Malignant neoplasms of the head and neck

Childhood Malignancies-Clinico-demographic Profile of Patients Attending the Department of Otorhinolaryngology at a Tertiary Care Centre in North-East India

INTRODUCTION

Malignancies in children are different from those found in adults and are a significant cause of childhood mortality.They have varied clinical presentation depending on site and type of disease.It is essential to recognize the early signs and symptoms of malignancies in childhood, especially those involving head and neck region, so as to reduce childhood mortality and morbidity.

MATERIALS

A total of 2384 children were admitted over a period of 7 years. Out of these, 1004 fulfilled the inclusion criteria and were chosen for further evaluation.They were thoroughly evaluated by undertaking a detailed history and clinical examination.Whenever required, additional investigations were performed.After carrying out the necessary investigations, the cases were accordingly managed. Data was evaluated using proper statistical tools.

RESULTS

Out of 1004 cases fulfilling the inclusion criteria, 42 turned out to be malignant, with a male-to-female ratio of 1:1.2. Malignancies in children were more common in the age group of 11-18 years, followed by 1-5 years,6-10 years and 0-1 years,with rates of 59.5%, 21.4%, 16.7% and 2.4% respectively. A wide variety of tumour types were recorded,e.g.,Hodgkin's lymphoma,non-Hodgkin's lymphoma,acute leukemia,papillary carcinoma thyroid, nasopharyngeal carcinoma,Langerhans cell histiocytosis,rhabdomyosarcoma, olfactory neuroblastoma and salivary gland neoplasm.

CONCLUSION

Incidence of head and neck tumors in pediatric age group was found to be 1.76% with lymphoma being the most frequent.Commonest age of presentation was above 10 years. There was an overall female predominance with a male:female ratio of 1:1.2. Awareness of a potential malignancy and careful follow-up of children with suspicious head and neck cancers is mandatory for early diagnosis and prompt treatment.

Evaluation of a Neck Mass in a Six-Month-Old Infant: A Case Report

Pediatric neck masses are one of the commonly encountered problems in clinical practice. They comprise a wide spectrum of congenital to acquired lesions manifesting in early or late childhood. They often pose a diagnostic challenge to the physician. We hereby present a case report of a six-month-old boy with a left-sided neck mass. Findings of a detailed workup were consistent with acute bacterial cervical lymphadenitis, ruling out neoplasia. The child showed significant improvement after including extended coverage of antibiotic therapy for methicillin-resistant Staphylococcus aureus (MRSA) and was put under follow-up.

Presentation and evaluation of an atypical, supraclavicular mass in a pediatric patient

Although the vast majority of pediatric neck masses are benign, pediatric malignancies commonly present in the supraclavicular region. We present the case of a 4-year-old male who presented with a mass in the trapezius muscle with accompanying lymphadenopathy. An extensive work-up was performed to exclude malignancy, and the patient was ultimately diagnosed with a benign monocytic mass, which surgically excised. He has been doing well since surgery with no evidence of recurrence. A review of the literature revealed this case to be the first of its kind to be reported.

Characterization of pediatric head and neck masses with quantitative analysis of diffusion-weighted imaging and measurement of apparent diffusion coefficients

Purpose:

Our objective was to investigate the accuracy of quantitative diffusion-weighted imaging (DWI) to determine the histopathologic diagnosis of pediatric head and neck lesions.

Materials and Methods:

This retrospective study included 100 pediatric patients recently diagnosed with head and neck tumors. All patients underwent preoperative conventional magnetic resonance imaging (MRI) and DWI. Each lesion was evaluated according to signal characteristics, enhancement pattern, and diffusivity. The average apparent diffusion coefficient (ADC) obtained from each tumor was compared to the histological diagnosis of benign, locally malignant, or malignant categories.

Results:

Our retrospective study showed a significant negative correlation between average ADC and tumor histopathologic diagnosis (P < 0.001, r = -0.54). The mean ADC values of benign, locally malignant lesions, and malignant tumors were 1.65 ± 0.58 × 10^–3, 1.43 ± 0.17 × 10^–3, and 0.83 ± 0.23 × 10^–3 mm² s^-1, respectively. The ADC values of benign and locally malignant lesions were overlapped. We found a cut-off value of ≥1.19 × 10^–3 mm²s^-1 to differentiate benign from malignant pediatric head and neck masses with a sensitivity of 97.3%, specificity of 80.0%, positive predictive value of 94.7%, and negative predictive value of 88.9%.

