Differential Diagnosis Of Neck Masses Research Articles

Bronchogenic Cyst as a Rare Differential in an Adult Cervical Cystic Swelling

ABSTRACT Introduction Bronchogenic cysts are rare congenital malformations of the ventral foregut development usually located in the mediastinum and intrapulmonary regions. Cervical bronchogenic cysts are unusual and have been reported predominantly in the pediatric age population, rarely in adults. Materials and methods We retrieved and analyzed medical records of all patients who were diagnosed to have bronchogenic cysts within the past 5 years who presented to the surgical departments of pediatric surgery, cardiothoracic, general surgery, ENT, and head and neck surgery. Data Thirty-three patients with bronchogenic cysts were identified, five of whom were children and only presented with a cyst in the neck. The details of the patient with cervical bronchogenic cyst are presented and discussed. Conclusion Bronchogenic cysts of the neck are rare differential diagnosis of neck masses in adults. The magnetic resonance imaging was found to be specific for diagnosis and preoperative assessment. Complete surgical excision is the treatment of choice, along with the prevention of future complications and establishment of diagnosis. How to cite this article George AJ, Gaikwad P. Bronchogenic Cyst as a Rare Differential in an Adult Cervical Cystic Swelling. Int J Head Neck Surg 2015;6(4):175-177.

Giant Cervical Immature Teratoma: A Case Report of a Fetal Autopsy

Introduction: Cervical teratoma is a rare neoplasm originating from the pluripotent cells and ectopic embryogenic non-germ cells and is manifested as a large and deformed mass in the neck. Case presentation: We reported a fetal autopsy case with the diagnosis of cervical immature teratoma. Prenatal sonography showed a huge neck mass with differential diagnosis of thyromegaly or thymoma. Conclusions: On autopsy, a well circumscribed encapsulated mass measuring 1075 centimeter was identified. Histopathological examination showed a neoplastic tissue composed of haphazardly arranged various mature and immature tissues derived from the three germ cell layers. The thyroid gland was not identified in the gross and serial sections of microscopic examination. Therefore teratoma must be considered in the differential diagnosis of neck masses in fetus and may involve the thyroid gland or arise from it.

Low-grade malignant triton tumor of the neck: a case report and review of the literature.

Rhabdomyoblastic differentiation in a malignant peripheral nerve sheath tumor (MPNST) is termed malignant triton tumor (MTT), a rare neoplasm that poses a diagnostic dilemma in the differential diagnosis of neck masses and portends poor prognosis. We report a sporadic case of MTT of the neck in a 23-year-old female. We present the pathological findings. Immunohistochemistry confirmed the neurogenic origin with S-100 expression and the rhabdomyoblastic differentiation with desmin and vimentin positivity. Radical surgical excision was done. After 4 years there were no signs of recurrence or distant metastasis. The clinical, microscopic, and long-term follow-up of this case are consistent with those of a low-grade malignancy.

Cervical spinal cord compression in a child with cervicofacial actinomycosis

Actinomycosis is a rare, chronic, suppurative, and slowly progressive granulomatous disease caused by a group of filamentous gram-positive anaerobic bacteria belonging to the normal flora of the oral cavity, gastrointestinal, and genitourinary tracts. It may involve several organs; however, spinal cord compression has rarely been reported. We report a 7-year-3-month-old girl who suffered from neck pain with restricted movement, poor appetite, body weight loss, mild right limbs weakness, and a non-tender neck mass. Histopathology of the neck mass revealed sulfur granules of actinomyces. Since actinomycosis was strongly suspected, she was treated with high dose of parenteral penicillin G followed by oral penicillin with complete recovery. The unusual features of our case suggested that actinomycosis should be considered as a differential diagnosis of neck mass and cervical spinal cord compression.

