Carcinoma: A Case Report

: Branchial cleft cyst carcinoma (BCCC) is an extremely rare malignancy originating from cells within the branchial cleft cyst wall. A 73-year-old man presented with a cystic mass with cellulitis mimicking abscess initially and recurred 3 years later as complex cystic lesion in right neck level II with multiple necrotic ipsilateral lymphadenopathy. The pathological diagnosis of cystic lesion was squamous cell carcinoma, suggesting possibility of originating from branchial cleft cyst. There was no identifiable primary cancer elsewhere by a thorough evaluation; eventually final diagnosis was branchial cleft cyst carcinoma to meet the modified criteria of Khafif et al. Up to the present time, there has been no evidence of recurrence. Although the BCCC is very rare, accurate diagnosis is important to plan proper treatment for patient. This report should help increase awareness of BCCC, which should be included in the differential diagnosis of a cystic neck mass.

Primary thyroglossal duct cyst papillary carcinoma. Case report and literature review

Aim: Primary papillary carcinoma in a thyroglossal duct cyst (PTGDPC) is a rare pathological condition diagnosed in only 1–2% of the cases of midline neck cysts. Diagnosis is most commonly made postoperatively after the cyst is dissected by Sistrunk’s operation. There is a lot of controversy over the definitive management of PTGDPC and the proper therapeutic approach to it especially when we consider using total thyroidectomy and subsequent adjuvant radioiodine therapy in the treatment. We report a case of papillary carcinoma in a thyroglossal duct cyst and review the relevant literature to clarify what algorithm should a clinician apply in such cases. Materials and methods: We present a case of a 38-year-old woman with papillary carcinoma arising from a cyst in ductus thyroglossus which was histologically identified after Sistrunk’s operation. We discuss also the pathogenesis of papillary carcinoma in a thyroglossal duct cyst and the need to perform thyroidectomy. Results: The patient (T. C.) was a 38-year-old woman hospitalized in the Clinic of Otorhinolaryngology at St. George University Hospital in Plovdiv with a diagnosis of midline neck cyst confirmed by neck computed tomography and ultrasound. Sistrunk’s procedure was used for the patient who was shown by postoperative histology and repeat verification to have papillary carcinoma. The patient’s thyroid was examined scintigraphically yielding inconclusive evidence for neoplasm and then removed by thyroidectomy. No synchronous papillary carcinoma in the thyroid gland was identified. The histology showed nodular colloid goitre. The patient received postoperatively radioactive iodine (I-131) therapy and hormone-replacement therapy with L-thyroxin. Conclusions: We have found total thyroidectomy to be rather controversial approach to managing papillary carcinoma in a thyroglossal duct cyst. Accurate identification of a possible primary focal area in the thyroid gland followed by total thyroidectomy in conjunction with I-131 ablation and hormone replacement therapy seem far more appropriate in such cases.

Cutaneous cylindroma: it's all about MYB.

Cutaneous cylindroma is a rare benign tumour that occasionally turns into malignant cylindrocarcinoma. The cancer can be sporadic or emerge in the context of Brooke-Spiegler syndrome (BSS), an inheritable condition characterized by mutation of the gene CYLD, encoding a tumour suppressor protein that controls the activity of the transcription factor NF-kB. Sporadic cylindromas present histological features shared with adenoid cystic carcinoma (ACC), a head and neck cancer originating from salivary or other exocrine glands. Like ACCs, sporadic cylindromas express, although at lower frequency, the aberrant fusion transcript MYB-NFIB. In a paper recently published in the Journal of Pathology, the research teams led by Neil Rajan and Goran Stenman demonstrate that CYLD-defective cyclindromas in BSS patients are negative for the MYB-NFIB fusion. Only the wild-type MYB oncoprotein is activated in the majority of these tumours. RNA interference studies in cells derived from BSS patients indicate that ablating MYB expression results in a striking reduction of cylindroma cell proliferation, suggesting that MYB plays a pivotal role in the biology of this cancer. The take-home message of the study is that activation of MYB, in its wild-type form or fusion derivatives, is a common feature of spontaneous and hereditary cylindromas, constituting a potentially actionable therapeutic target. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst.

ObjectiveIn this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed.Study DesignThis study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012.MethodsOne hundred thirty‐five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually.ResultsOf the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine‐needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics.ConclusionThis study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast‐track cancer referral program.Level of Evidence2b.

Infected cystic hygroma resulting in septic shock and respiratory failure: A case report

Abstract Macrocystic lymphatic malformations (cystic hygromas) are a common cause of cystic neck lesions. These lesions are often diagnosed prenatally in children. In cases without airway compromise, these children are discharged from the hospital for elective treatment. Surgical excision is one treatment modality while sclerotherapy has recently shown adequate results as well. While infection is a relatively common problem for lymphatic malformations, the majority can be treated with antibiotics alone. We present a case in which septic shock and respiratory failure resulted from primary infection of a macrocystic lymphatic malformation in a term infant discharged with a lymphatic malformation of the neck. Urgent surgical drainage failed, and complete excision was ultimately required for source control due to numerous small multiloculated small cysts inaccessible via incision and drainage.

