Internal jugular phlebectasia communicating with a cervicomediastinal lipoma: a case report

Venous aneurysms are an atypical presentation of neck masses in the paediatric population. The evaluation and surgical removal of internal jugular vein phlebectasia and a lipoma coexisting are described in this report. Internal jugular vein phlebectasia is theorised as a congenital defect and is becoming more common with advancing imaging technologies. Both phlebectasia and lipomas are considered benign conditions, but clinicians must be aware of tumours producing mass effect.

Syncope caused by lymphomatous encasement of the internal carotid artery

We present a case of a 77-year-old man who reported 5 months of syncopal episodes. He was found to have diffuse large B-cell lymphoma encasing the left internal carotid artery but not impeding blood flow. The syncopal episodes resolved after his first cycle of chemotherapy. Recurrent syncope in non-cardiac lymphomas and other head and neck masses is exceedingly rare and may be due to reflex syncope prompted by carotid baroreceptor activation. There are 11 previously described cases of recurrent syncope associated with non-cardiac lymphoma. In all cases, lymphadenopathy abutting the carotid artery was present and the syncopal episodes resolved with treatment. Our case illustrates that malignancy should be considered in patients with unexplained recurrent syncope.

A rare case of co-existing branchial cyst and thyroglossal cyst

<p class="abstract">Thyroglossal duct remnants and branchial arch anomalies are the most common congenital neck masses. These anomalies typically present in childhood or early adulthood as cysts, sinuses or cartilaginous remnants, but may rarely present in late adulthood. Although both thyroglossal duct remnants and branchial cysts may be encountered individually, these anomalies are rarely encountered together in the same individual. We report the third such case of co-existing branchial cyst and thyroglossal cyst occurring in the same individual with review of embryological development of thyroglossal duct cysts and second branchial arch anomalies.</p>

Pediatric Head and Neck Malignancies

Head and neck malignancies are a part of the differential diagnosis of head and neck masses seen in the pediatric age group. It is critical to make prompt diagnosis and employ proper treatment. We will review the most common malignant pathologies as well as their specific clinical presentations and management. Centers that are able to provide multidisciplinary care for pediatric patients with head and neck pathology can help achieve the best outcomes.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications

Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.</p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>