Differential Diagnosis Of Neck Masses Research Articles

Anterior Cervical Bronchogenic Cyst Mimicking a Thyroglossal Duct Cyst: A Case Report.

A bronchogenic cyst (BC) is a rare congenital cystic lesion, especially when located in the suprahyoid region of the anterior cervical front. We report a case of a male child who was misdiagnosed with a thyroglossal duct cyst due to the clinical presentation of a mass located near the anterior midline of the neck, in the region above the hyoid bone, which moved up and down with swallowing, characteristics consistent with a thyroglossal duct cyst. We excised the lesion under general anesthesia. Histopathological analysis revealed cartilage tissue, pseudostratified columnar epithelium of the cyst wall with cilia and mucous glands, finally diagnosing it as BC. BC should be considered in the differential diagnosis of neck masses.

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia.

Tularemia is a zoonotic disease caused by the Gram-negative coccobacillus Francisella tularensis. It is frequently overlooked in the differential diagnosis of neck masses because of its rarity. The purpose of this study is to report cases diagnosed with tularemia among patients presenting to our clinic with neck masses and to share our experience. Patients presented to our hospital with cervical masses and diagnosed with tularemia were included in this retrospective study. Medical files of all patients were evaluated, and physical examination findings, titration values, date of diagnosis, location of the abscess or mass, place of residence, occupation, drinking water sources, sedimentation (SED), C-reactive protein (CRP), and white blood cell (WBC) values were recorded. Seventy-six patients were included in the study. Forty patients (52.6%) were living in rural villages and 36 (47.4%) in urban areas. Thirty-one (40.8%) were engaged in animal husbandry and 29 (38.2%) in agriculture. In terms of drinking water sources, 59 patients (73.6%) obtained water from the mains, while 10 (13.32%) used well water. The most frequently observed clinical findings were swelling in the neck, sore throat, lethargy, and fever. Neck swelling frequently occurred in levels II and III. Since tularemia is rare and there are no specific clinical findings, diagnosis may be problematic. Ear, nose and throat (ENT) specialists should be familiar with the clinical symptoms of tularemia in the head and neck region and should consider a preliminary diagnosis of tularemia in the differential diagnosis of persistent neck masses.

Epithelial myoepithelial carcinoma in an ectopic salivary gland: A diagnostic dilemma

The ectopic Salivary Gland is the presence of salivary tissue in unusual locations which do not normally host it. Moreover, neoplasms arising from these ectopic tissues are very rare, however, tumourigenic changes in these inclusions have been observed in a few cases.We present a clinically unsuspected case of an ectopic salivary gland tissue present on the mid-neck, which was diagnosed as Small lymphocytic leukaemia outside Jawaharlal Nehru Medical College, Aligarh. On further evaluation, a definitive diagnosis of epithelial myoepithelial carcinoma arising in ectopic salivary gland tissue within the cervical lymph node was made. Therefore, these tumours need to be included in the differential diagnosis of neck masses, for a prompt diagnosis and adequate treatment.

Left Neck Mass: An Unusual Presentation of Testicular Cancer in a 50-Year-Old Man Case Report Seminoma - Havard'

Advanced testicular germ cell tumors commonly involve cervical lymph nodes. In most circumstances, the diagnosis of germ cell tumor is established before the neck disease is noted. In rare cases, these tumors have been found along with cervical lymphadenopathy in patients with a previously undiagnosed primary tumor. In this article, we report the unusual case of a 50-year-old man whose metastatic seminoma initially manifested as an asymptomatic neck mass. This finding reinforces the need to include metastatic disease in the differential diagnosis of neck masses. Our discussion of this case focuses on the appropriate management of cervical metastases of germ cell tumors.

A Case of Cervical Teratoma in an Infant.

Cervical teratoma is a rare form of teratoma in neonates and is an unusual cause of cervical masses in them. Teratomas are unusual tumors derived from all 3 germs cell layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical teratoma is a rare entity. Its prognosis mostly depends on the risk of neonatal respiratory distress, its extension and potential malignancy. Surgical management must be as complete as possible to avoid recurrences and malignant transformation. We report a case of a cervical immature teratoma in an infant with total excision and cure. No recurrence has been reported. The aim of our study is to review the diagnosis, management and outcomes of congenital cervical teratomas. Cervical teratoma although uncommon should be considered in the differential diagnosis of neck masses in neonates. Teratomas are rare tumors derived from all three germ cell layers affecting the neck in 3% of all cases. An early complete surgical approach to congenital cervical teratomas allows good results with low rates of complication and recurrence.

Management of external jugular vein aneurysm: a systematic review.