Origin of cystic squamous cell carcinoma metastases in head and neck lymph nodes: Addition of EBV testing improves diagnostic accuracy

Most cases of cystic squamous cell carcinoma (SCC) metastases in the upper neck are associated with an oropharyngeal primary, namely human papillomavirus (HPV)-associated SCC arising in the palatine or lingual tonsil. A retrospective study was performed on 22 patients who presented with cystic head and neck SCC metastases. The purpose of the study was to find out whether histological characteristics, p16 protein expression, HPV and Epstein-Barr virus (EBV) status could be useful in predicting the localization of the primary tumor. The primary site was identified in 20 of 22 patients and included the oropharynx in 14 patients (63.6%), the nasopharynx in 3 patients (13.6%), the lungs in 2 cases (9%), and the skin of the auricle in one case (4.5%). No primary was found in two patients (9%). Sixteen of 17 cases (94.1%) originating in Waldayer’s ring (oropharynx and nasopharynx), and both cases with an unknown primary showed morphology of non-keratinizing SCC or non-keratinizing SCC with maturation. All tumors with oropharyngeal primary and both cases with unknown primary showed diffuse p16 staining and presence of HPV DNA. All three cystic metastases of nasopharyngeal carcinoma were EBV-positive and p16/HPV-negative. In contrast, cutaneous and pulmonary metastases showed morphology of a well differentiated keratinizing SCC and poorly differentiated keratinizing SCC, respectively, and were HPV/EBV-negative. We confirmed that cystic SCC lymph node metastases of the head and neck region are strongly associated with the occult primary localized in the oropharynx. The oropharyngeal origin should always be corroborated by p16 immunohistochemistry and HPV-specific testing because SCC arising in other sites, such as nasopharynx, skin or lungs may manifest with cystic neck metastases as well. Addition of EBV testing in p16/HPV-negative cases can disclose the nasopharyngeal origin of the cystic neck metastases in a subset of cases.

The significance of anterolateral neck cysts in early diagnosis of fetal malformations

The objective of this study is to examine the association of lateral fetal neck cysts with increased nuchal translucency, chromosomal abnormalities and fetal malformations. In a consecutive collective of 4216 prenatal ultrasound examinations between 11 and 17 weeks of gestation 32 fetuses with lateral neck cysts were found. The size of the cysts was examined. The association of the findings with increased nuchal translucency, chromosomal aberrations and fetal malformations was examined. All but two out of 32 cases had bilateral cysts. Seventeen fetuses had aneuploidy and an increased nuchal translucency, 15 of those with major structural malformations. Of the 15 fetuses with normal karyotype nine (60%) had an increased nuchal translucency, seven had a fetal malformation or hydrops. A favorable outcome was found in 6/15 fetuses with normal karyotype and normal nuchal translucency. Lateral neck cyst diameter was associated to nuchal translucency, chromosomal abnormality and/or fetal malformations. Cysts smaller than 3 mm had a favorable outcome even in the presence of an increased nuchal translucency. Fetuses with lateral neck cysts often not only present with increased nuchal translucency and chromosomal aberrations but also with fetal malformations. Fetuses with lateral neck cysts and increased nuchal translucency were aneuploid or had a fetal malformation in 85%. Cysts smaller than 3 mm had a favorable outcome. © 2016 John Wiley & Sons, Ltd.

Efficacy of Percutaneous Ethanol Injection for Benign Neck Cyst

Received January 18, 2016 Revised March 22, 2016 Accepted March 22, 2016 Address for correspondence Jong Chul Hong, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel +82-51-240-5428 Fax +82-51-253-0712 E-mail santa@dau.ac.kr Background and ObjectivesZZAdvantages of percutaneous ethanol injection (PEI) were represented by insignificant mortality, minimal damage to normal parenchyma, relatively low cost and easy availability. The objective of the present study was to evaluate the efficacy of ethanol ablation as a minimally invasive management of cystic lesions in the neck or arising from the neck. Subjects and MethodZZBetween August 2010 and December 2015, 28 patients with cystic lesions in the neck were diagnosed and treated with percutaneous ethanol injection. We evaluated the outcome of treatment using the alteration of volume reduction and the improvement of symptomatic and cosmetic complaints and complications. ResultsZZThe initial mean tumor volume was 21 mL (range, 1.6-36.9 mL), as shown by ultrasonography. The mean number of the treatment sessions was 3.5 (range, 1-9 sessions). At the last follow-up, the mean volume of the treated neck cyst decreased significantly from 21 mL to 2.7 mL (p<0.001). The average volume reduction rate was 82.4% with the success rate of procedure of 82%. The mean symptoms and cosmetics visual analog scale improved from 5.4 to 2.4 and from 4.8 to 1.5 (p<0.001). No significant complications were observed during follow-ups. ConclusionZZPEI is simple, easy, safe, and effective without surgical scars and hospitalization for neck cyst patients and favorable outcomes can be achieved without significant complications. It can be used as a substitute for surgery in the treatment of benign neck cyst lesions. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(6):448-52

