Unilateral Neck Mass Research Articles

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.

Asymptomatic Necrotizing Granulomatous Disease of the Neck With Unknown Etiology

Patients presenting with unilateral neck masses is not an uncommon occurrence in an otolaryngology clinic. Especially those with risk factors such as older age and a history of smoking or drinking along with certain characteristics of the mass including rapidgrowth, immobility, and the presence of other masses elsewhere in the head and neck that can lead to more concerning etiologies such as cancer. However, in those who are younger with non-tender unilateral mobile masses, the differential is wide. We present the case of a 30-year-old male who presented with a non-tender left-sided neck mass with no associated or systemic symptoms. Workup including labs for HIV, syphilis, and fungal stains was negative. Pathology demonstrated lymphadenitis with necrotizing granulomas with no recurrence of symptoms after excisional biopsy. The patient continued to have no associated symptoms or recurrent mass thus no further workup was deemed necessary. Although unilateral neck mass and lymphadenitis with necrotizing lymphadenitis have a broad differential diagnosis, this patient's etiology continues to be unknown.

Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature

IntroductionSchwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling. ObjectiveIn this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature. MethodsPatients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done. ResultsTwenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root. ConclusionA long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.

Ectopic Cervical Thymic Cyst- A Rare Differential Diagnosis of Paediatric Lateral Neck Swellings

Congenital ectopic thymic cysts are one among the rare neck masses seen in paediatric age group. It should be considered in the differential diagnosis of cervical neck swellings in children. This is a case report of ectopic cervical thymic cyst presenting in a nine-year-old male child as unilateral neck mass. Histopathological features were suggestive of ectopic cervical thymic cyst. The embryological basis, clinical presentation and diagnosis of ectopic cervical thymic cyst is discussed in the study.

Jugular Vein Phlebectasia (IJP): Surgically Manageable But Ignored Entity.

IJP is a rare, congenital, benign, isolated, sporadically occurring fusiform or saccular dilatation of Internal Jugular Vein (IJV) of unknown aetiology usually presenting as a unilateral neck mass. It is mostly seen in children and young adults. We report a 4year old male presented to Expert ENT & Diagnostic Centre presenting with history of painless right neck swelling in the right carotid triangle first observed on crying with no history of trauma, facial congestion, chronic cough, difficulty in swallowing or breathing, non febrile, venous humps, heaviness or cessation of normal voice. Diagnosis of right IJP was made. Exploration and wrapping the dilated segment in polytetrafluoroethylene tube graft was done. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJP as differential diagnosis while dealing with such a swelling to avoid invasive investigations and inappropriate treatment.

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

Unusual Human Papillomavirus–Related Neoplasms of the Head and Neck: A Case Series and Review of Literature

Abstract Oropharyngeal squamous cell carcinoma accounts for the majority of human papillomavirus (HPV)–related neoplasms in the head and neck. However, recent studies have identified high-risk HPV in other, clinicopathologically distinct tumors in this region. We report a series of cases involving two unique HPV-mediated neoplasms. Human papillomavirus–related multiphenotypic sinonasal carcinoma is a locally aggressive tumor arising exclusively in the sinonasal tract with pathologic features reminiscent of high-grade adenoid cystic carcinoma. Ciliated adenosquamous carcinoma often presents as a unilateral neck mass and consists of admixed nonkeratinizing squamous cell carcinoma and glandular elements, which may be deceptively bland. Cilia are often present, which are traditionally associated with benignity and may lead to misdiagnosis as a benign branchial cleft cyst. In most cases, an oropharyngeal primary tumor is later identified. Despite aggressive features, both entities have a relatively favorable prognosis. These unusual tumors present unique diagnostic challenges that require particular attention to prevent misdiagnosis and mistreatment.

Tumors of glomus vagale: diagnostics and therapy

Introducing the diagnostic protocol and therapy of a rare disease reviewing the worldwide literature named as vagal paraganglioma is our main target. This type is specific for women of middle age, and it is appearing as a unilateral neck mass, with or without Fontaine's sign. Giving a heavy aspect on the ear, nose and throat examination, the most important diagnostic tool is CT-angiography. Carefully looking at the size and relationship with the narrowing arteries, veins, nerves, muscles and bony structures (skull base, cervical spine), in most of the cases we choose the surgical procedure. Orv Hetil. 2019; 160(34): 1358-1362.

