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Acquired Disorders of the Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Masses can arise from any of the structures in the neck including lymph nodes, the thyroid gland and the salivary glands. Enlargement may be in response to physiological stimuli but can be due to pathology, causing parental alarm and needing investigation and management. Lymph node enlargement – usually benign and of no pathological significance – is by far the commonest cause of a neck mass in children.
Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Papillary carcinoma often is detected as a painless mass, with enlargement of the cervical lymph nodes. However, some patients may complain about neck pain, hoarseness, and dysphagia. Patients have also nodal metastases in the lateral neck. Follicular thyroid carcinoma is often a painless tumor, from less than 1 cm in diameter up to several centimeters. Large tumors cause dyspnea or dysphagia, and throat or neck soreness and pain. There may be unintended weight loss and night sweats. Cervical lymph node enlargement at diagnosis is not common. Sometimes, the first symptom is metastasis that can be signified by a lung nodule or a bone fracture. If a metastasis is diagnosed as being from the thyroid, a neck examination will usually reveal a thyroid mass. In certain cases, findings of bone metastases prompt reexamination of an earlier resected thyroid mass that was believed to be an adenoma. There are also rare cases of functional follicular thyroid carcinoma related to hyperthyroidism. The majority of MTCs are painless. Extensive localized tumor growth causes upper airway obstruction plus dysphagia. With metastases, some patients experience flushing and severe diarrhea because of high circulating calcitonin levels and other products that result from the tumor. Patients may present with a firm neck mass that is fixed in one location. The tumor is widely infiltrative. Hoarseness, breathing problems, dysphagia, and pain are common symptoms, as well as dyspnea and vocal cord paralysis. Approximately 35% of patients initially present with distant metastasis to the lungs and bones.
Surgical Management of Anaplastic Thyroid Cancers
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Deepa Nair, K.S. Rathan Shetty
The most common clinical symptom is a rapidly enlarging neck mass with other concomitant symptoms like pain, dyspnea, dysphagia, hoarseness, and cough. These symptoms arise due to involvement of aerodigestive structures like the trachea, larynx, esophagus, recurrent laryngeal nerves, and great vessels [2,8,10]. Another hallmark of ATC is the frequency of distant metastasis at presentation, which can be seen in up to 50% of cases, leading to symptoms like chest pain, bone pain, dyspnea, cough, weight loss, and fatigue. Hyperthyroidism may also be a feature due to a rapidly enlarging mass leading to destruction of normal thyroid tissue causing release of thyroid hormones into the bloodstream or thyroiditis [2,8,10].
Otolaryngologic manifestations of Mpox: the Atlanta outbreak
Published in Acta Oto-Laryngologica, 2023
Kaitlyn A. Brooks, Nathaniel S. Neptune, Douglas E. Mattox
An 18-year-old man presented for odynophagia, fevers, and diarrhea. Otolaryngology was consulted for a left neck mass. White count (WBC) was mildly elevated (8,000 cells/mm3); erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were highly elevated at 63 mL/hr and 13.9 mg/L, respectively. He was recently diagnosed with HIV and took ART for 1 month. He had no skin involvement, but did have mucosal lesions on his tonsils, floor of mouth, and buccal mucosa. The remaining physical exam was significant for large bilateral lymph node conglomerates confirmed by ultrasound. He started broad spectrum antibiotics and fluconazole out of concern that his mucosal lesions were oral thrush. On HD 1, he developed the characteristic rash and was diagnosed with MPX. Tecovirimat was not started by infectious disease because his CD4 count was over 400 and his viral load was decreasing. At discharge on HD 5, he already had significant decrease in his lymphadenopathy without surgical intervention.
The Giant Infantile Fibrosarcoma of Fetal Oropharynx and Anterior Neck
Published in Fetal and Pediatric Pathology, 2022
Tugba Sarac Sıvrıkoz, Lutfiye Selcuk Uygu, Çiğdem Kunt İşgüder, Erhan Aygun, Ibrahim Halil Kalelioglu, Recep Has
A 24-year-old G3P1 pregnant woman was referred to our clinic at the 26th gestational week with an anterior fetal neck and oropharyngeal mass, first detected at 24 weeks’ gestation. Ultrasound detected a 55 × 54 × 33 mm anterior neck mass. The mass was hypervascular with irregular borders (Fig. 1a), expanded the hypopharynx in the sagittal plane, pushed the root of the tongue superiorly and out of the oral cavity (Fig. 1b). No additional findings were detected except moderate polyhydramnios. Middle cerebral artery peak systolic velocity was <1 MoM. By fetal magnetic resonance imaging (MRI), a 45 × 45 × 34 mm mass with a prominent necrotic component infiltrated into the left masseter, parotid and submandibular spaces (Fig. 1c), without hemorrhage or calcification, and was thought to represent a sarcoma.
Lateral neck cyst as initial presentation of thyroid malignancy
Published in Acta Chirurgica Belgica, 2020
Lieze Vancraeynest, Sam Van Slycke
Differential diagnosis between branchial cleft cysts, cystic degeneration of a malignant process, and other possible causes of a cystic neck mass has to be properly considered because of the important management implications. Thus, the initial assessment should include a complete medical history with specific attention towards a possible infectious etiology of the neck mass, thorough head and neck examination including the thyroid gland, any other nodes in the neck and a visual examination of the upper digestive tract should be performed. However, differential diagnosis is not always possible solely on clinical grounds; therefore, the threshold to perform US examination and FNAC, which can be carried out at the same time, should be extremely low. Some argue that these investigations are justified in all patients presenting with a solitary cystic mass of the lateral neck [9]. Further CT and MRI imaging should be considered when the cystic structure is found to be suspect in US and/or clinical examination (e.g. non pure cyst structure on US, clinical impression of indurated tumor with irregular surface, multiple enlarged lymph nodes, etc.) [9]. CT may be more readily available, but MRI may allow more precise anatomical localization and may help to distinguish cystic from solid components [3].