Incidence of Unsuspected Metastases in Lateral Cervical Cysts

Objective Solitary cystic squamous cell carcinoma metastases may be difficult to distinguish clinically from a benign cervical cyst. We sought to identify the incidence of solitary cystic squamous cell carcinoma metastasis in patients presenting with apparently benign cervical cysts. Study Design Retrospective review. Methods The records of all patients who presented with isolated lateral cervical cysts between 1983 and 1999 were reviewed. Patients with a clinically apparent primary malignancy, a history of head and neck cancer, a history of irradiation, or age less than 18 years were excluded from analysis, as were patients with a histological diagnosis of nonsquamous cell malignancy or those without a final histological diagnosis. Results One hundred twenty‐one adult patients presented with an initial diagnosis of lateral cervical cyst. Metastatic squamous cell carcinoma was demonstrated histologically after surgical excision in 12 patients (9.9%). The incidence of malignancy was significantly greater in patients greater than 40 years of age (23.5%, P < .0001). Results of preoperative fine‐needle aspiration (FNA) were negative for malignancy in five cases of metastatic squamous cell carcinoma. Panendoscopy with directed biopsies revealed an occult primary in the base of tongue in three patients, tonsil in one patient, and nasopharynx in one. No primary was found in six patients, despite repeated examinations and close follow‐up. Conclusions Solitary cervical cysts in patients older than 40 years of age should be presumed to be carcinoma until proven otherwise. A negative FNA result may be misleading, because of hypocellularity of the cyst fluid. Excisional biopsy should be undertaken with provisions made for frozen‐section analysis of the specimen and contingency panendoscopy with directed biopsies of Waldeyer's ring if frozen‐section histological examination reveals malignancy.     

Cervical tuberculosis: a decision tree for protecting healthcare workers

Objectives/Hypothesis: The clinical presentation of cervical tuberculosis (TB) is a unique challenge to the otolaryngologist. To minimize the risk of nosocomial transmission, otolaryngologists must suspect the diagnosis and be familiar with recommendations for TB prevention. Study Design: Scientific review. Methods: We review current literature and recent changes in TB prevention strategies including the Centers for Disease Control and Prevention “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health‐Care Settings, 2005.” Results: Nosocomial transmission may occur from either unrecognized pulmonary disease or from aerosolization of tubercle bacilli during diagnostic procedures. History of prior TB infection, residence in a country where TB is endemic, close contact with a TB patient, or positive tuberculin skin test should raise suspicion of cervical TB. Physical examination findings may include painless, unilateral cervical lymphadenopathy. Children and human immunodeficiency virus infected patients present unique challenges, as these groups may have atypical presentations. When cervical TB is suspected, the provider should always screen for pulmonary and laryngeal disease. Fine needle aspiration with polymerase chain reaction or culture may accurately identify cervical TB. In rare cases, excisional biopsy may be required. Conclusions: To facilitate interpretation and rapid diagnosis while minimizing risk to health care providers, we provide a decision tree based on new federal guidelines and the clinical experience of a team of infectious disease specialists and otolaryngologists.     

Primary embryonal rhabdomyosarcoma of the anterior neck and thyroid

Primary embryonal rhabdomyosarcoma of anterior neck involving the thyroid is extremely rare. This report is only the second of its kind that describes this form of nonorbital nonparameningeal rhabdomyosarcoma in a 7‐year‐old boy and adds to a new, seldom‐reported variant of rhabdomyosarcoma in the head‐neck region. The child presented with a huge anterior neck swelling that clinically resembled a thyroid mass. Computed tomography scan showed a heterogeneous mass in the anterior neck replacing the entire right lobe of thyroid. Fine‐needle aspiration cytology was nondiagnostic. Right hemithyroidectomy with selective neck dissection suggested embryonal rhabdomyosarcoma by histopathology; the diagnosis was confirmed by positive reactions to desmin and myogenin. The child was subsequently treated with chemotherapy. Repeat chemotherapy with radiotherapy was required when recurrences were detected in the mediastinum and cervical lymph nodes at 13‐month follow‐up. Laryngoscope, 123:2072–2076, 2013     

以急性会厌炎为首诊的3例颈部坏死性筋膜炎病例报告并文献复习

目的 探讨急性会厌炎与颈部坏死性筋膜炎的相关性及治疗经验。 方法 回顾性分析3例以急性会厌炎为首诊的颈部坏死性筋膜炎患者的临床资料,对急性会厌炎与颈部坏死性筋膜炎间的相关性及诊治经过进行分析。 结果 3例患者经颈部CT明确诊断后均行手术治疗,1例死亡,2例治愈出院。 结论 对于以急性会厌炎为首诊经积极抗感染抗炎治疗无效的患者应警惕颈部坏死性筋膜炎的可能。积极抗感染治疗、及时局部切开引流,并重视全身基础疾病的治疗是颈部坏死性筋膜炎治疗的关键。     

