Differential Diagnosis of Cystic Neck Lesions

Sira, James; Makura, Z. G. G.

doi:10.1177/000348941112000611

Cited by 40 publications

(52 citation statements)

References 14 publications

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“…Few previous studies have been carried out in a similar manner; the cohort of the present study is the largest ever reported. Sira et al described 29 patients and found a malignancy rate of 6.9%, while Cinberg et al reported a malignancy rate of 22% in 18 patients . The present findings are consistent with previous studies; however, our data was collected from four different hospitals, thus making them more heterogeneous compared to the studies by Sira et al and Cinberg et al…”

Section: Discussionmentioning

confidence: 99%

“…Benign/congenital lateral neck cysts (LNC) are a relatively rare clinical entity, appearing as head and neck masses in children and adults. LNC typically arise from the second branchial arch and most frequently become symptomatic in the second and third decade . Of all cervical tumors, the congenital conditions account for 12%; almost one‐fourth of these represent LNCs .…”

Section: Introductionmentioning

confidence: 99%

“…Malignant tumors of the neck are rare in patients younger than 40 years of age; however, among young nonsmokers, an increasing incidence of human papillomavirus (HPV)‐related head and neck squamous cell carcinomas (HNSCC) arising from the lymphatic tissue of Waldeyers ring has been reported . A typical debut of HNSCC could be in the form of a cystic metastasis on the lateral aspect of the neck, which clinically resembles LNC ,. Metastases from PTC might also mimic benign lateral and median neck cysts, even in patients younger than 40 years of age …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

Grønlund¹,

Mey

Andersen

et al. 2016

Laryngoscope Investig Oto

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ObjectiveIn this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed.Study DesignThis study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012.MethodsOne hundred thirty‐five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually.ResultsOf the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine‐needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics.ConclusionThis study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast‐track cancer referral program.Level of Evidence2b.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

Grønlund¹,

Mey

Andersen

et al. 2016

Laryngoscope Investig Oto

View full text Add to dashboard Cite

show abstract

“…In patients younger than 40 years, clinicians should be aware of a metastasis of a papillary thyroid carcinoma [1]. After a careful history and thorough clinical examination further investigations should include ultrasonography of the neck including FNAC and 3-dimensional imaging either with computed tomography (CT) or MRI.…”

Section: Discussionmentioning

confidence: 99%

Epithelial Cyst in the Posterior Triangle of the Neck: Atypical Branchial Cyst or Cystic Lymph Node Metastasis?

Vital

Huber

Pézier

et al. 2014

Case Reports in Otolaryngology

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We report the case of a 66-year-old man with a cervical neck mass located behind the left sternocleidomastoid muscle. To exclude malignancy, a full workup, including clinical, radiological, and cytological examination, was performed but failed to provide a definitive diagnosis. Histological analysis following excisional biopsy revealed a benign epithelial cyst, consistent with an atypically located branchial cyst. We describe an approach to the management of these neck masses and discuss several theories of the etiology of branchial cysts and how they may come to be abnormally located. Case PresentationA 66-year-old man was referred to our department with a 2-day history of a painless left cervical neck mass. He denied any other symptoms and reported that he only occasionally drank alcohol and had stopped smoking some 30 years ago with a total of 10 pack years. Clinical examination revealed a well-defined, painless neck lump, posterior to the sternocleidomastoid muscle close to the mastoid. The lump was some 5 centimeters in size, roughly oval, and not fixed to adjacent structures. There were no surrounding skin changes or other associated findings. Intraoral examination and transnasal fiber-endoscopy were normal. Cervical ultrasound showed an irregularly walled mass, 5 cm in diameter, with hyperechogenic reflections in an echo-poor center. The other neck structures were sonographically normal. Magnetic resonance imaging (MRI) showed a cystic lesion with an irregular wall lateral and posterior to the sternocleidomastoid muscle (neck level five; see Figures 1 and 2). Repeated fine-needle aspiration cytology (FNAC) revealed squamous epithelial cells without signs of malignancy, consistent with a branchial cleft cyst. However, given the patient's age and the atypical localization, the differential diagnosis included a metastasis of a well-differentiated squamous cell carcinoma (SCC). We therefore recommended the patient to undergo panendoscopy and extirpation of the mass with intraoperative frozen section analysis of the specimen. The patient agreed with neck dissection in case of malignancy. Panendoscopy revealed no extra findings, and both intraoperative frozen section and definitive histology of the excisional biopsy confirmed a branchial cleft cyst. The patient recovered well after surgery and was discharged from follow up 12 months later. DiscussionIn patients older than 40 years, especially with risk factors for malignant disease, it is prudent to consider all cystic lesions of the neck as malignant until proven otherwise. In patients younger than 40 years, clinicians should be aware of a metastasis of a papillary thyroid carcinoma [1]. After a careful history and thorough clinical examination further investigations should include ultrasonography of the neck including FNAC and 3-dimensional imaging either with computed tomography (CT) or MRI. Ultrasound-guided FNAC is often diagnostic but its sensitivity drops from >95%

