Clinical approach to pediatric neck masses. Retrospective analysis of 98 cases

Abstract

OBJECTIVE:Pediatric neck masses (PNMs) are a frequently encountered problem in otorhinolaryngology practice. The clinical approach to cervical masses in childhood varies from that of adults. Due to differences among clinicians in the assessment of a PNM, studies investigating this subject are significant contributions to the literature. For this reason, a review was conducted of pediatric PNM cases with an open biopsy (incisional/excisional) and a histopathological diagnosis.METHODS:The hospital records of 98 (34 girls, 64 boys) pediatric patients aged between 8.5 months and 16 years were reviewed. The history, physical examination findings, blood tests, medical treatments, imaging reports, and the pathology and/or microbiology results of the patients were recorded and evaluated. The cervical masses were categorized according to the etiology, imaging features, size, and location.RESULTS:Surgical biopsy was planned due to the suspicion of malignancy, typical clinical presentation or location, or size greater than 20 mm despite antibiotherapy for 2 to 6 weeks. Excisional biopsy (91.8%) was the first choice for histopathological sampling. Infectious masses were observed most commonly, followed by congenital and neoplastic masses, at a rate of 49%, 27.6%, and 23.4%, respectively. Hodgkin lymphoma was the most frequent type of malignancy (39.1%). Thyroglossal and branchial cysts constituted 74.1% of congenital masses. Sixty-seven percent of all masses were solid, and the lateral levels of the neck were the most affected locations (44.9%).CONCLUSION:In most cases, the diagnosis can be made with a detailed history and physical examination. In the presence of nonspecific findings, blood tests, imaging, and histopathological sampling are required. Ultrasound should be the first preference for imaging, and excisional biopsy is suggested rather than fine needle aspiration biopsy for histopathological sampling in pediatric neck masses.

Clinical and ultrasound characteristics of pediatric lateral neck masses

“…Acquired LNM had solid US appearance significantly more frequently than congenital ones, and it was substantiated by the high sensitivity of the US as diagnostic examination. It was previously reported that high percentage of LNM in children (45%) were solid [ 1 , 32 ].…”

“…Forty-one of all our patients presented with LNM (16,4%) had malignancies, thirty-one having lymph node malignancy, while ten had tumors of other origin ( Table 2 ). Other studies report malignancies in 12% to 15% of all neck masses [ 1 , 2 ]. In general pediatric population examined by primary care providers due to persistent lymph node enlargement, surgical biopsy showed malignancy in 15% to 22% [ 41 , 42 ].…”

“…Lateral neck masses (LNM) are common in pediatric population. Although they are mostly benign, extreme caution is necessary because malignancies are diagnosed in about 12% to 15% of all neck masses in children [ 1 , 2 ]. Knowledge of embryology, anatomy, and clinical presentation currently helps establishing the surgeon’s preoperative diagnosis.…”

A child in shock: carotid blowout syndrome

“…Ultrasound has been reported to have 95% sensitivity and 83% specificity in the differentiation between malignant and reactive lymph nodes7 ; malignancy (lymphoma) is more likely with an abnormally shaped, homogeneous, hypoechoic lymph node, compared with a heterogeneous lymph node that retains its normal architecture, with surrounding inflammation and central liquefaction (typical of inflamed/infected lymph nodes) 8. CT and MRI can provide more detailed information about the anatomical location, lesion characteristics and surrounding structures 6…”

Clinicopathological study and management of infective swellings of neck in pediatric age group patients

“…Majority of the time, anamnesis and physical examination is sufficient to establish the diagnosis, but when diagnosis can't be made additional FNAC and radiology of swelling are required. 11 Judicious use of investigations may avoid the unnecessary stress and anxiety for the treating doctor and parents. 12 Treatment of infective neck swelling can be done by conservative method and/or surgical methods.…”