Management of common head and neck masses

Diagnosing Midline Neck Masses: Comparing Clinical Exam, the SIST Score, and the 4S Algorithm

OBJECTIVE

To validate and compare novel ultrasound scoring systems for dermoid cysts and thyroglossal duct cysts among pediatric patients.

STUDY DESIGN

Retrospective study.

SETTING

Tertiary care children's hospital.

METHODS

An electronic medical record query of patients younger than 18 years old who underwent primary excision of a neck mass between January 2005 and February 2022, who underwent preoperative ultrasound, and had final histopathologic diagnosis of either thyroglossal duct cysts or dermoid cysts. This generated 260 results, of which 134 patients met the inclusion criteria. Charts were reviewed for demographic data, clinical impressions, and radiographic studies. Radiologists blindly reviewed ultrasound for SIST score (septae + irregular walls + solid components = thyroglossal), and 4S algorithm (Septations, depth relative to Strap muscles, Shape, Solid parts). Statistical analyses were performed to determine the accuracy of each diagnostic modality.

RESULTS

Of 134 patients, 90 (67%) had a final histopathologic diagnosis of thyroglossal duct cysts, and 44 (33%) were dermoid cysts. The accuracy of clinical diagnosis was 52%, and preoperative ultrasound report accuracy was 31%. The 4S and SIST accuracies were each 84%.

CONCLUSION

Both the 4S algorithm and SIST score provide increased accuracy of diagnosis relative to standard preoperative ultrasound assessment. Neither scoring modality was determined to be superior. Further research is warranted in improving the accuracy of preoperative assessments for pediatric congenital neck masses.

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.

Asymptomatic Necrotizing Granulomatous Disease of the Neck With Unknown Etiology

Patients presenting with unilateral neck masses is not an uncommon occurrence in an otolaryngology clinic. Especially those with risk factors such as older age and a history of smoking or drinking along with certain characteristics of the mass including rapid growth, immobility, and the presence of other masses elsewhere in the head and neck that can lead to more concerning etiologies such as cancer. However, in those who are younger with non-tender unilateral mobile masses, the differential is wide. We present the case of a 30-year-old male who presented with a non-tender left-sided neck mass with no associated or systemic symptoms. Workup including labs for HIV, syphilis, and fungal stains was negative. Pathology demonstrated lymphadenitis with necrotizing granulomas with no recurrence of symptoms after excisional biopsy. The patient continued to have no associated symptoms or recurrent mass thus no further workup was deemed necessary. Although unilateral neck mass and lymphadenitis with necrotizing lymphadenitis have a broad differential diagnosis, this patient's etiology continues to be unknown.

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.

Isolated lesions of the suprasternal notch in pediatric patients

BACKGROUND

Palpable masses of the head and neck are a common indication for imaging in the pediatric population. Midline lesions of the infrahyoid neck, particularly lesions isolated to the suprasternal notch, are not well studied.

OBJECTIVE

To delineate the histopathological and imaging spectrum of masses that occur within and isolated to the suprasternal notch.

MATERIALS AND METHODS

A retrospective study was performed to identify patients with an isolated lesion of the suprasternal notch that had available pathological diagnoses. Available imaging was reviewed and characterized by fellowship-trained pediatric radiologists and compared by descriptive statistics to the final pathological diagnoses.

RESULTS

Eighteen masses isolated to the suprasternal notch with available pathological diagnoses were identified. Of these, congenital epithelial inclusion cysts were diagnosed in 14 patients (77.8%) with dermoid cysts comprising 11 of those (61.1%) and epidermoid cysts accounting for 3 (16.7%). The most common imaging appearance was a cystic or pseudosolid appearance without vascularity.

CONCLUSIONS

Isolated resected lesions of the suprasternal notch in pediatric patients are most frequently dermoid/epidermoid cysts, with a differential diagnosis including other less common entities.

