Suture granulomas are rare benign inflammatory reactions to retained non absorbable suture materials that may clinically and radiologically mimic neoplastic recurrence. Present case is of a 48-year-old female who developed multiple anterior neck swellings 18 months after undergoing hemithyroidectomy for a biopsy-proven follicular adenoma. Imaging and cytology raised suspicion of recurrence. However, histopathological examination of excised tissue confirmed the diagnosis of a suture granuloma. This case highlights the diagnostic challenge posed by this entity and underscores the importance of considering benign postoperative complications in the differential diagnosis of new neck masses in previously operated patients.

Not just a neck mass: Primary thyroid diffuse large B-cell lymphoma

From the archives of MD Anderson Cancer Center: Small lymphocytic lymphoma/chronic lymphocytic leukemia diagnosed in Warthin tumor.

ABSTRACTPhrenic nerve schwannomas in the neck are exceptionally rare and can present as asymptomatic lateral neck masses. Intraoperative nerve identification is critical for the preservation of diaphragmatic function. Surgeons should include this rare entity in the differential diagnosis of cervical schwannomas to avoid misdiagnosis and inadvertent nerve injury.

A unilateral carotid artery pseudoaneurysm combined with a congenital absence of the contralateral internal carotid artery is clinically rare, and the currently available literature is limited. This article reports a case of a 37-year-old male patient with a left carotid artery pseudoaneurysm and congenital absence of the right common and internal carotid arteries, initially presenting with a neck mass. The patient recovered well 2 years after surgery.

Introduction: Diagnosis of swelling in the head and neck region is challenging due to the diversity of entities. Introduction of FNAC in diagnostic protocol of Space Occupying Lesion (SOL) of head and neck region has reduced the number of unnecessary surgery and excision biopsy. Existing Literature review indicates that clinical history and anatomical site of the lesion are valuable in terms of narrowing down the differential diagnosis of a SOL in head & neck region. FNAC has contributed a great deal to transform cytology from a primarily screening tool to a powerful diagnostic technique. With this background knowledge, the present study was performed to evaluate the wide spectrum of lesions diagnosed on Fine needle aspiration cytology (FNAC) in patients with head and neck swellings and to know the efficacy of FNAC in diagnosing head and neck lesions Materials and methods: The present prospective, observational single hospital based study was conducted in a tertiary care centre and medical college in eastern India, catering mainly rural population. Eighty (80) patients were included in the study, after obtaining written consent, presenting with superficially palpable swellings of head and neck area. After explanation of procedure and taking informed consent of patient, FNAC was done using 10 cc disposable syringe and 22 gauge needle maintain appropriate procedure. Three or four smears were prepared following standard guidelines. Smears were stained with Papanicolaou and Leishman-Giemsa stain. Ziehl- Neelsen staining for acid fast bacilli was done in suspected tubercular lesions. Cytomorphological diagnosis was given. For statistical analysis data were entered into a Microsoft excel spreadsheet. Data had been summarized as percentages for categorical variables. Results: In our study, maximum number of patient are in the age group of 16-45 years (65%) with a female preponderance. Lymph node (45%) is the most common site of FNAC followed by thyroid gland (24 %) and salivary gland (16%). Among the lymph node swellings, tubercular lymphadenitis is the commonest diagnosis. Among malignant cases of lymph nodes, metastatic carcinoma was seen in 8.3%. In these cases FNAC not only confirmed the malignancy but also gave a vital information regarding type of carcinoma (adeno or squamous) and so about the primary site of the malignancy. In salivary gland lesions, Pleomorphic adenoma appears to be the commonest cytological diagnosis followed by sialadenitis cases. Regarding cytopathology of thyroid aspirates, in our study, 50% cases appeared as nodular colloid goiter.16.6% cases were lymphocytic thyroiditis and 12.5% cases were papillary carcinoma. Cytopathology of other miscellaneous lesion of head and neck area aspirates show that inflammatory lesions constitute 25% of the cases. Conclusion: Due to technical ease, considerable accuracy and cost effectiveness, FNAC is an excellent screening test in the diagnosis of head and neck swelling and it is used as first-line investigation in diagnosing head and neck swellings nowadays. However, as seen in our study and in comparison to other similar studies, it is important to note that the diagnostic accuracy of FNA is variable for different conditions. Ultra- sound guidance (USG guided) and sampling from representative sites are sometimes necessary to improve the yield and diagnostic accuracy of FNAC. Introduction of FNAC in diagnostic protocol of head and neck area space occupying lesion (SOL) has reduced the rate of open tissue biopsy as well as unnecessary surgery.

