Lateral Neck Swelling Research Articles

Congenital thyroid teratoma in a newborn: Case report from Ethiopia

Teratoma is a germ cell tumor composed of elements from one or more of the three embryonic germ layers. The most common sites of occurrence in childhood are the sacrococcygeal region, gonads, mediastinum, and pineal region and rarely head and neck.[1–6] Cervical teratoma is a rare congenital disease that constitutes about 1–6% of all pediatric teratoma.[3,5] Few of these cervical tumors are very rarely located entirely in the thyroid gland which are called thyroid teratomas.[3,5–8] 17 days old female neonate born to a 32 years old Para III mother presented with right lateral neck swelling and respiratory distress since birth. The neonate underwent surgical excision at age of 20 days through a right transverse cervical incision and the intraoperative finding was a lobulated well defined capsulated cervical tumor measuring 4 * 4 cm with a cystic and solid component. The right lobe of the thyroid gland was not localized, but the left lobe of the thyroid gland was present laterally. Since the tumor has raised from the right lobe of the thyroid gland than from the soft tissue of the neck the tumor is defined as thyroid teratoma instead of cervical teratoma. Besides, the histopathology report confirmed this diagnosis which showed tissue composed of cystic and solid components consisting of the thyroid gland, brain tissue, and skin with the appendages with no immature tissues seen. thyroid teratoma is extremely rare and about 41 cases have been reported in the English literature so far.[5] It is usually benign; however, if not treated properly they can lead to death because of large growth and local effect on vital structures like airway compression.

ANTERIOR TRIANGLE NECK SWELLINGS- RELATIVE INCIDENCE OF VARIOUS CLINICAL CAUSES

Aims and objectives- The intented aim of our study was to find out the cause of various benign anterior triangle neck swellings. Material And Methods- A prospective study was carried out at ENT department of MMIMSR for a period one year from June 2017 to May 2018. The sample size consist of 50 patients. All patients attending the ENT OPD with neck swelling were included in this study. These patients were evaluated based on clinical history and examinations. Pathological investigations like FNAC (Fine needle aspiration cytology) & histopathological examination (HPE) along with radiological examination such as Ultrasounography (USG), X-ray, Magnetic resonance imaging (MRI), Computed tonnography (CT Scan) was carried out wherever it was required. Result – Out of 50 patients, 46 percent were male patients (n=23) and 54 percent were female patients (n=27). Patients with the age from 5 years to 70 years were affected with the mean age of 42years. Midline neck neck swellings were more common than lateral neck swellings (Anterior triangle). Among the midline neck swelling ,thyroid gland pathology was commonest with 72.4% of cases (n=21), followed by Thyroglossal duct cyst with 24% cases(n=7). Thyroglossal cyst was the most common congenital swelling seen in our study. In the lateral neck, salivary gland pathology was the commonest cause of neck swelling with 52.3% cases (n=11) followed by branchial cyst with 23.8% cases (n=5). 14.3% of cases (n=3) with tubercular lymphadenopathy were found in submandibular region

Extraoral Sublingual Epidermoid Cyst: A Case Report

Epidermoid Cysts (EC) are rare cysts of the head and neck region, which may confuse with many soft tissue sublingual mass pathologies. A presentation of such cyst is important to decide the surgical approach. The aim of this paper was to present the role of USG and MRI for determine the surgical approach. A female patient presented with chronic asymptomatic swelling over left submandibular neck which was single diffuse, non-tender, soft, compressible, fluctuant with normal overlying skin. Swelling was not movable with deglutination and protrusion of tongue. MRI and USG guided FNAC was conclusive to diagnose the lesion. Histological examination confirmed the diagnosis. Lateral neck swelling should be considered as EC for differential diagnosis. A careful physical examination and fine needle aspiration and diagnostic imaging should be performed which clarifies the surgical approach.

Vagal nerve Schwannoma- An interesting case presenting as lateral neck swelling

A Schwannoma is a benign nerve sheath tumor composed of Schwann cells. Schwannoma arising from the vagus nerve is an uncommon (2–5%) benign nerve tumor. Less than 1% becomes malignant. Definitive pre-operative diagnosis may be difficult and investigations such as FNAC have low specificity. Surgical removal of tumor is the treatment of choice for vagal schwannomas with nerve preservation. Surgical removal can be done either by intra capsular enucleation or extra capsular excision of tumor. Definitive diagnosis is obtained by means of surgical pathology. Here we present a case of 40 year old male presented with swelling over anterio -lateral aspect of left lower neck region for last four years with mild change in his voice for few months. CECT of the neck was suggestive of left neck cystic necrotic lesion. On FNAC the swelling was misdiagnosed as colloid nodule. The mass was excised. Grossly a single encapsulated globular cystic tissue piece measuring 8.5x7x6 cm was received in histopathology lab, which on cut section show a unilocular cyst filled with blood mixed mucoid material. On Histopathology, a diagnosis of Schwannoma was rendered. Keywords: Benign tumor, Neck swelling, Schwannoma, Vagal nerve.

