RT Book, Section
A1 Kozin, Elliott D.
A1 Lustig, Lawrence R.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1193145627
T1 Diseases Presenting as Neck Masses
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193145627
RD 2024/04/20
AB The  differential  diagnosis  of  neck  masses  is  heavily  dependent  on  the  location  in  the  neck,  the  age  of  the  patient,  and  the  presence  of  associated  disease  processes.  Rapid  growth  and  tenderness  suggest  an  inflammatory  process,  while  firm,  painless,  and  slowly  enlarging  masses  are  often  neoplastic.  In  young  adults,  most  neck  masses  are  benign  (branchial  cleft  cyst,  thyroglossal  duct  cyst,  reactive  lymphadenitis),  although  malignancy  should  always  be  considered  (lymphoma,  metastatic  thyroid  carcinoma).  Lymphadenopathy  is  common  in  HIV-positive  persons,  but  a  growing  or  dominant  mass  may  well  represent  lymphoma.  In  adults  over  age  40,  cancer  is  the  most  common  cause  of  persistent  neck  mass  and  should  be  definitively  ruled  out.  A  metastasis  from  squamous  cell  carcinoma  arising  within  the  mouth,  pharynx,  larynx,  or  upper  esophagus  should  be  suspected.  Risk  factors  for  squamous  cell  carcinoma  include  smoking  and  HPV  exposure.  Especially  among  patients  younger  than  30  or  older  than  70,  lymphoma  also  should  be  considered.  In  all  cases,  a  comprehensive  otolaryngologic  examination  is  needed.  Imaging  and  pathologic  evaluation  of  the  neck  mass  via  FNA  biopsy  is  likely  to  be  the  next  step  if  a  primary  tumor  is  not  obvious  on  physical  examination.