Solitary Fibrous Tumor of Neck Mimicking Cold Thyroid Nodule in 99m Tc Thyroid Scintigraphy

A 68-year-old man had a rapidly growing, painless neck mass, thought to be nodular goiter. Ultrasonography showed a giant, heterogeneous mass occupying the middle and superior poles and protruding outside of the left thyroid lobe. The results of the thyroid function tests were normal. Thyroid scintigraphy revealed a large hypoactive nodule in the left thyroid lobe. Complete surgical removal of tumor was performed and macroscopically demonstrated a well-demarked lesion outside the thyroid gland. Microscopically, the lesion was composed of fibroblast-like spindle cells in a patternless architecture and extensive stromal hyalinization. Immunohistochemistry showed positive reaction for CD34 in spindle cells and diffuse bcl-2 staining. The pathology was confirmed as solitary fibrous tumor. In the follow-up period after surgery, thyroid scintigraphy showed normal left thyroid lobe. Solitary fibrous tumor originated from or associated with thyroid gland is extremely rare. According to our knowledge, this is the first reported solitary fibrous tumor presenting like a cold thyroid nodule. This pathology must be considered for differential diagnosis of neck masses in the thyroid region.

Heterotopic pleomorphic adenoma in the postauricular area

Heterotopic salivary gland tissue is salivary tissue located outside the sites generally known to accommodate major and minor salivary glands. Although heterotopic salivary tumors were reported in various regions of the head and neck, they are seldom found in the superio-posterior neck region and can be confused with other neck masses. Herein, we present a rare case of a heterotopic pleomorphic adenoma in the postauricular area and remind clinicians that heterotopic salivary tumors should be in the differential diagnosis of neck masses.

Cervical foregut duplication cyst: A rare neck mass

Abstract Objective : To describe clinical, radiologic, and histological features of a foregut duplication cyst extending from the oropharynx to the thoracic inlet. Methods : The medical record of one-month-old female who was referred to a tertiary care pediatric hospital for assessment of a neck mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. Results : The child presented with a left neck mass identified during prenatal ultrasound exam. The infant gradually developed choking, gagging, and noisy breathing with feeds. Physical examination revealed a neck mass, extending from left submandibular region to left clavicle, was well-marginated, painless, soft, immobile, and nonadherent to the skin. A computerized tomography of the neck demonstrated a unilocular cystic mass extending from the level of the posterior oropharyngeal airway to the thoracic inlet. The mass was excised and histopathologic diagnosis was foregut duplication cyst. Conclusion : Foregut duplication cyst, although uncommon in the neck region, should be considered in the differential diagnosis of neck mass in children.

Cervical Ectopic Thymus: A Case Report

SUMMARY Cervical thymic masses are congenital lesions that result from aberrant thymic migration during embryogenesis. Most of these masses are asymptomatic. Rarely cervical thymus becomes symptomatic with encroachment on adjacent aerodigestive structures. It should be considered in the differential diagnosis of neck masses, especially in children. Most cases are clinically misinterpreted as branchial cleft remnants or cystic hygromas. Definitive diagnosis could be made only on histopathologic examination of a biopsy specimen in nearly all reported cases. This paper presents the case of a young male, who presented with a soft, fluctuating mass in the left side of his neck. Surgical excision revealed an ectopic thymic cyst. Case report was presented with a short review of the relative literature data.

Novel use of a Weerda laryngoscope for transoral excision of a cervical ganglioneuroma: a case report

IntroductionA ganglioneuroma is a benign neoplasm arising from neural crest cells of the sympathetic nerve fibers and is most commonly seen in the posterior mediastinum or retroperitoneum. Although very uncommon, ganglioneuromas must be included in the differential diagnosis of neck masses. In young adult women, neck incisions made for excision of these benign tumors should be avoided whenever possible.Case presentationWe herein describe the case of a 19-year-old Japanese woman with a ganglioneuroma. The tumor was found in the parapharyngeal space, an unusual location. A fine-needle aspiration biopsy was performed but was considered inadequate to make a definitive diagnosis, so the asymptomatic lesion was surgically excised using a Weerda laryngoscope. The lesion measured 4 × 3 cm in size and was encapsulated. A pathological analysis showed the presence of two distinct cell types, ganglion cells and Schwann cells, embedded in a loose myxoid stroma. The final diagnosis was a ganglioneuroma.ConclusionA complete excision was made possible by using a transoral approach with a novel use of the Weerda laryngoscope. Although its applicability to specific cases depends on the location, size and nature of the tumor, we believe that the Weerda laryngoscope will continue to be useful for performing transoral surgery for cervical tumors.