From presumed benign neck masses to delayed recognition of human papillomavirus-positive oropharyngeal cancer.

To describe patients with delayed diagnosis of human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC) after initial incorrect diagnosis of branchial cleft cyst or nondiagnostic workup of unilateral neck mass. Retrospective case series. Patients with delayed diagnosis of HPV-OPC after initial nondiagnostic workup for unilateral neck mass were eligible. Medical record abstraction was performed to describe clinical characteristics at initial presentation and later diagnosis of HPV-OPC. To estimate nodal growth rates, the short axis diameter of the lymph nodes was determined from imaging reports. Six patients met eligibility criteria. After a median interval of 42 months (range, 3 months-7 years) from initial presentation with unilateral neck mass, patients were diagnosed with HPV-OPC. At the time of HPV-OPC diagnosis, five were AJCC eighth edition overall stage I, and one was stage II. Primary tumors were T0 or T1 in the majority (83.3%, n = 5). Among five patients with available serial imaging, despite diagnostic delay, three of five still had a single lymph node without involvement of additional nodes, whereas the remaining two developed additional suspicious nodes (ipsilateral and contralateral). Two of five developed evidence of extranodal extension. Median lymph node growth was 9.5% per year (range, -6% to 32%). Although the natural history of HPV-OPC is not well understood, this case series suggests that it can be slow growing and mimic benign processes, leading to diagnostic delays. Adults presenting with neck masses should undergo complete diagnostic evaluation. 4 Laryngoscope, 130:392-397, 2020.

The Outcome of Multidisciplinary Management of Carotid Body Tumors: Retrospective Cohort Study.

Carotid body tumor (CBT) is a rare paraganglionic hyper-vascular tumor of the carotid body. The standard treatment for CBTs is surgery, but it involves risk. The study is aimed to assess the CBTs and evaluate the outcome of multidisciplinary management. A retrospective cohort study included patients with CBTs who were managed by surgical excision between May 2006 and April 2018. A multidisciplinary team was established to excise the tumor completely with minimal neurovascular compromise. The study comprised of 32 patients in the age group of 23-65years. The main presentation was a unilateral painless neck mass. Six cases (18.75%) were Shamblin I, 10 (31.25%) Shamblin II and 16 (50%) Shamblin III. Complete excision was performed for all cases. Ligation of the external carotid artery was done in 15 cases (46.88%) and repair of the internal carotid artery in 6 (18.75%). Postoperative cranial nerve complications occurred in six patients (18.75%): four transient hypoglossal pareses and two hoarseness of voice. Histopathologically, one case (3.125%) was malignant. No recurrence was detected through the follow-up period. A multidisciplinary approach is essential for management of CBTs. Early diagnosis and surgical resection minimize morbidity and carry good surgical outcome. ChiCTR1800018722 (Agency: Chinese Clinical Trial Registry).

Atypical Presentation of Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma (NPC) is a rare neoplasm which is associated with Epstein Barr Virus (EBV). We report a case of an 18 year-old African American male patient with no significant past medical history, presenting with a unilateral neck mass. Imaging and biopsy confirmed a neoplasm, diagnosed as nasopharyngeal carcinoma. Our case is remarkable as NPC is perhaps most common in China where annual incidence is 25 cases per 100,000 compared to the US, with an annual incidence of 0.5 cases per 100,000. Our patient is African American and had never been outside the country. Furthermore, he is young, while most cases of NPC happen in the elderly. While age and race were atypical, our patient was both a smoker and EBV positive. Finally, as a stage 2 NPC he received chemo radiotherapy and has thus far responded well.

Cervical Thymic Cyst: A Rare Differential Diagnosis in Lateral Neck Swelling

Introduction. Thymic cysts are among the rarest cysts found in the neck. Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen in 50% of cervical thymic cysts. Case Report. We report an uncommon case of a 15-year-old male, who noted a painless, growing mass on left side of his neck of one-year duration. Computerised tomographic scan showed a multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level. Here, we discuss the surgical aspect, histopathology, and management of this rare lateral neck swelling. Discussion. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis.

Large Unilateral Neck Mass in Submandibular Region

A 44-year-old male presented to the oral and maxillofacial surgery clinic at The Brooklyn Hospital Center. The patient's chief complaint was an enlarging asymptomatic mass to the right side of his neck in the submandibular region, as shown in Figures 1 and 2. The patient noticed the mass 10 years ago but noticed a slow increase in size in the past 5 years. The patient's medical history was significant for hypertension, asthma, and obesity. The patient denied any surgeries in the past and any drug and alcohol use.

Branchial cleft cyst: an unusual ultrasound diagnosis in an austere environment

Abstract Branchial cleft cysts are typically benign congenital cysts lined by epithelial cells that arise on the lateral part of the neck. Ultrasound is useful in situations, where CT scanning and MRI are unavailable. We report a case of a 29-year-old Ugandan male who presents with a unilateral neck mass. We highlight the usefulness of ultrasound in diagnosing a lesion consistent with a branchial cleft cyst, while ruling out other causes of neck masses.

Extra Vestibular Schwannoma: A Two Year Experience

We present series of head, neck extracranial non-vestibular schwannomas treated during 2-year period. All patients with head and neck schwannomas treated at our department from April 2007 to July 2009 were reviewed. There was female predominance (72%). The mean age at diagnosis was 38years. All (100%) presented with a neck mass. Most common nerves of origin were the vagus and the cervical sympathetic chain. Treatment for all cases was complete excision with nerve preservation. Among all schwannoma patients, postoperative neural deficit occurred in four with partial to complete resolution in three. The follow-up period was 24months. Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin.

Clinical history of HIV infection may be misleading in cytopathology

Human immunodeficiency virus (HIV)-infected patients are at an increased risk for developing opportunistic infections, reactive conditions and neoplasms. As a result, a broad range of conditions are frequently included in the differential diagnosis of HIV-related lesions. The clinical history of HIV infection may, however, be misleading in some cases. Illustrative cases are presented in which knowledge of a patient's HIV status proved to be misleading and increased the degree of complexity of the cytologic evaluation. Case 1 involved the fine needle aspiration (FNA) of a painful 3 cm unilateral neck mass in a 38-year-old female with generalized lymphadenopathy. Her aspirate revealed a spindle cell proliferation devoid of mycobacteria that was immunoreactive for S-100 and macrophage markers (KP-1, PGM1). Multiple noncontributory repeat procedures were performed until a final excision revealed a schwannoma. Case 2 was a CT-guided FNA of a positron emission tomography positive lung mass in a 53-year-old man. The acellular aspirate in this case contained structures resembling fungal spore forms that were negative for mucicarmine and GMS stains, as well as cryptococcal antigen immunocytochemistry. A Von Kossa stain confirmed that these pseudo-fungal structures were calcified debris. Follow up revealed multiple calcified lung and hilar node based granulomata. Case 3 involved the cytologic evaluation of pleural fluid from a 47-year-old man with Kaposi sarcoma and recurrent chylous pleural effusions. Large atypical cells identified in his effusion were concerning for primary effusion lymphoma. Subsequent pleural biopsy revealed extramedullary hematopoiesis, documenting these atypical cells as megakaryocytes. These cases demonstrate that knowledge of a patient's HIV status can be misleading in the evaluation of cytology specimens, with potential for misdiagnosis and/or multiple procedures. To avoid this pitfall in the setting of HIV infection, common entities unrelated to HIV infection and artifacts should always be included in the differential diagnosis.

Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience

We present a series of head and neck extracranial non-vestibular schwannomas treated during a ten-year period, assessing epidemiology, presenting signs and symptoms, location, nerve of origin, diagnostic modalities, treatment and clinical outcome. Clinical records of all patients with head and neck schwannomas treated at our department from April 1995 to July 2005 were retrospectively reviewed. There was female predominance (67%). The mean age at diagnosis was 48 years. Sixteen (76%) presented with a unilateral neck mass. Eleven schwannomas (52%) were in the parapharyngeal space. The most common nerves of origin were the vagus and the cervical sympathetic chain. The tumour may masquerade as a cervical lymph node and other myriad conditions. Treatment for all but 2 cases was complete excision with nerve preservation. Two cases of facial schwannoma required sacrifice of the affected nerve portion with nerve reconstruction. All facial schwannoma patients suffered postoperative facial palsy with only partial resolution (mean final House-Brackman grade, 3.25/6). Among non-facial schwannoma patients, postoperative neural deficit occurred in 12 with partial to complete resolution in 7. The median follow-up period was 24 months. No schwannoma was malignant and none recurred. Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral parapharyngeal neck mass. Preoperative diagnosis may be aided by fine-needle cytology and magnetic resonance imaging or computed tomographic imaging. The mainstay of treatment is complete intracapsular excision preserving the nerve of origin, but for extensive tumour or facial schwannomas, subtotal resection or nerve sacrifice with reconstruction and rehabilitation are considerations. Surgery on intraparotid facial schwannomas carries considerable morbidity and conservative management has a place in treatment. Early recognition of facial schwannomas is key to optimal treatment.

An Unusual Cause of a Neck Mass

The patient, a 34-year-old woman, presented with a 4-week history of a painful, unilateral neck mass and torticollis. On examination, she had swelling and tenderness over the right sternocleidomastoid muscle along with restricted neck movement. Her serum creatine kinase level was 186 IU/L (normal 0–165), serum aldolase was 8.9 U/L (normal 1–8), ESR normal. Serology for Trichinella and toxoplasmosis were negative. Biopsy of the sternocleidomastoid muscle demonstrated marked interstitial fibrosis, focal lymphocyte infiltration, no evidence of regeneration, degeneration or vasculitis and a normal amount of glycogen. MRI of the neck revealed significant inflammation in the right sternocleidomastoid muscle (Figs. 1 and 2). She was treated with prednisone and methotrexate for about 10 months with significant improvement of her symptoms. Repeated MRI revealed no enhancement in the right sternocleidomastoid muscle (Fig. 3). She never developed any sign of polymyositis with eighteen months follow-up. Focal myositis is characterized by the selective involvement of a single muscle by the inflammatory process. The diagnosis of focal myositis is determined by biopsy of the muscle. The clinical course is variable, with a high rate of spontaneous regression. However, focal recurrence in other muscles or progression to polymyositis has been reported. Muscle enzymes and erythrocyte sedimentation are usually within the normal range. Heffner and Barron reported 6 patients, each of whom initially had a single, localized, painful mass. They concluded that an essential clue to the diagnosis of polymyositis at the early localized stage is the elevation of ESR and serum creatine kinase that does not occur in focal myositis.

Ectopic cervical thymus in an infant

We report a case of accessory cervical thymus presenting as a unilateral neck mass in a 2-month-old boy. Ultrasonography (US) showed a mass isoechogenic to muscle in the left neck. Computed tomography (CT) revealed a well-defined, mildly enhanced mass located anterior to the sternocleidomastoid muscle, anterolateral to the carotid sheath, and posterior to the submandibular gland. On magnetic resonance imaging (MRI), the mass was isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Diffusion-weighted images showed relatively low apparent diffusion coefficient (ADC) values, and the mass was slightly enhanced after administration of contrast material. We suspected ectopic thymus, but we could not exclude the possibility of a malignant lesion. Therefore, the tumor was surgically resected. The histological diagnosis was ectopic cervical thymus. Ectopic thymus should be included in the differential diagnosis of a submandibular or cervical mass in infants. US and MRI can provide useful information for the diagnosis of ectopic cervical thymus.

Intrathyroid dermoid cyst presenting as a unilateral “Cold” nodule

A dermoid cyst arising in the left lobe of the thyroid gland in a 5-year-old boy was managed with a left hemi-thyroidectomy. While congenital lesions feature frequently in the differential diagnosis of childhood neck masses, dermoid cysts presenting as a unilateral neck mass are rare. When found within the thyroid, their pathogenesis may be explained by a disruption of normal thyroid development. Excision appears the treatment of choice.