BackgroundCongenital pyriform sinus fistula (CPSF) is a rare condition in which accurate preoperative imaging and diagnosis is critical for surgical modality selection and outcomes. The purpose of the study is to analyze the MRI characteristics of CPSF in newborns for improved diagnosis.MethodsThis retrospective study included 12 cases of neonatal CPSF diagnosed at our hospital from January 2016 to January 2023, with available MRI data. The clinical and MRI characteristics of these cases were systematically analyzed. Descriptive statistical methods were utilized to characterize the study population and summarize the key features of the observed data.ResultsNine cases (75.0%) presented with a neck mass. The MRI of all cases revealed irregular unilocular cystic masses in the left neck, closely related to the thyroid gland. All cysts demonstrated consistent anatomical boundaries: anteriorly by the anterior cervical soft tissues, laterally by the sternocleidomastoid muscle, superiorly at the atlas (C1) level (41.7%) or pyriform sinus level (58.3%), inferiorly to the thyroid gland level (41.7%) or superior mediastinum (58.3%), posteriorly adjacent to the anterior vertebral surface (75.0%) or extending posteriorly from the paravertebral region (25.0%), and medially crossing the midline anterior to the vertebral body via the retropharyngeal space (66.7%) or abutting the left tracheal border (33.3%). Thyroid parenchymal involvement was observed in seven cases (58.3%), and the carotid sheath was located on the posterolateral side of the mass in 11 cases (91.7%). The presence of air bubbles within the cyst was observed in six cases (50.0%), and a high signal fluid level within the cyst was noted in nine cases (81.8%) on DWI. A strip-like high-signal intensity in the retropharyngeal space was observed in all 12 cases on T2WI-STIR images.ConclusionsCyst location proved critical for diagnosing neonatal pyriform sinus fistula and all cysts demonstrated consistent anatomical boundaries in this case series. MRI demonstrates a cystic lesion adjacent to the thyroid and carotid sheath, frequently characterized by intralesional gas bubbles and a fluid level with restricted diffusion.

Abstract: Retrosternal goiter (RG) is a thyroid enlargement that extends into the chest, often causing compression of nearby structures such as trachea and esophagus. Thyroidectomy for RG is a complex procedure, with the choice of surgical approach depending on the goiter’s size and position. A cervical approach is typically preferred, though sternotomy may be required in some cases. We reported a 57-year-old female presented with a 20-year history of a progressively enlarging neck lump, which extended from the right to the left side, neck vein enlargement, and radiating pain. Laboratory tests were within normal limit. Pathology biopsy revealed a follicular thyroid nodule with a Bethesda II classification and imaging revealed a multinodular goiter causing compression of the trachea. This case was classified as type A with a pyramidal shape, apex pointing downward, type I with location in the anterior mediastinum, and Grade I with location above the aortic arch (at the level of T4); so, sternotomy was not required, considering the potential complications associated with sternotomy. The patient was then diagnosed with toxic retrosternal goiter in the euthyroid phase and underwent a total thyroidectomy without sternotomy. Postoperative care included fluids, antibiotics, H2 blocker, and analgesics. The patient showed good recovery, with no complications or symptoms of thyrotoxicosis at the two-week follow-up. In conclusion, in this case surgical intervention is focused on releasing decompression, and a total thyroidectomy was performed without sternotomy. An important technique that can be shared is to remove surgically the superior pole first, releasing it from Berry's ligament on one of the lobes and should always free the tissue as close to the goiter tissue as possible to avoid damage to the surrounding structures. The successful outcomes in studies emphasize that with careful assessment, retrosternal goiter can be safely treated with minimal complications. Keywords: retrosternal goiter; non-sternotomy procedure

Spontaneous neck hematoma is a rare but potentially life-threatening condition due to its risk of rapid airway compromise. It is most commonly associated with aneurysm, infection, thyroid or parathyroid tumors, or underlying coagulopathy, and may also occur in patients receiving anticoagulation or thrombolytic therapy. We report the case of an 87-year-old male with massive pulmonary embolism and deep vein thrombosis who developed a spontaneous cervical hematoma following catheter-directed thrombolysis with alteplase and systemic heparin. The patient presented with progressive neck swelling, ecchymosis, and airway deviation confirmed by contrast-enhanced computed tomography (CT) and flexible fiberoptic laryngoscopy. Airway protection was achieved with endotracheal intubation, and anticoagulation was withheld. He was managed conservatively with intravenous steroids and antibiotics. Extubation was carefully planned using cuff-leak testing, which was successful without the need for surgical intervention. The hematoma resolved gradually, and the patient recovered fully. This case underscores the importance of early recognition, multidisciplinary decision-making, and individualized airway management strategies in optimizing outcomes for spontaneous neck hematoma, especially in anticoagulated patients.

