Neck Mass

NECK MASS
Assessment of a neck mass

M. Hosseini M.D.
Head & Neck Surgeon
Rasool Akram Hspital
Iran University
Question :
1- What structure is the neck mass arising from ?
2- Is it a lymph node ?
3- Is the mass arising from a normally occurring
structure (thyroid – never – vessel – muscle) ?
4- Abnormal structure (larngocele – brachial –
cleft – cystic hygroma) ?
5- Is the mass soft , fluctuant – mobile – fixed ?
6- Palsato
7- Bruit
8- Superficial – deep
9- Is it attached to the skin ?
10 - Tender
- Duration
- Growth rate ( M > B )
- Location (Congenital – Developmental)

Risk Factor :
Tobacco
Alcohol
Leukoplakia
Erthroplakia
Poor Hygiene
Submucosal fibrosis
Local inflammation due to trauma
Trauma
- Deletion of chromosomes 3p & 18q
- Amplification of int – 2 and bcl -1
- Mutation of p 53
- Overexpression of transforming
growth factor – (TGF – α)
- Epidermal growth factor receptor (EGF1)
I. Muscle & fibrous tissue
A. Congenital / developmental – fibromatosis colli

B. Inflammatory – myositis
C. Neoplastic
1. Benign – rhabdomyoma
2. Aggressive – fibromatoses
3. Malignant – rhabdomyosarcoma
D. Miscellaneous
1. Benign masseter muscle hypertrophy
2. Compensatory muscle hypertrophy (often seen after
R . N . D)
II. Lymphatic & reticuloendothelial
systems
A. Congenital – cystic hygroma , hamartoma
B. Inflammatory lymphadenitis
1. Viral
a. Cat – scratch disease
b. Infectious monoucleosis
2. Bacterial
a. Routine ( strept. Staph. )
b. Syphilis
c. T.B.
d. Actinomycosis
3. Fungal
a. Histoplasmosis
b. Blastomycosis
4. Parasitic
a. Toxoplasmosis
b. Leishmaniasis
II. Lymphatic & reticuloendothelial
systems
C. Neoplastic (Primary & metastatic lymphnode)

1. Sarcomas
a. Lymphomas (Hodgkin’s & non- hodgkin)
b. Soft part sarcoma
c. Leukemias
2. Carcionomas ( all – metastatic)
a. Squamous cell
b. Melanoma
c. Thyroid malig.
d. Salivary gland malig.
D. Miscellaneous
Drug reaction (Phenytoin)
III. Salivary glands
A. Congenital – cysts
B. Inflammatory
1. Acute viral sialoadenitis (mumps)
2. Acute bacterial sialoadenitis
3. Chronic sialoadenitis
C. Enlargement secondary to systemic disease – obesity ,
alcoholism, malnutrition
III. Salivary glands
D. Neoplastic
1. Benign – hemangioma, mixed tumor, warthin’s
2. Malignant – nucoepidermoid ca. , adenoid cystic ca.
E. Obstructive enlargement
1. Sialolithiasis
2. Ductal stricture
F. Miscellaneous enlargements of salivary glands
1. Sjogren’s synd.
2. Drug reaction (iodine)
IV. Vascular system
A. Developmental / degenerative / traumatic
1. Aneurysm
2. Arteriovenous malf.
3. Tortuous arteries
4. Hematoma
B. Neoplastic
1. Hemangiomas
2. Angiosarcomas
3. Hemangiopericytoma
4. Carotid body tumor
V. Nervous system
A. Benign
1. Neurofibroma
2. Neuroma
3. Neurilemmoma (schwannoma)
4. Paragangliomas (carotid body, vagal body, &
glomus jugulare tumors)
B. Malignant (rare)
1. Neurogenous sar.
2. Neuroepithelioma
3. Malig. schwannoma
VI. Thyroid gland
A. Congenital / developmental – cysts