A Rare Case of Epidermoid Cyst in Neck

ABSTRACT Epidermoid cysts are common lesions, but malignant transformation of their epithelium is rare. There are few case reports in the literature concerning malignant transformation of an epidermal cyst into squamous cell carcinoma. Two epidermoid cysts occurring simultaneously in the neck is rare and not a single case report is available in the literature. One of the cysts transforming into squamous cell carcinoma and the other showing atypical changes is still the rarest and not reported till date. We present a case of two epidermal inclusion cysts in a patient out of which there were atypical changes in one cyst and other cyst showed squamous cell carcinoma. How to cite this article Mohan C, Srivastava A, Agrawal R, Bhardwaj P. A Rare Case of Epidermoid Cyst in Neck. Int J Adv Integ Med Sci 2016;1(1):15-17.

Epidermoid cyst a rare entity in lower left side of the face-A case report

Epidermoid cyst is a rare developmental cyst of the oro-facial region which results from entrapped epidermal elements without adnexal appendages. Dermoid and epidermoid cysts occur in orofacial region with an incidence of 6.9–7%. Teratomas always refered to as dermoid cysts. Epidermoid dermoid cyst is also used to describe inclusion cysts of face, neck, and floor of the mouth. These cyst also also shows epidermal tissues and even hair follicles, sweat and sebaceous glands in the cyst wall and keratin and sebum in the cyst cavity.

A Case of Oropharyngeal Carcinoma with Cystic Neck Metastasis Initially Suspected as a Lateral Cervical Cyst

A Case of Oropharyngeal Carcinoma with Cystic Neck Metastasis Initially Suspected as a Lateral Cervical Cyst

Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.

Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid.

Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382–0.618), 0.645 (95% CI, 0.526–0.752), 0.945 (95% CI, 0.866–0.984), and 0.973 (95% CI, 0.907–0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions.

Abstract B22: Outcomes and genomic mutational profiling results in patients with cancers of the head and neck treated with dovitinib in the Signature Program

Abstract In the Signature Program, patients with advanced solid and hematologic cancers without other standard treatment options are enrolled in 1 of 8 tissue-agnostic, mutation-specific protocols. With no predetermined study sites, the program is able to bring the protocol to the patient through local enrollment via physician-directed genomic profiling of tumors. The primary endpoint of each study is clinical benefit, including complete response, partial response, or stable disease [SD], at 16 weeks by investigator assessment using Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 or appropriate hematologic criteria. This novel design allows rapid matching of patients to a relevant targeted therapy. Dovitinib, a tyrosine kinase inhibitor with activity against multiple receptor tyrosine kinases, is currently in clinical development. Eighty patients were accrued in the dovitinib (TKI258) protocol from May 2013 to January 2015. Here, we describe a head and neck cancer subset of this population, including adenoid cystic carcinoma (ADC; n = 6), head and neck squamous cell carcinoma (HNSCC; n = 5), and salivary gland cancer (n = 1). The median age was 62 years, and patients had a median of 2 prior lines of therapy; 69% of patients were male, 85% were Caucasian, and 31% and 69% had an Eastern Cooperative Oncology Group performance status of 0 and 1, respectively. Patients met mutational inclusion criteria, with mutations in PDGFRα/β, c-KIT, VEGFR2, FGFR1/2, and RET. There were no confirmed responses; however, 5 patients had SD on study. Of the 5 patients with SD, 4 had clinical benefit at 16 weeks (1 patient with SD at 8 weeks discontinued before 16 weeks). Consistent with other studies of dovitinib monotherapy, gastrointestinal adverse events (fatigue [69%], nausea [69%], diarrhea [54%], and vomiting [54%]) were the most common. In addition, pretreatment tissue biopsies from all patients were analyzed by a large multigene next-generation sequencing assay. Results to date indicate that the ADC cohort has a lower mutational load and fewer prior therapies than the HNSCC cohort. Further analysis of a correlation between clinical benefit and specific mutational profile is ongoing. Citation Format: Sarina A. Piha-Paul, James A. Knost, Luis E. Raez, Allen L. Cohn, Hussein A. Tawbi, Sudha Parasuraman, Barinder P. Kang, Renata M. Matys, Eric D. Slosberg. Outcomes and genomic mutational profiling results in patients with cancers of the head and neck treated with dovitinib in the Signature Program. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr B22.