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Evans V, Prades E, Passant C, Owens D, Harris A. Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy. J Laryngol Otol 2024; 138:99-104. [PMID: 37218625 DOI: 10.1017/s002221512300097x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Management of lateral cystic neck masses with no apparent upper aerodigestive tract primary tumour in adults is controversial. Imaging modalities and fine needle aspiration cytology often struggle to distinguish the presence of malignancy. METHOD This study entailed a multicentre retrospective review of all patients with isolated lateral cystic neck masses from 2012 to 2018 in three Welsh health boards, utilising demographic data and first-line investigations (ultrasound scanning and fine needle aspiration cytology) to develop an evidence-based predictive tool for risk of malignancy. RESULTS It was found that 29.1 per cent of cystic lesions were malignant on final histology. Age, male gender, non-benign ultrasound scan findings and fine needle aspiration cytology were significant risk factors on univariate analysis. The final multivariate analysis predicted a risk of malignancy ranging from 2.1 to 65.0 per cent depending on the covariate pattern. Smoking status was non-significant. CONCLUSION A rigorous, risk-stratified approach to the management of these patients should aid the clinician in minimising morbidity and optimising resources.
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Affiliation(s)
- Victoria Evans
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Eduard Prades
- Department of Otolaryngology, Betsi Cadwaladr University Health Board, Rhyl, Wales, UK
| | - Carl Passant
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - David Owens
- Department of Otolaryngology, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Andrew Harris
- Department of Otolaryngology, Aneurin Bevan University Health Board, Newport, Wales, UK
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Lateral cystic neck masses in adults: a ten-year series and comparative analysis of diagnostic modalities. J Laryngol Otol 2023; 137:312-318. [PMID: 35172908 DOI: 10.1017/s0022215122000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In adults, the solitary lateral cystic neck mass remains a diagnostic challenge with little solid material to target for cytology and few clues on imaging modalities to suggest underlying malignancy. METHOD This study was a retrospective review of patients presenting with a lateral cystic neck mass to a tertiary academic head and neck centre over a 10-year period. RESULTS A total of 25 of 157 cystic lesions were subsequently malignant on paraffin section histopathology, with the youngest patient being 42 years. In the age cohort over 40 years, 30 per cent of males and 10 per cent of females were diagnosed with malignancy. The ipsilateral palatine tonsil was the most common primary site (50 per cent). A total of 85 per cent of cases demonstrated integrated human papillomavirus infection. Age, male sex and alcohol were significant risk factors on univariate analysis. Ultrasound-guided fine needle aspiration cytology and magnetic resonance imaging represented the most accurate pre-open biopsy tests. CONCLUSION The authors of this study advocate for a risk-stratified, evidence-based workup in patients with solitary lateral cystic neck mass in order to optimise timely diagnosis.
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Branchial cleft cyst and branchial cleft cyst carcinoma, or cystic lymph node and cystic nodal metastasis? J Laryngol Otol 2023; 137:31-36. [PMID: 35712979 PMCID: PMC9834707 DOI: 10.1017/s0022215122001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lateral cervical cysts are usually considered as of branchial cleft origin, despite many studies showing that branchial cysts do not arise from the remnants of the branchial apparatus. In the same way, some authors still consider that a true clinicopathological entity such as 'branchial cleft cyst carcinoma' could exist, at least in theory. Despite insufficient evidence in support of the branchial theory, a number of publications continue to emphasise this concept. METHODS A literature review of articles in Medline and PubMed databases was carried out to retrieve papers relevant to the topic. RESULTS AND CONCLUSION The evidence from lateral cervical cyst studies and knowledge about cystic metastasis of Waldeyer's ring could be applicable for both diagnoses. Terms such as 'branchial cleft cyst' and 'branchial cleft cyst carcinoma' are confusing and misleading, and it is questionable as to whether their usage is still tenable.
