Neck Mass Research Articles

Warthin-like Papillary Thyroid Carcinoma: A Case Report and Review of the Literature.

Warthin-like subtype of papillary thyroid carcinoma (WLPTC) is a rare subtype of papillary thyroid carcinoma. This PTC subtype shows some pattern resemblance to Warthin tumors of the salivary gland, which confers its name but is a not genetically similar to salivary Warthin tumor, with the most frequent genetic change in WLPTC being BRAF p.V600E, the most frequent genetic driver of PTC. Warthin-like subtype of papillary thyroid carcinoma is found to have a favorable prognosis. We report a 44-year-old woman who presented with anterior neck swelling and elevated levels of antithyroid peroxidase antibodies. Fine-needle aspiration cytology showed features of papillary thyroid carcinoma and lymphocytic thyroiditis. On histopathological examination, thyroid follicular cells have oncocytic cytoplasm with infiltration of the tumor and fibrovascular cores by a dense lymphoplasmacytic infiltrate. Numerous multinucleated giant cells in the tumor are a notable feature. The final diagnosis is Warthin-like papillary thyroid carcinoma arising in association with chronic lymphocytic (Hashimoto) thyroiditis. Along with this case report, we perform a literature review of WLPTC between 2010 and 2024.

The importance of multimodality imaging in diagnosing cystic parathyroid gland hyperplasia: a case report and systematic review

Abstract Background Parathyroid cysts account for a small percentage of parathyroid lesions and are more prevalent in females. Cystic parathyroid hyperplasia is exceptionally rare, with only two cases reported thus far. This case report provides the readers with the first multimodality imaging in cystic parathyroid hyperplasia as well as the authors’ first experience in using a 4D computed tomography (CT) scan in our institution while the systematic review will comprehensively search and present similar cases. Main text The literature search started and ended on August 4, 2024. We searched five academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. The studied population was all patients with cystic parathyroid gland hyperplasia, confirmed by histopathology. A total of 205 articles were initially identified, out of which 29 duplicates were promptly eliminated, leaving 176 unique articles for screening. Following the evaluation of titles and abstracts, ultimately only two studies were included in the systematic review. A 61-year-old male presented with recurrent abdominal pain and weight loss. Ultrasound revealed a left neck mass, cystic. The laryngeal CT scan agreed with the ultrasound while the Technetium-99 sestamibi scan suggested a thyroid lesion. A 4D CT scan confirmed a lobulated cystic lesion in the left parathyroid region. The patient underwent successful surgery, and histopathology confirmed parathyroid hyperplasia with a pseudocyst appearance. Conclusions This case report presents the first imaging multimodality in cystic parathyroid hyperplasia while highlighting the rarity of this case, with two cases worldwide. In addition, this article describes our institution’s first experience with a 4D CT scan.

Unusual neck swellings: a case series of a new Pandora’s box

The neck is an important region in the body containing the greatest number of vital structures traversing it. The variety of structures also means that many varied neck masses may present in this region. We described a series of eight such cases of large and rare neck swellings. These include cystic swellings, benign tumours as well as malignant secondary nodal metastasis. We also describe for the first time a rare case of a large air pocket in the neck. Thus, this series serves to highlight the amazing capability of the neck to throw up a wide range of complex and rare swellings - earning its name as a new Pandora’s box.

The Use of Trendelenburg Position in the Management of Retropharyngeal Abscess: A Case Report and Clinical Considerations

Background: Retropharyngeal abscess (RPA) is a serious deep neck space infection that can lead to life-threatening complications such as airway obstruction, mediastinitis, and sepsis. The Trendelenburg position, where the patient's head is lower than their feet, has been traditionally used in the management of RPA to prevent aspiration of pus in case of abscess rupture. However, the optimal positioning for patients with RPA remains a topic of debate. Case presentation: A 51-year-old male patient presented to the emergency room with a 5-day history of progressive dysphagia and neck swelling. He was diagnosed with a ruptured retropharyngeal abscess extending to the mediastinum (descending necrotizing mediastinitis). The patient underwent surgical drainage and was subsequently admitted to the intensive care unit (ICU), where he was intubated and mechanically ventilated in the Trendelenburg position. Five days later, the patient developed pneumonia, suspected to be ventilator-associated pneumonia (VAP). Conclusion: The Trendelenburg position may be considered in the management of RPA to minimize the risk of aspiration. However, it is essential to weigh the potential benefits against the risks, including VAP, and to consider alternative positions such as the lateral Trendelenburg position, which may offer similar benefits with reduced risk. Further research is needed to determine the optimal positioning strategy for patients with RPA.