Aneurysms of the jugular vein system are rare and high clinical suspicion is needed for diagnosis. External jugular vein aneurysms (EJVA) are considered innocent lesions that need treatment mainly for aesthetic reasons. The aim of this systematic review was to present current literature regarding diagnosis and management of EJVAs. A literature review was conducted through the Pubmed/Medline and Scopus regarding articles referring on EJVA from 2000 to 2020. Using the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses), 30 articles were identified, according to inclusion criteria. Demographics, clinical characteristics, etiology, diagnostic imaging, complications, treatment, and histopathological findings were recorded and analyzed. Twenty-seven case reports and one case series were identified, including 30 patients and 31 EJVAs. One-third of patients (30.3%) were < 18 years old (mean age 32 years, range 1-72 years) and 54% of them were females. In 51% of the cases, the lesion was characterized as a true aneurysm after histological evaluation. The presence of a soft cervical mass was the most common clinical symptom, while Valsalva maneuver pointed out the presence of an EJVA in 66.7% of patients. Diagnosis was achieved using ultrasonography, computed tomography, or magnetic resonance imaging. Forty-three percent of the patients underwent more than one radiological examination. Twenty patients underwent surgical management. The primary indication of surgical treatment was aesthetic reasons (11/20, 55%). Thrombosis was the most common EJVA complication (11/30, 36.3%). Differential diagnosis of neck mass should include EJVA. High clinical suspicion and adequate imaging are important for diagnosis. Open surgical approach is the more commonly applied therapeutic strategy.

Importance and Impact of Appropriate Radiology in the Management of Branchial Cleft Anomalies.

Branchial cleft anomalies are common differential diagnosis of neck masses. However, depending on the origin (1st, 2nd, 3rd or 4th arch), this pathology presents at different locations as cyst, sinus and fistula. Incomplete excision or incision and drainage of infected branchial cleft anomalies (cystic presentation) can lead to multiple recurrences. Appropriate radiology is imperative to make a correct diagnosis and to achieve complete excision to prevent recurrence. Our case series highlights the mode of presentation, appropriate radiology and management for each type of branchial cleft anomalies. Data of 27 patients with the diagnosis of branchial cleft anomaly and treated in the department of Otolaryngology-Head and Neck Surgery in a tertiary care referral centre in last 5years was analysed retrospectively. Demographic data in terms of age, sex, laterality, clinical presentation, duration of symptoms and radiological investigations if any were recorded. The mean age at presentation was 22.1years in this series of 27 cases including six (22.2%) recurrent cases. Most common clinical presentation was discharging sinus (59.25%) followed by cystic neck swelling (33.3%). Second branchial cleft anomalies were commonest (51.8%) followed by first branchial cleft anomalies (29.6%). Appropriate radiology was available for 17 (62.9%) patients. Branchial cleft anomaly is an important differential diagnosis of neck mass. Appropriate radiology helps in complete excision and prevents recurrences. Recurrent cases pose surgical challenge owing to fibrosis from previous surgery which further increases the chances of incomplete excision.

Anatomical variations in the digastric muscle.

The aim of this study was to investigate anatomical variations in the digastric muscle. Anatomical dissections of the head and neck region were performed in 15 cadavers at the Anatomy Department during a gross anatomy course. Three cadaver heads revealed anatomical variations in the anterior belly of the digastric muscle. The positional relationships among the accessory muscle bundles, the anterior belly of the digastric muscle, and the mylohyoid muscle were examined. Innervating branches from the mylohyoid nerve were also investigated. The remaining 12 cadaver heads without accessory muscle bundles were used for comparison. Of the three heads with accessory muscle bundles, one head (male) had two muscle bundles of the unilateral type, one head (male) had symmetrical muscle bundles of the crossover type, and one head (female) had a mix of unilateral and crossover types. The likely explanation for these and various other anomalies reported in the literature is the complex morphogenesis of the first branchial arch. Therefore, clinicians should be aware of these anatomical variations of the submental region when performing surgical procedures involving the head and neck and when using computed tomography and magnetic resonance imaging for interpretation or differential diagnosis of neck masses.

Internal jugular phlebectasia: A rare case report in an Indian female

Phlebectasia is an abnormal dilatation of an isolated vein, which may affect any vein, and is rarely symptomatic. Internal jugular vein phlebectasia (JVP) presents as fusiform neck mass during straining or triggered by Valsalva maneuver. Due to its rarity, it is often misdiagnosed and ignored. Most cases are reported in children and sometimes later in age. The authors here report a case of right internal JVP, with an unusual coexisting presentation of tongue deformity in an Indian female patient. The aim of documenting this case is to sensitize the oral physician of this rare neck mass which is seldom reported in the dental literature. Furthermore, phlebectasia should be one of the differential diagnosis of neck mass. Although there are rarely any complications recorded in the literature, thorough investigations (ultrasound with Doppler) are needed for correct diagnosis and referral if needed. Diagnosis would prevent unnecessary surgical interventions. The patients are generally followed up by conservative treatment.