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Touska P, Connor S. Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment. Br J Radiol 2022; 95:20220149. [PMID: 35687667 PMCID: PMC9815738 DOI: 10.1259/bjr.20220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023] Open
Abstract
The clinical behaviour and outcomes of patients with oropharyngeal cancer (OPC) may be dichotomised according to their association with human papilloma virus (HPV) infection. Patients with HPV-associated disease (HPV+OPC) have a distinct demographic profile, clinical phenotype and demonstrate considerably better responses to chemoradiotherapy. This has led to a reappraisal of staging and treatment strategies for HPV+OPC, which are underpinned by radiological data. Structural modalities, such as CT and MRI can provide accurate staging information. These can be combined with ultrasound-guided tissue sampling and functional techniques (such as diffusion-weighted MRI and 18F-fludeoxyglucose positron emission tomography-CT) to monitor response to treatment, derive prognostic information, and to identify individuals who might benefit from intensification or deintensification strategies. Furthermore, advanced MRI techniques, such as intravoxel incoherent motion and perfusion MRI as well as application of artificial intelligence and radiomic techniques, have shown promise in treatment response monitoring and prognostication. The following review will consider the contemporary role and knowledge on imaging in HPV+OPC.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Botwin A, Juliano A. Pearls and Pitfalls in Neck Imaging. Neuroimaging Clin N Am 2022; 32:375-390. [DOI: 10.1016/j.nic.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brad Hall A, Hasara S, Coker P. Identification of a branchial cleft anomaly via handheld point-of-care ultrasound. J Ultrason 2022; 22:e67-e69. [PMID: 35449698 PMCID: PMC9009347 DOI: 10.15557/jou.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Aim of the study Branchial anomalies result from incomplete obliteration of the branchial arch structures during embryogenesis. Second branchial arch anomalies are commonly found on the lower third of the neck, with an opening at the anterior border of the sternocleidomastoid muscle, and may drain secretions or purulent material. This case demonstrates the use of handheld point-of-care ultrasound to aid in the diagnosis of a branchial anomaly. Case description The patient presented with a “hole” in the neck with intermittent drainage from the site. A 2 mm defect in the skin was noted anterior to the sternocleidomastoid muscle. A handheld ultrasound system was used to identify a well-defined, hypoechoic, cyst-like structure. Given the history, physical findings, and point-of-care ultrasound imaging, the diagnosis of a second branchial cleft sinus was made. Conclusions The use of point-of-care ultrasound and knowledge of the sonographic characteristics of these lesions can assist the physician in the diagnosis of branchial arch anomalies.
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Affiliation(s)
- A Brad Hall
- Morsani College of Medicine, University of South Florida, United States
| | | | - Phillip Coker
- Emergency Medicine, Lakeland Regional Health, United States
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Radiological differences in computed tomography findings and texture analysis between cystic lymph node metastases of human papillomavirus-positive oropharyngeal cancer and second branchial cysts. Pol J Radiol 2021; 86:e177-e182. [PMID: 33828630 PMCID: PMC8018266 DOI: 10.5114/pjr.2021.104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The study aimed to analyse radiological differences in computed tomography (CT) findings and texture analysis between cystic lymph node metastases (CNM) in human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) and second branchial cleft cysts (2nd BC). Material and methods Patients with pathological evidence of CNM-HPV-OPC and 2nd BC, who underwent contrast-enhanced CT, were retrospectively evaluated. The evaluated characteristics include age, sex, and CT findings. CT findings included the maximum and minimum transverse diameters, maximum caudal diameter, thickness of the peripheral wall, presence of internal septation, presence of surrounding fat stranding, location, and 40 texture parameters. Results A total of 13 patients had CNM-HPV-OPC (19 lesions), while 20 patients had 2nd BC (20 lesions). Patients with 2nd BC were significantly younger than those with CNM-HPV-OPC (p < 0.001). In terms of diameter, 2nd BC lesions were significantly larger than the CNM-HPV-OPC lesions (p < 0.001). CNM-HPV OPC lesions had significantly thicker walls than 2nd BC lesions (p < 0.001). CNM-HPV-OPC lesions had significantly higher association with internal septations than 2nd BC lesions (p < 0.001). Second BC lesions were significantly less common at level III than CNM-HPV-OPC lesions (p = 0.047). Among the 40 texture parameters measured, 8 had significant differences (p ≤ 0.001). Conclusions There were significant differences in CT findings and textural parameters between CNM-HPV-OPC and 2nd BC lesions. These results may help in differentiating one from the other.
