Neck lumps

Question 1

What questions would you ask to characterise a neck lump?

Answer 1

• What is its site?
• What is its size?
• What is its shape?
• Is it smooth or lobulated?
• Is it in the midline?
• Is it solid or cystic?
• Is there more than one lump?
• Is it tender?
• Is it attached to any viscus or skin?
• Is it connected to the thyroid and therefore moves on swallowing?
• Is it pulsatile?
• Is there any associated acute or chronic inflammation or ulceration anywhere within the head & neck?

Question 2

How would you investigate a neck lump?

Answer 2

FBC, ESR, WBC 🡪 infection

Monospot/Paul Bunnell test 🡪 infectious mononucleosis

• Antibody test for EBV
• But also examine axilla & groin for LN and check for liver & spleen enlargement

HIV screen

Radiology: CT, chest X-ray, ultrasound, MRI, PET

Cytology – fine needle aspiration cytology (FNAC) (only 3 month validity, need stop aspirin 5 days prior)

Endoscopy – to look for primary site of tumour

Biopsy (excisional) -> biopsy of cancerous lesions may lead to tumour cells seeding in soft tissue if incisional approach is used

Bethesda classification (thyroid) for reporting FNACs – suggestive prognosis + Mx

Question 3

where is a brachial cyst normally located?

Answer 3

Young men 20-30yo, with a neck mass at junction between upper 1/3 and lower 2/3 of SCM, occurring anteriorly to SCM (around level 2)

Question 4

What is a dermoid cyst??

Answer 4

• Painless midline swellings, along embryological lines of fusion
  Do not move on swallowing or tongue protrusion, cannot be separated from overlying skin
• Due to defects of fusion in embryo – elements of skin trapped subcutaneously and develop into cysts lined with squamous epithelium & skin appendages
• Congenital: Ectodermal elements can trapped within the mesodermal layers. Usually midline, due to embryological development
• Acquired: gunshot wound or trauma (bits of skin trapped inside)

Question 5

What is a cystic hygroma?

Answer 5

• Rare type of lymphangioma (benign tumour of lymph vessels) where vessels are very large & dilated
• Usually noticed at or soon after birth, may be very large (can compress vital structures within the neck)