Histopathological Records of Oral and Maxillofacial Lesions among Pediatric and Adolescent Patients in Sulaimani Governorate

Oral and maxillofacial lesions (OMFLs) in pediatrics differ markedly from their adult counterparts in terms of clinical conduct, pathological behavior, and management. This study aims to determine the frequency of OMFLs among pediatric and adolescent patients and to correlate the demographics information to the site, and histopathological findings. Pathological records of pediatric and adolescent patients were retrieved from three major pathological centers in Sulaimani city of Iraq. Demographic information, surgical procedure, anatomical sites, and histopathological diagnosis were recorded. Furthermore, The World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-10) was used for coding. A Chi-square test was used to find the relation between different variables, and a p-value < 0.05 was considered statistically significant. This study archived 309 (13.3%) out of 2319 pediatric and adolescent patients, with a mean age of 11.04 ± 4.62. Females were more commonly detected (52.8%). The most frequently diagnosed lesions were salivary gland diseases (20.7%), followed by reactive hyperplastic connective tissue (18.4%). A significant relation was found between age groups and diagnostic categories (p = 0.001). The lips were the most commonly detected sites (20.7%). Mucocele was the most frequently seen non-neoplastic lesions (19.4%), followed by pyogenic granuloma (8.7%). Neoplastic lesions revealed predominant hemangioma (3.2%), followed by peripheral ossifying fibroma (1.9%). Traumatic and or reactive lesions were the most commonly reported lesions. Malignant neoplasms can be identified. The current study enabled systematic data recording of pediatric and adolescent patients, encouraging the importance of the oral healthcare system in identifying and managing the problem early in this critical age in this region.

Reliability of Neck Mass Point-of-Care Ultrasound by Pediatric Emergency Physicians

OBJECTIVES

Neck masses are a common reason for presentations to the pediatric emergency department (PED). We sought to determine the agreement and time difference between point-of-care ultrasound (POCUS) imaging by pediatric emergency physicians compared to radiology department imaging for children with neck masses in the PED.

METHODS

We performed a retrospective study of patients aged 0 to 18 years presenting to our tertiary PED who received both POCUS by a pediatric emergency physician and radiology department imaging. Charts were reviewed for POCUS diagnoses, final diagnoses, and imaging time metrics.

RESULTS

Seventy-five patients met the study criteria. In 58 of 75 cases there was agreement between the POCUS diagnosis and final diagnosis (κ = 0.71; 95% confidence interval, 0.6-0.83). There was agreement in 25 of the 28 cases in which POCUS examinations were performed by PED physicians with fellowship training in POCUS (κ = 0.87; 95% confidence interval, 0.72-1.00). The results for POCUS were generated in a median of 115 minutes (interquartile range, 68-185 minutes) before radiology department imaging results.

CONCLUSIONS

Point-of-care ultrasound imaging by pediatric emergency physicians for children with neck masses is a promising new POCUS application that may be able to save time in the PED.

Congenital multinodular goiter in a neonate presenting with airway obstruction

Background

Congenital goiter constitutes a rare cause of congenital neck masses. Goitrous enlargement can be associated with serious airway obstruction.

Case description

We report a term, girl baby with a large asymmetrical neck mass who presented on day 2 of life. Clinical examination revealed stridor and local examination showed an asymmetric nodular firm swelling with no signs of inflammation. The computerized tomography of the neck and fine needle aspiration cytology (FNAC) confirmed the swelling as being a multinodular goiter. The thyroid function test (TFT) was suggestive of hypothyroid status. Further investigations revealed the cause as being dyshormonogenesis probably secondary to a thyroglobulin synthetic defect. The baby was started on levothroxine supplementation (13 μg/kg/day); neck swelling markedly reduced with normalization of TFT over the next 3 weeks. To the best of our knowledge this is the first reported case of the presence of multinodularity in a baby with congenital goiter.

