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Differential Diagnosis of Head and Neck Mass Lesions

Article information

J Korean Med Assoc. 2006;49(3):239-250
Publication date (electronic) : 2006 March 31
doi : https://doi.org/10.5124/jkma.2006.49.3.239
Hang-Seok Chang, M.D.
Department of General Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Korea. surghsc@yumc.yonsei.ac.kr

Abstract

For the differential diagnosis of head and neck mass lesions, the age and presenting locations should be the primary considerations. The characteristic patterns of age- and site-predilection allow a diagnostic work-up and treatment plans for the patients with head and neck mass lesions. In children and young adults, the underlying causes are; inflammatory, congenital and developmental, and neoplastic masses in decreasing frequency. By contrast, neoplastic diseases are most frequent in the elderly. Because of the characteristic lymphatic spread patterns of head and neck diseases, the location of the mass in the cervical lymphatic nodal chain may be the key for the identification and differential diagnosis of the primary disease site. Besides, the evaluation of specific historical and physical findings is mandatory for the accurate diagnosis. When the signs of inflammation are associated, conservative treatment and observation is first considered. On the other hand, for persistent or progressively enlarging masses and those with suspicious findings of malignancy, surgical intervention should be considered.

Keywords: Head and neck masses; Differential Diagnosis; Age group; Location

References

2. McGuit WF. In : Shockley WW, Pillsbury HC III, eds. Neck Masses: Differential Diagnosis and Therapeutic Approach. THE NECK Diagnosis and Surgery 1994. St. Louis: Mosby-Year Book; 73–89.
3. Altman RP, Margileth AM. Cervical lymphadenopathy from atypical mycobacteria: Diagnosis and surgical treatment. J Pediatr Surg 1975. 10411–417.
4. Coker DD, Casterline PF, Chambers RG, Jaques DA. Metastases to lymph nodes of the head and neck from an unknown primary site. Am J Surg 1977. 134517–522.
5. Lee D-J, Rostock RA, Harris A, Kashima H, Johns M. Clinical evaluation of patients with occult primary tumor. South Med J 1986. 79979–983.
6. Lindberg R. Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tract. Cancer 1972. 291446–1449.
7. Knight PJ, Mulne AF, Vassy LE. When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982. 69391–396.
8. DeVita VT Jr, Jaffe ES, Hellman S. In : DeVita VT Jr, Hellman S, Rosenberg SA, eds. Hodgkin's disease and the non-Hodgkin's lymphomas. Cancer. Principles and Practice of Oncology 1985. 2nd edth ed. Philadelphia: JB Lippincott Co; 1623–1710.
9. Skandalakis JE, Godwin JT, Androulakis JA, Gray SW. The differential diagnosis of tumors of the neck. Prog Clin cancer 1970. 4141–159.
10. MacComb WS. Diagnosis and treatment of metastatic cervical cancerous nodes from unknown primary site. Am J Surg 1972. 124441–449.
11. Parsons JT, Million RR, Cassisi NJ. The influence of excisional or incisional biopsy of metastatic neck nodes on the management of head and neck cancer. Int J Radiat Oncol Biol Phys 1985. 111447–1454.
12. Shapiro AL, Pincus RL. Fine needle aspiration of diffuse cervical lymphadenopathy in patients with acquired immunodeficiency syndrome. Otolaryngol Head Neck Surg 1991. 105419–421.
13. McGuirt WF. Panendoscopy as a screening examination for simultaneous primary tumors in head and neck cancer: A prospective sequential study and review of the literature. Laryngoscope 1982. 92569–576.
14. Drake AF, Hulka GF. In : Shockley WW, Pillsbury HC III, eds. Congenital Neck Masses. THE NECK Diagnosis and Surgery 1994. St. Louis: Mosby-Year Book; 93–107.
15. Sistrunk WE. Technique of removal of cysts and sinuses of the thyroglossal duct. Surg Gynecol Obstet 1928. 46109.
16. Maddox PR, Malcolm HW. In : Clark OH, Duh QY, Kebebew E, eds. Approach to thyroid nodules. Textbook of Endocrine Surgery 2005. 2nd edth ed. Philadelphia: Elsevier Saunders; 85–92.
17. Fujimoto Y, Obara T, Okamoto T. In : Clark OH, Duh QY, Kebebew E, eds. Papillary thyroid carcinoma: Rationale for hemithyroidectomy. Textbook of Endocrine Surgery 2005. 2nd edth ed. Philadelphia: Elsevier Saunders; 102–109.
18. Clark OH. In : Clark OH, Duh QY, Kebebew E, eds. Papillary thyroid carcinoma: Rationale for total thyroidectomy. Textbook of Endocrine Surgery 2005. 2nd edth ed. Philadelphia: Elsevier Saunders; 110–113.
19. Hamming JF, Roukema JA. In : Clark OH, Duh QY, Kebebew E, eds. Management of regional lymph nodes in papullary, follicular, and medullary thyroid cancer. Textbook of Endocrine Surgery 2005. 2nd edth ed. Philadelphia: Elsevier Saunders; 195–206.
21. Moley JF, Shervin N. In : Clark OH, Duh QY, Kebebew E, eds. Medullary thyroid carcinoma. Textbook of Endocrine Surgery 2005. 2nd edth ed. Philadelphia: Elsevier Saunders; 129–141.

Article information Continued

Copyright © 2006 Korean Medical Association

Figure 1

Figure 1

Clinical description of the location in neck

Figure 2

Figure 2

Classification of neck nodes group in neck:

A) Classification of MD Anderson Cancer Center

B) Classification of Memorial Sloan-Kettering Cancer Center

Table 1

Classification of neck masses

Table 1

Table 2

Distribution of disease categories by age (in order to frequency)

Table 2

Table 3

Distribution of disease categories by location

Table 3

Table 4

Location of primary tumor associated with lymph node metastasis in neck

Table 4