Neck masses differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating neck masses from other Diseases

Differential diagnosis of neck masses include:

Category	Diseases		Benign/Malignant	Clinical manifestation								Paraclinical findings			Gold standard diagnosis	Associated findings
				Demography	History	Symptoms		Signs				Lab findings	Histopathology	Imaging
				Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging
Congenital	Branchial cleft cyst^[1]		Benign	Age: 1-15 yrs/ varies Familial occurence is noted	Lateral neck mass	-	+/-	Solitary Smooth Mobile Welldefined Non-pulsatile Fluctuant	A pit is found at the opening of the cyst	-	-	-	Squamous or ciliated epithelial lining Lymphoid tissue with germinal centers and subcapsular sinuses	CT: Well defined fluid attenuation with slight enhancement of the capsule Ultrasound: Typical features of a cyst are seen		Brachio-oto-renal syndrome Sinus Fistula
	Thyroglossal duct cyst^[2]^[3]		Benign	Age: 1-10 yrs/ varies	Midline neck mass	-	-	Mobile Moves upwards with tongue protrusion and swallowing	-	-	-	-	Squamous or ciliated pseudostratified columnar lining Foci of thyroid gland tissue Granulation tissue or giant cells if it gets infected	Ultrasound: Anechoic, thin walls, and heterogeneous with internal septae CT with contrast: Well circumscribed,homogeneous fluid attenuation, thin enhancing rim MRI: T1- dark, T2-bright images		-
	Haemangioma^[4]		Benign	Age: birth - 2 yrs Females>males	Presents with a flat red or purple patch	-	-	Firm Rubbery Well-demarcated	Blanching Telangiectasias Erythematous patch	-	Regress gradually with age	GLUT-1 VEGF	Lined by non atypical endothelial cells Vascular structures with RBC	Ultrasound: High flow with vascular channels MRI: With or without Gd is the modality of choice		POEMS and Castleman's disease
	Vascular malformations^[5]^[6]		Benign	Incidence: 1 in 2000 to 5000 births Sex: No predilection	Venous: Present with a bluish swelling AV malformations: Present with purple/red swelling	-/+	-	Soft Compressible Non-tender Venous: No thrill,↑ in size on valsalva AV malformations: Thrill, warm, pulsatile	-	-	Grow proportionally with age	↑ D-dimer level in venous malfomations	Lined by single endothelial layer	Doppler ultrasound: Venous malformations show slow flow, hypoechoic, AV malformations show high flow MRI with Gd: Diffuse enhancement	MRI	-
	Lymphatic malformations^[7]^[8]		Benign	Age: Birth - 5yrs Sex: No predilection	Presents with a large swelling mainly in the neck	-	+	Soft Non-compressible Non-pulsatile Fluctuant Transillumination+	-	-	Never regress, expand/contract based on inflammation	-	Dilated lymphatic channels lined by endothelial cells Positive D2-40 stain	Ultrasound: Hypo/anechoic with thick septa and fluid CT: Homogeneous and cystic mass MRI: Hyperintense on T2 & peripheral wall enhancement on T1		Down syndrome, turner syndrome
	Laryngocele^[9]^[10]^[11]		Benign	More common in adults Male: female = 5:1	Presents with a neck swelling, hoarseness, stridor and globus sensation Episodic in nature	-	+	Soft Reducible Increase in size on valsalva	-	-	Common in glass blowers, trumpet players	-	Lined by pseudostratified ciliated epithelium	X-ray, CT: Fluid and air containing cystic masses CT is the preferred one Direct laryngoscopy	CT scan is the gold standard imaging for diagnosis	-
	Ranula^[12]^[13]		Benign	Age: 1st and 2nd decade Female: male=1:1.4	Presents with a blue colored swelling in the floor of the mouth	-	-	Well circumscribed Fluctuant Soft	-	-	-	-	H&E: Shows mucin surrounded by inflammatory cells & fibrosis	CT: Shows cystic mass with tail sign	-
	Teratoma^[14]^[15]		Benign/malignant	Incidence: 1:4000 births Sex: No predilection	Presents as a firm lateral neck mass	-	-	Firm Non-tender	-	-	-	High ALP levels	Shows ecto, meso and endodermal tissues	CT & MRI: Shows calcifications
	Dermoid cyst^[16]^[17]		Benign	Incidence: 3 per 10000 population Age: birth - 5 yrs	Presents as a slow growing mass or a sinus	-	-	Freely mobile Solitary Rubbery Nonpulsatile Noncompressible	Usually normal/sometimes a pit or sinus is seen A tuft of hair at the center of the pit for nasal dermoid cyst	-	-	-	Keratinizing squamous epithelium Occasional remnants of hair follicles, adipose tissue, and sweat glands	Ultrasound: Thin walled, unilocular CT: With contrast well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
	Thymic cyst^[18]		Benign	Age: 1-10 yrs Males>Females	Presents as a soft mass, gradually enlarging, on left side of the neck(usual)	-	-	Soft Compressible	-	-	-	-	Squamous/cuboidal epithelium Lymphoid tissue in the cyst wall contains hassall corpuscles	Ultrasound: Unilocular cystic mass CT: Uni/multilocular, well circumscribed and nonenhancing
Category	Diseases		Benign	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
		Actinomycosis
		Mycobacterial infections
		Staphylococcal or streptococcal infection
	Parasitic lymphadenopathy	Toxoplasma gondii
	Sarcoidosis
	Amyloidosis
	Sjögren syndrome
	Castleman disease (angiofollicular lymphoproliferative disease)
	Kikuchi disease (histiocytic necrotizing lymphadenitis)
	Kimura disease
	Rosai-Dorfman disease
	Kawasaki disease
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Primary thyroid tumor
	Salivary gland neoplasm	Pleomorphic adenoma	+
		Warthin's tumor	+
		Lymphoepithelioma	+
		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
	Metastatic head and neck carcinoma
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