The use of point of care ultrasound in the evaluation of pediatric soft tissue neck masses

OBJECTIVE

Most soft tissue neck masses represent benign inflammatory or infectious processes; however, in some cases the diagnosis is not clear and a broader differential must be considered. The aim of this study was to compare point-of-care ultrasound (POCUS) to radiology department imaging (RDI) in the diagnosis of soft tissue neck masses.

METHODS

This prospective pilot study involved a convenience sample of patients ranging in age from 1 month to 18 years of age presenting to the Pediatric Emergency Department (PED) with a soft tissue neck mass. All children who presented to the PED with soft tissue neck mass at times when an investigator was in the department, and who were candidates for enrollment, underwent a POCUS. The managing pediatric emergency medicine (PEM) provider determined whether RDI was indicated. The results of the POCUS sonologist and radiologist were compared. The kappa statistic was used to analyze agreement with p < 0.05 denoting statistical significance.

RESULTS

Twenty-seven patients were enrolled into the study. Twenty-two received radiology ultrasound (RUS), 3 patients received CT, and 2 patients received both RUS and CT. There was agreement between POCUS and RDI diagnoses in 21/27 cases (78%). Accordingly, overall concordance between POCUS and RDI diagnoses was good: the kappa statistic comparing diagnoses obtained by POCUS versus RDI was 0.69 (p < 0.001).

CONCLUSION

This prospective pilot study describes the reliability of POCUS as an imaging modality in the management of patients with undifferentiated soft tissue neck masses. POCUS demonstrated good agreement with RDI as a bedside imaging tool in the evaluation of pediatric soft tissue neck masses.

The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience

Background

The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children.

Methods

The study included 73 patients operated on because of TGDC in years 2011-2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice.

Results

In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection.

Conclusions

A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.

The Central Neck Dissection or the Modified Sistrunk Procedure in the Treatment of the Thyroglossal Duct Cysts in Children: Our Experience

Background

The aim of the study was to present the surgical techniques providing the lowest recurrence rate in treatment of the primary and recurrent thyroglossal duct cyst (TGDC) in children.

Methods

The study included 73 patients operated on because of TGDC in years 2011–2016. Ultrasound was performed in all patients preoperatively. In 8 patients with the recurrence of the disease, the CT or MR was carried out before the surgery. Children with the primary disease underwent the modified Sistrunk procedure. In the revision cases the central neck dissection was a method of choice.

Results

In 45 children, the modified Sistrunk procedure was performed and 28 underwent the central neck dissection. In 2 patients, hematoma occurred after the modified Sistrunk procedure with the need of the surgical revision in one. No complications were observed after the central neck dissection.

Conclusions

A modified Sistrunk procedure is method of choice in the treatment of the uncomplicated TGDC. In selected cases of the TGDC with a history of infected cyst or incision of an abscess or in revision cases the central neck dissection should be considered in order to avoid the risk of the further recurrences.

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.

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.

Lymphadenopathy and Diseases of the Spleen

Lymphadenopathy and splenomegaly are common findings in children. Both benign and malignant processes can produce these findings and it is important to distinguish between the two so that appropriate management can be undertaken.

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.

Primary papillary carcinoma in thyroglossal cysts. Case reports and literature review

The thyroglossal cyst can exceptionally appear as a primary cyst carcinoma. We discuss a series of 6 adult patients, assessed for long-lasting asymptomatic suprahyoid or lateral-to-larynx mass. The images showed a heterogeneous mass invading adjacent soft tissues. Fine needle aspiration biopsy did not contribute to diagnosis. We performed a Sistrunk procedure in all cases, 3 combined with total thyroidectomy and 1 with neck dissection. The postoperative course was favourable. No additional treatment was required, without evidence of recurrence in follow-up. The management is controversial due to the limited number of cases reported. Some classifications based on size and extent have been proposed to define the surgical treatment of such cysts.

FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy

INTRODUCTION

Pediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy.

METHODS

This was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance.

RESULTS

The sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428).

CONCLUSIONS

Results demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.