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Diagnostic Approach to Evaluating Superficial Masses on Ultrasound. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cooc A, Chong I, Wang KY, Jiang K, Lincolns CM. Papillary thyroid carcinoma metastasis to a branchial cleft cyst: a case report and review of imaging. Clin Imaging 2020; 64:1-6. [PMID: 32193065 DOI: 10.1016/j.clinimag.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/04/2020] [Indexed: 12/20/2022]
Abstract
Branchial cleft cysts are the most common lesions in the lateral neck with ectopic thyroid tissue found only rarely within these cysts. Over the years, multiple cases of papillary thyroid carcinoma arising from these ectopic thyroid tissues have been described in the literature with these cases sharing a normal thyroid gland on surgical and histological evaluation. Recently, however, there are three cases of papillary thyroid carcinoma in a branchial cleft cyst reported to be the result of metastasis from a thyroid primary. We present a 49-year-old female with a rare case of papillary thyroid carcinoma metastasis to a branchial cleft cyst with imaging characteristics that may prospectively suggest metastatic involvement.
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Affiliation(s)
- Andy Cooc
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - Insun Chong
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Kevin Yuqi Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Kevin Jiang
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
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Liang HH, Chen CY, Chen WY, Chen TM, Chan WP. Solitary cystic metastatic lymph node of occult human papillomavirus-related oropharyngeal cancer mimicking second branchial cleft cyst: A case report. Medicine (Baltimore) 2019; 98:e17800. [PMID: 31689859 PMCID: PMC6946570 DOI: 10.1097/md.0000000000017800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Human papillomavirus (HPV)-related oropharyngeal cancer is becoming more common, the primary cancer AQ4 usually occult and appearing only as cystic cervical lymph node (LN) metastasis. Distinguishing between a benign cystic lesion and cystic LN metastasis is challenging given their similar radiologic and histologic appearances. PATIENT CONCERNS A 54-year-old man presented with a bulging cystic mass measuring 6.4cm on the right side of neck. DIAGNOSES Postexcision diagnosis was second branchial cleft cyst. After 2 years, the cystic mass recurred, and HPV-related tonsillar squamous cell carcinoma with cystic metastatic LNs was confirmed after wide tonsillectomy and neck dissection. The previous cystic lesion proved to be a cystic metastatic LN from the same malignancy with additional p16 immunostain. INTERVENTIONS The patient was treated with adjuvant concurrent chemoradiation therapy. OUTCOMES The patient was followed up in the outpatient department with no evidence of recurrence after 1 year. LESSONS When an adult has a cystic mass in the upper neck, we must rigorously exclude it as a cystic metastatic LN of occult HPV-related oropharyngeal cancer. Additional p16 staining might be helpful.
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MESH Headings
- Branchioma/diagnosis
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/virology
- Diagnosis, Differential
- Humans
- Lymph Nodes/pathology
- Lymph Nodes/virology
- Lymphatic Metastasis/diagnosis
- Male
- Middle Aged
- Neck/pathology
- Neck/virology
- Neck Dissection
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/secondary
- Neoplasms, Cystic, Mucinous, and Serous/virology
- Neoplasms, Unknown Primary/diagnosis
- Neoplasms, Unknown Primary/pathology
- Neoplasms, Unknown Primary/virology
- Oropharyngeal Neoplasms/diagnosis
- Oropharyngeal Neoplasms/secondary
- Oropharyngeal Neoplasms/virology
- Papillomaviridae
- Papillomavirus Infections/complications
- Papillomavirus Infections/virology
- Tonsillar Neoplasms/diagnosis
- Tonsillar Neoplasms/pathology
- Tonsillar Neoplasms/virology
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Affiliation(s)
- Han-Hsuan Liang
- Department of Radiology, Wan Fang Hospital
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University
| | - Wei-Yu Chen
- Department of Pathology, Wan Fang Hospital
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Tsung-Ming Chen
- Department of Otolaryngology, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University
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Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:489-496. [PMID: 31186166 DOI: 10.1016/j.anorl.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect. METHODS A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).