Thyroglossal cyst with intralaryngeal extension – An unusual case report

Thyroglossal duct cysts are the most prevalent congenital neck masses originating from thyroglossal duct remnants. Here, we present a case of thyroglossal dust cyst with hoarseness and difficulty breathing. A contrast-enhanced computed tomography scan confirmed the intra-laryngeal extension and airway compromise. Sistrunk procedure along with laryngeal reconstruction was done. Histopathology confirmed thyroid follicles in the cyst wall.

Neck lumps: Early Detection with Dental Magnetic Resonance Imaging?

Cervical lymphadenopathy can indicate a range of diseases, including infections, inflammation, and neoplastic processes. Accurate diagnosis is crucial for identifying the underlying cause and determining appropriate treatment. Diagnostic procedures include clinical examination, ultrasound, fine needle aspiration, biopsy, and imaging techniques. While conventional imaging methods such as X-ray and computed tomography (CT) have proven useful, they exhibit limitations in sensitivity and specificity, especially for soft tissue structures. Magnetic resonance imaging (MRI) provides superior soft tissue contrast, offering additional critical information for differential diagnosis. This article presents a case study of a 29-year-old male with a cervical mass. Advanced dental MRI protocols, including DESS, SPACE-SPAIR, and SPACE-STIR sequences, have significantly enhanced the imaging capabilities of the den-tomaxillofacial region, enabling the generation of high-resolution images of both hard and soft tissues. Especially, MR OPGs have demonstrated the capacity to identify early signs of potential pathology. These protocols have the potential to enhance early detection, thereby con-tributing to accurate diagnosis and effective treatment planning.

A case of anterior mediastinal mature teratoma with severe inflammatory extension into the neck

BackgroundWe present the case of a rare occurrence of an anterior mediastinal mature teratoma extending into the neck, commonly referred to as a cervicothoracic mature teratoma.Case presentationA 19-year-old female presented with right-sided neck pain and swelling, which were found to be attributed to a 14 cm cystic lesion originating from the right thyroid lobe and extending into the mediastinum. A diagnosis of mediastinal teratoma with extension to the neck was made. Robot-assisted thymectomy was initiated but was complicated by dense tumor adherence to the superior vena cava and brachiocephalic veins, prompting a switch to a midline sternotomy. Simultaneous resection of the right thyroid lobe was performed due to inflammation. The transition to a midline sternotomy allowed successful excision of the tumor, which was confirmed to be a mature teratoma confined to the thoracic region. The patient's favorable postoperative course led to discharge on day 5 with no recurrence at nine months.ConclusionsEmphasizing the challenges and the importance of prompt intervention in the management of mediastinal teratomas with neck extension.

081. Radiofrequency Ablation for Retrosternal Thyroid Tumour: A Rare Case Report

Background: Retrosternal thyroid tumours, though uncommon, present complex diagnostic and therapeutic challenges due to their location behind the sternum. These tumours can cause significant symptoms, such as difficulty breathing and chest pressure, which can impact patient quality of life. Radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option, offering potential benefits over conventional surgical methods for retrosternal thyroid tumor. Case: A 54-year-old male with a history of right thyroid isthmolobectomy presented with a rapidly growing left-sided neck mass, causing increasing chest pressure and shortness of breath. Imaging studies, including ultrasound and CT scans, revealed a large tumour extending retrosternally and compressing the trachea. The patient opted for RFA over surgery. A core biopsy confirmed a benign struma adenomatosa. RFA was performed using the moving shoot technique, resulting in effective tumor ablation. Follow-up imaging showed a significant reduction in tumor size and symptom relief. Conclusion: This case demonstrates that RFA is a safe and effective alternative to conventional surgery for retrosternal thyroid tumours. It provides substantial symptom relief and tumour reduction with fewer complications. RFA should be considered a valuable treatment option for patients who are not ideal candidates for surgery or who prefer less invasive approaches. Continued research and long-term studies are needed to confirm its broader efficacy.

