Evaluation Of Cervical Mass Research Articles

Man With Neck Swelling.

A 53-year-old man with a medical history of hypertension and end-stage renal disease presented to the emergency department with 2 weeks of swelling masses on the right side of the neck. In addition, he experienced a low-grade fever, general malaise, and decreased appetite without weight loss. Physical examination showed multiple enlarged and firm lymph nodes on the neck bilaterally. Laboratory studies revealed a white blood cell count of 14,570 μL and an elevated C-reactive protein concentration of 75 mg/L. Point-of-care ultrasound (Figure 1) and computed tomography (CT) (Figure 2) were performed.Figure 2Computed tomography showing multiple enlarged lymph nodes with central necrosis and peripheral rim enhancement (circles). Left panel, coronal view. Right panel, sagittal view.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Cervical tuberculous lymphadenitis (scrofula). The patient underwent an excisional biopsy of the neck masses, the smear of which showed acid-fast bacilli. The polymerase chain reaction and tuberculosis culture of the specimens were positive for Mycobacterium tuberculosis. The chest radiograph was expected, and the serological testing for HIV was nonreactive. He was initiated on a first-line antituberculosis regimen. Scrofula, known as the “king’s evil” in Europe, was thought to be cured by the royal touch until the 18th century.1Grzybowski S. Allen E.A. History and importance of scrofula.Lancet. 1995; 346: 1472-1474Abstract PubMed Google Scholar Cervical lymphadenitis is the most common form of extrapulmonary tuberculosis. The clinical features are chronic, swollen, and nontender cervical nodes that may fluctuate with fistula formation.2Khalid S.K. Jassim O. Images in clinical medicine. Scrofula.N Engl J Med. 2006; 354: e18Crossref Scopus (0) Google Scholar,3Sharawat I.K. Dawman L. Scrofula.J Pediatr. 2017; 189: 236Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Ultrasonography is a useful imaging tool in the evaluation of cervical masses, and tuberculous nodes tend to be hypoechoic, round, and without echogenic hilus.4Ahuja A.T. Ying M. Sonographic evaluation of cervical lymph nodes.AJR Am J Roentgenol. 2005; 184: 1691-1699Crossref PubMed Scopus (211) Google Scholar The CT findings of scrofula are multiple low-attenuation lymph nodes with thick and irregular rims of peripheral enhancement.5Hanson R.A. Thoongsuwan N. Scrofula.Curr Probl Diagn Radiol. 2002; 31: 227-229Crossref PubMed Scopus (2) Google Scholar

A Rare Case of Synchronous Cervical Lymph Node Metastasis from Renal and Thyroid Cancer

Papillary thyroid cancer (PTC) has a propensity to metastasize to the cervical lymph nodes (LNs). Renal cancer (RC) can also spread to the cervical LNs and is the most common cause of metastatic infiltration of the thyroid gland. We describe here the case of a 71-year-old patient with a previous history of surgically treated RC who underwent evaluation of a large left cervical mass. Initial cytological investigation on fine needle aspiration (FNA) indicated metastatic PTC. Computed tomography (CT) scanning revealed no other suspicious foci. The patient underwent total thyroidectomy and central and left lateral cervical LN dissection, during which a large neck mass along the left jugular vein was also removed. Histology demonstrated metastatic spread of RC to the thyroid gland and lateral cervical LNs and concurrent LN metastases from PTC. One LN showed evidence of synchronous RC and PTC metastasis. Only a small papillary thyroid microcarcinoma with no aggressive histological features was detected in the thyroid, raising the possibility that the primary focus of metastatic PTC was the large left lateral neck mass. The patient was discharged after successful treatment for transient hypoparathyroidism. The synchronous presence of RC and PTC in the thyroid and cervical LNs and the concurrent metastases in one of the LNs renders this case unique. Evaluation of a cervical mass in a patient with a prior history of malignancy can prove vexing, and surgery may be the only option for the establishment of a definitive diagnosis.

Fetal MRI: what is the future?

Fetal MRI: what is the future?