Sandbox: Gertrude

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Gertrude Djouka, M.D.[2]

Differential diagnosis of neck masses==

Differential diagnosis of neck masses include:

Category	Diseases		Benign or Malignant	Clinical manifestation								Paraclinical findings			Gold standard diagnosis	Associated findings
				Demography	History	Symptoms		Signs				Lab findings	Histopathology	Imaging
						Pain	Dysphagia	Mass exam	Skin changes	LAP	Others
Congenital	Branchial cleft cyst		Benign
	Thyroglossal duct cyst
	Hemangioma
	Vascular malformations
	Lymphatic malformations
	Laryngocele
	Ranula
	Teratoma
	Dermoid cyst
	Thymic cyst
Category	Diseases		Benign or Malignant	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Inflammatory	Acute sialadenitis
	Chronic sialadenitis
	Reactive viral lymphadenopathy	CMV
		EBV
		HIV
		Viral URI
	Bacterial lymphadenopathy	Tularemia
		Brucellosis
		Cat-scratch disease	Benign	More common in the Southern of U.S among children and young adults.	Cat exposure Fever Fatigue Headache	+	-	Tender cervical nodes	Vesicular Erythema Papule at site of inoculation	+		↑ ESR Serology: + antibody to Bartonella Henselae	Satellite micro-abscess with granuloma	-	-	Bacillary Angiomatosis Bacillary Peliosis
		Actinomycosis	Benign	No predilection in race, age Male to female ratio : 1.5 to 3:1	History of dental procedure or trauma Poor oral hygiene Swelling mandible	-	-	Tender at the beginning Painless Fluctuant Non-tender at late stage	Red Blue	-		↑ ESR ↑ CRP Gram stains: Gram positive filamentous rods	Sulfur granules Filamentous organism	-	Histological examination Bacterial culture of the abscess	Mandible osteomyelitis
		Mycobacterial infections	Benign	More common in adults and children in endemic continent such as Africa	Recent travel to endemic regions Exposure to TB patients	-	-	Matted cervical nodes Firm Non-tender	Indurated	+		PPD: + Sputum smear: Presence of acid fast bacilli	Chronic necrotizing caseating calcified granuloma	Neck Ultrasound: Multiple lymph nodes Fusion tendency Internal echoes	Culture for mycobacteria	-
		Streptococcal infection	Benign	More common in children and adolescents	Fever Absence of cough Difficulty swallowing Swollen pharynx	+	+	Tender anterior cervical nodes Tonsillar exudates	-	+		Rapid antigen detection tests: +/-	Follicular hyperplasia Infiltration of polymorphonuclear cells	-	Throat culture	Acute rheumatic fever Post-streptoccocal glomerulonephritis
	Parasitic lymphadenopathy	Toxoplasma gondii	Benign	6 years old and older adults are more affected in U.S. Seen in Hot climates	Cats or birds feces exposure Drinking unpasteurized milk Undercooked food Organ transplant recipients	+	-	Bilateral Non-tender Symmetrical Non-fluctuant	-	+		Serology : + IgG and IgM antibodies	Follicular hyperplasia	MRI: Multiple rings enhanced lesions	Serology Immunofluorescence MRI CT scan	-
	Sarcoidosis		Benign	More common in African American women aged 20 - 40 years.	Family history of sarcoidosis Fatigue Swelling and pain in the joints	-	-	Bilateral tender lymph nodes Swollen Non-tender parotid glands	Erythema nodosum Lupus pernios	+		↑ ESR ↑ ACE	Non-necrotizing epithelioid granuloma	CXR: B/L hilar adenopathy MRI: B/L multiples enlarged cervical lymph nodes	Biopsy	Heerfordt's syndrome: uveitis, facial nerve paralysis, parotitis
	Sjögren syndrome		Benign	Female to male ratio: 9 to 1 May happen at any age Mean age: 40-50	History of RA, SLE, and non-hodgkin B-cell lymphoma. Dry mouth, dry eyes.	-	+	Firm, B/L enlarged parotid glands	Pruritis Rashes Dry	+		↑ ESR Anti-SSA/Ro: + Anti-SSB/La: + Cytopenia Wetting <5 mm on Schirmer's test	Hyperactivity of B cells and lymphocytes which lead to infiltration of the exocrine glands.	US: Hypoechoic and inhomogeneous salivary glands	Biopsy	-