Conclusion:

Diffusion-weighted MRI study is an accurate, fast, noninvasive, and nonenhanced technique that can be used to characterize head and neck lesions. DWI helps to differentiate malignant from benign lesions based on calculated ADC values. Additionally, DWI is helpful to guide biopsy target sites and decrease the rate of unnecessary invasive procedures.

A child in shock: carotid blowout syndrome

Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually the result of blunt or penetrating trauma, infection or vasculitis/connective tissue disorders. They can present with a variety of symptoms including neck pain, as a pulsatile neck mass or with compressive symptoms (for example, cranial nerve palsies or dyspnoea). Pseudoaneurysms carry a risk of rupture in which case they are fatal, unless immediate treatment is provided.We report a 17-month-old male child with idiopathic carotid artery blowout syndrome presenting with acute oropharyngeal haemorrhage leading to asystolic cardiac arrest. He was successfully resuscitated and emergency embolisation controlled the bleeding. Despite extensive left hemispheric infarct, he has survived.Carotid artery blowout syndrome needs to be recognised as a potential cause of major haemorrhage in childhood. The purpose of this case report is to remind readers of the differential diagnosis and work-up of a child presenting with a neck lump, to highlight important aspects of the acute management of major haemorrhage and massive blood transfusion in paediatrics, to describe the aetiology, presentation and management of carotid artery pseudoaneurysm in children and to discuss long term rehabilitation in patients with consequent neurological sequelae (including the need for input from multiple specialty teams).

The snoring 2-year-old boy: a case of primary nasopharyngeal Burkitt's lymphoma

Sporadic Burkitt's lymphoma affecting the nasopharyngeal region is an extremely rare disease, especially in infants. We describe the case of a 2-year-old boy who presented to the ear, nose and throat department with a history of snoring, blood-stained rhinorrhoea and symptoms consistent with upper respiratory tract infections. Physical examination revealed massive cervical lymphadenopathy. MRI of the head and neck showed a mass lesion in the nasopharynx with bilateral lymph node enlargement. Debulking of the mass was performed and biopsies were sent for histology, which confirmed Burkitt's lymphoma. The patient was treated with complex chemotherapy and had a good clinical response. The patient remains in remission after 6 years.

Neck masses in children: a 10-year single-centre experience in Northwest China

Neck masses in children are a common clinical concern but there is a paucity of published information about them. We organised this retrospective study to analyse their prevalence and treatment in Northwest China. The records of 207 children who presented with neck masses between 2008 and 2017 were retrieved from the Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, and age, sex, clinical presentation, preoperative investigation, surgical procedure, histopathological diagnosis, and complications were recorded. Their mean (range) age was 10 years (6 months to 21 years), and the male:female ratio was 1.23:1. In total 128 patients (62%) had congenital lesions, 35 (17%) had inflammatory lesions, and 44 (21%) had neoplastic lesions. The most common mass was a thyroglossal cyst (31%), followed by plunging ranula (17%) and lymphangioma (16%). Temporary injury to the facial nerve and wound infection were the major complications of surgical treatment. The types of neck masses in Northwest China differ from those previously reported, which may be attributed to genetic alterations in people of this race. The present report adds to the knowledge of diagnosis and treatment of neck masses in children in Northwest China, and brings out the demographic differences between races.

Lateral neck lumps: A systematic approach for the general paediatrician

Lateral neck lumps are very common in children, and are largely benign in nature. The majority of lumps may be diagnosed on history and clinical examination alone, and further investigations are often not required. The most common pathologies in young children include reactive lymphadenopathy, lymphadenitis and atypical mycobacterial infections. A lateral neck lump is an uncommon presentation for malignancy and is largely restricted to older children and adolescents. The paediatric surgeon plays an important role in the assessment and management of lateral neck lumps, often in the form of reassurance to the patients and their carers.

