Neck masses differential diagnosis: Difference between revisions

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! align="center" style="background:#DCDCDC;" |[[HIV]]<ref name="pmid20459560">{{cite journal |vauthors=Moonim MT, Alarcon L, Freeman J, Mahadeva U, van der Walt JD, Lucas SB |title=Identifying HIV infection in diagnostic histopathology tissue samples--the role of HIV-1 p24 immunohistochemistry in identifying clinically unsuspected HIV infection: a 3-year analysis |journal=Histopathology |volume=56 |issue=4 |pages=530–41 |date=March 2010 |pmid=20459560 |doi=10.1111/j.1365-2559.2010.03513.x |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[HIV]]<ref name="pmid20459560">{{cite journal |vauthors=Moonim MT, Alarcon L, Freeman J, Mahadeva U, van der Walt JD, Lucas SB |title=Identifying HIV infection in diagnostic histopathology tissue samples--the role of HIV-1 p24 immunohistochemistry in identifying clinically unsuspected HIV infection: a 3-year analysis |journal=Histopathology |volume=56 |issue=4 |pages=530–41 |date=March 2010 |pmid=20459560 |doi=10.1111/j.1365-2559.2010.03513.x |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Benign]]
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| align="center" style="background:#F5F5F5;" |[[Prevalence]]: 1.1 million in U.S
* [[Benign]]
Sex: [[Males]]>[[females]]
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*[[Prevalence]]: 1.1 million in U.S
*Sex: [[Males]]>[[females]]
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*[[Flu]]-like illness
*[[Flu]]-like illness
*[[Rash]]
*[[Rash]]
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| align="center" style="background:#F5F5F5;" |Non-tender
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*Non-tender mass
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*Generalized [[lymphadenopathy]]
*Generalized [[lymphadenopathy]]
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*[[Leukopenia]]
*[[Leukopenia]]
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
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*Elevated [[CRP]]
*Elevated [[CRP]]
*Elevated [[ESR]]
*Elevated [[ESR]]
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* Lymphoid [[hyperplasia]]
* Lymphoid [[hyperplasia]]
| align="center" style="background:#F5F5F5;" |Usually not necessary
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| align="center" style="background:#F5F5F5;" |[[Western blot]] & P24 antigen assay
*Usually not necessary
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*[[Western blot]] & P24 antigen assay
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
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! align="center" style="background:#DCDCDC;" |Viral [[Upper respiratory tract infection|URI]]<ref name="pmid30422556">{{cite journal |vauthors=Thomas M, Bomar PA |title= |journal= |volume= |issue= |pages= |date= |pmid=30422556 |doi= |url=}}</ref>
! align="center" style="background:#DCDCDC;" |Viral [[Upper respiratory tract infection|URI]]<ref name="pmid30422556">{{cite journal |vauthors=Thomas M, Bomar PA |title= |journal= |volume= |issue= |pages= |date= |pmid=30422556 |doi= |url=}}</ref>
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*[[Benign]]
*[[Benign]]
| align="center" style="background:#F5F5F5;" |[[Incidence]]: More in fall & winter
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[[Age]]: Common in elderly and infants
*[[Incidence]]: More in fall & winter
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*[[Age]]: Common in elderly and infants
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*[[Sore throat]]
*[[Sore throat]]
*[[Cough]]
*[[Cough]]
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*Non-tender
*Non-tender
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*Mild cervical [[lymphadenopathy]]
*Mild cervical [[lymphadenopathy]]
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*[[Lymphocytosis]]
*[[Lymphocytosis]]
*[[ESR]] & [[C-reactive protein (CRP)|C-reactive protein]]
*Elevated [[ESR]] & [[C-reactive protein (CRP)|C-reactive protein]]
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* [[Inflammation|Inflammatory]] infiltrate
* [[Inflammation|Inflammatory]] infiltrate
 
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*
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*No specific findings
*No specific findings
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
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! rowspan="6" align="center" style="background:#DCDCDC;" |Bacterial lymphadenopathy
! rowspan="6" align="center" style="background:#DCDCDC;" |Bacterial lymphadenopathy
! align="center" style="background:#DCDCDC;" |[[Tularemia]]<ref name="pmid10618283">{{cite journal |vauthors=Grunow R, Splettstoesser W, McDonald S, Otterbein C, O'Brien T, Morgan C, Aldrich J, Hofer E, Finke EJ, Meyer H |title=Detection of Francisella tularensis in biological specimens using a capture enzyme-linked immunosorbent assay, an immunochromatographic handheld assay, and a PCR |journal=Clin. Diagn. Lab. Immunol. |volume=7 |issue=1 |pages=86–90 |date=January 2000 |pmid=10618283 |pmc=95828 |doi= |url=}}</ref><ref name="Koç2012">{{cite journal|last1=Koç|first1=Sema|title=Clinical and laboratory findings of tularemia: a retrospective analysis|journal=The Turkish Journal of Ear Nose and Throat|year=2012|pages=26–31|issn=13007475|doi=10.5606/kbbihtisas.2012.005}}</ref>
! align="center" style="background:#DCDCDC;" |[[Tularemia]]<ref name="pmid10618283">{{cite journal |vauthors=Grunow R, Splettstoesser W, McDonald S, Otterbein C, O'Brien T, Morgan C, Aldrich J, Hofer E, Finke EJ, Meyer H |title=Detection of Francisella tularensis in biological specimens using a capture enzyme-linked immunosorbent assay, an immunochromatographic handheld assay, and a PCR |journal=Clin. Diagn. Lab. Immunol. |volume=7 |issue=1 |pages=86–90 |date=January 2000 |pmid=10618283 |pmc=95828 |doi= |url=}}</ref><ref name="Koç2012">{{cite journal|last1=Koç|first1=Sema|title=Clinical and laboratory findings of tularemia: a retrospective analysis|journal=The Turkish Journal of Ear Nose and Throat|year=2012|pages=26–31|issn=13007475|doi=10.5606/kbbihtisas.2012.005}}</ref>
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*[[Benign]]
*[[Benign]]
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*[[Age]]: Affects all age groups
*[[Age]]: Affects all age groups
*Sex: No predilection
*Sex: No predilection
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*[[Fever]]
*[[Fever]]
*[[Chills]]
*[[Chills]]
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*[[Tenderness|Tender]]
*[[Tenderness|Tender]]
*Edematous
*Edematous
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*Regional [[lymphadenopathy]]
*Regional [[lymphadenopathy]]
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*[[ESR]]
*Elevated [[ESR]]
*[[C-reactive protein (CRP)|C-reactive protein]]
*Elevated [[C-reactive protein (CRP)|C-reactive protein]]
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*[[Caseating]] [[granuloma]] +/- [[multinucleated giant cells]]
*[[Caseating]] [[granuloma]] +/- [[multinucleated giant cells]]
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*No specific findings
*No specific findings
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*[[PCR]] & [[serology]]
*[[PCR]] & [[serology]]
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|-
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! align="center" style="background:#DCDCDC;" |[[Brucellosis]]<ref name="pmid28766326">{{cite journal |vauthors=Golshani M, Buozari S |title=A review of Brucellosis in Iran: Epidemiology, Risk Factors, Diagnosis, Control, and Prevention |journal=Iran. Biomed. J. |volume=21 |issue=6 |pages=349–59 |date=November 2017 |pmid=28766326 |pmc=5572431 |doi= |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Brucellosis]]<ref name="pmid28766326">{{cite journal |vauthors=Golshani M, Buozari S |title=A review of Brucellosis in Iran: Epidemiology, Risk Factors, Diagnosis, Control, and Prevention |journal=Iran. Biomed. J. |volume=21 |issue=6 |pages=349–59 |date=November 2017 |pmid=28766326 |pmc=5572431 |doi= |url=}}</ref>
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*[[Benign]]
*[[Benign]]
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*[[Incidence]]: 100-200 cases anually in USA
*[[Incidence]]: 100-200 cases anually in USA
*Sex: [[Males]]>[[females]]
*Sex: [[Males]]>[[females]]
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*[[Flu]]-like illness
*[[Flu]]-like illness
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*[[Tenderness|Tender]]
*[[Tenderness|Tender]]
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*Cervical [[lymphadenopathy]]
*Cervical [[lymphadenopathy]]
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* [[ESR]]
*Elevated [[ESR]]
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*Non-[[caseating]] [[granuloma]]+ [[giant cells]], epitheloid cells
*Non-[[caseating]] [[granuloma]] + [[giant cells]], epitheloid cells
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*No specific findings
*No specific findings
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* [[Serology]]
* [[Serology]]
| align="center" style="background:#F5F5F5;" |−
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! align="center" style="background:#DCDCDC;" |[[Cat-scratch disease]]<ref name="urlCat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC">{{cite web |url=https://wwwnc.cdc.gov/eid/article/22/10/16-0115_article |title=Cat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC |format= |work= |accessdate=}}</ref><ref name="HansmannDeMartino2005">{{cite journal|last1=Hansmann|first1=Y.|last2=DeMartino|first2=S.|last3=Piemont|first3=Y.|last4=Meyer|first4=N.|last5=Mariet|first5=P.|last6=Heller|first6=R.|last7=Christmann|first7=D.|last8=Jaulhac|first8=B.|title=Diagnosis of Cat Scratch Disease with Detection of Bartonella henselae by PCR: a Study of Patients with Lymph Node Enlargement|journal=Journal of Clinical Microbiology|volume=43|issue=8|year=2005|pages=3800–3806|issn=0095-1137|doi=10.1128/JCM.43.8.3800-3806.2005}}</ref>
! align="center" style="background:#DCDCDC;" |[[Cat-scratch disease]]<ref name="urlCat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC">{{cite web |url=https://wwwnc.cdc.gov/eid/article/22/10/16-0115_article |title=Cat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC |format= |work= |accessdate=}}</ref><ref name="HansmannDeMartino2005">{{cite journal|last1=Hansmann|first1=Y.|last2=DeMartino|first2=S.|last3=Piemont|first3=Y.|last4=Meyer|first4=N.|last5=Mariet|first5=P.|last6=Heller|first6=R.|last7=Christmann|first7=D.|last8=Jaulhac|first8=B.|title=Diagnosis of Cat Scratch Disease with Detection of Bartonella henselae by PCR: a Study of Patients with Lymph Node Enlargement|journal=Journal of Clinical Microbiology|volume=43|issue=8|year=2005|pages=3800–3806|issn=0095-1137|doi=10.1128/JCM.43.8.3800-3806.2005}}</ref>
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* [[Benign]]
* [[Benign]]
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* More common in the Southern of U.S among [[children]] and young adults.
* More common in the Southern of U.S among [[children]] and young adults
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* Cat exposure
* Cat exposure
* [[Fever]]
* [[Fever]]
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* Tender [[cervical]] [[Lymph node|nodes]]
* Tender [[cervical]] [[Lymph node|nodes]]
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* [[Vesicular]]
* [[Vesicular]]
* [[Erythema]]   
* [[Erythema]]   
* [[Papule]] at site of inoculation
* [[Papule]] at site of inoculation
* Lymphadenopathy
* [[Lymphadenopathy]]
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* [[ESR]]
* Elevated [[ESR]]
[[Serology]]:  
* [[Serology]]: Positive [[antibody]] to [[Bartonella]] Henselae
* + [[antibody]] to [[Bartonella]] Henselae
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* Satellite [[micro]]-[[abscess]] with [[granuloma]]
* Satellite [[micro]]-[[abscess]] with [[granuloma]]
| align="center" style="background:#F5F5F5;" | −
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* [[Bacillary angiomatosis|Bacillary]] [[Angiomatosis]]
* [[Bacillary angiomatosis]]
* [[Bacillary angiomatosis|Bacillary]] peliosis
* Bacillary peliosis
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! align="center" style="background:#DCDCDC;" |[[Actinomycosis]]<ref name="pmid25045274">{{cite journal |vauthors=Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T |title=Actinomycosis: etiology, clinical features, diagnosis, treatment, and management |journal=Infect Drug Resist |volume=7 |issue= |pages=183–97 |date=2014 |pmid=25045274 |pmc=4094581 |doi=10.2147/IDR.S39601 |url=}}</ref><ref name="pmid27311002">{{cite journal |vauthors=Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L |title=Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations |journal=Medicine (Baltimore) |volume=95 |issue=24 |pages=e3923 |date=June 2016 |pmid=27311002 |pmc=4998488 |doi=10.1097/MD.0000000000003923 |url=}}</ref>  