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Incidence and clinical predictors of cystic squamous cell carcinoma metastases in lateral cervical cysts. The Journal of Laryngology & Otology 2019; 133:430-435. [DOI: 10.1017/s0022215119000823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThis study aimed to determine the incidence of metastatic squamous cell carcinoma in patients with an isolated cervical cystic mass, and to describe the clinical features that might predict the origin of cystic tumours.MethodAdult patients with isolated lateral cervical cystic masses who were scheduled for surgery from 1st January 2010 to 31st August 2016 in two tertiary care referral centres in Slovakia were analysed retrospectively.ResultsThe incidence of cystic metastases in the whole cohort and in patients aged over 40 years were 9.9 per cent and 18.5 per cent, respectively. The incidence in patients aged over 40 years (18.5 per cent) was statistically significant (p = 0.003).ConclusionThe incidence of cystic squamous cell carcinoma metastases in lateral cervical cysts in patients aged over 40 years is high enough to call for excisional biopsy with frozen section, panendoscopy with direct biopsies, tonsillectomy and even neck dissection in cases of histologically confirmed carcinoma.
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Kawaguchi M, Kato H, Aoki M, Kuze B, Hara A, Matsuo M. CT and MR imaging findings of infection-free and benign second branchial cleft cysts. Radiol Med 2018; 124:199-205. [PMID: 30421386 DOI: 10.1007/s11547-018-0959-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The present study aimed to assess CT and MR imaging findings of infection-free and benign second branchial cleft cysts (SBCCs). METHODS Eleven patients with histopathologically confirmed infection-free and benign SBCCs underwent preoperative contrast-enhanced CT (CECT) and/or MR imaging. We assessed qualitative (presence and extent of wall thickening, degree of contrast enhancement of the thickened wall on CECT images, and signal intensity of the thickened wall on T2-weighted images) and quantitative (maximum thickness of the thickened wall) imaging findings. RESULTS Eccentric and smooth wall thickening was observed in 11/11 (100%) patients. The wall thickening extent (percentage of the thickened wall to the circumference of the wall) was small (1%-25%) in 4/11 (36%), moderate (26%-50%) in 6/11 (54%), extensive (51%-75%) in 1/11 (9%), and diffuse (76%-100%) in 0/11 (0%) patients. Mild homogeneous enhancement of the thickened wall on CECT images was observed in 7/7 (100%) patients. The signal intensity of the thickened wall on T2-weighted images was isointense relative to that of normal lymph nodes in 7/8 (88%) and mildly hyperintense in 1/8 (12%) patient. The maximum thickness of the thickened walls ranged from 2 to 4 (mean 3.4) mm. CONCLUSIONS Infection-free and benign SBCCs are identifiable as cysts with eccentric and smooth wall thickening on CECT and MR images. The wall thickness was almost always less than half of the wall circumference, isointense relative to normal lymph nodes, and showed mild homogeneous enhancement.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Bunya Kuze
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Koch EM, Fazel A, Hoffmann M. Cystic masses of the lateral neck – Proposition of an algorithm for increased treatment efficiency. J Craniomaxillofac Surg 2018; 46:1664-1668. [DOI: 10.1016/j.jcms.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 12/23/2022] Open
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The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm. Eur Arch Otorhinolaryngol 2017; 275:767-773. [PMID: 29282522 DOI: 10.1007/s00405-017-4855-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
Abstract
AIM Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.
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Grønlund S, Mey K, Andersen E, Rasmussen ER. The true malignancy rate in 135 patients with preoperative diagnosis of a lateral neck cyst. Laryngoscope Investig Otolaryngol 2016; 1:78-82. [PMID: 28894805 PMCID: PMC5510250 DOI: 10.1002/lio2.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 12/14/2022] Open
Abstract
Objective In this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed. Study Design This study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012. Methods One hundred thirty‐five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually. Results Of the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine‐needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics. Conclusion This study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast‐track cancer referral program. Level of Evidence 2b.