Study of benign neck swellings of anterior neck triangle at a tertiary care centre

<p class="abstract"><strong>Background:</strong> Tumors of the neck are interesting to surgeons especially because of the complex neck anatomy and difficult differential diagnosis. The aim is to study different types of neck swellings i.e. thyroid swelling, salivary gland swelling, other neck swellings such as thyroglossal cyst, branchial cyst, lymphangioma and also the miscellaneous and rare lumps in the neck. The study also discusses their age and sex-wise distribution, clinical features, presentation, diagnostic modalities and treatment.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study, conducted at our institute Government Medical College, Latur from June 2017 to May 2018 for a duration of one year. </p><p class="abstract"><strong>Results:</strong> A total of 57 patients were studied during this period. Out of the 57 patients, 47 of them were midline swellings (82.45%) and 10 among them were lateral neck swellings (17.55%). People over a wide range of age group between 5-60 years were affected. Midline neck swelling were more common than lateral neck swellings.</p><p class="abstract"><strong>Conclusions:</strong> Among the midline benign neck swellings, thyroid swelling was found to be the commonest followed by thyroglossal cyst. Thyroid swellings occur more commonly in the females than males. Ultrasound guided FNAC is the most common, effective and safe investigation that aids in the diagnosis. Treatment of choice for benign, non-inflammatory and non-malignant neck swelling is mostly surgical excision rather than medical management.</p>

Cervical thymic cyst in adult: a rare entity

<p>Cervical thymic cysts in adults are rare and seldom diagnosed preoperatively as it may mimic other cystic cervical swellings like a branchial cleft cyst. We present our first encounter with an adult-onset cervical thymic cyst presenting as a lateral neck mass as the sole symptom. Clinical, radiological and cytological evaluations are excellent tools to approach and assess cervical thymic cysts. Histopatholgical examination is the only mean to provide a definitive diagnosis. Adult-onset cervical thymic cyst is a rare entity but should be included in the differential diagnosis for lateral neck swelling. Surgical excision is both diagnostic and therapeutic, once malignancy has been exluded.</p>

An unexpected finding from a submental mass.

This case describes a fit and well 17-year-old male who underwent surgical resection of a longstanding, painless, right lateral neck swelling. Believed to be either a vascular malformation, ranula or enlarged sublingual gland from pre-operative MR studies, histopathological examination of the mass revealed it as normal thyroid tissue. Post-operative imaging confirmed the absence of any remaining thyroid tissue. Hypothyroidism was confirmed with subsequent thyroid function tests. Interestingly, a “thyroid storm” which presented unknowingly during the surgical removal of the lesion did not trigger suspicion that thyroid tissue was being handled at the time. Normal, ectopic thyroid tissue in the lateral neck is rare but should be considered a differential diagnosis for neck lumps, particularly if it also presents as an intraoral swelling, as in this case. The presence of the orthotopic thyroid gland should be confirmed with diagnostic imaging prior to surgical excision of unknown neck masse

Presentation of Branchial Cleft Anomalies: Case Reports and Review of Literature

Type 2 branchial cleft anomalies are the most common cause of lateral neck swelling. We report two cases of type 2 branchial cleft anomalies. The first case is branchial cleft cyst and the second one is branchial fistula. Both cases were managed surgically. The post operative outcomes were uneventful. Second branchial cleft anomalies are the most common branchial anomalies. Branchial cysts are more common than sinuses and branchial fistulae are extremely rare. There is no gender predilection. The location, clinical symptoms and imaging findings aid in the diagnosis of this condition. Surgical excision is the mainstay of treatment.Keywords: branchial cleft; branchial cyst; branchial fistula.

Venous Malformation in the Neck

Introduction
 Venous malformation is a benign vascular lesion. Approximately 40% of such cases occur in head and neck.
 Case Report
 Venous malformation in a 19 year old man is reported, which presented as a lateral neck swelling.
 Discussion
 The venous malformation in the head and neck region may confuse the surgeon in distinguishing it from its other common congeners e.g. hemangioma, lymphangioma etc. and may also cause dilemma regarding its treatment modality. Treatment options include surgery, laser therapy, sclerotherapy or a combination depending upon the complexity of the lesion.

Life-threatening parapharyngeal and retropharyngeal abscess in an infant

Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever,...

Fourth branchial pouch or cleft anomalies

Fourth branchial cleft and pouch anomalies are rare but clinically important entities that require a high index of suspicion. A missed diagnosis can prolong patient morbidity resulting in incorrect treatment and probable recurrence. These anomalies are secondary to errors in embryogenesis from incomplete involution of the fourth branchial cleft or pouch, resulting in the formation of a cyst, sinus, or fistula. They commonly present as a recurrent lateral neck swelling in the pediatric population. Surgery is the mainstay of treatment.

Parapharyngeal space schwannomas: our experience and review of literature

<p class="abstract"><strong>Background:</strong> Tumors of the parapharyngeal space are a rare group of head & neck tumors. Due to their indolent nature they present late with either cranial nerve palsy or lateral neck swelling. The aim of the study was i) to determine the incidence of parapharyngeal space schwannoma among defence personnel’s and their dependents presenting to ENT OPD and ii) to study the clinical presentation, management and outcomes of such lesion.</p><p class="abstract"><strong>Methods:</strong> The study is a retrospective observational study. All new patients referred to ENT OPD at our center were included in the study. Data was collected from our OPD records over two years between Jan 2015 and Dec 2016. </p><p class="abstract"><strong>Results:</strong> It was found that the incidence rate of parapharyngeal space schwannoma was 0.034% out of all fresh cases reporting to ENT OPD and 0.47% out of all fresh diagnosed cases of head and neck tumours at our centre. Out of the total 5 cases of parapharyngeal space schwannomas, 2 patients had vagal schwannomas and one each had hypoglossal nerve schwannoma, spinal accessory nerve schwannoma and sympathetic chain schwannoma.</p><p><strong>Conclusions:</strong> Schwannomas of the parapharyngeal region can be very extensive and may require to be removed in a staged procedure involving the head & neck and neurosurgeons.It is important to distinguish these tumors from other head and neck malignancies by detail clinical and radiological examinations. Despite the benign nature of the disease, the surgery can be morbid with cranial nerve palsies in extensive tumors. </p>

The clinical study and management of lateral neck masses

Background: Tumors of neck are especially interesting to surgeons because of complex neck anatomy and difficult differential diagnosis. The aim is to study different type of lateral neck masses excluding thyroid and salivary swellings, there relation with age and se, there clinical features, presentation, and complications, diagnostic modalities and treatment according to the diagnosis and miscellaneous and rare lumps in the neck.Methods: The study was conducted at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India from January 2012 to December 2015. In cases of tubercular lympahdenopathy, patients are treated with antitubercular chemotherapy regime DOT’s. In cases of malignant secondaries in neck, patients were offered radical neck dissection, radical radiotherapy or neoadjuvant chemotherapy followed by neck dissection.Results: Total 228 patients are studied. 74.56% were benign and 25.44% were malignant. Most common age group affected was 11-20 years. Malignant lesions were more common after 50 years. Male female ratio was nearly equal. Most common lesion overall was tubercular lymphadenopathy followed by malignant lymph nodes.Conclusions: Lymphadenopathy predominated lateral neck swellings of which tubercular lymphadenopathy found to be commonest followed by malignant secondries. Tubercular infections are common during 1st and 2nd decade, while malignant lesions after 5th decade. FNAC was most common and most effective investigation. Treatment varies according to the cause of lateral neck mass.

Solitary cysticercosis of sternocleidomastoid muscle: a rare entity

<p class="abstract">An infection with the larval stage of tapeworm (<em>Taenia solium</em>) is known as cysticercosis. It is seen as cysts in various human tissues, most commonly in the the brain and orbit. Head and neck (except brain and orbit) is a rare location for cysticercosis. We present a case of lateral neck swelling which turned out to be solitary cysticercosis of sternocleidomastoid (SCM). The case is reported because it is rare and to reinforce the fact that possibility of parasitic infection should be considered while dealing with a case of neck swelling. It can be managed medically and high resolution sonography can be a reliable tool for diagnosis and follow-up<span lang="EN-IN">.</span></p>

An unusual presentation of papillary thyroid carcinoma in the lateral aspect of the neck