True extracranial carotid artery aneurysm in a child

Isolated true aneurysm of the extracranial carotid artery is a rare entity in the pediatric population, with nine reported cases found in the literature. Contrary to adult carotid aneurysms, which are often due to atherosclerotic disease, pediatric aneurysms are more likely to be the result of congenital malformations, connective tissue diseases, or systemic inflammatory conditions. We present the case of a 10-year-old boy with an isolated true aneurysm of the internal carotid artery and a review of the literature.

Neck masses in paediatric population: An experience with children attended the Central Teaching Hospital of Pediatrics in Baghdad 2008-2009

BACKGROUND

Pediatric neck mass is a frequent cause for surgical consultation. Neck masses can be simply classified into congenital, inflammatory, and neoplastic. Although most of the cases are due to benign processes, malignant causes must not be overlooked. The aim of this study is to assess the paediatric neck masses in Iraqi patients highlighting the distribution of cases according to their demographic characteristics and etiology.

PATIENTS AND METHODS

A cross-sectional observed study is conducted in the Department of Pediatric Surgery, at the Central Teaching Hospital of Pediatrics in Baghdad from April 2008 to March 2009. Sixty four patients with neck masses aged 14 years and below were examined and managed. The underlying causes of the neck masses were addressed and categorized.

RESULTS

Among the 64 patients, 42 (65.6%) were male. The inflammatory group represents 57% of the cases, while the malignant neoplasm accounts for approximately 10% of the conditions mainly due to lymphoma 5 (7.8%). Sixteen patients (25%) fall in the congenital group, in which the thyroglossal duct cyst was the commonest type. Wound infection developed in two patients, while one patient with cystic hygroma showed recurrence.

CONCLUSION

Pediatrics neck masses are distributed in categories that similar in pattern and distribution in the world except the infectious/inflammatory category that shows variation in distribution in respect to the socioeconomic status. The surgical intervention and procedures are related to the facility as well as to the experience.

Cervical lung herniation complicating a case of acute asphyxial asthma in a child

The abrupt onset of respiratory failure secondary to asthma, known as acute asphyxial asthma (AAA) in adults, is uncommonly reported in children. Here, we report a case of a child with the acute onset of respiratory failure consistent with AAA complicated by the finding of a neck mass during resuscitation. This 11-year-old boy with a history of asthma initially presented in respiratory failure with altered mental status after the complaint of difficulty in breathing minutes before collapsing at home. Initially, his respiratory failure was thought to be secondary to status asthmaticus, and treatment was initiated accordingly. However, a neck mass noted during the resuscitation was cause for concern, and other etiologies for his respiratory failure were considered, including an airway obstructing neck mass. After pediatric surgery and anesthesia consultation for intubation and possible tracheostomy placement, general anesthesia was induced in the operating room with an inhaled anesthetic, with prompt resolution of the bronchspasm and decompression of the neck mass. Review of the imaging and clinical course ultimately yielded a diagnosis of cervical lung herniation as the etiology of his neck mass. We report this case of AAA and cervical lung herniation and a review of the literature of these 2 uncommon phenomena in children.

Paediatric neck masses at a University teaching hospital in northwestern Tanzania: a prospective analysis of 148 cases

Background

Pediatric neck masses are one of the common surgical conditions presenting to the pediatric surgical wards and clinics in many centers worldwide. There is paucity of published information regarding pediatric neck masses in Tanzania and the study area in particular. This study determines the etiology, clinico-histopathological patterns and treatment outcome of pediatric neck masses and to identify predictors of outcome in our local setting.

Methods

This was a prospective cross-sectional hospital based study done in children aged ten years and below with neck masses for a five months period. Statistical data analysis was done using SPSS version 17.0.