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Affiliation(s)
- Søren Grønlund
- Department of Otorhinolaryngology Hillerød Hospital Hillerød Denmark
| | - Kristianna Mey
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology Rigshospitalet and Gentofte Hospital, University of Copenhagen Copenhagen Denmark
| | | | - Eva Rye Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology Rigshospitalet, University of Copenhagen Copenhagen East Denmark
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Buckley L, Gupta R, Ashford B, Jabbour J, Clark JR. Oropharyngeal cancer and human papilloma virus: evolving diagnostic and management paradigms. ANZ J Surg 2015; 86:442-7. [DOI: 10.1111/ans.13417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa Buckley
- Graduate School of Medicine; University of Wollongong; Wollongong New South Wales Australia
| | - Ruta Gupta
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Bruce Ashford
- Illawarra Health and Medical Research Institute; Wollongong New South Wales Australia
| | - Joe Jabbour
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
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Wratten C, Anne S, Tieu MT, Kumar B, Eisenberg R. The dangers of diagnosing cystic neck masses as benign in the era of HPV-associated oropharyngeal cancer. Med J Aust 2015; 203:371-2. [PMID: 26510810 DOI: 10.5694/mja15.00697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022]
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Abstract
Medical imaging is an important tool in the evaluation and classification of pediatric head and neck masses. Such lesions may include congenital, inflammatory, infectious, vascular, or neoplastic processes. Ultrasound is often the first line modality in the workup of a neck mass in a child, followed by MRI or CT depending on the scenario. This information must be interpreted in the context of the patient's clinical history, physical examination, and demographics. The medical imaging workup of a neck mass in a child must be focused to yield the maximum information possible while minimizing the risks of radiation and sedation.
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Zhang GZ, Liu ZL, Gong JS, Cheng ZQ, Ke C. Cystic metastatic nasopharyngeal carcinoma presenting as branchial cleft cyst: report of two cases and review of the literature. J Oral Maxillofac Surg 2014; 72:2366-74. [PMID: 25172673 DOI: 10.1016/j.joms.2014.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/10/2014] [Accepted: 05/17/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the differential diagnosis between solitary cystic metastatic carcinoma from branchial cleft cyst and provide references for clinicians to treat cystic metastases from primary sites of the head and neck region. MATERIALS AND METHODS Two cases of cystic metastatic nasopharyngeal carcinoma (NPC) are presented and a review of the relevant English literature on cystic metastasis from head and neck cancer was performed. RESULTS Two adult patients with a lateral cystic neck mass were initially clinically diagnosed as branchial cleft cysts. Based on the postoperative histopathologic examination and nasopharyngeal blind biopsy, they were finally diagnosed as cystic metastases from occult nasopharyngeal carcinoma. After a review of the literature, diagnostic strategies, histopathologic features, and therapeutic options for cervical cystic metastases were discussed. CONCLUSION Cervical cystic metastasis of NPC in adults may mimic branchial cleft cyst in clinical, radiological, and even histological features. Surgeons should bear in mind that when lateral neck cysts with characteristics of suspected malignancy are confronted, nasopharynx examination, including blind or random biopsy, is highly recommended before surgery. Metastatic disease should always be considered as a potential differential diagnosis in adult patients with a cystic neck lesion. Correct diagnosis is important so that appropriate surgical and radiotherapeutic treatment can be delivered.
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Affiliation(s)
- Guo Zhi Zhang
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China.
| | - Zi Long Liu
- Resident, Department of Oral and Maxillofacial Surgery, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Jing Shan Gong
- Professor and Chairman, Department of Radiology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zhi Qiang Cheng
- Professor and Chairman, Department of Pathology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - ChaoYang Ke
- Professor and Chairman, Department of Otorhinolaryngology, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
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22
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Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography 2014; 33:83-90. [PMID: 24936500 PMCID: PMC4058977 DOI: 10.14366/usg.13026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/28/2014] [Indexed: 11/03/2022] Open
Abstract
Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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23
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Abstract
Sonography is the modality of choice for imaging cervical lymph nodes in patients with papillary thyroid cancer, both before surgery and for postoperative surveillance. Sonography is also an invaluable tool to guide fine-needle aspiration of abnormal nodes. Microcalcifications, cystic changes, abnormal morphology, and disordered vascularity are features of metastatic nodal involvement with papillary thyroid carcinoma and should be sought during surveillance scans as well as in targeting for fine-needle aspiration.
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