Cervical bronchogenic cysts: case report and review of the literature

Pediatric cervical masses can present a diagnostic dilemma given their broad differential diagnosis. We present a 3-year-old girl with a midline anterior neck mass found to have histopathologic findings consistent with a bronchogenic cyst. Although rare, bronchogenic cysts should be considered in the differential diagnosis in both lateral and anterior pediatric cervical masses as their pathophysiology and embryogenesis differ considerably from more common cervical masses. Imaging is an important aspect in the pre-operative work-up, although diagnosis is only made after histopathologic analysis. Complete surgical excision is the definitive treatment.     

Rosai-Dorfman syndrome. On the differential diagnosis of lymph node swelling]

The Rosai-Dorfman syndrome is a benign disease, one of its commonest affected sites being the cervical lymph nodes. This disease should be considered in the differential diagnosis of a cervical lymphadenopathy. The syndrome often begins with a chronic rhinitis, and is accompanied by sinusitis, tonsillitis or pharyngitis; blood tests indicate chronic infection. The pathogenesis of the disease is still unknown but may include infection or an abnormal autoimmune reaction. The diagnosis is established by the findings of characteristic histiocytes with haemophagocytosis. We report a female patient with persistent cervical lymph node swelling resistant to treatment. The cause was proved by histology to be a Rosai-Dorfman syndrome.     

Cervical manifestation of blastomycosis

Blastomycosis is a common systemic fungal infection in which the physical and radiographic findings appear far more serious than the subjective signs and symptoms. Although blastomycosis of the head and neck is often difficult to diagnose, clues in the patient's history and a few laboratory tests can establish the diagnosis. Involvement of the skin and soft tissues provides an unusual opportunity for direct access to the organism for culture and pathologic diagnosis. We present a case of blastomycosis presenting in a single abscessed cervical lymph node. The diagnosis was established by fine-needle aspiration of the cervical mass. The primary lung disease was confirmed by chest radiography and computed tomography. The clinical and pathologic features of the disease are discussed. [Editorial comment: Pulmonary blastomycosis may present with cervical adenopathy. This article demonstrates the potential value of fine needle aspiration in establishing this diagnosis.]     

Real steak knives of cincinnati: Repeated foreign body ingestion with novel endoscopic removal

Repeated ingestion of foreign objects presents a multidisciplinary endoscopic dilemma. We report a 32‐year‐old female patient with history of multiple previous foreign body ingestions requiring several past exploratory laparotomies, who presents with a knife blade in the esophagus. We present a novel method of using a rigid cervical esophagoscope with a salivary bypass tube. The tip of the knife was isolated into the cervical esophagoscope, and the salivary bypass tube advanced off the cervical esophagoscope over the knife, shielding the serrated edge during removal preventing laceration to the esophagus. Laryngoscope, 129:567–568, 2019     

Kawasaki disease and cervical adenopathy

Kawasaki disease (KD) is an acute illness of unknown cause that affects infants and children. The diagnosis is confirmed in patients with prolonged fever and four of the following clinical features: (1) nonexudative conjunctivitis; (2) oral cavity changes; (3) rash; (4) extremity changes; and (5) cervical adenopathy. Complications of KD include coronary artery aneurysms, which may lead to myocardial infarction, chronic coronary insufficiency, or death. We describe a series of 83 patients with KD in whom 43 (52%) of 83 developed cervical adenopathy during their acute illness. Eighteen (42%) of these 43 patients were initially misdiagnosed as having cervical adenitis and were treated with antibiotics. The otolaryngologist may see these patients in referral and should consider the diagnosis of KD in patients with cervical adenopathy, prolonged fever, signs of mucosal inflammation, or rash. Early diagnosis and intravenous treatment with high-dose gamma-globulin is effective in reducing the prevalence of coronary artery abnormalities.     

Ectopic thymus presenting as a subglottic mass: diagnostic and management dilemmas

The commonest subglottic mass in infants is a congenital haemangioma, which is usually managed conservatively without a histological diagnosis. Ectopic cervical thymus is rare and usually presents as a cervical mass, with only one case of subglottic ectopic thymus reported to date. Due to its rarity, the diagnosis in most cases relies on surgical excision and histological examination. However, histological diagnosis may not always be easily reached, as is demonstrated in this case report. In this article, an infant with congenital stridor secondary to a subglottic mass is described and the clinical and diagnostic difficulties in its management are discussed.     

Management strategy of mycobacterial cervical lymphadenitis

The objectives of this study were to investigate the typical clinical presentation, diagnosis and treatment of mycobacterial cervical lymphadenitis (MCL). Medical records of 87 patients who were treated for MCL were retrospectively reviewed. Definitive diagnosis of MCL was made when a neck mass persisted for several weeks or months and one or more of the following was obtained: (1) positive mycobacterial cultures from biopsy material; (2) Positive mycobacterial staining of biopsy material; (3) Granulomatous inflammation and caseating necrosis on histopathological examination of biopsy material. Clinical findings were reviewed prior to treatment. The treatment included standard antituberculous medications followed by surgery in which either total excision or selective nodal dissection of the cervical lump was made. Follow-up results are presented. The chief complaint was a cervical mass that was localized mostly to the posterior cervical or submandibular regions. A fistula formation was encountered in 11.5 per cent. All patients recovered from MCL by combined antituberculous drug and surgical treatments. Clinical presentation of the disease and histopathological assessment are important in the diagnosis of MCL as well as in the differential diagnosis of tuberculous and nontuberculous MCL. Utilizing the combined medical and surgical treatment options, both tuberculous and non-tuberculous cervical adenitis can be treated successfully.     

闭合性颈段气管断离伤的诊断及治疗（附5例报告）

目的进一步提高闭合性颈段气管断离伤的诊断及治疗水平。方法回顾性分析5例闭合性气管断离伤的临床资料，其中3例气管2～3环全断离，2例3～4环全断离；1例合并腹膜后血肿，1例合并双侧气胸。全部病例均作低位气管切开，气管退缩至胸腔者游离松解后上提，气管断端吻合。外科处理腹膜后血肿及气胸。结果全部病例气管断端吻合口愈合，2周后拔除气管套管，呼吸、进食正常。2例声音嘶哑，为左声带固定。结论及早诊断、正确处理是抢救闭合性颈段气管全断离伤的关键。     

Dysphagia 27 years after cervical disc arthroplasty

IntroductionDysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation.Care reportA 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms.DiscussionProsthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.     

Tuberculous retropharyngeal abscess with posterior mediastinal extension and quadriplegia in a 13-year-old Nigerian girl

Neglected cervical tuberculosis (TB) in a 13-year-old girl with extensive prevertebral abscess extending from C1-T4 is presented along with the plain radiographic and computed tomographic findings. The tuberculous infection progresses to cause multiple vertebral destructions and quadriplegia due to delayed diagnosis. The diagnosis was made on radiological imaging and confirmed by positive mycobacterium bacilli culture. This case illustrated that delayed diagnosis and treatment of cervical spinal TB can be catastrophic. Hence, we suggest consideration of TB of the spine in the differential diagnosis of any patient presenting with neck/back pain since it can be successfully treated, especially if detected early. We advocated the use of easy operating and low-cost examinations such as tuberculin skin test, abscess puncture (not cut) and pus cultivation especially in developing countries for early diagnosis TB infection.     

Meningeal marginal zone B-cell lymphoma: The meningioma trap

ObjectiveTo report a case of marginal zone MALT lymphoma of the temporal dura mater, initially mistaken for temporal meningioma.Case reportA 60-year-old immunocompetent woman, followed for more than 10 years for temporal meningioma causing vertigo and mixed hearing loss, presented with cervical lymphadenopathy, revealing marked progression of an intracranial lesion, leading to a diagnosis of marginal zone MALT lymphoma based on histological examination of a cervical lymph node. Treatment with 6 cycles of rituximab and bendamustine allowed complete remission of cervical lymph node and intracranial lesions, confirming the diagnosis of temporal dural mater lymphoma.ConclusionPrimary dural lymphoma must be part of the differential diagnosis of meningioma. Long-term follow-up allows correction of the diagnosis.     

Contemporary management of cervical tuberculosis.

Although excisional biopsy has traditionally been required to diagnose cervical tuberculosis (TB), fine needle aspiration biopsy (FNAB) has also been found to be useful. The presentation and management of 47 patients diagnosed with cervical TB between 1984 and 1988 were retrospectively reviewed. Chest x-rays were normal in 58% of the patients, and purified protein derivative (PPD) skin testing was positive in 96%. When FNAB was used, TB could be suspected in 83% of cases and definitively established in 62%. Open biopsy correctly diagnosed cervical TB in all masses excised. Medical therapy alone resulted in resolution of disease in 94% of patients diagnosed by FNAB, and subsequent excisional biopsy was necessary in only one patient. The results suggest that FNAB is a useful initial procedure in the diagnosis of cervical TB. Excisional biopsy should be reserved for cases where no diagnosis by FNAB can be made, or for persistent cervical disease despite full-course antituberculous chemotherapy.     

甲状腺乳头状癌合并颈部局灶型Castleman病1例

摘要：目的探讨甲状腺乳头状癌(PTC)合并颈部局灶型Castleman病 (UCD)的临床诊治经验。方法回顾性分析1 例PTC合并颈部UCD的临床病例资料，并检索国内外文献。该患者术前行甲状腺结节穿刺细胞学检查(FNA)倾向PTC，合并右颈侧区淋巴结肿大，行甲状腺右侧腺叶合并峡部切除及右颈II、III、IV、VI区淋巴结清扫术。结果术后切口愈合良好，无声音嘶哑及低钙症状，术后 4 d治愈出院。术后随访6个月无复发。术后病理证实颈侧区肿大淋巴结为UCD。结论PTC合并UCD极为罕见，且UCD的术前诊断较为困难，但手术切除多可治愈；PTC合并颈部淋巴结肿大者，临床医生不仅需考虑甲状腺癌转移淋巴结可能，还需警惕UCD的存在。     

Clinical study of 28 cases of cervical lymph node metastasis from an unknown primary carcinoma

From 1989 to 2005, 28 patients--20 men and 8 women--with cervical lymph node metastasis from an unknown primary carcinoma were treated and studied retrospectively. In histological diagnosis, open biopsy was conducted in 11 patients and non-open biopsy (FNA or frozen section diagnosis during surgery) in 17. Blind biopsy under general anesthesia was conducted in 10 patients, showing one primary tumor in the nasopharynx. Tonsillectomy for diagnosis was not done. In region of maximum-size lymph node metastasis, the upper cervical region accounted for 22 cases (79%). The N stage of cervical lymph nodes was as follows: N2a in 4, N2b in 14, N2c in 3, and N3 in 7. The histopathological diagnosis of cervical lymph node was as follows: squamous cell carcinoma in 21, adenocarcinoma in 3, mucoepidermoid carcinoma in 2, and others in 2. Therapy was as follows: only neck dissection in 7, neck dissection with postoperative radiation therapy in 13, and irradiation and chemotherapy in 8. All patients treated with irradiation and chemotherapy had been judged to be inoperable. Seven patients were found to have a subsequent primary tumor. Primary tumor sites were as follows: tonsils in 3 and upper gingiva, base of tongue, lung, and nasopharynx in 1 each. FDG-PET was conducted in 7 patients but revealed no primary tumor. Overall 5-year survival in this study was 46%. We should pay particular attention to the tonsils for detecting primary tumors in patients with cervical metastasis from an unknown primary carcinoma.     

颈淋巴结结核临床分析

目的 分析颈淋巴结结核的临床表现及诊治。方法　回顾性分析我院2007～2015年收治100例颈淋巴结结核患者临床资料。结果　纳入患者多以颈部肿块就诊,仅8例伴有低热、盗汗、乏力等全身中毒症状。95例患者经术后病理检查确诊,15例患者术前经细针穿刺确诊。共95例患者接受手术治疗,术后行全身标准抗结核治疗6个月;余 5例患者予以全身标准抗结核治疗,取得满意疗效。手术方式主要有单纯颈淋巴结切除术31例、颈淋巴结清扫术53例和脓肿切开清创术11例,所有患者随访均无复发。结论 颈淋巴结结核的临床表现复杂,细针穿刺活检阳性率不高,术后病理检查有助于进一步明确诊断,外科手术联合术后全身规范抗结核治疗可作为颈淋巴结结核的治疗方法。     

Cervical Pott's disease revealed by retropharyngeal abscesses

INTRODUCTION: Retropharyngeal abscesses are exceptional in adults. The etiologies are numerous, cervical spine tuberculosis is one of them. OBSERVATION: We report two cases of cervical Pott's disease revealed by a retropharyngeal abscess. The clinical presentation was non-specific, dominated by oropharyngeal obstruction. Radiological findings suggested the diagnosis, showing a retropharyngeal collection with vertebral osteolysis. The bacteriological and histological assessment confirmed the diagnosis. The evolution was favorable after treatment by antituberculosis drugs. DISCUSSION: Vertebral tuberculosis is rare. Cervical involvement is exceptional, and retropharyngeal abscesses can be the revealing feature of this condition. Symptoms are not specific. The diagnosis is based on radiological and bacteriological assessment. Treatment with antituberculosis drugs leads to a good outcome.