	Castleman disease (angiofollicular lymphoproliferative disease)		Benign	Mean age: 30-40 years	Asymptomatic at early onset B-symptoms	-	-	Non tender cervical node	Papule Cherry hemangiomata	+		↑ ESR ↑ CRP Anemia Polyclonal hypergammaglobulinemia	Hyaline vascular variant Plasma cell variant Mixed variant	CT scan of thorax Matted lymphadenopathy Solitary, noninvasive mass	Biopsy	HHSV-8 Kaposi Sarcoma Non-hodgkin lymphoma POEMS syndrome
	Kikuchi disease (histiocytic necrotizing lymphadenitis)		Benign	High prevalence in Japan More common in young adults <30 years old	Fever Flu-like prodrome	+	-	Tender cervical nodes	rashes	+		↑ ESR Abnormal liver enzymes leucopenia	Irregular paracortical areas of coagulative necrosis with abundant karyorrhectic debris	-	Biopsy	Hashimoto thyroiditis
	Kimura disease		Benign	More common in Asian males.	History of painless cervical lump	-	-	Large Non-tender cervical node	Itching	+		↑ Eosinophils	Conserved lymph node structure Eosinophilic infiltration High postcapillary venules	-	Biopsy	Nephrotic syndrome Hypercoagulable state
	Rosai-Dorfman disease		Benign	More common in children	Fever	-	-	Non-tender enlarged cervical lymph nodes	Erythema	+		↑ ESR Polyclonal hypergammaglobulinemia	-	-	-	-
	Kawasaki disease		Benign	More common in children younger than 5 years old. Highest incidence in Japan. Most leading cause of acquired heart disease in U.S.	High fever B/L conjunctivitis Rash Swelling of hands and feet Inflammation of lips Strawberry tongue	-	-	Large, single palpable cervical node	Rashes Desquamation of skin	+		↑ ESR ↑ CRP	Inflammation of medium sized arteries and organs.	Echocardiography: Coronary artery dilation Coronary artery aneurysm	Clinical findings
	Category	Diseases		Benign or Malignant	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Hypopharyngeal cancer		Malignant	More common in males Age: 55-65 years old Incidence: < 1/100,000 in U.S. More common: Japan, India, Iran	Tobacco use Abuse alcohol consumption HPV infection Lump in the neck Odynophagia Hoarseness	-	+	Non tender cervical node	-	+		-	Spindle cells Nuclear atypia Basaloid cells Abundant chromatin	Neck CT scan: Soft tissue mass Irregular thickening of mucosa Necrotic region MRI: Tumors are hypointense on T1 and hyperintense on T2	Biopsy	-
	Salivary gland neoplasm	Pleomorphic adenoma	Benign	More common in Females Incidence increase with age. Incidence : 2-3.5 cases per 100,000 population	History of swelling Dysphagia Hoarseness	-	+	Palpable mass of deep lobe of parotid gland Firm Mobile	-	-		-	Proliferation of epithelial cells and stromal matrix in the ducts.	MRI: Homogenous on T1 Abundant myxochondroid stroma on T2	Biopsy	-
		Warthin's tumor	Benign	Male to Female ratio : 4:1 More common in people aged 60 to 70 years old.	History of swollen salivary gland Jaw pain Tinnitus	-	+	Non tender Mobile Firm Solitary	-	-		-	Papillae Fibrous capsule Cystic spaces	Neck CT: Cystic lesion posteriorly within the parotid gland. MRI: B/L lesions Heterogeneous	Biopsy
		Oncocytoma
		Monomorphic adenoma
		Mucoepidermoid carcinoma
		Adenoid cystic carcinoma
		Adenocarcinoma
		Salivary duct carcinoma
		Squamous cell carcinoma
		Parathyroid tumors
	Carotid body tumors
	Paraganglioma
	Schwannoma
	Lymphoma
	Liposarcoma
	Lipoma
	Glomus vagale, glomus jugulare tumors
	Nasopharyngeal cancer
	Other	Hematoma
Arteriovenous fistula
Goiter
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings