Neck Mass and Swelling

Question 1

Mass of Neck Midline

Answer 1

Thyroglossal Duct Cyst – Moves as patient swallows
Dermoid or Epidermoid tumors – Firm, rubber-like
Ranulas
Lipomas
Lymphangiomas
Lymphoid
◦ Bartonella henselae (Cat-scratch Fever)
◦ Hodgkins Lymphoma
◦ Non-hodgkins Lymphoma

Question 2

Mass of Lateral Neck

Answer 2

Neoplastic
◦ Metastatic Tumor
◦ Carotid Body Tumor
◦ Hodgkins Lymphoma
◦ Non-Hodgkins Lymphoma
Congenital
◦ Branchial Cleft Cyst
◦ Dermoid Cyst
◦ Sebaceous Cyst
Inflammatory
◦ Cat Scratch Fever
◦ Scrofula

Question 3

Cat Scratch Fever

Answer 3

Lymphadenitis is MOST COMMON presentation
◦ Regional lymphadenopathy within 1-2 weeks post exposure
Papule at the site of inculcation (Cat Scratch Exposure)
Low grade fever/malaise – Occur in some patients
5-10% can progress into systemic involvement
◦ Liver, Spleen, Osteomyelitis, Lung, Nervous System, Ocular
Treatment: Supportive with/without antibiotics (Azithromycin/Ciprofloxacin)
◦ Self limiting and symptoms resolve within 2-4 months

Inflammatory cells present
Lymph Nodes and Fibroconnective Tissue: Necrotizing granulomatous inflammation
Negative for PPD and Chest radiograph should be clear
Caused by Bartonella henselae, via exposure to infected kitten/cat
Need 3 or 4 criteria for diagnosis
◦ Cat or flea contact – no need for inoculation site
◦ Positive Bartonella PCR assay, Negative for other causes
◦ Positive serology for Bartonella henselae
◦ Positive granulomatous inflammation or Positive Warthin-Starry silver stain

Question 4

Peripheral Odontogenic Tumors

Answer 4

Odontogenic Tumors can appear in soft tissue
◦ Peripheral ameloblastoma is MOST COMMON
◦ Odontoma, odontogenic fibroma, peripheral COC, peripheral CEOT
Painless nodule, non-ulcerated, ALWAYS located on gingiva or alveolar mucosa
S L O W growth
Middle age adult is most common, but children can exhibit this pathology
F = M
Excise surgically, but can reoccur (15-20%), Rarely transform into malignancy

Question 5

Cystic Hygroma

Answer 5

Lymphangioma, angiolymphangioma, lymphatic malformation
Benign tumor composed of lymphatic tissue and vessels
Result of errors in vascular morphogenesis
Unknown etiology
Superficial lesion with pebbly surface and clear to bluish in color
Deeper lesions are typically soft and ill-defined borders
Location of lesion can impact airway
Odontogenic infections can spread more rapidly if space is infected and increase airway
compromise