Management of pediatric head and neck rhabdomyosarcoma: A case-series of 36 patients

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric population. In 35% of cases, RMS develops in the head and neck (H&N) region, and only combined therapy is recognized as a curative treatment. However, recent advances in skull base and reconstructive surgery, along with microsurgery and endoscopic surgery, have strengthened the role of surgery as an important part of RMS treatment. In the present study, 36 pediatric RMS cases (24 males and 12 females) were analyzed after surgical treatment. The average age at diagnosis was 7 years. In total, 67% of tumors were localized in the parameningeal region. Alveolar RMS was the most common histopathological type. A total of 16 patients were treated due to disease recurrence or a previous non-radical surgical procedure, while 19 cases had inductive chemotherapy and/or radiotherapy preceding surgical treatment due to locally advanced disease. In 1 case, only diagnostic biopsy was performed. It is recommended that the management of H&N RMS is interdisciplinary from the beginning. Extensive surgical dissection in the H&N region for RMS may result in severe cosmetic defects and functional impairment; thus, these risks should be considered during treatment planning, and the surgical approach should be based on the individual characteristics of each patient.

Chemotherapy in Children with Head and Neck Cancers: Perspectives and Review of Current Therapies

Cancers of the head and neck in children represent a heterogeneous group of malignancies requiring a variety of treatment modalities. In many instances of childhood head and neck cancers, chemotherapy will be required for treatment, often in conjunction with surgery and/or radiation therapy. Chemotherapy in children with head and neck cancers poses unique challenges in terms of immediate as well as long-term toxicities. This article focuses on the common chemotherapeutic agents, with a particular focus on early and late effects, used in the treatment of children with head and neck cancers.

Paediatric Neck Lumps I – Inflammatory and Neoplastic Lesions Including Salivary Gland Abnormalities

This article will concentrate on solid neck masses in children, giving an overview of 3 main areas: cervical lymphadenopathy, neoplasms presenting as neck masses and salivary gland abnormalities in children. Most neck lumps in children are benign, even solid masses and the child's age is an important factor in narrowing the differential diagnosis. Inflammatory lesions are very common, especially in young children and usually involve lymph nodes, but infected congenital cystic lesions can mimic inflammatory processes. The most common inflammatory masses are reactive or suppurative lymphadenitis, which classically present following an upper respiratory tract or pharyngeal infection. Malignant lesions are seen occasionally and it is important to know when to be concerned about a child's neck mass. Malignant lesions tend to be painless, solid and associated with systemic manifestations. Ultrasound is the primary imaging modality of choice for children, but does have limitations. It is vital that all imaging is interpreted in conjunction with clinical information, especially as imaging findings can be non-specific. Any lesion that does not have typical benign appearances or behaviour requires biopsy. Salivary gland disorders are uncommon in children compared with adults; salivary calculi, autoimmune disorders and tumours are rare. The most frequent cause of parotid swelling in a child is infection, usually viral, although intra-parotid lymph nodes can suppurate resulting in abscess formation. As with neck masses in other locations, certain factors in the clinical history should raise the possibility of malignancy and prompt further investigation, including biopsy. These include rapid growth, facial nerve palsy and associated lymphadenopathy.

Differentiation of malignant cervical lymphadenopathy by dual-energy CT: a preliminary analysis

The accurate diagnosis of malignant cervical lymphadenopathy remains challenging. In this study, we determined the value of quantitative parameters derived from dual-energy computed tomography (DECT) for differentiating malignant cervical lymphadenopathy caused by thyroid carcinoma (TC), salivary gland carcinoma (SC), squamous cell carcinoma (SCC) and lymphoma. We retrospectively analysed 92 patients with pathologically confirmed cervical lymphadenopathy due to TC, SC, SCC and lymphoma. All patients received a DECT scan before therapy. Using GSI (gemstone spectral imaging) Volume Viewer software, we analysed the enhanced monochromatic data, and the quantitative parameters we acquired included the iodine concentration (IC), water concentration (WC) and the slope of the spectral HU curve (λ_HU). One-way ANOVA showed significant differences in the IC and λ_HU among different groups (P < 0.05). Post-hoc pairwise comparisons demonstrated the IC and λ_HU of TC group were significantly higher than those of SC, SCC and lymphoma groups (P < 0.05). In addition, the IC and λ_HU of SC group were significantly higher than those of the SCC and lymphoma groups (P < 0.05). Other comparisons of IC and λ_HU values showed no significant differences (P > 0.05). The quantitative parameters derived from DECT were useful supplements to conventional computed tomography images and were helpful for distinguishing different malignant cervical lymphadenopathies.