B. Inflammatory
1. Acute thyroiditis
2. Subacute (de Quervain’s)
3. Chronic thyroiditis
a. Lymphocytic (Hashimoto’s)
b. Fibrous/ ligneous (Riedel’s)
VI. Thyroid gland
C. Neoplastic
1. Benign – adenomas
2. Malignant
a. Papillary car.
b. Follicular car.
c. Medullary car.
d. Poorly diff. car.
D. Miscellaneous
1. Diffuse colloid goiter
2. Diffuse goiter with hyperthyroidism
3. Nodular goiter
VII. Miscellaneous soft tissue neop.
A. Benign
1. Lipoma
2. Myxoma
3. Hibernoma
B. Malignant
1. Synovial cell sarc.
2. Liposarcoma
VIII. Larynx, pharynx, & deep neck
structures
A. Developmental
1. Malformed laryngeal cartilage
2. External laryngocele
3. Branchial cleft abnormalities
B. Inflammatory
1. Deep neck infection / abscess
2. Osteomyelitis of cervical spine
C. Neoplastic
1. Car. Of larynx & pharynx
2. Chordoma of larynx
3. Neoplasm of cervical spine
IX. Other assorted lesions
A. Bezold’s (mastoid) abscess

B. Cholesteatoma from mastoid
C. Thymoma
D. Epidermoid inclusion cyst
AGE ( YEARS )
0 - 15
Inflammatory Neoplastic
Adenitis Lymphoma (AT/PT)
Bacterial (AT/PT) Thyroid Carcinoma (M)
Viral (AT/PT) Sarcoma (AT/PT)
Granlomatous (PT/AT)
Congenital
Branchial cyst (AT)
Thyroglossal cyst (M)
Vascular Lesion (PT)
Dermoid (M)
AGE ( YEARS )
16 - 40
Inflammatory Neoplastic
Adenitis Lymphoma (AT/PT)
Viral (AT/PT) Thyroid Carcinoma (M)
Bacterial (AT/PT) Salivary (AT)
Granlomatous (PT/AT) Metastatic (AT/PT)
Aids (AT/PT) Vascular (AT/PT)
Congenital Neurogenic (AT)
Branchial cyst (AT)
Dermoid (M)
AGE ( YEARS )
40 +
Neoplastic
Metastatic carcinoma (AT/PT)
Thyroid carcinoma (M)
Inflammatory
Adenitis
Viral (AT/PT)
Bacterial (AT/PT)
Granlomatous (PT/AT)
Aids (AT/PT)
Congenital
Branchial cyst (AT)

Chronic infection
1- T.B
2- Fungal
3- Syphilis
4- Cat – scratch fever
5- Aids
6- Sarcoidosis
7- Mononucleosis
Infection – inflammation ( Fever – Pain – Tenderness )
T.B
Sarcoidosis
Fungal infection
Dental problems
Trauma to H. & N.
‍ ancer ( Skin lesion – Head & Neck Tumor )
C
Night sweats ( lymphoma )
Exposure to the sun ( Skin cancer )
Smoking or excessive alcohol consumption
( S.C.C of the fead & Neck )
}
Nasal obstruction
Nasal bleeding
Otalgia
Malignancy of upper aerodigestive tract
Odynophagia
Dyspahgia
Hoarseness
Exposure to low – dose therapeutic radiation ( risk factor for thyroid

Cancer)
Biopsy
FNA
1- Preferred method
2- Cystic form solid
3- Often diagnose malignancy
4- Standard for making treatment decisions
in patiets with thyroid nodules
5- Bleeding from it make problem for CT & MRI
6- Fna is not valuable in :
Nodul of thyroid with History of Radiation,
Lymphoma.
Thyroid Nodules
- Childern , young men , pregnant women ,

radiation , family history of the thyroid cancer .
Imaging Studies
Ultrasonography
A - Solid – Cystic
B - Congenital – developmental ( cyst )
C - Vascular , thyroid & parathyroid abnormality
CT
A - Solid – Cystic
B- Mass is within or outside a gland or nodal chain
C- Small tongue – base , tonsillar mass that
have minimal mucosal component
MRI
T2 – Weighted gadolinium enhanced scans is