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“…Biopsja jest użytecznym narzędziem diagnostycznym i uznanym standardem postępowania w odniesieniu do guzów litych, gdzie jej swoistość ocenia się na bliską 100%, a odsetek wyników fałszywie negatywnych na mniej niż 3%. W odniesieniu do zmian torbielowatych biopsja cienkoigłowa jest znacznie mniej przydatna, ze względu na bardzo wysoki odsetek wyników fałszywie negatywnych, sięgający 38-63% według różnych badań [12,13]. Nordemar i wsp.…”

Section: Omówienieunclassified

Torbiel boczna szyi czy przerzut raka płaskonabłonkowego

Litwiniuk¹,

Nyckowska²,

Bruzgielewicz³

et al. 2014

Polski Przegląd Otorynolaryngologiczny

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WstępTorbiel boczna szyi jest łagodnym guzem występującym na bocznej powierzchni szyi. Mechanizm powstawania tego typu torbieli pozostaje nie do końca wyjaśniony. Przez wiele lat powszechnie obowiązywała teoria, według której zmiana ta wywodzi się z pozostałości nieprawidłowo zamkniętej w trakcie rozwoju embrionalnego drugiej kieszonki skrzelowej. Hipoteza ta nie tłumaczy jednak pochodzenia nietypowo położonych torbieli. Dlatego też w ostatnich latach coraz większą popularność zdobywa teoria, według której torbiel boczna szyi powstaje w wyniku torbielowatego zwyrodnienia węzłów chłonnych [1]. Torbiel boczna szyi jest najczęstszym guzem występującym w tej okolicy u dzieci oraz młodych dorosłych. U osób po 40. roku życia rozpoznanie torbieli p o l s k i p r z e g l Ą d o t o r y n o l a r y n g o l o g i c z n y 3 ( 2 0 1 4 ) 1 5 2 -1 5 5 i n f o r m a c j e o a r t y k u l e Historia artykułu: Słowa kluczowe: torbiel boczna szyi rak płaskonabłonkowy przerzuty regionalne pierścień Waldeyera Keywords: Branchial cleft cyst Squamous cell carcinoma Regional lymph nodes metastases Waldeyer's ring a b s t r a c tCystic cervical mass is a difficult diagnostic challenge. Branchial cleft cysts are considered to be the most common cause of the cystic neck lesions. However, squamous cell carcinoma (SCC) of the upper aerodigestive tract may send regional lymph node metastases that can also manifest clinically as a cystic tumor. This possibility should especially be considered in adult patients. Therefore, a more attentive pre-and postoperative diagnostics is necessary in patients over 40 years of age, presenting with a cystic cervical mass. In this article we present two cases of cystic neck masses in patients over 40 years old, that have been initially considered to be branchial cleft cysts and turned out to be malignant lesions in a course of diagnostics.

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Differential Diagnosis of Cystic Neck Lesions

Cited by 40 publications

References 14 publications

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst

Epithelial Cyst in the Posterior Triangle of the Neck: Atypical Branchial Cyst or Cystic Lymph Node Metastasis?

Torbiel boczna szyi czy przerzut raka płaskonabłonkowego

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