Vagal schwannomas are rare benign neurogenic tumours of the head and neck that may closely mimic carotid body tumours (CBTs) on clinical and radiological evaluation. Differentiating the two entities is essential to optimize surgical planning, preserve neural function, and prevent unnecessary morbidity. We present the case of a 23-year-old female with a slowly enlarging, non-pulsatile left neck swelling in the carotid triangle. Clinical examination and magnetic resonance imaging (MRI) suggested a carotid space lesion displacing the common carotid artery anteromedially and internal jugular vein posterolaterally. Preoperative biochemical screening for catecholamine excess was negative. The lesion was excised via a transcervical approach using intracapsular enucleation, with careful preservation of vagal nerve fibres. Intraoperative findings confirmed an encapsulated spindle-shaped tumour arising from the vagus nerve. Histopathology revealed Antoni A and Antoni B areas with Verocay bodies, strongly positive for S-100 protein, consistent with schwannoma. Postoperative recovery was uneventful, with preserved vocal cord mobility and no features of Horner’s syndrome. At 12-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the diagnostic challenge of differentiating vagal schwannomas from CBTs. MRI vascular displacement patterns-anteromedial displacement of the carotid artery and posterolateral displacement of the IJV-are key imaging clues. Intracapsular excision offers the advantage of neural preservation with low recurrence risk when combined with meticulous dissection and long-term follow-up.

Rationale:Head and neck osteosarcoma is a rare malignancy, accounting for 6%–10% of all osteosarcomas, and typically affects younger individuals. Its occurrence as a metachronous tumor in elderly patients, particularly after radiotherapy, is exceedingly uncommon.Patient concerns:A 91-year-old man with a history of right lateral tongue verrucous carcinoma treated by surgery and adjuvant radiotherapy (50 Gy) in 2006 presented in 2024 with progressive hoarseness and dysphagia for 6 months.Diagnoses:Clinical examination revealed a firm neck mass. Laryngeal biopsy showed benign keratosis, while core needle biopsy demonstrated a malignant mesenchymal tumor with osteoid production. Immunohistochemistry showed negative cytokeratin and p63, and Ki-67 positivity in 20% of cells, confirming osteosarcoma. Imaging revealed a calcified lesion involving the hyoid, thyroid cartilage, and tongue base, consistent with metachronous head and neck osteosarcoma.Interventions:Due to advanced age and comorbidities (hypertension and diabetes), palliative radiotherapy (30 Gy in 15 fractions) was administered. Surgery and chemotherapy were avoided because of frailty and limited benefit.Outcomes:The patient tolerated treatment well, achieving partial symptom relief without major toxicity. Long-term follow-up continues with a focus on quality of life.Lessons:This case highlights the diagnostic challenges of secondary head and neck osteosarcoma following radiotherapy and the importance of long-term surveillance in elderly patients. Individualized management balancing treatment efficacy and tolerability is essential in geriatric oncology.

Abstract Cervical schwannomas are rare benign tumors that can present a significant diagnostic challenge, particularly when they exhibit cystic changes that mimic more common lesions such as second-branchial cleft cysts. We report the case of a 36-year-old male who presented with a gradually enlarging, firm, nontender neck mass. Imaging studies, including ultrasound and contrast-enhanced computed tomography, suggested a cystic lesion, most likely a second branchial cleft cyst. Fine-needle aspiration cytology was inconclusive. Surgical excision was undertaken, and histopathological examination revealed a schwannoma with areas of cystic degeneration. Immunohistochemistry demonstrated strong diffuse positivity for S100 protein, confirming the diagnosis. Postoperatively, the patient had an uneventful recovery without neurological deficits. This case highlights the importance of considering cervical schwannoma in the differential diagnosis of cystic neck masses and underscores the essential role of histopathology and immunohistochemistry in establishing an accurate diagnosis. Early recognition and complete surgical excision are key to achieving favorable outcomes.

Cervical Chondrocutaneous Branchial Remnants (CCBRs) are rare congenital choristomas characterized by cartilaginous tissue within the cervical skin. We report a case of a 4-year-old girl presenting with bilateral soft tissue swellings in the lower neck, present since birth. Clinical examination and imaging suggested a congenital branchial remnant. Complete surgical excision was performed and histopathology confirmed hyaline cartilage surrounded by normal adnexal structures. Postoperative recovery was uneventful and no recurrence was noted. Bilateral CCBRs are exceedingly uncommon. Awareness of this entity is essential to differentiate it from other congenital neck masses and to evaluate for associated systemic anomalies.

