Lateral Neck Mass Research Articles

Lateral neck mass in a child

Lateral neck mass in a child

Neck Masses in Children

Educational objectives: To develop a practical approach to the evaluation of a child with a neck mass and to become familiar with etiologies, clinical diagnosis, and management of midline, lateral, and posterior neck masses.

Carotid body tumor mimicking adenocarcinoma on fine-needle aspiration.

We report an 86-year-old woman who presented with a 6-month history of a mass in the left side of her neck. MRI and MRI angiography favored a diagnosis of a neural tumor. FNAB showed a large cluster of cohesive, pleomorphic cells with intranuclear inclusion bodies; a diagnosis of adenocarcinoma was favored. At surgery, a 7 x 5 x 2.5 cm, firm, encapsulated mass was excised. Microscopically, the richly vascularized tumor had characteristics of a CBT, with large pleomorphic chief cells and spindle-shaped sustentacular cells in small, poorly formed nests. The chief cells were strongly immunoreactive for neuron-specific enolase and chromogranin, and focally positive for neurofilament, enkephalin, somatostatin, and beta-endorphin. The sustentacular cells were strongly immunoreactive for S-100 protein and glial fibrillary acidic protein and focally positive for vimentin. Ultrastructurally, the chief cells contained abundant neurosecretory granules. We emphasize that CBT must be included in the differential diagnosis of lateral neck masses. The distinction from adenocarcinoma is difficult on FNAB. The marked cytological atypia in an aspirate of a CBT does not indicate malignancy and may lead to an erroneous diagnosis.

Tumours of the parapharyngeal space: Our experience

Parapharyngeal tumours are rare and constitute only about 0.5% of all head and neck neoplasia. They pose considerable diagnostic and therapeutic challenges. A series of nine parapharyngeal tumours which were surgically treated over an eight year period is presented. Neurogenic and salivary tumours accounted for most of these. Medial displacement of the lateral oropharyngeal wall and ill- defined upper lateral neck mass were the most common physical signs. Histopathological diagnosis was not possible pre- operatively in any patient. External surgical approaches were used with a high degree of success. There were no significant long- term complications except in cases where nerve trunks had to be transected for ensuring complete tumour removal.

Neurilemmomas of the cervical vagus nerve

Four patients were seen with neurilemmoma which arose in the cervical vagus nerve. Three tumors arose in the upper third of the lateral neck, and the remaining one in the lower third. Lateral neck mass was a prominent symptom in 3 patients, and parapharyngeal mass in the remaining one. The parapharyngeal mass bulged into the oropharynx in the tonsillar and retrotonsillar region and caused mild swallowing difficulty. Complete surgical extirpation by means of intracapsular enucleation was possible in all 4 patients. All patients remained free of disease for periods ranging from 15 to 75 months following surgery. It would appear that an intracapsular enucleation may be advisable for clearance of this kind of tumor.

Persistent third branchial apparatus

Neck sinuses, cysts or fistulae arising from the third branchial apparatus, have seldom been reported. Between 1979 and 1989, 16 cases were diagnosed as persistent third branchial apparatus based on a fistula open or in proximity to the pyriform sinus. There were 8 boys and 8 girls whose ages ranged from newborn to 13 years. Esophagogram was performed in 6; 4 showed a fistula tract leading to the pyriform sinus. Others were demonstrated at surgery. The main presentations were suppurative thyroiditis (5), lateral neck fistula (5), cyst (3), mass (1), abscess (1), and esophageal stricture (1). This was interpreted as a spectrum of disease that in the newborn may present as a cyst, and later in childhood as a fistula in the lower neck or recurrent suppurative thyroiditis if the fistula ends in the thyroid gland. It is imperative to search for this internal communication to the pyriform sinus to make a correct diagnosis and to avoid development of esophagocutaneous fistula postoperatively. With more awareness of this disease entity, the noted incidence should increase.

Cervical lymph nodes from an unknown primary tumor in 190 patients

Over 10 years, 475 patients with isolated lateral neck masses were evaluated: 190 with lymph nodes from an unknown primary tumor (LNUP), 188 with neck lymphomas, 78 with benign tumors, 10 with sarcomas, and 9 with chemodectomas. This study focused on the patients with LNUP. Only 86 patients were treated with surgery (plus radiotherapy). Other patients were treated with radiotherapy (84) or chemotherapy (13) or had no treatment (7). For the overall population, failures in the neck occurred in 51% of the patients and distant metastases in 27%, while primary tumors appeared in 16%. Survival rates at 3, 5, and 10 years were 27%, 19%, and 7%, respectively, for the overall population and 45%, 35%, and 19%, respectively, for the surgical group. The diagnosis and therapeutic approach had a direct effect on neck control; failure in the neck occurred in 7 of 47 patients (15%) when fine needle aspiration and radical neck dissection with radiotherapy were performed, in 5 of 12 patients (42%) when fine needle aspiration and modified neck dissection with radiotherapy were used, in 5 of 12 patients (42%) when adenectomy diagnosis and radiotherapy treatment were performed, and in 6 of 11 patients (54%) when diagnosis by incisional biopsy was performed prior to admission, despite subsequent radical neck dissection and radiotherapy treatment. In our opinion, panendoscopy and fine needle aspiration should be the first-line diagnostic approach. When cytologic diagnosis proves impossible, the second-line approach must consist of cervical exploration with frozen section examination and excisional biopsy, followed by immediate appropriate treatment. In cases of LNUP, radical neck dissection seems to be preferable.

Lateral neck mass as the initial manifestation of thyroid carcinoma.

Of 238 thyroid cancer patients, 24 exhibited a lateral neck mass as the initial presentation. Twenty four (77.4%) of 31 metastatic masses were located at the midjugular and lower jugular lymph chains. The average number of histologically proven metastatic nodes was 6.5. Histologically, 22 cases were diagnosed as papillary carcinoma, 1 as follicular carcinoma, and the remaining case as medullary carcinoma. Fifteen thyroid glands were found to have a single primary focus, while 9 others had multiple foci. The mean diameter of the primary foci was 1.2 cm. The rates of detection of primary foci by thyroid scan and ultrasonography were 60% and 37.5%, respectively. Surgical procedures for the thyroid lesions included total or near-total thyroidectomy in 18 cases and lobectomy in 6 cases; for metastatic neck nodes, 13 were treated by modified neck dissection, 5 by standard radical neck dissection, and six by partial neck dissection. All 24 patients were followed for a mean duration of 4.5 years with a range of 2.0 to 7.5 years, and all except 1 are still living. In the presence of a lateral neck mass as the initial manifestation of thyroid carcinoma, no matter what size the primary tumor foci, a total or near-total thyroidectomy appears to be justified in addition to an appropriate neck dissection.

Ectopic Thyroid in the Right Carotid Triangle

A neck mass in the right carotid triangle of a 28-year-old woman was found to be the only thyroid tissue she possessed. Resection of the mass led to clinical and biochemical hypothyroidism. A possible explanation for the unlikely occurrence of lateral aberrant thyroid tissue and absence of a thyroid gland in the usual location is offered. It is suggested that patients with midline or low lateral neck masses undergo isotopic scanning of the thyroid gland before any iodinated contrast materials are administered or surgery performed.

The sternocleidomastoid tumor of infancy

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little attention in the otolaryngological literature. The diagnosis must be considered in any infant presenting with a lateral neck mass. Although its natural history favors spontaneous regression, the mass may initially grow in size. The purpose of treatment is the prevention of torticollis and craniofacial asymmetry. The initial treatment is non-surgical, passive and active exercises. Only when this treatment fails should surgery be performed. The disappearance of the lesion is not always a predictable sign. A small number of children will develop delayed torticollis or craniofacial asymmetry. It is important that parents be informed of this possibility and of the necessity for long term follow-up.

Persistent pharyngeal pouch derivatives in the neonate

Internal branchial sinuses are rare compared to other branchial anomalies. A case is described in which such a sinus presented as an air-containing inflammatory lateral neck mass in a neonate and evidence is presented to support the theory that this originated from the fourth pharyngeal pouch. Review of six similar cases from the literature shows this to be a well-defined clinical entity.