A Second Branchial Cleft Cyst Presenting as a Dumbbell -Shaped Anterior Neck Mass

A Second Branchial Cleft Cyst Presenting as a Dumbbell -Shaped Anterior Neck Mass

The Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differentiation of Head and Neck Masses.

The purpose of this study was to evaluate the value of diffusion-weighted MRI (DW-MRI) in differentiating benign and malignant head and neck masses by comparing their apparent diffusion coefficient (ADC) values. The study included 32 patients with a neck mass >1 cm in diameter who were examined with echo planar DW-MRI. Two different diffusion gradients (b values of b = 0 and b = 1000 s/mm2) were applied. DWI and ADC maps of 32 neck masses in 32 patients were obtained. Mean ADC values of benign and malignant neck lesions were measured and compared statistically. A total of 15 (46.9%) malignant masses and 17 (53.1%) benign masses were determined. Of all the neck masses, the ADC value of cystic masses was the highest and that of lymphomas was the lowest. The mean ADC values of benign and malignant neck masses were 1.57 × 10−3 mm2/s and 0.90 × 10−3 mm2/s, respectively. The difference between mean ADC values of benign and malignant neck masses was significant (p < 0.01). Diffusion-weighted MRI with ADC measurements can be useful in the differential diagnosis of neck masses.

Misdiagnosic analysis and treatment of pyriform sinus fistula in children

Objective: To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness. Methods: The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years, with the median age of 5 years, and who were surgically treated from January 2013 to January 2017 in Kunming Children's Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT, internal fistula was found by self-retaining laryngoscope, traced by methylene blue, and excised by high ligation. Results: Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope, piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis, undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis, 2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them, 2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth, and no hoarseness, bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically. Conclusions: Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physician including some otolaryngologists were lack of understanding of the disease.It should be regarded as one of the important differential diagnosis of neck mass in children.Children with recurrent left neck infection and/or abscess should be highly suspected.Self-retaining laryngoscopic examination can make a definite diagnosis and high ligation of the fistula through the external neck approach can achieve good therapeutic effect.

Neck node in adult: a dignostic dilemma

&lt;p&gt;A tender neck mass in adults is a common disease and can be a diagnostic challenge because of its varied presentations, that can range from reactive lymphadenopathy to malignancy. We would like to describe a case report of young male with an enlarged tender neck swelling of short duration. The diagnostic imaging findings mimicked that of scrofula, which prompted a complete workup. Since the other investigations could not prompt to a specific diagnosis, an excision biopsy was performed. The histopathology report showed reactive lymphadenitis and the patient symptomatically improved with broad spectrum antibiotics. We would like to conclude that reactive lymphadenitis can mimic many features of other important differential diagnosis of neck masses. Hence a clinician should have a wide array of suspicion before coming to the definitive diagnosis and management. &lt;/p&gt;

Unilateral asymmetrical anterior bellies of the digastric muscle in coexistence with accessory muscle bundles in the submental triangle: A rare case report

A three-headed anterior belly of the digastric muscle (ABDM) on the right side of a 54-year old Greek male cadaver coexisted with two accessory muscle bundles (AMB) in the submental region. The left ABDM was typical. Typical ABDM was attached to the digastric fossa, while the accessory right anterior bellies to the lower border of the mandible. A muscle bundle arising from the attachment of the left ABDM to the hyoid bone was also observed fusing with the AMB of the ipsilateral side. It is of extreme importance to be aware of the submental region anatomical variations during surgery, imaging interpretation or differential diagnosis of neck masses.

Lateral cervical thymic cyst in a child: a case report

BackgroundCervical thymic cysts are uncommon lesions, rarely considered in the differential diagnosis of neck cysts in children.Case presentationWe report a rare case of multiloculated thymic cyst in an 8-year-old boy on the right side of the neck. Perioperative diagnosis was a cystic hygroma. Macroscopic examination showed a cystic mass measuring 6.5 cm in total length. Histopathology of the excised specimen revealed thymic tissue with prominent Hassall’s corpuscles associated with multiloculated cyst. The cyst wall is bordered by a flattened or multilayered epithelium, often abraded.ConclusionThis case is presented here for its rarity and should be included in the differential diagnosis of neck masses in children. So, it’s a lesion to be well aware of, particularly by pathologists.