Background: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy accounting for 1-5% of thyroid cancers. While often presenting with cervical lymphadenopathy, distant metastasis to bone and soft tissue mimicking a primary sarcoma is exceptionally rare. This report details a case of MTC where the primary diagnostic challenge was a massive, destructive shoulder mass. Case presentation: A 58-year-old woman presented with a disabling, 20 cm mass in her left shoulder, progressively enlarging over two years. The patient also noted a 30-year history of a stable, asymptomatic neck lump. Magnetic Resonance Imaging (MRI) revealed a large, hypervascular, destructive mass obliterating the scapula and invading surrounding musculature, with a radiological differential diagnosis of a primary soft tissue sarcoma. Laboratory investigation, however, revealed a massively elevated serum calcitonin (>2000 pg/mL) and carcinoembryonic antigen (CEA) (180 ng/mL). A CT-guided core biopsy of the shoulder mass, initially suspected to be a sarcoma, was negative for all sarcoma markers. Instead, it was strongly positive for neuroendocrine (Synaptophysin, Chromogranin A) and thyroid-specific (TTF-1, PAX-8) markers, as well as definitive MTC markers (Calcitonin, CEA). This confirmed the diagnosis of metastatic MTC. Staging was completed as pT3a pN1b M1. The patient underwent total thyroidectomy with bilateral central and left modified radical neck dissection, followed by planned palliative resection of the shoulder metastasis and systemic therapy with a selective RET inhibitor. Conclusion: This case highlights a critical diagnostic pitfall. Metastatic MTC can present as a massive soft tissue neoplasm mimicking a primary sarcoma. In such cases, a systematic diagnostic approach combining serum biomarkers (Calcitonin, CEA) with a comprehensive immunohistochemical panel is essential to establish the correct diagnosis and initiate appropriate, life-extending targeted therapy.

A BSTRACT An 11-month-old female presented with respiratory distress, neck swelling, and sepsis following the manual removal of a foreign body (a broken Shivling) from her throat. Imaging revealed pneumo-retropharynx and a large retropharyngeal abscess. After initial stabilization and resuscitation, transcervical endoscopy was employed to drain the abscess and repair a mucosal tear in the left pyriform sinus. The patient recovered well, with no postoperative complications and complete healing confirmed via endoscopy and esophagogram. This case highlights an innovative endoscopic approach, which enabled precise visualization and suturing of the hypopharyngeal perforation while avoiding extensive neck dissection, large cervical scars, and associated morbidity.

Introduction and importance: Neck masses are common, but primary vascular tumors of the external jugular vein are exceptionally rare and often overlooked in differential diagnoses. This case is notable for its prolonged course, distinctive clinical presentation, and histological confirmation, underscoring the value of imaging, surgical excision, and attention to cosmetic outcomes. Case Presentation: We describe a 20-year-old female who presented with an 8-year history of a progressively enlarging right-sided neck swelling that became painful in the past two years. On examination, a 3 × 2 cm non-reducible mass with bluish discoloration was noted in the lower anterior triangle of the neck, which enlarged on coughing and during the Valsalva maneuver. Initial imaging with ultrasonography revealed a vascular lesion, further characterized by CT angiography as a 20 × 15 mm enhancing mass attached to the right external jugular vein. Surgical excision was performed under general anesthesia. Intraoperatively, a well-circumscribed vascular mass was found adjacent to the sternocleidomastoid muscle and excised completely. Histopathological analysis confirmed a benign venous angioma. Clinical discussion: Vascular tumors of the external jugular vein are exceptionally uncommon and often absent from routine differential diagnoses. Their clinical presentation may mimic benign cysts or lymphadenopathy, contributing to diagnostic uncertainty. Imaging helps narrow the diagnosis but cannot confirm histology. Surgical excision is essential for both definitive diagnosis and symptom relief. In this case, the patient also had aesthetic concerns, which were addressed successfully with a concealed incision and uneventful recovery. Conclusion: Venous angioma of the external jugular vein is a rare differential for neck masses. Surgical excision remains the mainstay for diagnosis and management, with excellent long-term outcomes.