Pediatric Mass Lesions of the Head and Neck Region and Fine-Needle Aspiration Biopsy Results

Objective

1. To provide a classification of pediatric mass of the head and neck region and evaluate their frequency. 2. To examine the findings of fine-needle aspiration biopsy (FNAB) in pediatric patients along with its contribution to diagnosis.

Methods

Totally, 233 pediatric patients (125 boys and 108 girls) operated at Başkent University for head and neck mass were included. Clinical, radiological, and histopathological data were retrieved from medical records.

Results

The mean age was 119±65 months, and the mean duration of follow-up was 75±49 months. Localization of the masses was as follows: 208 (89%) in the neck, 21 (9%) in the oral cavity, 2 (1%) in the neck and nasopharynx, and two (1%) in the larynx. The most common surgical procedure was open excisional biopsy (n=105, 45%) followed by cystic mass excision (n=72, 31%) and salivary gland excision (n=33, 14%). Based on histopathological findings, benign cystic lesions were the most common disease group (n=77, 33.1%), whereas reactive lymphadenopathy was the most common condition (n=36, 15%) when a single disease was considered. Infectious/inflammatory diseases, malignancies, and benign salivary gland diseases were present in 49 (21%), 24 (10.3%), and 22 (9.4%) patients, respectively. FNAB was performed in 29.8% of the patients with an accuracy of 90.3% (95% CI, 80.1-96.4).

Conclusion

The differential diagnosis of head and neck masses during childhood includes a wide spectrum with the different conditions being benign cystic diseases of congenital origin and reactive lymphadenopathies. Owing to its high predictive value, FNAB represents a rapid and reliable method that can be commonly used in both adult and pediatric patients.

The management of pediatric neck masses

Neck masses are a common clinical concern both in adults and children. The differential diagnosis is quite broad, from congenital lesions to malignant tumors. Based on the different pathologic diagnosis, the treatments are varied. To the best of our knowledge, limited reports, which specifically discuss the incidence and distribution of neck diseases in early childhood, have been published. Because of the great population in China, a thorough review of the previous clinical data for pediatric neck masses might be potentially valuable for oral and maxillofacial surgeons, which might provide a deeper understanding and better the accuracy of our clinical diagnosis and management. In this article, a 10-year retrospective review was completed; the whole cases were diagnosed and treated in the same major clinical institute in east China, which might represent as a typical cohort for the patient population and serve as a reference for future clinical management.

Rhabdomyosarcoma of the head and neck in children

Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma in children. It is localized in the head and neck region in 40% of cases. Treatment of RMS is complex, including multi-drug chemotherapy, radiotherapy and surgery. The progress that has been accomplished in oncology in recent decades significantly improved outcomes. The 5-year survival rate raised from 25% in 1970 to 73% in 2001, according to IRS-IV data. The outcome is influenced by primary tumor localization, clinical staging, histological tumor type and age at the moment of diagnosis. The relatively rare incidence of these tumors resulted in difficulties in creating more standardized therapeutic protocols. Comparison of outcomes in large patients groups led to an increase in the number of patients with complete remission. Although survival rates of RMS patients have improved, searching for new therapeutic modalities and substances is still essential to improve outcomes in cases of more advanced stages and unfavorable tumor localizations.

Correlation between pre-operative diagnosis and post-operative pathology reading in pediatric neck masses--a review of 281 cases

OBJECTIVE

Describe the pre-operative diagnosis correlation of pediatric neck masses with the final post-operative pathology reading. Evaluate if added imaging studies were associated with higher frequency of correct diagnosis.

STUDY DESIGN

Retrospective case series review.

SETTING

Tertiary Academic Medical Center.

SUBJECTS AND METHODS

Data was collected from 281 pediatric patients with an undiagnosed neck mass that underwent open biopsy from January 1986 to December 2011. Data collection included pre-operative accuracy and relative contributions of clinical clues and imaging studies.