Infant ectopic cervical thymus one case report: Diagnostic and management difficulties

Cervical ectopic thymus (CET), an embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. Furthermore, aberrant cervical thymic tissue is an infrequently reported cause of neck masses, and especially for pediatric patients. However, according to clinical work, it should be included in the differential diagnosis of neck masses, particularly for children patients. Thymic tissue rests can be found all along the route of thymic descent from the neck into the anterior mediastinum. In routine practice, the preoperative diagnosis of ectopic cervical thymus is seldom considered and it is often misdiagnosed as a possible tumor or as a lymph node, which leads to biopsy or surgical removal. Here, a case of ectopic thymic tissue was presented in the neck misdiagnosed as cystic hydroma (one type of lymphatic malformation). Our misdiagnosis was introduced, the literature about diagnosis and management controversy were reviewed in recent years.

Adult lymphangioma - a rare entity: a report of two cases

Lymphangiomas 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 two years of age. We report these cases to emphasize the need to consider cystic lymphangiomas in differential diagnosis of neck masses in adults. We describe two cases in adults, one a 27-year-old man and the other a 59-year-old male. The former presented with recurrent neck mass for 5 years, and the latter presented with asymptomatic neck mass of a short duration. Both were not associated with any pain, discoloration, discharge or sudden increase in size. The awareness of occurrence of cystic lymphangioma in adults is important for its proper management which includes complete surgical removal, to prevent recurrence.

Aberrant cervical thymic cyst - Case report

The objective of this study is to highlight the embryological development of cervical remnants and to report a case of thymocervical duct cyst. Cervical ectopic thymic tissue is rarely reported. However, it should be included in the differential diagnosis of neck masses especially in children and young adults

V.-jugularis-Thrombose aufgrund eines neuroendokrinen nichtkleinzelligen Lungenkarzinoms

A 65-year-old patient presented with extensive swelling of the lateral neck. B-mode ultrasound showed an oval, well defined, hypoechoic formation consisting of multiple circular layers extending from the base of the skull to the subclavian vein. On subsequent computed tomography the size of the lesion was confirmed and the cause, a mediastinal mass compressing the superior caval vein, was identified. Histological examination of the mass revealed a neuroendocrine active non-small-cell-cancer of the lung. Treatment with high-dose heparin and antibiotics was started immediately, combined with palliative chemotherapy.The differential diagnosis of neck masses includes congenital, infectious, neoplastic and secondary causes due to disease in other regions of the body. Etiologies for jugular vein thrombosis include prolonged central venous catheterization, trauma, obstruction, infection as well as hypercoagulation. In order to diagnose masses in the head and neck region, other parts of the body need to be successively included if no local cause can be identified.

Ectopia tiroidea dual: hipotiroidismo subclínico tras exéresis de una masa submandibular

Ectopic thyroid tissue is a rare clinical entity, and more so when it is present in two different locations. We present the case of a 38-year-old euthyroid woman with submandibular and lingual ectopic thyroid tissue in the absence of a normally located thyroid gland, diagnosed after the extirpation of an asymptomatic mass misdiagnosed as a neoplasm of the submaxillary gland. Despite its low frequency, the possibility of ectopic thyroid should be considered when making a differential diagnosis of neck masses, using ultrasound, thyroid scan and ultrasound-guided fine-needle aspiration biopsy.

Tularemia is becoming increasingly important as a differential diagnosis in suspicious neck masses: experience in Turkey

Neck mass can be an initial finding of many diseases at any age. The differential diagnosis is broad and includes inflammatory, congenital and neoplastic lesions. We retrospectively analyzed charts of the 145 patients with neck mass and without known primary malignancy whose diagnoses were confirmed with histopathologic and serologic examination between July 2003 and July 2008. Twenty-six patients (17.9%) were diagnosed with tularemia. Before 2004, serologic testing for tularemia was not a part of our workup for patients with an inflammatory neck mass. Otolaryngologists should be familiar with head and neck manifestations of tularemia and consider the disease in the differential diagnosis of neck masses. The tularemia outbreak in central Black Sea region, Turkey in 2004 changed our approach to a patient presenting with neck mass.

