Carotid body tumor differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Maria Fernanda Villarreal, M.D. [3]

Overview

Carotid body tumor must be differentiated from other diseases that cause neck mass including schwannomas and lymphadenopathy.

Differentiating Carotid Body Tumor from Other Diseases

Differentiating carotid body tumor from other diseases causing neck mass

Neck masses may be classified into subgroups including congenital abnormalities, inflammatory, and malignant lesions.

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Congenital Branchial cleft cyst[3]
  • Age: 1-15 years old
  • Familial occurrence
  • Lateral neck mass
±
  • Solitary
  • Smooth
  • Mobile
  • Well-defined
  • Non-pulsatile
  • Fluctuant
  • A pit at the opening of the cyst
Thyroglossal duct cyst[4][5]
  • Age: 1-10 years old
  • Midline neck mass
Hemangioma[6]
  • Presents with a flat red or purple patch
  • Regress gradually with age
  • Firm
  • Rubbery
  • Well-demarcated
Vascular malformation[7][8]
  • Incidence: 1 in 2000 to 5000 births
  • Gender: No predilection
±
  • Grow proportionally with age
  • MRI
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Lymphatic malformation[9][10]
  • Age: Birth-5 years old
  • Gender: No predilection
+
Laryngocele[11][12][13] +
  • Soft
  • Reducible
  • Increase in size on valsalva
  • Common in glass blowers and trumpet players
Ranula[14][15]
  • Well circumscribed
  • Fluctuant
  • Soft
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Teratoma[16][17]
  • Incidence: 1:4000 births
  • Gender: No predilection
  • Presents as a firm lateral neck mass
  • Firm
  • Non-tender
  • High ALP levels
Dermoid cyst[18][19]
  • Freely mobile
  • Solitary
  • Rubbery
  • Nonpulsatile
  • Noncompressible
  • Ultrasound: Thin walled, unilocular
  • CT with contrast: Well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
Thymic cyst[20]
  • Presents as a soft mass, gradually enlarging, on left side of the neck (usual)
  • Soft
  • Compressible
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis[21]
  • Age: Occurs in all age groups
  • Gender: No predilection
+ -
Chronic sialadenitis[22]
  • Age: Occurs in all age groups
  • Gender: No predilection
  • Presents with an unilateral swelling
  • Recurrent episodes common
+
  • Non-tender
  • Firm
  • Smooth
Reactive viral lymphadenopathy CMV[23]
  • Age: 10-35 years old
  • Gender: No predilection
  • Flu-like illness
  • Non-tender
  • Soft
  • Usually not necessary
EBV[24][25]
  • Age: Mainly adolescents
  • Gender: No predilection
  • Non-tender
  • Firm
  • Usually not necessary
HIV[26]
  • Non-tender mass
  • Usually not necessary
Viral URI[27]
  • Incidence: More in fall & winter
  • Age: Common in elderly and infants
  • Non-tender
  • No specific findings
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Bacterial lymphadenopathy Tularemia[28][29]
  • Age: Affects all age groups
  • Gender: No predilection
+
  • No specific findings
Brucellosis[30]
  • Flu-like illness
+
  • No specific findings
Cat-scratch disease[31][32]
  • More common in the Southern of U.S among children and young adults
+
Actinomycosis[33][34]
  • No predilection in race, age
  • [[Male] to female ratio : 1.5 to 3:1
  • Tender at the beginning
  • Painless
  • Fluctuant
  • Non-tender at late stage
Mycobacterial infections[24][35][36]
Streptococcal infection[23][37] + +
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Parasitic lymphadenopathy Toxoplasma gondii[38][39]
  • 6 years old and older adults are more affected in U.S.
  • Seen in hot climates
+
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
Sarcoidosis[40][21]
  • More common in African American women aged 20-40 years
Sjögren syndrome[41]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
+
Castleman disease (angiofollicular lymphoproliferative disease)[42][43]
  • Mean age: 30-40 years
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Kikuchi disease (histiocytic necrotizing lymphadenitis)[44]
  • High prevalence in Japan
  • More common in young adults < 30 years old
+
Kimura disease[45]
  • More common in Asian males
Rosai-Dorfman disease[46][47]
Kawasaki disease[48][49]
  • More common in children < 5 years old
  • Highest incidence in Japan
  • Most leading cause of acquired heart disease in U.S
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Pleomorphic adenoma[50][51] +
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
Warthin's tumor[52][53]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
+
Oncocytoma

[54]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
-
Monomorphic adenoma [55][56][57]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
± ±
  • Normal
-
Mucoepidermoid carcinoma

[58]

  • Age: Mean age of 59
  • Female predilection
± ±
  • Cystic and solid component with variable appearance on CT and MRI
  • Association with CMV
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Adenoid cystic carcinoma [59]
  • Age: 40s-60s
  • Gender: Female predominance
± ±
Adenocarcinoma

[60]

  • Age: young age predilection
Salivary duct cancer[61][62][63]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
± ±
  • Painless
  • Hard
  • Non-compressible mass
Squamous cell carcinoma[64][65]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
+
  • Tumor dimension can be delineated using both CT and MRI
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[66][67][68]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common in Japan, India, Iran
+
Parathyroid cancer[69][70][71]
  • Incidence: Rare
  • Mean age : 44-54 years old
  • Gender: Female predilection
+ +
Carotid body tumors[72][73][74][75]
  • Age: 26-55 years
  • Male predominance
+
Paraganglioma[76][77][78]
  • Age 50-70 years
  • More in females
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma[79][80][81]
  • Rare tumor
  • Incidence: 1-10%
+ ±
  • Multiple
  • Slow growing nodules on the skin
  • May be normal
  • Encapsulated neural tissue growth
Lymphoma [82][83][84][85][86][87]
  • Age: Predilection for older age
  • Mean age: 55
±
  • On complete node analysis four patterns are described:
    • Nodular/follicular
    • Diffuse pattern
    • Transition from a nodular to a diffuse pattern in adjacent nodes
    • Transition from a lower to a higher grade of involvement within a single node
Liposarcoma [88][89][90][91]
  • Rare tumor
  • Age: Relatively in older age
  • Gender: No gender predilection
  • Mobile mass
  • Few symptoms until they grow enough to compress the surrounding structures
  • Symptoms of neural deficit, pain, tingling, or skin changes
±
  • Intact skin and normal color
  • Normal
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [92][93][94]
  • One or multiple soft, painless skin nodules
  • May causes pain or compressive symptoms
±
  • Normal
  • Normal
  • Diagnoses is usually clinical
  • Tissue biopsy may show:
    • Bundle of well-demarcated lipocytes
    • Single nuclei aligned to the side
    • Intra-cytoplasimic fat granules
Glomus vagale, glomus jugulare tumors[95][96][97][98][99][100]
  • Rare tumor
  • Painless slowly enlarging mass in the neck
±
  • Normal
Metastatic head and neck cancer[101][102] ±
  • Vary depending on the underlying cancer
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer[103][104] Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
± ±

human papillomavirus (HPV) infection

Arteriovenous fistula

[105][106]

  • Depends on the risk factors
  • Varies depending on the etiology
Thyroid nodule/ Goiter

[107][108][109][110]

  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
± ±
  • Painless
  • Non-tender
  • Asymmetrical neck mass in front of neck
  • With smooth overlying skin
  • Nodular surface
  • Depending on the type:
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

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