RESULTS

Pre-operative and post-operative diagnoses match varied for each category of diagnoses. The difference in distribution of correct pre-operative diagnoses between 6 categories of neck masses was statistically significant. The highest number of cases with correct pre-op diagnosis was seen with congenital masses which were correctly diagnosed with 75% of cases (n=109), followed by benign tumors which were diagnosed with 73.7% of cases (n=19). When CT scans were included in the pre-op work up, it was associated with a non-significant trend toward a less frequent correlation between pre and post-operative diagnosis in congenital, nodal inflammatory and miscellaneous masses. However, with regards to the diagnosis of benign tumors, CT scan was associated with a trend toward higher proportion of correct pre-op diagnosis. In cases where US was included in the evaluation, we found a trend toward less frequent correlation with post op diagnosis in benign tumors, nodal inflammatory, non-nodal inflammatory and miscellaneous diagnoses and an increase in accuracy for congenital masses.

CONCLUSION

Certain types of pediatric neck masses are easy to diagnose likely due to their classic presentation. Failure to diagnose masses often occurs when the clinical picture is vague or non-specific. Ancillary imaging studies do not always correlate with increased accuracy of diagnosis, particularly when the clinical clues are typical.

Pediatric head and neck tumors: an intra-demographic analysis using the SEER* database

Background

The aim of this study was to determine the most frequently presenting tumors exclusive to the head and neck within the pediatric population, and to identify racial disparities within the existing incidence rates.

Material/Methods

The population-based Surveillance, Epidemiology, and End Results (SEER) registry was utilized to identify the frequency and incidence rates of various tumors found exclusively in the head and neck, diagnosed between 1973 and 2008 in pediatric patients. The tumor categories were based on those defined by the US Department of Health and Human Services National Cancer Institute (NCI). Proportional comparisons were applied to evaluate the intra-demographic incidence rate differences.

Results

Among the 11 categories defined, the 5 most prevalent head and neck cancers within the pediatric population were salivary gland tumors (n=319); followed by nasopharyngeal neoplasms (n=311); tumors of the nose, nasal cavity and middle ear (n=208); gum and other mouth tumors (n=134); and glossal tumors (n=61). Proportional comparisons between racial frequency rates indicated that salivary gland tumors were greatest among white pediatric patients (n=246, CI=0.8 to 14.1%, p<.05). Nasopharyngeal cancers were highest among blacks (CI=−26.8 to −12.1%) and other races (CI=−23.6 to −3.4%) relative to the white population.

Conclusions

Salivary gland tumors were the most commonly seen head and neck tumors overall among pediatric patients between 1973 and 2008. Incidence rate differences between white, black, and other racial background pediatric patients revealed that overall, head and neck tumors are most prevalent among pediatric patients within the white ethnic population, while nasopharyngeal tumors showed a strong prevalence in blacks and other ethnic populations.

Childhood cancers: what is a possible role of infectious agents?

The etiology of childhood cancers has been studied for more than 40 years. However, most if not all cancers occurring in children are attributed to unknown causes. This review is focused on the role of infections in cancer development and progression in children. The main infectious agents include human herpesviruses, polyoma viruses, and human papilloma viruses. It is known that infections can lead to carcinogenesis through various mechanisms, and most likely act in addition to genetic and environmental factors. Given the importance of the infectious etiology of childhood cancers, clinical implications and possible prevention strategies are discussed.

Head and neck tumours in Ghanaian children. A 20 year review

Histological reports on tumour specimens recorded at a teaching hospital in Accra, Ghana from 1989 to 2008 were reviewed to determine the incidence of head and neck tumours in children less than 16 years old. There were 4546 reports of head and neck tumours (2041 malignant, 2505 benign). Of these 613 met the study age selection criteria. 186(30.3%) were malignant and 427(69.7%) benign. The male to female ratio for malignant tumours was 1.86:1, benign 0.73:1 and for all tumours 1:1.04. Lymphoma (54.8%), nasopharyngeal carcinoma (19.9%) and rhabdomyosarcoma (14%), together constituted over 88% of malignant neoplasms. The commonest benign neoplasm was squamous papilloma (76/427) 17.8%, and then haemangioma (60/427) 14.05%. The incidence increased with age, peaking in those aged 12-16 years. The commonest site for benign tumours was the larynx and for malignant tumours the neck (cervical lymph nodes). Relative to all head and neck malignancies, the incidence of childhood head and neck malignancies was 11% (186/2041). This study reveals that malignant head and neck tumours are not rare in Ghana compared to benign tumours and the incidence of rhabdomyosarcoma is higher in females.