Navigating Diagnostic Uncertainty: A Neck Swelling in an Elderly Patient Prompting Reflection on Over-investigation

Navigating Diagnostic Uncertainty: A Neck Swelling in an Elderly Patient Prompting Reflection on Over-investigation

Ex utero intrapartum treatment (EXIT) procedure for the second twin with neck mass in a twin pregnancy with vertex/breech presentation

We report a case of a dichorionic diamniotic twin pregnancy where twin B was diagnosed with a large multi-loculated exophytic cystic neck mass arising from the right side with involvement of the right proximal upper limb and significant mass effect on the trachea diagnosed during antenatal MRI. After multidisciplinary discussion, an ex utero intrapartum treatment (EXIT) procedure was planned given concerns about airway obstruction in twin B. Successful EXIT was performed with the delivery of twin A first, followed by an intraoperative external cephalic version of twin B and subsequent delivery of the fetal head and intubation on maternal circulation.

The clinicopathologic significance of psammoma bodies in cytology specimens: A series of 78 cases.

Currently the clinicopathologic significance of psammoma bodies in cytology specimens are not completely understood, including types of cytology specimens and pathologic conditions frequently associated with this unique cytologic feature. In this study, we undertook a retrospective approach to review the specimen types, cytology preparations, patient characteristics, organs or tissues involved and differential diagnoses in cytology specimens with the finding of psammoma bodies. Cytology cases with the finding of psammoma bodies from January 2004 to December 2022 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed. A total of 78 cytology specimens with the finding of psammoma bodies were recorded in our CoPath system. The mean age at diagnosis was 59 years. The patient group showed female gender predominancy (90%). FNA specimens comprised about 38.5% of total cases. Other common specimen types were body cavity fluids (38.5%), including pleural effusion and peritoneal fluid, and about 20.5% of the cases were pelvic washing performed during gynecologic surgeries. Most cytology cases with psammoma bodies had a malignant diagnosis (69%). About 18% of the cases were in the indeterminate diagnostic categories, with 12% suspicious for malignancy and 6% of the cases with atypical cells. About 5% of cases were placed in the neoplastic category, while 8% of cases were negative for malignancy. About 79% of peritoneal cytology with psammoma bodies were neoplastic and mostly gynecologic tumors. Pleural fluids with psammoma bodies were very likely to be malignant and involved by serous carcinoma (15 of 16 cases, 94%). Papillary thyroid carcinoma was the second most common malignancy in our series, present in about 53% of thyroid cytologies with the finding of psammoma bodies. Our study showed that psammoma bodies in cytology preparations were more often associated with malignancies in our study of 78 cytology specimens (69%). The most sampled location in our study was peritoneal cavity, followed by pleural cavity, thyroid, lymph nodes, neck masses, and omentum. The clinicopathologic value of psammoma bodies in predicting malignancy varies depending on locations and specimen types.