Melioidotic Necrotizing Fasciitis Presenting as a Supraclavicular Mass

Melioidosis is an infection caused by Burkholderia pseudomallei that usually involves the respiratory tract. It may manifest as pneumonia, septicemia, or localized infection. We present here a case of melioidosis initially manifesting as a mass over the supraclavicular area and subsequently progressing to necrotizing fasciitis. With appropriate antimicrobial treatment and adequate surgical debridement, localized melioidosis can be treated successfully. Melioidosis should be considered in the differential diagnosis of neck masses, especially in patients who have traveled to or stayed in an endemic area.

A Case Report of Accessory Cervical Thymus

【Accessory cervical thymic tissue has been rarely reported. However, it should be included in the differential diagnosis of neck masses in children, along with branchial anomalies, lymph nodes and other tumors. This lesion occurs along the descending line of the thymus between the angle of mandible and superior mediastinum. A 2-month-old infant presented with an asymptomatic left sided neck mass. MRI revealed a well defined homogeneous mass in the deep lobe of left parotid gland. At operation, an easily identified soft tissue mass was found in the left submandibular area, measuring $3{\times}1.5cm$ . It was completely excised. Microscopic examination revealed normal thymic tissue.】

Hyoid Chondroma Presenting as an External Neck Mass

Chondromas of the larynx are rare neoplasms; only a few examples of cartilaginous tumors affecting hyoid bone have been reported. A 33-year-old woman presented with a neck mass on the left carotid triangle. The patient's computed tomography and magnetic resonance imaging revealed a heterogenous mass, which seemed to originate from the left greater cornu of hyoid. The mass was excised using a transcervical approach with left greater cornu of hyoid bone. The pathologic diagnosis was chondroma of hyoid. Expert radiologic and pathologic review is mandatory in cartilaginous neoplasms of the larynx. Cartilaginous neoplasms of the hyoid should be included in the differential diagnosis of neck masses at the carotid triangle.

Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer

Fine-needle aspiration cytology is frequently used for differential diagnosis of neck masses of unknown origin. Inconclusive and even false-negative results are not uncommon. To evaluate the utility of thyroglobulin (Tg) measurement in fine-needle aspirates (FNA-Tg) for detecting cervical lymph node (CLNs) metastases from differentiated thyroid carcinomas. An ultrasound-guided fine-needle aspiration was done in 67 patients with 83 suspicious enlarged CLNs to obtain material for cytology and Tg measurement in the needle washout, using an immunometric chemiluminescent assay. Measurement of anti-Tg antibodies (FNA-TgAb) was also carried out in half of all the aspirates. Subjects were divided into two groups: one of 16 patients awaiting thyroidectomy and the other of 51 patients in follow-up after surgery. The first group of patients had positive FNA biopsy (FNAB-Tg) in 14 out of the 18 studied CLNs with a range of 3.2-43 352 ng/ml, while FNAB-cytology indicated metastasis in only 8 out of the 14 CLNs with positive histology. A total of 65 CLNs were studied in the follow-up group. Lymphadenectomy was performed in 23 patients and 28 aspirated CLNs were removed. Histology confirmed the diagnosis of metastasis suggested by FNAB-Tg in 20 CLNs and of reactive lymphadenitis in the remaining 8 CLNs. FNAB-cytology was positive in only 11 CLNs. Sensitivity of FNAB-Tg was not affected by the studied FNAB-TgAb. The FNAB-Tg achieved a sensitivity of 100% in both groups. FNAB-Tg is an easy and inexpensive technique which proved to increase the diagnostic of cytology in the early diagnosis of papillary carcinoma recurrence to CLN even in the presence of serum TgAb.

Cervical paraganglioma—A case report and review of all cases reported to the Manchester Children's Tumour Registry 1954–2004

We report a 6-year-old male with left-sided ptosis, aniscoria and an initially missed slow growing left-sided neck mass, which was surgically excised when he was 9 years old and confirmed to be a paraganglioma. Seven years later he developed recurrent symptoms and was found to have a recurrence in the anterior mediastinum. We also report on all cases of cervical paragangliomas registered with the Manchester Children's Tumour Registry (MCTR) for the 50-year period 1954-2004. Paragangliomas are very rare tumours in the head and neck but should be considered in the differential diagnosis of neck masses especially when presenting with Horner syndrome. Recurrent symptoms and signs of hypertension herald recurrence. As these tumours can form part of a familial syndrome, long-term follow-up is necessary. Family members should be screened for early detection.