The role of neoadjuvant chemotherapy in children with malignant solid tumors

Pediatric surgeons play a critical role in diagnosing, staging, and treating malignant solid tumors in children. Over the years, the surgical management of the primary tumor site has evolved from an aggressive en-bloc resection at diagnosis to a more tailored surgical approach, often affecting definitive local control after the delivery of neoadjuvant therapy, as currently directed by many solid tumor protocols. In fact, inappropriate upfront resection can lead to unnecessary short- and long-term morbidity, an incomplete resection, and may be associated with a delay in the initiation of the systemic chemotherapy that is critical to the treatment of gross or occult metastatic disease. Therefore, it is important for the pediatric surgeon, as a member of the multidisciplinary team involved in the care of these children, to understand the indications for and implications of neoadjuvant therapy in the treatment of pediatric solid tumors. Here we review the current management of childhood solid tumors focusing on the role of neoadjuvant therapy.

Non-hematological tumors of head and neck region in the pediatric age group in a tertiary care cancer center

PURPOSE

To analyze the clinical profile, management and outcome of non-hematological tumors in head and neck region in children less than 18 years of age.

PATIENTS AND METHODS

Medical records of patients (0-18 years) presenting with non-hematological tumors of head and neck region from 2000 to 2010 were reviewed.

RESULT

Out of the 78 patients identified, 50 were males with median age of 14 years (3 months to 18 years). Histologically, 58 out of the 78 patients had malignant tumors and 20 were metastatic at presentation. Common site of tumor origin was noted as thyroid (23/78), salivary glands (21/78) and nasopharynx (13/78). Out of 78 patients, 44 patients were treated by surgery, 26 patients received radiation and 13 patients received chemotherapy, while 9 patients received radio-iodine (I-131) treatment. Median follow up of all cases was 22 months (range 1 month to 8 years). The event free survival was 74.1% and overall survival was 89.6%. Subset analysis revealed patients with thyroid and salivary gland malignancies have excellent survival, while those with squamous cell carcinoma and high risk neuroblastoma had poor outcome.

CONCLUSION

This study reveals the interesting profile of head and neck tumors in children, and important role of surgery for favorable outcome.

Spectrum of head and neck cancer in children

Aim:

To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital.

Methods:

In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases.

Results:

Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%). Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39%) followed by the rhabdomyosarcoma (20.75%) and the nasopharyngeal carcinoma (15.09%). Of the lymphomas, the non-Hodgkin's lymphoma was predominant (26.41%). Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid.

Conclusions:

Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.

Pattern of acquired neck masses in a Kenyan paediatric population

Acquired paediatric neck masses constitute a diagnostic challenge. Their pattern is important in formulating management protocol. Reports from developing countries including Kenya are scarce. This study describes the causes, location, clinical features and gender distribution of these masses in a Kenyan paediatric population. This prospective cross-sectional study was carried out in a regional Eastern and Central African referral centre in Kenya. Children aged 16 years and below with neck masses, who presented to various clinics and wards in a 5 month period were examined. One hundred and eighty four of 235 masses (78%) were acquired. Inflammatory cases were the most common (64%), followed by malignant neoplasm (32%). The most common inflammatory cases were abscesses, reactive lymphadenopathy and tuberculous adenitis. They mainly involved upper cervical and submandibular lymph nodes and were more prevalent in those aged less than 4 years. Lymphomas were the most common malignant masses (42%). Malignant masses were widespread in location; non-tender, and most frequent in those aged 4-8 years. In conclusion, inflammatory conditions consistent with upper airway infection cause most acquired paediatric neck masses, but malignant neoplasms constitute a significant proportion. Prudent management of infection and early confirmation of diagnosis are recommended.

Ectopic thymic carcinoma in the neck

Thymic carcinoma is a rare tumor arising from the thymus, which is most commonly located in the anterior mediastinum. We report a 24-year-old woman who presented with a neck tumor. The patient underwent complete resection and the pathology sections showed thymic carcinoma. The patient received adjuvant chemotherapy and radiotherapy. After a 6-month follow-up, the patient is well without any evidence of recurrence.

Undifferentiated sarcoma of the thyroid in a child

The most common malignant tumor of the thyroid is papillary carcinoma. Sarcoma of the thyroid is encountered very rarely; its therapy is complex and poses significant problems due to the problematic location of the tumor. A 14-year-old female was diagnosed with undifferentiated sarcoma of the thyroid and received combined therapy comprising surgery, chemo- and radiotherapy without significant side effects. This case underlines the fact that undifferentiated thyroid sarcoma may be a diagnostic possibility in children with malignant masses of the neck and may be successfully treated with modern therapeutic strategies.