ULTRASONOGRAPHY EVALUATION OF PEDIATRIC NECK MASSES

Background: Neck masses are a frequent discovery in children and pose challenges in diagnosis. These masses can stem from congenital, inflammatory, neoplastic, or vascular origins. Understanding the cervical anatomy and compartments is crucial for differential diagnosis. There are different cystic lesions like ranula, thyroglossal cyst, brachial cyst, lymphangioma and vascular malformation and solid lesions like reactive lymph nodes,thyroid lesions,ectopic thymus etc.Rare lesions like teratoma,rhabdomyosarcoma,neurofibroma also exists. Aims: To assess congenital and acquired neck masses in children using ultrasonography (USG) and correlate imaging findings with pathology. Materials and Methods: This prospective observational study involved 30 pediatric patients with clinically palpable neck swellings referred for USG. Imaging was followed by necessary USG-guided procedures, and radiological findings were compared with histopathology. Results: Among 30 patients, 68% were male and 32% female. Most patients (53%) were aged 1-10 years. Right-sided lesions were most common (41.15%), with bilateral (17.25%) and midline (11.5%) presentations noted. Inflammatory causes were predominant (76.1%), followed by congenital (16.3%) and neoplastic (7.5%). USG revealed features such as reactive lymphadenitis (14 cases), TB lymphadenitis (6 cases), abscesses (2 cases, confirmed by aspiration), thyroglossal cysts (3 cases), lipomas (2 cases, confirmed by histopathology), malignancies (2 cases, confirmed by biopsy), and a branchial cyst (1 case). Conclusion: Pediatric neck masses are common and diagnostically challenging. Detailed clinical history, physical examination, and knowledge of cervical anatomy are crucial for accurate diagnosis. Utilizing neck compartments and multimodality imaging aids in precise diagnosis and appropriate management.

Primary Small Cell Carcinoma of Left Maxillary Sinus: A Case Report of Rare Tumor on Rare Location

Introduction: Primary extrapulmonary small cell carcinoma (EPSCC) is a rare and aggressive tumor with diverse clinical manifestations. In the realm of head and neck pathology, EPSCC most commonly presents in the larynx or oral cavity. Sinonasal small cell neuroendocrine carcinoma represents a particularly infrequent and aggressive neoplasm affecting the nasal cavity and paranasal sinuses. Case Presentation: Here in, we are presenting a case of a 40-year-old nonsmoking male with left maxillary sinus EPSCC, demonstrating extensive local invasion and regional lymphadenopathy. The patient presented with nasal obstruction, ocular swelling, visual loss, and multiple neck swellings. Diagnosis was challenging, requiring a multidisciplinary approach and histopathological confirmation. Immunohistochemistry revealed positive cytokeratin AE1/AE3 and synaptophysin markers validating the diagnosis of small cell carcinoma. Conclusion: This case underscores the diagnostic complexities and highlights the importance of swift intervention and a multidisciplinary treatment approach for optimizing patient outcomes in rare and aggressive tumors like EPSCC. Early detection and prompt management are crucial in resource-limited settings to mitigate morbidity and mortality.

Management of pediatric thyroglossal duct cyst: A case report

Introduction: Thyroglossal duct cysts are common congenital neck anomalies in children, diagnosed through clinical assessment and ultrasound, and treated with the Sistrunk procedure to prevent complications like infection and malignancy. Case Description: We present a case of a 4-year-old male patient with a progressively enlarging neck mass for three months. The mass was asymptomatic, did not cause any eating difficulties, and moved upwards during swallowing and tongue protrusion. Upon physical examination, a soft, mobile, cystic mass approximately 3 cm in diameter was identified beneath the hyoid bone. Supporting examinations, including ultrasound and fine-needle aspiration cytology, led to the diagnosis of a thyroglossal duct cyst. The patient underwent a successful Sistrunk procedure, which involved the excision of the cyst along with a portion of the hyoid bone. Postoperative management included administration of intravenous antibiotics and paracetamol, culminating in a full recovery without any signs of infection. The patient exhibited complete wound healing within two weeks. There was no evidence of cyst recurrence during a follow-up examination six months later. Conclusion: Despite being common, thyroglossal duct cysts require thorough evaluation to avoid misdiagnosis, and are typically identified by a slowly growing midline neck mass that moves with swallowing and tongue protrusion, often near the hyoid bone.

Internal Jugular Phlebectasia; A Challenging Neck Mass in Children

Cystic neck masses are uncommon in children, and a minority of them are soft. Internal jugular vein phlebectasia (IJVP) is a rare cause of soft neck cysts. It presents usually as a unilateral soft neck mass of changing size. In most cases it is unilateral, right sided and predominantly in males. Imaging study modalities are diagnostic and helpful for observation and follow up. In the vast majority of cases, it decreases in size with time requiring only conservative treatment. However, surgery might be necessary in large or complicated phlebectasia. IJVP is underdiagnosed or misdiagnosed especially in pediatrics, with few cases documented in medical literature. To improve awareness of presentation and management-plan of this rare case, the authors present an extremely rare case of huge left internal jugular phlebectasia in a 14 year-old boy worsened and complicated over years of wait and see approach that needed surgical treatment.