Background: Carotid body tumors (CBTs), or paragangliomas, are rare, highly vascular neuroendocrine neoplasms arising at the carotid bifurcation. Though generally benign and slow-growing, their close association with critical neurovascular structures, including the carotid arteries, presents complex diagnostic and therapeutic challenges with significant cardiovascular implications. Case Presentation: A 66-year-old female presented with a right-sided neck swelling of 3 months’ duration, accompanied by intermittent dull headaches and episodic sweating. Physical examination revealed a 7×4 cm firm, expansile mass in the right carotid triangle, mobile horizontally, with palpable pulsations and intact cranial nerve function. Imaging with CT angiography, contrast-enhanced MRI, and digital subtraction angiography demonstrated a highly vascular, enhancing mass at the carotid bifurcation causing splaying of the internal and external carotid arteries—characteristic of a carotid body tumor. Additionally, enlarged right cervical lymph nodes suggestive of paragangliomas were noted. Intervention: The patient underwent successful surgical excision of the tumor via a transcervical approach. Intraoperative vascular control was critical to prevent hemorrhage and preserve cerebral perfusion. Histopathology revealed nests of round to oval cells with eosinophilic cytoplasm arranged in a “zellballen” pattern, confirming paraganglioma. Outcome: Postoperative recovery was uneventful without neurological deficits. The patient remains under close follow-up for surveillance. Conclusion: This case underscores the significance of early vascular imaging and a multidisciplinary approach in managing carotid body tumors. Given the tumor’s direct involvement with carotid arteries and the potential for vascular complications, cardiovascular specialists must be engaged in diagnosis, surgical planning, and perioperative care. Surgical resection remains the definitive treatment, with histopathology confirming diagnosis. Vigilant long-term follow-up is essential due to the tumor’s proximity to critical neurovascular structures and potential syndromic associations.

Medullary thyroid carcinoma is an uncommon form of thyroid cancer that arises from the parafollicular C cells. In this case report, a high-grade medullary thyroid carcinoma is discussed, which was initially diagnosed as papillary carcinoma due to the presence of papillary-like nuclear features in the cytological evaluation. A 65-year-old female presented to the ear, nose, and throat department with a palpable neck mass. Based on the cytological features of the fine needle aspiration (FNA), a diagnosis of 'malignant, papillary carcinoma', (Bethesda category 6) was made. After surgery, histological and immunohistochemical results led to a diagnosis of medullary thyroid carcinoma. Papillary carcinoma-like nuclear features may also be observed in medullary thyroid carcinoma and some cases could be mistakenly interpreted as papillary carcinoma in cytological examination.

Fibromatosis colli, or sternocleidomastoid pseudotumor of infancy, is a rare condition characterised by a unilateral neck mass in infants, often associated with birth trauma. Ultrasound is the primary diagnostic tool, but the role of Doppler ultrasound to assess lesion vascularity is underexplored. This study investigates the vascularity of fibromatosis colli lesions and explores its possible clinical implications. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched twice for case reports involving patients aged 0-16 years diagnosed with fibromatosis colli and assessed with Doppler ultrasound. Data was analysed using SPSS® to identify the proportion of vascularised fibromatosis colli lesions, with a secondary aim of establishing if there is a link between vascularisation status and age. Twenty case reports (34 cases total) were included. Sixty-two per cent of lesions were vascularised on Doppler ultrasound. No significant age-related difference (p = 0.24) was found between patients with vascularised versus non-vascularised lesions. Doppler ultrasound is underused for assessing vascularity in fibromatosis colli, and standardised imaging protocols are lacking across published reports. The prognostic value of the presence of vascularisation in fibromatosis colli remains uncertain due to the limited and heterogeneous nature of the data. Larger, prospective studies using clearly defined Doppler protocols are necessary to determine the clinical relevance of vascularisation in fibromatosis colli management.

This case report presents a male child in his middle childhood, diagnosed with resistance to thyroid hormone, a rare endocrine condition marked by diminished tissue responsiveness to thyroid hormones (THs) despite elevated circulating levels. The patient presented with neck swelling, nocturnal enuresis and tachycardia. Biochemically, he had elevated free T3 and T4 with inappropriately normal thyroid-stimulating hormone (TSH) levels. Clinical features reflected a mixed state of hyper- and hypothyroidism due to differential tissue distribution of thyroid hormone receptors (TRα and TRβ). Treatment included propranolol, amitriptyline, loperamide and vitamin D supplementation, resulting in symptomatic improvement. The case underscores the importance of considering thyroid hormone resistance beta (THRβ) in patients with discordant thyroid function tests and emphasises the role of genetic testing in establishing the diagnosis. It also highlights the phenotypic variability of THRβ and the need for individualised management. Differential diagnoses like TSH-producing adenoma (TSHoma), laboratory assay interference and drug-induced thyroid dysfunction were ruled out.