Lumps in the neck

Question 1

Why should an excision or incision biopsy of neck lumps be avoided

Answer 1

It may jeopardize subsequent treatment

Question 2

Describe the 6 anatomical regions of the neck

Answer 2

1- Submandibular gland, nodes, thyroglossal duct, plunging ranula
2- upper jugular nodes, carotid body tumour, aneurysm, branchial cyst, pharyngeal pouch
3- mid jugular nodes, branchial cyst
4- inferior jugular nodes, virchow Trossier node
5- nodes
6- thyroid, parathyroid, thryroglossal duct cyst, nodes

Question 3

Prinicpal differential diagnosis for central mass

Answer 3

• Thyroglossal duct remnant
• Dermoid cyst
• Cervical lymphadenopathy
• Lipoma
• Haemangioma
• Fibroma

Question 4

Causes of supraclavicular nodes

Answer 4

• Secondary to disease in the chest, breasts, oesophagus or abdominal malignancy

Question 5

Causes of cervical adenopathy

Answer 5

Lymphoma, TB or AIDs

Question 6

Where may a thyroglossal duct cyst develop

Answer 6

• Can develop anywhere from the foramen caecum at the base of the tongue to the isthmus of the thyroid gland
• usually appears as a smooth, well- circumscribed upper midline non tender mass in the region of the hyoid bone.

Question 7

Possible sequelae of an infected thyroglossal duct cyst

Answer 7

An infected cyst may become adherent to the overlying skin, through which spontaneous rupture may occur. After rupture or surgical drainage, a persistent thyroglossal duct sinus is formed

Question 8

What happens to a thyroglossal duct cyst when the tongue is protruded

Answer 8

The cystic mass can usually be seen to rise in the neck

Question 9

What is the treatment of a thyroglossal duct cyst

Answer 9

Treatment is by excision of the cyst, together with the body of the hyoid bone and a core of tongue up to the foramen caecum (Sistrunk operation)

Question 10

How do inclusion dermoid cysts present

Answer 10

• These cysts may present in the midline between the cricoid bone and the suprasternal notch and are usually found in children or young adults
• Firm, non-tender and smooth
• Difficult to distinguish clinically from a thyroglossal cyst or a nodule of the thyroid isthmus

Question 11

What may Branchial cleft remnants give rise to

Answer 11

• Branchial cysts, sinuses or fistulae
• It may present as lateral neck swelling or draining sinus/fistula anywhere between the pre-auricular area and the clavicle along the medial border of the sternocleidomastoid

Question 12

When do branchial cysts most often present

Answer 12

Can present in childhood, most often in the third decade of life though

Question 13

What is a branchial cyst made up of

Answer 13

Cyst contains cholesterol crystals and is lined by squamous epithelium. its contents varying from clear fluid to a cheesy substance

Question 14

Treatment of branchial cysts

Answer 14

The cyst/ sinus should be excised together with any embryonic remnants

Question 15

Commonest complication of a branchial cyst

Answer 15

Infection following an upper respiratory infection or tonsillitis

Question 16

How do cystic hygromas present

Answer 16

• Present at birth or within the first year of life
• May be located in the anterior or posterior triangles of the neck and may extend into the mouth
• The lesions are soft, irregular, transilluminate and compressible

Question 17

Cause of a pharyngeal pouch

Answer 17

Hypertension of the crico-pharyngeus sphincter

Question 18

Presentation of a pharyngeal pouch

Answer 18

• Dysphagia, regurgitation, food inhalation
• Mass felt on the side of the neck
• Diagnosis established by barium swallow

Question 19

Presentation of a carotid body tumour

Answer 19

• Asymptomatic mass at the angle of the jaw

- It moves from side to side and transmits pulsation

Question 20

Causes of acute (pyogenic) lymphadenitis

Answer 20

secondary to dental, tonsillar, ear and scalp infections

Question 21

How does Cervical tuberculous lymphadenitis present

Answer 21

The glands are matted and may have overlying oedema. In late disease, caseation may occur producing fluctuation, and after breakdown, sinus formation, which has the characteristic appearance of neck masses with suppurating sinuses

Question 22

when Cervical tuberculous lymphadenitis, what tests should be performed

Answer 22

Pus swab (looking for acid fast bacilli), chest radiograph, FNAC (when pus is not evident

Question 23

Consistency of glands in lymphoma

Answer 23

Glands have characteristic firm, rubbery consistency

Question 24

Investigations to be done in suspected lymphoma

Answer 24

FNAC to exclude inflammatory lymphadenitis,
followed by excisional biopsy to
characterise the lymphoma

Question 25

management of lymphoma

Answer 25

Patients should be referred to specialist centres
for management, which is usually with
combination chemotherapy, and
perhaps radiotherapy