Results

A total of 148 patients were studied. Their ages ranged from 2 months to 10 years (median 3 years). The male to female ratio was 2.5:1. Inflammatory lesions were the most frequent cause of neck masses accounting for 43.9% of cases. The median duration of illness was 2 years. Except for the neck mass, 72 (48.6%) of the children had clinically stable health condition on presentation. The posterior triangle was commonly involved in 118 (79.7%) patients. eight (5.4%) were HIV positive. The majority of patients (95.9%) were treated surgically. Postoperative complication rate was 30.4% and surgical site infection was the most frequent complication in 37.5% of cases. The median length of hospital stay was 10 days and was significantly longer in patients with malignant masses and those with surgical site infection (p <0.001). The overall mortality rate in this study was 8.1% and it was significantly associated with malignant masses, associated pre-existing illness, late presentation, HIV positivity, low CD 4 count, high ASA class and presence of surgical site infections (p <0.001). The outcome of patients on discharge was excellent as more than 90% of patients were successfully treated and discharged well.

Conclusion

Pediatric neck masses are among the most common causes of paediatric surgical admissions and pose a diagnostic and therapeutic challenge in our setting. We advocate early surgical consultation and thorough and timely histopathological examination of neck masses in children.

Role of fine needle aspiration cytology in head and neck lesions of paediatric age group

CONTEXT

Fine Needle Aspiration Cytology [FNAC] of the head and neck region is well accepted as a diagnostic procedure. Various studies in the context of FNAC in the head and neck region are available for the adult population, but only few studies are available for the paediatric age group.

AIMS

To study the role of fine needle aspiration cytology and its utility in paediatric head and neck lesions.

SETTINGS AND DESIGN

This was a hospital based, prospective study.

METHOD AND MATERIALS

Hundred cases of head and neck lesions of the paediatric age group [0-15 years] were studied for cytomorphology through fine needle aspiration cytology and the results were correlated with the histomorphology.

RESULTS

There was a male predominance in the case distribution among both the sexes in children [55%]. The head and neck lesions were most frequent in the age group of 10-15 years, followed by the age group of 5-10 years than the age group of 0-5 years. Lesions in the cervical lymph nodes constituted 81% of the head and neck lesions and 87% of the adequate smears, followed by those in the skin and subcutaneous tissues [3 cases (3.2%)], the thyroid [4 cases (4.3%)] and the salivary gland [1 case (1%)]. 88.17% cases of head and neck lesions in children were diagnosed as benign on their smears and 11.83% cases were diagnosed as malignant, of which 8 cases of malignant lesions were located in the cervical lymph nodes, 1 case was located in the thyroid and 2 cases of malignant lesions were located in the orbits.

CONCLUSIONS

FNAC is an important and a non-invasive, investigational tool in children for identifying and planning the medical management of inflammatory and infectious conditions. It helped us in indicating the diagnosis of the lesions in congenital or aquired malformations, cystic lesions and benign neoplastic lesions, in which surgical management were needed and we got confirmations on histological examinations. For the malignant lesions, FNAC was a more important investigation tool than an accurate investigation tool, which suggested about the lesions and guided us to do more advanced specific investigations for obtaining the diagnosis.

Unusual presentation of angiomyomatous hamartoma in an eight-month-old infant: case report and literature review

BACKGROUND

Evaluation of palpable neck masses may be a diagnostic problem in pediatric patients, with differential diagnosis including congenital, inflammatory, tumoral and traumatic lesions. Ultrasonography is usually a satisfactory method to make a correct pre-operative evaluation of neck masses, although diagnosis is often challenging for the surgeon and the radiologist and sometimes only possible after a histopathological examination of the resected lesion.

CASE PRESENTATION

We report an 8-month-old patient with a cervical, anterior midline mass. Ultrasonographic images showed features suggesting a partly cystic lesion, with a preoperative suspect of thyroglossal duct cyst. Histological examination, performed after surgical removal of the mass, led to a diagnosis of lymph node angiomyomatous hamartoma (AH).