Riedel’s thyroiditis: A case report and review of the ultrasound findings of this rare disease entity

Introduction: Riedel’s thyroiditis is a rare inflammatory disease of the thyroid with non-specific and varied presentations. A typical presentation and ultrasound findings are reported in this case. Case Report: A 68-year-old male is referred to Ear, Nose and Throat for a neck lump that varied in size over 2 years. An ultrasound scan identified a suspicious nodule on the left thyroid that was biopsied confirming the diagnosis of Riedel’s thyroiditis. Discussion: The aetiology, presentation and management of Riedel’s thyroiditis are explored. The use of ultrasound and the utility of other imaging and biochemical tests are discussed. Conclusion: Riedel’s thyroiditis is a difficult condition to diagnose due to rarity, varied presentation, with non-specific clinical, biochemical and radiographic findings which often mimic thyroid cancers. Definitive diagnosis of Riedel’s thyroiditis requires histological analysis, and while fine-needle aspirations are typically insufficient, diagnostic samples can be taken with ultrasound-guided core biopsies.

Thyroid Gland Diffuse Lipomatosis: A Case Study and Comprehensive Literature Review.

Diffuse lipomatosis of the thyroid (DLT) is an uncommon condition where mature fat cells infiltrate the thyroid gland, disrupting its normal structure. Although rare, it typically manifests as neck enlargement or symptoms of compression, including breathing difficulties, trouble swallowing, and voice changes, which can complicate diagnosis. This report presents a case of a 61-year-old woman with DLT, who exhibited a multinodular goiter and progressive neck swelling, and examines 53 additional cases from the existing literature. The analysis indicates that DLT is frequently misdiagnosed because of its similarities with other thyroid disorders. The precise mechanism underlying its development remains uncertain, but theories include oxygen deprivation in tissues, developmental abnormalities, and disruptions in fat metabolism. Surgical removal is the preferred treatment, especially for patients experiencing symptoms, and has shown favorable long-term outcomes. Additional studies should aim to elucidate the exact cause of DLT and enhance diagnostic precision, particularly in distinguishing it from other fat-containing thyroid lesions such as amyloid goiter and adenolipomas. A deeper understanding of this condition will inform better treatment approaches and enhance patient outcomes for this uncommon but significant thyroid disorder.

Reliability of a Tailored Tele-Medicine Model for Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) Clinical Practice in Remote Areas of Nepal: A Pilot Study from Tertiary Referral Center.

Introduction: Despite the ever-expanding scope of telemedicine, studies regarding its application in the field of otorhinolaryngology-head and neck surgery (ORL-HNS) in remote parts of the world are lacking. This pilot study aims to bridge the research gap and to assess the efficacy of our tailored telemedicine clinic model, operating in an "asynchronous" mode, in diagnosing various ORL-HNS diseases. Methods: This is a cross-sectional study conducted at a tertiary care center of Nepal. An asynchronous telemedicine portal was used with a store and share approach to telecast the pen endoscopic camera findings to the consultant in order to formulate a diagnosis and a management plan. Interobserver reliability was assessed using SPSS version 26 based on Cohen's kappa. The association between the results of the Mimi Hearing App (v. 5.0) and pure tone audiometry were performed using chi-square test. Results: The overall diagnostic agreement in our study was substantial to almost perfect with kappa values of .843, .784, .737, and .764 for rhinology, head and neck, otology, and pediatric cases. Chronic otitis media was the predominant diagnosis across all age groups. Various head and neck swellings, symptomatic deviated nasal septum and chronic rhinosinusitis with polyposis followed closely. Discussion: The future of telemedicine in otorhinolaryngology can be gauged to be effective in reducing cost and human resource use in the limited setting of Nepal with the model allowing for remote but effective communication between the concerned patients and the expert doctor in clarifying doubts and making diagnosis, early recognition of diseases and preventing or decreasing complications of those diseases.

Liver Metastasis Masking as Neuroendocrine Carcinoma (NEC) Predates Discovery of Intra/Peri-Thyroid Thymic Carcinoma (ITTC)

Abstract Introduction/Objective Intrathyroidal thymic carcinoma (ITTC) also known as Carcinoma showing Thymus-Like differentiation (CASTLE) is a rare malignancy comprising 0.1 to 0.15% of thyroid cancers. The WHO 5th Edition emphasizes that these tumors may also occur outside the thyroid typically at the lower pole Methods/Case Report Our aim is to show that NEC is a mimic of ITTC; that CD5, c-KIT (CD 117), p40, CK5/6 expression distinguishes ITTC from NEC, and that ITTC may at times express NE markers. Briefly, a 51-year-old man presented with hoarseness left neck mass and a PET avid liver lesion in 2016. Biopsy of the neck and liver masses revealed an infiltrating poorly differentiated “NEC” with similar morphology; positive for p53, chromogranin, and synaptophysin; negative for cam5.2, thyroglobulin, TTF-1, CD20, Pax5, CD3, CD5, S-100, calcitonin, CD56, p16, p63, c-KIT (CD117), AE1/3; and 100% staining for Ki-67. The patient underwent chemotherapy, responded well, remained under surveillance, and was symptom-free in the interim. A new 2.1 x 2.0 cm nodule appeared at the left thyroid lower pole after 6 years. The tumor was positive for CD5, CD117, p40, CK5/6, with > 95% Ki67 expression. Chromogranin, synaptophysin, CD56, thyroglobulin, calponin, TTF1, and Epstein Barr virus were negative and was overall diagnostic of ITTC Results (if a Case Study enter NA) NA Conclusion This shows the diagnostic dilemma of distinguishing ITTC from NEC which may share expression of neuroendocrine (NEC) markers and that positivity for CD5, c-KIT (CD117), p40, and CK5/6 are key diagnostic features of ITTC.

CD5+ Large B cell lymphoma with IRF4 rearrangement: case report and review of the literature

Abstract Introduction/Objective Large B cell lymphoma with IRF4 rearrangement was introduced as a diagnosis by WHO in 2017. It is a rare entity that affects Waldeyer’s ring in mostly males, children and young adults. The lesional immunophenotype may be positive for CD10. FISH is positive for IRF4 rearrangement on chromosome 6p25.Among reported cases in the English literature only 6 cases have reported specifically CD5 being negative. We present review of the literature during years 2020-2024, and a case of large B cell lymphoma with IRF4 rearrangement, specifically positive for CD5. Methods/Case Report The patient is a 5 years old male, since 2017 suffering from recurring ear infections with approximately 4-5 episodes of otitis media during every 6 months. In 2019 the patient’s mother reported snoring, constant sore throat, bad breath for 2 years. On physical examination the left tonsil appeared enlarged; exudative tonsillitis was present. Later on, an asymmetric, firm mass in the location of the left tonsil with induration of the left palate was identified. CT scan showed mild asymmetric soft tissue thickening of the left aspect of the soft palate and left palatine tonsil. Mildly prominent left-sided levels IIa and IIb lymph nodes, measuring up to 1 cm were identified. H&E sections revealed an expansile proliferation of neoplastic cells, large with void to indented nuclei, vesicular chromatin, small nucleoli, visible cytoplasms. Frequent mitoses, apoptosis and individual cell necrosis were seen. Immunohistochemistry revealed CD20+ B cell neoplasm with high expression for MUM1 and high proliferation rate along with strong CD5+ and CD10-. By multicolor flow cytometric studies, an abnormal B cell population was found (40%) with increased forward scatter along with expression for CD5, CD19, CD20, CD22, CD45, CD79a (cytoplasmic), FMC7, (dim) lambda-restriction. Fluorescence In Situ Hybridization Study revealed IRF4 (DUSP22) rearrangement on chromosome 6p25. Results (if a Case Study enter NA) NA Conclusion We analyzed 24 cases reported in the English literature. The mean age of the patients is 7 years old. The majority are males (14/24 = 58%).The most common location is tonsil/ neck mass (15/24 = 62%).CD5 was negative in 6/24 cases.