References

↑ Nahata, Vaishali (2016). "Branchial cleft cyst". Indian Journal of Dermatology. 61 (6): 701. doi:10.4103/0019-5154.193718. ISSN 0019-5154.
↑ Amos J, Shermetaro C. PMID 30085599. Missing or empty |title= (help)
↑ Deaver MJ, Silman EF, Lotfipour S (August 2009). "Infected thyroglossal duct cyst". West J Emerg Med. 10 (3): 205. PMC 2729228. PMID 19718389.
↑ Léauté-Labrèze, C.; Prey, S.; Ezzedine, K. (2011). "Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities". Journal of the European Academy of Dermatology and Venereology. 25 (11): 1245–1253. doi:10.1111/j.1468-3083.2011.04102.x. ISSN 0926-9959.
↑ Cox JA, Bartlett E, Lee EI (May 2014). "Vascular malformations: a review". Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.
↑ Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R (December 2016). "Venous malformations: clinical diagnosis and treatment". Cardiovasc Diagn Ther. 6 (6): 557–569. doi:10.21037/cdt.2016.11.10. PMC 5220204. PMID 28123976.
↑ Cox JA, Bartlett E, Lee EI (May 2014). "Vascular malformations: a review". Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.
↑ Guruprasad Y, Chauhan DS (September 2012). "Cervical cystic hygroma". J Maxillofac Oral Surg. 11 (3): 333–6. doi:10.1007/s12663-010-0149-x. PMC 3428451. PMID 23997487.
↑ Werner RL, Schroeder JW, Castle JT (March 2014). "Bilateral laryngoceles". Head Neck Pathol. 8 (1): 110–3. doi:10.1007/s12105-013-0478-4. PMC 3950389. PMID 23881550.
↑ Prasad KC, Vijayalakshmi S, Prasad SC (December 2008). "Laryngoceles - presentations and management". Indian J Otolaryngol Head Neck Surg. 60 (4): 303–8. doi:10.1007/s12070-008-0108-8. PMC 3476818. PMID 23120570.
↑ Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M (July 2017). "Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection". Iran J Otorhinolaryngol. 29 (93): 225–228. PMC 5554815. PMID 28819622.
↑ Packiri S, Gurunathan D, Selvarasu K (September 2017). "Management of Paediatric Oral Ranula: A Systematic Review". J Clin Diagn Res. 11 (9): ZE06–ZE09. doi:10.7860/JCDR/2017/28498.10622. PMC 5713871. PMID 29207849.
↑ Kokong D, Iduh A, Chukwu I, Mugu J, Nuhu S, Augustine S (June 2017). "Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options". World J Surg. 41 (6): 1476–1481. doi:10.1007/s00268-017-3901-2. PMC 5422487. PMID 28194490.
↑ Chauhan DS, Guruprasad Y, Inderchand S (September 2011). "Congenital nasopharyngeal teratoma with a cleft palate: case report and a 7 year follow up". J Maxillofac Oral Surg. 10 (3): 253–6. doi:10.1007/s12663-010-0140-6. PMC 3238564. PMID 22942597.
↑ Bahgat M, Bahgat Y, Bahgat A (July 2012). "Oropharyngeal teratoma, a rare cause of airway obstruction in neonates". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-006580. PMC 4543570. PMID 22814615.
↑ Paradis, Josée; Koltai, Peter J. (2015). "Pediatric Teratoma and Dermoid Cysts". Otolaryngologic Clinics of North America. 48 (1): 121–136. doi:10.1016/j.otc.2014.09.009. ISSN 0030-6665.
↑ Gaddikeri S, Vattoth S, Gaddikeri RS, Stuart R, Harrison K, Young D, Bhargava P (2014). "Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation". Curr Probl Diagn Radiol. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. PMID 24629659.
↑ Gaddikeri, Santhosh; Vattoth, Surjith; Gaddikeri, Ramya S.; Stuart, Royal; Harrison, Keith; Young, Daniel; Bhargava, Puneet (2014). "Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation". Current Problems in Diagnostic Radiology. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. ISSN 0363-0188.