! align="center" style="background:#DCDCDC;" |[[Actinomycosis]]<ref name="pmid25045274">{{cite journal |vauthors=Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T |title=Actinomycosis: etiology, clinical features, diagnosis, treatment, and management |journal=Infect Drug Resist |volume=7 |issue= |pages=183–97 |date=2014 |pmid=25045274 |pmc=4094581 |doi=10.2147/IDR.S39601 |url=}}</ref><ref name="pmid27311002">{{cite journal |vauthors=Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L |title=Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations |journal=Medicine (Baltimore) |volume=95 |issue=24 |pages=e3923 |date=June 2016 |pmid=27311002 |pmc=4998488 |doi=10.1097/MD.0000000000003923 |url=}}</ref>  
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* [[Benign]]
* [[Benign]]
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* No predilection in [[race]], [[age]]
* No predilection in [[race]], [[age]]
* [[Male] to [[female]] ratio : 1.5 to 3:1
* [[Male] to [[female]] ratio : 1.5 to 3:1
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* History of [[dental]] [[procedure]] or [[trauma]]
* History of [[dental]] [[procedure]] or [[trauma]]
* Poor [[oral]] [[hygiene]]
* Poor [[oral]] [[hygiene]]
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* [[Tenderness (medicine)|Tender]] at the beginning   
* [[Tenderness (medicine)|Tender]] at the beginning   
* Painless
* Painless
* Fluctuant
* Fluctuant
* Non-tender at late stage
* Non-tender at late stage
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* Red or blue [[Rash|skin rash]]
* Red or blue [[Rash|skin rash]]
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* [[ESR]]
*Elevated [[ESR]]
* [[CRP]]
*Elevated [[CRP]]
 
* [[Gram positive bacteria|Gram positive filamentous rods]]
* [[Gram positive bacteria|Gram positive filamentous rods]]
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* [[Sulfur|Sulfur granules]]
* [[Sulfur|Sulfur granules]]
* [[Filamentous]] [[organism]]
* [[Filamentous]] [[organism]]
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* [[Histological]] [[examination]]
* [[Histological]] [[examination]]
* [[Bacterial]] [[culture]] of the [[abscess]]
* [[Bacterial]] [[culture]] of the [[abscess]]
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* [[Mandible]] [[osteomyelitis]]
* [[Mandible]] [[osteomyelitis]]
|-
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! align="center" style="background:#DCDCDC;" |[[Mycobacterial infection|Mycobacterial infections]]<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid9241478">{{cite journal |vauthors=Suskind DL, Handler SD, Tom LW, Potsic WP, Wetmore RF |title=Nontuberculous mycobacterial cervical adenitis |journal=Clin Pediatr (Phila) |volume=36 |issue=7 |pages=403–9 |date=July 1997 |pmid=9241478 |doi=10.1177/000992289703600705 |url=}}</ref><ref name="pmid12614730">{{cite journal |vauthors=Drobniewski FA, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141–7 |date=March 2003 |pmid=12614730 |doi= |url=}}</ref>  
! align="center" style="background:#DCDCDC;" |[[Mycobacterial infection|Mycobacterial infections]]<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid9241478">{{cite journal |vauthors=Suskind DL, Handler SD, Tom LW, Potsic WP, Wetmore RF |title=Nontuberculous mycobacterial cervical adenitis |journal=Clin Pediatr (Phila) |volume=36 |issue=7 |pages=403–9 |date=July 1997 |pmid=9241478 |doi=10.1177/000992289703600705 |url=}}</ref><ref name="pmid12614730">{{cite journal |vauthors=Drobniewski FA, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141–7 |date=March 2003 |pmid=12614730 |doi= |url=}}</ref>  
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* [[Benign]]
* [[Benign]]
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* More common in adults and [[children]] in [[endemic]] continent such as Africa
* More common in adults and [[children]] in [[endemic]] continent such as Africa
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| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Matted [[cervical]]  [[Lymph node|nodes]]
* Matted [[cervical]]  [[Lymph node|nodes]]
* Firm
* Firm
* Non-tender
* Non-tender
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Lymphadenopathy]]
*[[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[PPD-tuberculin skin test|PPD]]: +
* Positive [[PPD-tuberculin skin test|PPD]]
[[Sputum]] [[Smear test|smear]]:
* Presence of [[Acid fast|acid fast bacilli]] on [[Sputum]] [[Smear test|smear]]
* Presence of [[Acid fast|acid fast bacilli]]
| align="left" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Chronic [[necrotizing]] [[caseating]] [[Calcification|calcified]] [[granuloma]]