Teratoma of the neonatal head and neck: A 41-year experience

ObjectiveTo review our institution's experience with the presentation, evaluation, and management of teratoma of the head and neck in the neonatal population. DesignRetrospective case series (November 1970 through September 2011). SettingTertiary care children's hospital. Patients14 patients (12 boys and 2 girls). InterventionDetailed review of presentation, diagnostic approaches, surgical management, and outcomes. Main outcome measuresAnatomic sites, use of pre and post-natal imaging, use of EXIT (ex utero intrapartum treatment) procedure, presenting symptoms, surgical approaches, additional therapeutic modalities, and outcomes are reviewed. ResultsSeven patients were diagnosed prenatally, while the remaining 7 patients were diagnosed at birth or shortly thereafter. The tumor emanated from the neck in 9 patients, the nasopharynx/oropharynx in 3 patients, the external nose in 1 patient and the face in 1 patient. Nine patients had associated upper airway obstruction. Four underwent an EXIT procedure, with 3 requiring intubation and 1 requiring tracheostomy. All patients underwent surgical resection. One patient demonstrated recurrence at follow-up. ConclusionsTeratoma of the head and neck, though rare, is an important part of the differential diagnosis of neck masses in children, particularly in the perinatal period. The ability to make this diagnosis prenatally with high-resolution fetal ultrasound and MRI (magnetic resonance imaging) permits planning for airway and tumor management prior to delivery. An EXIT procedure should be considered when airway compromise by tumor compression is suspected. Early surgical excision is the treatment of choice and recurrence is rare when a complete resection is achieved.

Extraosseous Ewing Sarcoma: Expanding the Differential Diagnosis of Supraclavicular Fossa Tumors

A broad spectrum of diseases can be included in the differential diagnosis of neck masses. We report a case of extraosseous Ewing sarcoma that presented as a neck mass in a 70-year-old man. To the best of our knowledge, this is the first reported case of extraosseous Ewing sarcoma of the supraclavicular fossa. Published cases of extraosseous Ewing sarcoma in the neck have been described in other age groups, but those tumors were confined to the parapharyngeal space. Also, there have been reported cases in patients older than 70 years in which Ewing sarcoma affected other structures such as the larynx and the pelvis, but none in the soft tissues of the neck. This case adds extraosseous Ewing sarcoma as a possible diagnosis to consider when evaluating a neck mass in the supraclavicular fossa.

English

Incomplete atrophy of thyroglossal tract or retained epithelial cysts, creates the basis for the origin of a thyroglossal duct cyst. Thyroglossal duct cysts are the most common anomaly in thyroid development that occurs in 7% of adult population. In general duct cysts are benign and the incidence of a carcinoma in a thyroglossal duct cyst is very rare, the incidence of which is 1% of all cysts. The vast majority of these are papillary carcinoma (82%), other types of malignancies occurring being mixed papillary and follicular carcinoma, squamous cell carcinoma, follicular carcinoma and anaplastic carcinoma in descending order of frequency. Review of literature has revealed 25 reported cases of squamous cell carcinoma of the thyroglossal duct cyst till date.[1] CASE REPORT We present a case of a forty nine year old male patient, who presented with a swelling in front of the neck which gradually appeared over 4 months with associated change in voice. Further investigations revealed a squamous cell carcinoma with features suggesting the site of origin to be the thyroglossal duct. Sistrunk’s operation was done under general anaesthesia, followed by postoperative concurrent chemoradiotherapy. CONCLUSION Malignancy, although rare, within a thyroglossal duct cyst should be included in the differential diagnosis of neck masses. Aggressive treatment in the form of a combined modality of surgery, radiation and chemotherapy is usually the preferred plan of treatment.

Adult Cystic Hygroma– A Rare Entity

Objective: Lymphangiomas (Cystic Hygromas) are rare congenital malformations commonly seen in children. Its occurrence in adults is uncommon with very scarce reports in the literature. It mainly occurs in infants or children younger than 2 years of age. We report this case to emphasise the need to consider cystic hygroma in differential diagnosis of neck masses in adults. Case Reports: A 50-year-old female presented with a swelling over the antero– lateral aspect of neck of size 8´6 cm since last 4 years, which was not associated with pain, discharge, discolouration or sudden increase in size. Conclusion: The awareness of occurrence of cystic lymphangio main adults is important for its proper management, which includescomplete surgical removal, to prevent recurrence.

Acquired Hemophilia A Simulating Retropharyngeal Abscess: Importance of Differential Diagnosis of Neck Masses before Surgery

The coexistence of acquired hemophilia A with a secondary retropharyngeal hematoma is an extremely unusual condition with important clinical implications. The purpose of this paper is to present a case involving a patient whose first clinical manifestation, namely dysphagia, along with specific clinical examination and imaging findings, led to an incorrect initial diagnosis of a retropharyngeal abscess. However, performance of a more thorough clinical examination led to the correct diagnosis of a hematoma secondary to acquired hemophilia A. This allowed surgery to be avoided in a patient at a high risk of bleeding. Conclusions: Acute neck masses require meticulous differential diagnosis assessing the possible presence of various causative systemic diseases before the most appropriate therapy can be determined.