CONCLUSIONS

AH, a rarely occurring benign lymph node lesion, has been reported in the neck lateral region only twice. This case, presenting as a palpable neck midline mass, is the first reported case occurring in infancy. Although rare, AH should be included in the differential diagnosis of head and neck masses.

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.

Branchio-oculo-facial syndrome presenting with concomitant thyroglossal duct cyst

Branchial cleft anomalies are rare developmental defects of the neck, with an estimated 2% to 3% being bilateral. Although most are isolated findings, some are associated with syndromes. We report a 2-month-old boy with bilateral branchial cleft anomalies, low-set ears, and hydronephrosis who tested positive for a mutation in the TFAP2A gene (A256V) implicated in branchio-oculo-facial (BOF) syndrome. Magnetic resonance imaging (MRI) revealed a thyroglossal duct cyst at the base of the tongue. To our knowledge, this is the first reported case of BOF syndrome presenting concomitantly with a thyroglossal duct cyst.

Surgical management of a subepiglottic thyroglossal duct cyst in a dog

A 2 yr old dog presented for dysphagia and coughing secondary to a 4 cm × 4 cm turgid subepiglottic mass. Cervical radiographs, an esophagram, and computed tomography confirmed the presence of a cystic mass that was not intimately associated with any surrounding structures. An incisional biopsy confirmed the cystic nature of the mass and helped to rule out a malignancy. A marginal surgical excision was performed via a ventral approach. Histopathology of the mass was consistent with a thyroglossal duct cyst. This is the first report of a thyroglossal duct cyst in this location in a dog. There was no recurrence of clinical signs 14 mo after surgery.

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.

Cervical lymphadenitis: etiology, diagnosis, and management

Cervical lymphadenopathy is a common problem in children. The condition most commonly represents a transient response to a benign local or generalized infection. Acute bilateral cervical lymphadenitis is usually caused by a viral upper respiratory tract infection or streptococcal pharyngitis. Acute unilateral cervical lymphadenitis is caused by streptococcal or staphylococcal infection in 40% to 80% of cases. Common causes of subacute or chronic lymphadenitis include cat-scratch disease and mycobacterial infection. Generalized lymphadenopathy is often caused by a viral infection, and less frequently by malignancies, collagen vascular diseases, and medications. Laboratory tests are not necessary in most children with cervical lymphadenopathy. Most cases of cervical lymphadenitis are self-limited and require no treatment. The treatment of acute bacterial cervical lymphadenitis without a known primary source should provide adequate coverage for both Staphylococcus aureus and Streptococcus pyogenes.

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.

[Papillary carcinoma in thyroglossal duct cyst]

Authors present a rare case of the papillary thyroid carcinoma in thyroglossal duct cyst in a 40 year-old woman. Preoperative assessment (palpation and ultrasonography) showed symptoms of typical thyroglossal duct cyst and the final diagnosis was established after histopathological examination of the surgical specimen. Epidemiology, diagnostic methods and treatment of this rare disease were also discussed in the study.

Pediatric salivary gland imaging

A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces.

Congenital neck masses

Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.

A thyroglossal duct cyst presenting as a thyroid nodule in the lateral neck

The patient is a 55-year-old female with a history of multinodular goiter. She was followed for several years for a dominant left-sided superior pole thyroid nodule. Several prior fine needle aspiration biopsies had been performed. All were consistent with the diagnosis of degenerative colloid nodule. Eventually she developed symptoms of intermittent choking and shortness of breath and presented for surgical evaluation. On physical examination, including ultrasound, a left-sided superior thyroid nodule was noted. At operation, the nodule was found to be completely separate from the thyroid. Dissection revealed a thyroglossal duct cyst (TDC) located lateral to the superior pole of the thyroid gland, attached to the mid portion of the hyoid bone by a pedicle. The standard Sistrunk procedure was performed. Here we describe an unusual late presentation of a TDC located lateral to a multinodular goiter and producing compressive symptoms.

Thyroglossal duct cyst: personal experience and literature review

The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.