The role of radiology in head and neck tumours in children

Head and neck malignancy is rare in children. However, distinguishing malignant tumours from the more common and numerous benign causes of neck masses in childhood is crucial as many malignant conditions have an excellent prognosis with appropriate oncological management. Ultrasound, computed tomography and magnetic resonance imaging all have crucial roles in the diagnosis of head and neck malignancy in children and there is an emerging role for positron emission tomography, particularly in the management and follow-up of lymphoma. We describe the imaging appearances of the common malignant tumours arising in the extracranial head and neck in children, focusing on lymphoma, rhabdomyosarcoma and nasopharyngeal carcinoma. The clinical presentation and radiological appearances of benign tumours in the head and neck in children may overlap with those seen in malignant disease. We describe the imaging appearances of juvenile angiofibroma, vascular abnormalities involving the extracranial head and neck and cervical teratomas. Advances in both imaging techniques and cancer staging systems, many of the latter aimed at avoiding over-treatment and treatment-related complications, will lead to an increasingly central role for imaging in childhood head and neck cancer.

Imaging findings in craniofacial childhood rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the commonest paediatric soft-tissue sarcoma constituting 3-5% of all malignancies in childhood. RMS has a predilection for the head and neck area and tumours in this location account for 40% of all childhood RMS cases. In this review we address the clinical and imaging presentations of craniofacial RMS, discuss the most appropriate imaging techniques, present characteristic imaging features and offer an overview of differential diagnostic considerations. Post-treatment changes will be briefly addressed.

The value of fine-needle aspiration cytology in the evaluation of pediatric head and neck tumors

OBJECTIVE

To study the efficacy of fine-needle aspiration cytology (FNAC) of head and neck masses in pediatric patients.

STUDY DESIGN

Of the 128 cases studied, FNAC was performed in 74 patients and their cyto-histological correlation done. Sensitivity and specificity of cytological diagnosis was then computed.

RESULTS

Benign lesions were found to be more common than the malignant variety, the commonest being soft tissue tumors (46.87%). Lymphomas were the commonest tumors (22.6%) in the malignant category. Cytology was done in 74 patients of whom smears from 21 patients were unsatisfactory for diagnosis. There was one false positive and two false negative cases resulting in the specificity and sensitivity of FNAC in pediatric head and neck tumors to be 95.65% and 93.3% respectively.

CONCLUSION

FNAC is a useful and reliable tool in the diagnosis of head and neck masses with no contraindications and minimal complications even in children.

Spectrum of head and neck lesions diagnosed by fine-needle aspiration cytology in the pediatric population

Fine-needle aspiration cytology (FNAC) of the head and neck region is well accepted as a diagnostic procedure in the adult population. FNAC in the pediatric population is gaining acceptance as clinicians add this technique to the diagnostic armamentarium. An experience with FNAC of the head and neck region in the pediatric population is described from 2 large inner-city hospitals. Eighty-five cases were retrieved from patients age <18 years. In 52 cases, clinical or surgical follow-up was obtained and among these cases the specificity and sensitivity of FNA was 93% and 100%, respectively. The high specificity of FNAC allows the clinician to be confident of malignancy in a clinically suspicious lesion of the head and neck in a pediatric patient.

Management of common head and neck masses

Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities occur repeatedly within the various age groups and can be differentiated with a clear understanding of embryology and anatomy of the region, and an understanding of the natural history of a specific lesion. Congenital lesions most commonly found in the pediatric population include the thyroglossal duct cyst and the branchial cleft and arch anomalies. The inflammatory masses are secondary to local or systemic infections. The most common etiology for cervical adenopathy in children is reactive lymphadenopathy following a viral or bacterial illness. Persistent adenopathy raises more concerns, especially enlarged lymph nodes within the posterior triangle or supraclavicular space, nodes that are painless, firm, and not mobile, or a single dominant node that persists for more than 6 weeks should all heighten concern for malignancy. In this review, we discuss the current principles of surgical management of the most common head and neck masses that present to pediatricians and pediatric surgeons.