Carotid body tumor: The Lahey Clinic experience

We believe that paragangliomas of the carotid body should be excised in all patients unless formidible medical conditions prohibit the use of general anesthesia. If these tumors are left unresected, they will eventually grow to invade the skull and kill the patient. With definitive diagnostic modalities available, in addition to comparatively low-risk anesthesia, autotransfusion, and replacement of the carotid artery, there are few patients who cannot be surgically treated. The important point is that although such a tumor is rare, its presence must always be considered when dealing with a lateral neck mass. Carotid arteriography should be performed when a carotid body tumor is suspected.

Paragangliomas of the Neck: Clinical and Pathologic Analysis of 116 Cases

Neck tumors developing from the paraganglion system are best called paragangliomas. They may be described further as to site of origin and as to whether they are functioning or nonfunctioning. Review was made of 116 cases in which operation for paraganglioma was performed at the Mayo Clinic. The diagnosis depends upon demonstration of a lateral neck mass, elimination of other causes, and a tumor blush on angiography. Screening tests should be done to determine whether the tumor is producing epinephrine. Surgical management should be selective, depending upon the location and involvement of surrounding structures, particularly the carotid artery system. A conservative approach is indicated for those patients whose tumor surrounds the carotid vessels, because the risk of complications is greater than the risk of leaving the tumor in the neck. Conservatism is also indicated for patients in the older age group, because of the slow growth of these tumors and the low incidence of malignancy.

Bilateral carotid body tumors.

A case of bilateral carotid body tumors is reported with discussion of the pathology and the angiographic findings. The heredofamilial predisposition of these tumors, especially in association with bilaterality, is discussed.Carotid body tumors are rare and may not be considered in the differential diagnosis of lateral neck masses; however, several clinical findings should suggest their presence. If a carotid body tumor is suspected, arteriography should be performed, preferably by the femoral route, not only to study the side of the suspected tumor, but also to study the contralateral carotid and cerebral circulation for patency, and to detect small contralateral carotid body tumors which are not suspected.

Unsuspected Etiology of Lateral Neck Masses: Cat-Scratch Disease

In the adult population the presence of a cervical mass can be an ominous sign; over 50% of such lesions are malignant. Another obviously more benign and frequently undiagnosed cause for the same alarming symptoms is cat-scratch disease. Accurate, early diagnosis is imperative in order that definitive therapy, when indicated, be carried out. When the clinical diagnosis of cat-scratch disease is substantiated by a positive skin test with specific cat-scratch disease antigen, expectant treatment may be indicated. In the equivocal situation, however, histopathologic proof of the absence of malignancy must be obtained since unjustified delay or a mistaken diagnosis may prove fatal. Thorough investigation of the possibility of cat-scratch disease is suggested in all clinically suspicious situations.

Extraparotid Warthin's tumour: usual tumour adjacent to usual site

Lateral neck swelling is a common presentation in ORL practice. The complexity of the neck structures warrants a thorough examination and investigation to narrow down the differential diagnosis. Neoplasm need to be ruled out especially if the neck swelling present in an adult. We report a case of a lateral neck mass being treated as lymphadenopathy before the patient defaulted follow up. The patient represented after 3 years and investigations performed. FNAC revealed sialadenosis but radiologically and intra-operatively consistently showed the mass located outside parotid gland. The final diagnosis of Whartin's confirmed after the HPE evaluation. The diagnosis dilemma is discussed. Keywords: Lateral neck selling; warthin's tumour; extra parotid DOI: http://dx.doi.org/10.3329/bjms.v10i4.9506 BJMS 2011; 10(4): 296-298

Carcinoma of the thyroid after X-ray therapy to the neck: Report of a patient treated after thirty-two years

A case is reported of papillary adenocarcinoma of the thyroid in an adult who had received irradiation to the neck in childhood. This tumor appeared in childhood, presenting as a lateral neck mass seven years after irradiation to the neck and was treated surgically thirty-two years after its appearance.