Useful for invasion of soft tissue by tumor.
Arteriography
A- evaluating vascular lesions

B- fixation of tumor to the carotid
C- vascularity of mass
D- specific blood supply
Thyroglossal duct cysts
1- 70% of all congenital abnormalities of the neck

2- First decade of life
3- Midline
4- Move side to side but not up to down
5- 1% contain cancer ( papillary ca-S.c.c. )
Branchial cleft cysts
1- Five branchial arches & four clefts
2- Internal tract or opening is situated at pharyngeal
groove such as tonsil ( second Arch ) or piriform
Sinus ( Third & fourth arches )
3- The Second arch is the most common
4- Anterior border of S.C.M
5- Most are diagnosed in the first two decades of life
( any age )
6- Lateral neck ( smooth , painless , slowly enlarging
mass )
Cystic Hygroma
( Lymphangiomas )
1- Second year of life

2- 80% in P.T.
3- Floor of the mouth- supraclavicular, root of
the neck , angle of the jaw – may involved
parotid – tongue – larynx .
4-Diffuse , soft , doughy , irregular mass .
5- Transilluminated
6- Aspiration yields straw – colored fluid
Vascular Malformation
( Hemangiomas )
- Congenital
- Bluish – purple coloration , increased warmth ,
compressibility , bruit , thrill – most of them
resolve spontaneously
Salivary gland Tumors (B)
- Complete submandibular resection &

superficial parotidectomy
PATIENT AGE ( YEARS )
16 - 40
FREQUENCY OF DISEASE GROUPINGS
INFLAMMATORY
CONGENITAL / DEVELOPMENTAL
NEOPLASTIC
MALIGNANT
BENIGN
TRAUMATIC
LOCATION
Anterior triangle
40 +
NEOPLASTIC
MALIGNANT
BENIGN
INFLAMMATORY
TRAUMATIC
LOCATION
Posterior triangle
0 - 15
INFLAMMATORY
NEOPLASTIC
MALIGNANT
BENIGN
TRAUMATIC
LOCATION
Midline and anterior neck
16 - 40
CAUSATIVE DISEASES BY LOCATION
Congenital / Developmental
Thymic cyst
Sialadenopathy
Parotid
Submandibular
INFLAMMATORY
Adenitis Sialadenitis
Viral Parotid
Bacterial Submandibular
Granulomatus
Neoplastic
Metastatic Lymphoma
Upper jugular (II) Primary vascular
Oropharynx Carotid body
Oral cavity Glomus
Oral cavity Hemangioma
Nasal sinus
Face
Mid – jugular (III)
Hypopharynx
Larynx
Traumatic
False aneurysm
0 - 15
Thyroglossal duct cyst
Dermoid Laryngocele
Inflammatory Adenitis
Neoplastic Thyroid
Lymphoma Traumatic
Sternocleidomastoid
Hematoma / fibroma
INFLAMMATORY
Adenitis Sialadenitis
Viral Parotid
Bacterial Submandibular
Granulomatus
40 +
Lymphangiom Neoplastic
Inflammatory Lymphoma Nasopharynx
Adenitis Metastatic (V) SCALP
Bacterial Superior Supraclavicular

Viral Breast
Granulomatous Lung
Gastrointestinal
Traumatic Genitourinary
Neuroma Gyneocologic

Neck Mass

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NECK MASS

Assessment of a neck mass

- Growth rate ( M > B )

- Location (Congenital – Developmental)

A. Congenital / developmental – fibromatosis colli

C. Neoplastic (Primary & metastatic lymphnode)

A. Congenital / developmental – cysts

A. Bezold’s (mastoid) abscess

Thyroglossal cyst (M)

Exposure to low – dose therapeutic radiation ( risk factor for thyroid

- Childern , young men , pregnant women ,

T2 – Weighted gadolinium enhanced scans is

A- evaluating vascular lesions

1- 70% of all congenital abnormalities of the neck

1- Second year of life

- Complete submandibular resection &

Adenitis Metastatic (V) SCALP

Bacterial Superior Supraclavicular

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