Calcifying Fibrous Pseudotumor of the Neck: Diagnostic Challenges of a Rare Benign Lesion

Neck masses, frequently encountered by physicians, comprise a vast range of diagnoses, with malignancy being the greatest concern. Calcifying fibrous pseudotumor (CFP) is a rare lesion with unknown pathogenesis, characterized pathologically by a predominance of abundant hyalinized collagenous tissue with focal lymphoplasmacytic infiltrate and psammomatous or dystrophic calcifications. We present the case of a 29-year-old woman who presented with a 4-cm left neck mass, accompanied by constitutional symptoms of vague weakness and lethargy. After the lesion failed to respond to a course of antibiotic therapy, fine-needle aspiration was performed, the pathology of which was indeterminate. The concern was that the lesion was a lymphoproliferative disorder–further workup was performed. CT of the chest, abdomen, and pelvis revealed no evidence of adenopathy or neoplasms. Subsequently, an incisional biopsy was performed, suggesting a diagnosis of CFP. Magnetic resonance imaging with contrast, performed to delineate the anatomy, revealed the lesion in the left neck, deep to the left clavicle, that extended superiorly into the supraclavicular fossa. Complete surgical removal of the lesion was successfully performed, with immunophenotyping confirming the initial diagnosis of CFP. We present a case report of cervical CFP, discuss the approach to neck masses, and review the recent literature on this rare, benign entity.

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Paediatric neck masses – a diagnostic dilemma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100137867 ◽

1997 ◽

Vol 111 (6) ◽

pp. 541-545 ◽

Cited By ~ 29

Author(s):

A. A. P. Connolly ◽

K. MacKenzie

Keyword(s):

Lymph Node ◽

Needle Aspiration ◽

Neck Mass ◽

Malignant Tumours ◽

Diagnostic Dilemma ◽

Neck Masses ◽

The Mean ◽

Needle Aspiration Cytology ◽

Sick Children ◽

Reactive Hyperplasia

AbstractThree hundred and sixty children who had a head and neck mass excised during 1987 to 1992 at the Royal Hospital for Sick Children, Glasgow were studied. There were 210 males and 150 females with a mean age of 60.7 months (0.5 to 198 months). Pilomatrixomata/sebaceous cysts (34 per cent), thyroglossal cysts (13 per cent), branchial remnants (nine per cent) and dermoids (nine per cent) accounted for almost twothirds of the 264 non-lymphadenomatous benign lesions excised. Ninety-three lymphadenopathy masses consisted of 60 with reactive hyperplasia, 21 with Mycobacterium infection and 12 lymphomas. There were three solid malignant tumours, two were rhabdomyosarcomata and one disseminated round cell tumour. The correlation between clinical diagnosis and histopathology of benign non-lymph node masses and solid tumours was 90 per cent and 100 per cent respectively, in benign lymph nodes, 66 per cent, but was poor in differentiating lymph node content. The mean time from presentation of a swelling to its excision was almost a year and the mean in-patient stay for excision of a mass was almost five days. The role of fine needle aspiration cytology (FNAC) in arriving at a diagnosis and reducing patient morbidity is discussed.

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Life threatening complication of fine needle aspiration of neck mass in a child: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181888 ◽

2018 ◽

Vol 4 (3) ◽

pp. 860 ◽

Cited By ~ 1

Author(s):

Pramod S. ◽

Rewanth Reddy

Keyword(s):

Fine Needle Aspiration ◽

Internal Carotid ◽

Needle Aspiration ◽

Neck Mass ◽

First Line ◽

Fine Needle ◽

Neck Masses ◽

Life Threatening ◽

Life Threatening Complication ◽

Internal Carotid Artery Injury

Fine needle aspiration biopsy has become an important first line of investigation in palpable neck masses. It is simple, sensitive, inexpensive and safe investigation. Minor complications include pain, rashes and irritation at the site of aspiration. Life threatening complication occurs rarely. This is a report of child who presented with internal carotid artery injury with a massive hematoma causing respiratory distress following Fine needle aspiration. The child underwent neck exploration with evacuation of hematoma. Though life threatening complications post Fine needle aspiration are rare, this case highlights the precautions to be taken while performing fine needle aspiration in deep seated neck mass.

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Enigma in the diagnosis of congenital neck masses: a prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195708 ◽

2019 ◽

Vol 6 (1) ◽

pp. 159

Author(s):

Rajesh Radhakrishna Havaldar ◽

Anju Singh ◽

Priti S. Hajare ◽

Shama A. Bellad ◽

R. S. Mudhol

Keyword(s):

Prospective Study ◽

Bronchogenic Cyst ◽

Histopathological Examination ◽

Tertiary Care ◽

Needle Aspiration ◽

Neck Mass ◽

Care Hospital ◽

Duct Cyst ◽

Neck Masses ◽

A Prospective Study

Background: Head and neck swellings are common in routine otorhinolaryngologic practice. This study was done to assess the incidence and varied presentation of different congenital neck swellings.Methods: Hospital based prospective study done in the Department of Otorhinolaryngology at a tertiary care hospital from January 2017 to December 2018. A total of 28 patients with slow, progressive neck swellings were selected after excluding thyroid swellings and acute inflammatory neck swellings. All patients had no other complaints. After a thorough clinical examination and investigations like ultrasonography, fine needle aspiration cytology and radiological examination, surgery was done, and specimens obtained were sent for histopathological examination. Patients were followed up to 1 year. Results: 28 patients with congenital neck mass were studied. 15 were thyroglossal cysts, 7 were branchial anomalies, 5 were dermoid cysts and 1 was bronchogenic cyst. The most frequent congenital neck mass was thyroglossal duct cyst and fistula (53.57%) followed by, in descending order, cysts and fistulas of the branchial apparatus (25%), dermoid cysts (17.85%) and bronchogenic cyst (3.5%) respectively.Conclusions: The overall presentation in terms of age group, location, incidence and clinical features of congenital neck swellings is an enigma to the treating surgeon as well as the pathologist. The prevalence varies largely among centres. A knowledge of the varied differential diagnosis of slow progressive masses in the neck should be kept in mind while planning the surgical procedure for total removal of the lesion to avoid recurrence.

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Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0073 ◽

2017 ◽

Vol 99 (6) ◽

pp. e162-e164

Author(s):

M Walsh ◽

M Supriya ◽

N Railton

Keyword(s):

Needle Aspiration ◽

Neck Mass ◽

Major Haemorrhage ◽

Resonance Imaging ◽

Biopsy Result ◽

Open Biopsy ◽

Arm Pain ◽

Transarterial Embolisation ◽

Supraclavicular Fossa ◽

Upper Thoracic

A 65-year-old man presented with a right supraclavicular neck mass and right arm pain. Magnetic resonance imaging revealed a 96mm lesion in the upper thoracic paraspinal region extending into the deep supraclavicular fossa. The presentation was consistent with a sarcoma or lymphoma but fine needle aspiration was inconclusive. During open biopsy of the lesion, the patient had a rapid intraoperative haemorrhage of 1l from the tumour. Haemostasis could only be achieved by transarterial embolisation of the feeding vessel and the biopsy result confirmed Ewing’s sarcoma. Open biopsy is considered the gold standard in the diagnosis of certain tumour types; however, the morbidity from haemorrhage must be considered. This case highlights the key role that transarterial embolisation can play in achieving haemostasis in the neck.

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Extraosseous Ewing Sarcoma: Expanding the Differential Diagnosis of Supraclavicular Fossa Tumors

Ear Nose & Throat Journal ◽

10.1177/014556131709600104 ◽

2017 ◽

Vol 96 (1) ◽

pp. E29-E32 ◽

Cited By ~ 1

Author(s):

Julio Rama-López ◽

Rafael Ramos Asensio ◽

Cesar García-Garza ◽

Pablo Luna Fra ◽

Maria del Carmen Gassent Balaguer ◽

...

Keyword(s):

Differential Diagnosis ◽

Broad Spectrum ◽

Ewing Sarcoma ◽

Soft Tissues ◽

Parapharyngeal Space ◽

Age Groups ◽

Neck Mass ◽

Neck Masses ◽

Supraclavicular Fossa ◽

Extraosseous Ewing Sarcoma

A broad spectrum of diseases can be included in the differential diagnosis of neck masses. We report a case of extraosseous Ewing sarcoma that presented as a neck mass in a 70-year-old man. To the best of our knowledge, this is the first reported case of extraosseous Ewing sarcoma of the supraclavicular fossa. Published cases of extraosseous Ewing sarcoma in the neck have been described in other age groups, but those tumors were confined to the parapharyngeal space. Also, there have been reported cases in patients older than 70 years in which Ewing sarcoma affected other structures such as the larynx and the pelvis, but none in the soft tissues of the neck. This case adds extraosseous Ewing sarcoma as a possible diagnosis to consider when evaluating a neck mass in the supraclavicular fossa.

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A Killian-Jaimeson Diverticulum Masquerading as a Thyroid Nodule

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1866 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A914-A914

Author(s):

Reema Patel ◽

Maha Abdulla ◽

Jianyu Rao ◽

Abemayor Elliot ◽

Dianne Cheung

Keyword(s):

Thyroid Nodule ◽

Thyroid Tissue ◽

Disease Process ◽

Neck Surgery ◽

Needle Aspiration ◽

Neck Mass ◽

Care Physician ◽

Pathology Report ◽

Left Neck ◽

Foreign Materials

Abstract Background: A Killian-Jaimeson diverticulum is a rare outpouching in the cervical esophagus, just below the cricopharyngeus muscle, that can be easily mistaken for a thyroid nodule on ultrasonography (1). Clinical Case: A 65-year-old woman underwent a thyroid ultrasound after her primary care physician noted left-sided thyromegaly. The ultrasound described a 33 mm solid, hypoechoic, wider-than-tall nodule in the left mid gland with an obscured posterior margin as well as macro- and microcalcifications. Given the size and highly suspicious features on ultrasound, she was referred to endocrinology clinic for a fine needle aspiration (FNA). She underwent ultrasound-guided FNA of what appeared to be the previously described thyroid nodule. Surprisingly, the pathology report noted degenerative changes with amorphous debris and possible foreign materials (vegetable or food) without any thyroid tissue. She was sent for an MRI neck, which showed the left neck mass communicating with the esophagus, favoring a left lateral projecting Killian-Jamieson esophageal diverticulum with internal debris. She was referred to head and neck surgery. Given only minimal symptoms of dysphagia, there are no current plans for surgery. Conclusion: This case illustrates the possibility of mistaking a Killian-Jaimeson diverticulum as a thyroid nodule. Recognition of this rare disease process in the differential diagnosis of thyroid nodules with high risk ultrasound characteristics may prompt more advanced imaging with MRI or CT, and lead to an accurate diagnosis prior to subjecting patients to unnecessary and potentially harmful FNAs (2). References: (1) Kim HK, Lee JI, Jang HW, et al. Characteristics of Killian-Jamieson diverticula mimicking a thyroid nodule. Head Neck. 2012;34(4):599-603. doi:10.1002/hed.21575. (2) Bonacchi G, Seghieri M, Becciolini M. Killian-Jamieson diverticulum: real-time sonographic findings. J Ultrasound. 2016;19(4):295-298. Published 2016 Apr 21. doi:10.1007/s40477-016-0208-3.

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Cytopathological and histopathological evaluation of neck mass in a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213275 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1432

Author(s):

Yaladahalli G. Lokesh ◽

Dudda Ravi ◽

Hodeyala J. Srikanth

Keyword(s):

Diagnostic Tool ◽

Predictive Value ◽

Tertiary Care ◽

Needle Aspiration ◽

Neck Mass ◽

Care Hospital ◽

Neck Masses ◽

Cytological Features ◽

Needle Aspiration Cytology ◽

Sensitivity Specificity

Background: Patients with neck swellings are commonly seen in ENT outpatient and leads to dilemma in diagnosis. To prevent unnecessary investigations and surgery a simple and sensitive diagnostic tool is needed. Fine needle aspiration cytology (FNAC) is a simple and sensitive diagnostic tool that can provide results in minutes.Methods: This prospective study was done at the department of ENT, Mandya institute of medical sciences, Mandya, Karnataka, India from November 2017 to April 2019 including 100 cases of neck masses in patients aged above 18 years. FNAC was done for all neck masses and then these cases were subjected for biopsy. The cytological features was then reviewed with corresponding histopathology features.Results: Out of the 100 neck masses under study 67 (67%) were males and 33 (33%) were females with male:female ratio (1:2.03). Thyroid aspirations (43%) were most common followed by lymph node (24%), salivary gland aspirations (18%), congenital swellings (8%) and others (7%). Out of the 100 cases 26% were neoplastic and 74% were non-neoplastic. Histopathological correlations were available in all the 100 cases with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 84.2%, 98.65%, 95.65% and 94.81% respectively. FNAC was in correlation with histopathology in 86% of cases and found to be statistically significant.Conclusions: FNAC is safe, simple and minimally invasive first line investigation of choice for the patients presenting with palpable neck masses and can provide results rapidly and but histopathology remains the gold standard.

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Solitary Fibrous Tumor of the Larynx and Anterior Neck

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v34i1.973 ◽

2019 ◽

Vol 34 (1) ◽

pp. 64-67

Author(s):

Guinevere S. Pabayos ◽

Armando M. Chiong

Keyword(s):

Solitary Fibrous Tumor ◽

Thyroid Cartilage ◽

Upper Airway ◽

Needle Aspiration ◽

Neck Mass ◽

Anterior Neck ◽

Neck Masses ◽

Airway Opening ◽

Fibrous Tumor ◽

The Right

Whether benign or malignant, laryngeal and neck masses may involve the upper airway and obstruct breathing. While surgically-resectable malignancies are generally extirpated with adequate margins of normal tissue, benign lesions are usually excised conservatively. However, even benign masses may behave malignantly, necessitating more aggressive surgical resection. We present one such case. CASE REPORT A 35-year-old man from Cotabato City consulted due to difficulty of breathing. He had a six-year history of progressively enlarging anterior neck mass with intermittent dyspnea, foreign body sensation, progressive dysphagia and hoarseness over the last three months. Physical examination revealed a well-defined, 5 x 6 cm smooth, firm, non-tender anterior neck mass that moved with deglutition. Rigid endoscopy showed a right supraglottic mass with bulging of the right glottic and subglottic area, with a less than 10% airway opening. (Figure 1A) Both arytenoids were visibly mobile, but glottic closure was impaired. (Figure 1B) Tracheostomy and suspension laryngoscopy with biopsy yielded inconclusive results (fibromuscular tissue) and fine needle aspiration cytology (FNAC) of the anterior neck mass only revealed blood and colloid. Contrast computed tomography of the neck showed a well-marginated, hypodense, thick-walled, heterogeneously enhancing mass in the right laryngeal fossa measuring 2.86 x 1.78 cm with a larger extension anteriorly measuring 4.66 x 2.52 cm. Effacement of the epiglottis and aryepiglottic fold was noted. The hyoid and thyroid cartilage were intact, and the thyroid gland was normal. (Figure 2A, B) Because of inconclusive histopathological and cytological results, an incision biopsy of the anterior neck mass was performed. Histopathological evaluation revealed spindle cell mesenchymal proliferation, and immunohistochemical stains showed positive immunoreactivity for CD34, with a weakly positive S-100 and negative SMA, favoring a solitary fibrous tumor.

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Etiopathological study of pediatric neck masses in a rural population

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183398 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1206

Author(s):

Mudassar A. Shariff

Keyword(s):

Pediatric Patients ◽

Histopathological Examination ◽

Pediatric Population ◽

Needle Aspiration ◽

Neck Mass ◽

Age Group ◽

Medical College ◽

Pediatric Age Group ◽

Neck Masses ◽

A Prospective Study

Background: Neck mass in pediatric age group is a common clinical condition encountered by an ENT Specialist. Detailed clinical examination and knowledge of the common neck masses in children, which differ from those in adults is vital in early diagnosis and treatment. Diagnostic modalities such as Ultrasonography, Computerised Tomography, Fine needle aspiration cytology (FNAC) and histopathological examination aids in the diagnosis of superficial neck masses. The majority of neck masses in the pediatric population are congenital or inflammatory in origin and some are neoplastic. This study was conducted to establish the various causes of neck masses and the site of origin of neck masses in pediatric patients attending ENT OPD.Methods: 50 patients in the age group of 1 month to 18 years presenting with neck masses to the ENT OPD of Vinayaka Mission’s Medical College and Hospital, Karaikal were included in the study. This was a prospective study conducted for a period of 2 years. All the cases underwent FNAC. Biopsy and histopathological examination was done in cases where the cytological diagnosis was inconclusive. Results: Of the 50 cases clinically evaluated, 24 were lymph node swellings, 7 were thyroid swellings, 8 were salivary gland swellings, 10 were congenital neck swellings, with 1 swelling being due to other cause.Conclusions: Inflammatory swelling arising from the Lymph nodes were the commonest cause of neck swelling in pediatric patients. Neck swellings were located most commonly in the Submandibular triangle in the study.

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Small Cell Neuroendocrine Carcinoma in Head and Neck

Indonesian Journal of Cancer ◽

10.33371/ijoc.v15i4.805 ◽

2021 ◽

Vol 15 (4) ◽

pp. 211

Author(s):

Sondang Nora Harahap ◽

Daan Khambri

Keyword(s):

Head And Neck ◽

Histopathological Examination ◽

Early Recognition ◽

Neck Mass ◽

Small Cell ◽

Morbidity And Mortality ◽

Surgical Removal ◽

Left Neck ◽

Mortality Case ◽

Poorly Differentiated

Introduction: Poorly differentiated neuroendocrine carcinomas (NECs) originating from the eye are rare and very highly malignant diseases with a poor prognosis. Small cell NEC of the head and neck is a rare disease and highly aggressive. Early recognition and treatment are crucial for reducing morbidity and mortality. Case Presentation: A 19-year-old male visited our oncology surgery outpatient department due to the progressive neck mass enlargement originating from the eye. The patient was previously diagnosed with invasive choroid malignant melanoma of the left eye which had metastasized to the lymph nodes of the left neck. He underwent a surgical removal/exenteration of the left eye. The result showed that the patient’s survival with poorly differentiated tumors was about 14% while patients with well-differentiated NEC had a survival rate of 34%. It also indicates that the prognosis of these tumors is very poor with a total of over 90% of patients having distant metastatic disease. Histopathological examination showed the tumor tissue and its immunohistochemistry with positive streaks of CD56, NSE, Synaptophysin, and Ki67 suggested small cell NEC.Conclusions: it is crucial to establish an early diagnosis of these tumors to reduce morbidity and mortality. No optimal treatment for such disease has yet been established.

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