[Nahata20162-1] Nahata, Vaishali (2016). "Branchial cleft cyst". Indian Journal of Dermatology. 61 (6): 701. doi:10.4103/0019-5154.193718. ISSN 0019-5154.

[pmid30085599-2] Amos J, Shermetaro C. PMID 30085599. Missing or empty |title= (help)

[pmid19718389-3] Deaver MJ, Silman EF, Lotfipour S (August 2009). "Infected thyroglossal duct cyst". West J Emerg Med. 10 (3): 205. PMC 2729228. PMID 19718389.

[Léauté-LabrèzePrey2011-4] Léauté-Labrèze, C.; Prey, S.; Ezzedine, K. (2011). "Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities". Journal of the European Academy of Dermatology and Venereology. 25 (11): 1245–1253. doi:10.1111/j.1468-3083.2011.04102.x. ISSN 0926-9959.

[pmid25045330-5] Cox JA, Bartlett E, Lee EI (May 2014). "Vascular malformations: a review". Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.

[pmid28123976-6] Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, Oklu R (December 2016). "Venous malformations: clinical diagnosis and treatment". Cardiovasc Diagn Ther. 6 (6): 557–569. doi:10.21037/cdt.2016.11.10. PMC 5220204. PMID 28123976.

[pmid250453302-7] Cox JA, Bartlett E, Lee EI (May 2014). "Vascular malformations: a review". Semin Plast Surg. 28 (2): 58–63. doi:10.1055/s-0034-1376263. PMC 4078214. PMID 25045330.

[pmid23997487-8] Guruprasad Y, Chauhan DS (September 2012). "Cervical cystic hygroma". J Maxillofac Oral Surg. 11 (3): 333–6. doi:10.1007/s12663-010-0149-x. PMC 3428451. PMID 23997487.

[pmid23881550-9] Werner RL, Schroeder JW, Castle JT (March 2014). "Bilateral laryngoceles". Head Neck Pathol. 8 (1): 110–3. doi:10.1007/s12105-013-0478-4. PMC 3950389. PMID 23881550.

[pmid23120570-10] Prasad KC, Vijayalakshmi S, Prasad SC (December 2008). "Laryngoceles - presentations and management". Indian J Otolaryngol Head Neck Surg. 60 (4): 303–8. doi:10.1007/s12070-008-0108-8. PMC 3476818. PMID 23120570.

[pmid28819622-11] Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M (July 2017). "Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection". Iran J Otorhinolaryngol. 29 (93): 225–228. PMC 5554815. PMID 28819622.

[pmid29207849-12] Packiri S, Gurunathan D, Selvarasu K (September 2017). "Management of Paediatric Oral Ranula: A Systematic Review". J Clin Diagn Res. 11 (9): ZE06–ZE09. doi:10.7860/JCDR/2017/28498.10622. PMC 5713871. PMID 29207849.

[pmid28194490-13] Kokong D, Iduh A, Chukwu I, Mugu J, Nuhu S, Augustine S (June 2017). "Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options". World J Surg. 41 (6): 1476–1481. doi:10.1007/s00268-017-3901-2. PMC 5422487. PMID 28194490.

[pmid22942597-14] Chauhan DS, Guruprasad Y, Inderchand S (September 2011). "Congenital nasopharyngeal teratoma with a cleft palate: case report and a 7 year follow up". J Maxillofac Oral Surg. 10 (3): 253–6. doi:10.1007/s12663-010-0140-6. PMC 3238564. PMID 22942597.

[pmid22814615-15] Bahgat M, Bahgat Y, Bahgat A (July 2012). "Oropharyngeal teratoma, a rare cause of airway obstruction in neonates". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-006580. PMC 4543570. PMID 22814615.

[ParadisKoltai2015-16] Paradis, Josée; Koltai, Peter J. (2015). "Pediatric Teratoma and Dermoid Cysts". Otolaryngologic Clinics of North America. 48 (1): 121–136. doi:10.1016/j.otc.2014.09.009. ISSN 0030-6665.

[pmid24629659-17] Gaddikeri S, Vattoth S, Gaddikeri RS, Stuart R, Harrison K, Young D, Bhargava P (2014). "Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation". Curr Probl Diagn Radiol. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. PMID 24629659.

[GaddikeriVattoth2014-18] Gaddikeri, Santhosh; Vattoth, Surjith; Gaddikeri, Ramya S.; Stuart, Royal; Harrison, Keith; Young, Daniel; Bhargava, Puneet (2014). "Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation". Current Problems in Diagnostic Radiology. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. ISSN 0363-0188.

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Neck masses differential diagnosis

Overview

Differentiating neck masses from other Diseases

References

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