Two hundred sixty-seven patients with tumors in the neck, observed at the Children's Memorial Hospital, have been reviewed. Forty-seven of these patients had malignancy. The most common malignancy was lymphosancoma or Hodgkin's disease (20 cases). The highest incidence of malignant degeneration in tumors of a specific organ occurred in the thyroid (50%). The over-all malignancy rate in neck tumors in this series was 15.7%.
This study was undertaken primarily to evaluate clinical patterns and diagnostic methods. It was of great interest to find that tumors of the neck are not as deadly as one might suppose. At least 84% of the lesions were benign and responded well when accepted methods for their treatment were carried out. Moreover, it was fascinating to find that, aside from certain organspecific carcinomas (e.g., thyroid and parotid glands), most cervical neoplasms arose from mesodermal tissues and, when malignant, offered a very poor prognosis. Yet, most lesions arising in the neck manifested themselves before metastasizing beyond the region, so that, if they were localized, surgical excision offered excellent opportunity for adequate containment. Certainly, the backbone of treatment of neck tumors, regardless of type, was surgical ablation, wherever possible.
A few neck tumors were metastatic in nature, but adequate study and evaluation of the patient usually demonstrated the distal primary before operation was undertaken.
Another interesting point, not entirely foolproof but fairly reliable, is the observation that malignant tumors generally were located in the posterior cervical triangle. This applied almost universally, except for lesions in the thyroid gland. Although biopsy is the only way to be certain, it is comforting to have some assurance preoperatively that a solitary mass in the anterior cervical triangle probably is benign. The probability that a cervical tumor is malignant increases in the following order: (1) multiple tumors located in the anterior triangle of the neck; (2) tumors, single or multiple, located in the posterior cervical triangle; (3) multiple tumors located both in the anterior and posterior cervical triangles. Tumors of the thyroid gland represent a class unto themselves. When they are present the malignancy rate is very high, and in this series represented approximately 50%.
Intraductal Carcinoma of the Parotid Gland Presenting as Parapharyngeal Mass