Introduction: Papillary thyroid carcinoma (Ptc) is the most common thyroid cancer. Papillary thyroid carcinoma presenting as a lateral neck mass in the presence of a normal thyroid is extremely rare. Ectopic thyroid tissue can arise in the lateral aspect of the neck, and, therefore, Ptc may arise at this site in ectopic tissue. Alternatively, cervical cystic lymph node metastasis may be a first presentation of occult Ptc. case report: A case of a 28-year-old male was referred for investigation of a painless leftsided neck swelling. Excisional biopsy revealed Ptc, and completion surgery revealed papillary microcarcinoma and a further lymph node metastasis in the definitive resection specimen. conclusion: this case highlights that Ptc always needs to be considered in the differential diagnosis of lateral neck swellings even in presence of a normal thyroid. Establishing the exact etiology of lateral cystic Ptc can be challenging.

Vagal Nerve Schwannoma: Presentation of Two Case Reports

ABSTRACTVagal nerve schwannomas are rare neural sheath tumors. Although schwannomas are generally benign lesions, they are known to enlarge at a rate of 2.5 to 3 mm per year according to published reports. Vagal nerve schwannoma usually occurs between the 3rd and 5th decades of life, it does not show sex predilection, with both sexes being equally affected, and it most often presents as a painless, slow-growing, lateral neck mass. The treatment of choice is complete surgical excision with preservation of the neural pathway, when it is possible. These tumors, in fact, are almost always benign, and a conservative surgical approach is emphasized by most of the authors. Here, we are presenting two cases of cervical vagal schwannoma, both were middle aged females and presenting in the ear, nose, and throat (ENT) department as a painless lateral neck swelling and were operated by horizontal skin crease incision. Of the two cases, we succeeded to secure nerve functions in one case. The clinical features, diagnosis, management, and pathological findings of cervical vagal schwannoma are discussed.How to cite this articleGujrathi AB, Ambulgekar V, Chavan S. Vagal Nerve Schwannoma: Presentation of Two Case Reports. Int J Otorhinolaryngol Clin 2016;8(3):116-118.

Cystic schwannoma of cervical sympathetic chain masquerading as type II second branchial cleft cyst

<p class="abstract"><span lang="EN-US">Brachial cleft cyst is the most common differential diagnosis of benign lateral neck swelling but other cystic swellings like carotid body tumours and cystic schwannomas should be kept in mind. MRI of neck is of great assistance in determining the nature of the swelling as fine needle aspiration cytology will fail in diagnosing such swellings accurately. We present a case of 22 year old female who presented with a slow growing swelling which was diagnosed as brachial cyst on FNAC and CT but turned out to be cystic schwannoma of cervical sympathetic chain which highlights the importance of considering various differentials of lateral neck swelling and limitation of FNAC and importance of pre-operative MRI in such cases.</span></p>

Ancient schwannoma of cervical sympathetic chain masquerading as carotid body tumour

Schwannomas are benign tumours arising from the nerve sheath cell. 25-40% of schwannomas are found in head and neck. Ancient schwannona of cervical sympathetic chain is very entity. It is a slow growing benign swelling in lateral neck and hence can be confused with other benign swellings of neck. We present a case of ancient schwanoma of cervical sympathetic chain which masqueraded as carotid body tumour highlighting the importance of contrast enhanced CT and MRI pre-operatively along with restricted utility of FNAC in correct diagnosis of lateral neck swelling.

Right Internal Jugular Vein Ectasia in African Woman: A Report of 2 Cases

Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. Accurate diagnosis from careful history, physical examination and radiological study can be made. We report here two cases of IJV ectasia in African adults with right lateral neck mass dilating when increase intrathoracic pressure. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJV ectasia as differential diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment. The asymptomatic case management of IJV ectasia is conservative with long-term surveillance.

English

Benign tumors of larynx in adults are common and are often presents with hoarseness of voice or respiratory difficulty with stridor. Papilloma constitutes the major benign tumor of larynx in adults and usually presents with hoarseness of voice or stridor. A unique case of inflammatory myofibroblastic tumour of left aryepiglottic fold in a 19 year old female presenting with lateral neck swelling is presented. MRI revealed a polypoidal left aryepiglottic fold mass with caudal extension into the glottis and changing its position into the left PFS on e-phonation. The diagnosis of inflammatory myofibroblastic tumour remained elusive till it was proved histopathologically, after excision by laryngofissure approach. We present this rare case so that this condition and its surgical approach can be better recognized and understood.