* Chronic [[necrotizing]] [[caseating]] [[Calcification|calcified]] [[granuloma]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Ultrasound|Neck Ultrasound]]: Multiple [[lymph nodes]]
* [[Ultrasound|Neck Ultrasound]]: Multiple [[lymph nodes]]
* Fusion tendency
* Fusion tendency
* Internal echoes
* Internal echoes
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Mycobacteria|Culture for mycobacteria]]
* [[Mycobacteria|Culture for mycobacteria]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
|-
|-
! align="center" style="background:#DCDCDC;" |[[Streptococcal infection]]<ref name="pmid247536382">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid19450346">{{cite journal |vauthors=Kenealy T |title=Sore throat |journal=BMJ Clin Evid |volume=2007 |issue= |pages= |date=November 2007 |pmid=19450346 |pmc=2943825 |doi= |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Streptococcal infection]]<ref name="pmid247536382">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid19450346">{{cite journal |vauthors=Kenealy T |title=Sore throat |journal=BMJ Clin Evid |volume=2007 |issue= |pages= |date=November 2007 |pmid=19450346 |pmc=2943825 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in [[children]] and [[Adolescent|adolescents]]
* More common in [[children]] and [[Adolescent|adolescents]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Fever]]
* [[Fever]]
* Absence of [[cough]]
* Absence of [[cough]]
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| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Tender [[anterior]] cervical nodes
* Tender [[anterior]] cervical [[nodes]]
* [[Tonsillar Disease|Tonsillar]] exudates
* [[Tonsillar Disease|Tonsillar]] exudates
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Lymphadenopathy]]
*[[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Rapid [[antigen]] detection [[Test|tests]]: ±
* Rapid [[antigen]] detection [[Test|tests]]: ±
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Follicular [[hyperplasia]]
* Follicular [[hyperplasia]]
* [[Infiltration (medical)|Infiltration]] of [[Polymorphonuclear cells|polymorphonuclear]] [[cells]]
* [[Infiltration (medical)|Infiltration]] of [[Polymorphonuclear cells|polymorphonuclear cells]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Throat culture]]
* [[Throat culture]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Acute rheumatic fever]]
* [[Acute rheumatic fever]]
* [[Glomerulonephritis|Post-streptoccocal glomerulonephritis]]
* [[Glomerulonephritis|Post-streptoccocal glomerulonephritis]]
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! align="center" style="background:#DCDCDC;" |[[Parasitic|Parasitic lymphadenopathy]]
! align="center" style="background:#DCDCDC;" |[[Parasitic|Parasitic lymphadenopathy]]
! align="center" style="background:#DCDCDC;" |[[Toxoplasma gondii]]<ref name="pmid20512900">{{cite journal |vauthors=Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK |title=Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature |journal=J Magn Reson Imaging |volume=31 |issue=6 |pages=1469–72 |date=June 2010 |pmid=20512900 |pmc=2908244 |doi=10.1002/jmri.22192 |url=}}</ref><ref name="urlCDC - Toxoplasmosis - Diagnosis">{{cite web |url=+https://www.cdc.gov/parasites/toxoplasmosis/diagnosis.html |title=CDC - Toxoplasmosis - Diagnosis |format= |work= |accessdate=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Toxoplasma gondii]]<ref name="pmid20512900">{{cite journal |vauthors=Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK |title=Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature |journal=J Magn Reson Imaging |volume=31 |issue=6 |pages=1469–72 |date=June 2010 |pmid=20512900 |pmc=2908244 |doi=10.1002/jmri.22192 |url=}}</ref><ref name="urlCDC - Toxoplasmosis - Diagnosis">{{cite web |url=+https://www.cdc.gov/parasites/toxoplasmosis/diagnosis.html |title=CDC - Toxoplasmosis - Diagnosis |format= |work= |accessdate=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* 6 years old and older adults are more affected in U.S.
* 6 years old and older adults are more affected in U.S.
* Seen in hot climates
* Seen in hot climates
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Cat-scratch|Cats]] or birds [[feces]] exposure
* [[Cat-scratch|Cats]] or birds [[feces]] exposure
* Drinking [[unpasteurized milk]]
* Drinking [[unpasteurized milk]]
* Undercooked food
* Undercooked food
* [[Organ (anatomy)|Organ]] [[Organ transplant|transplant]] recipients
* [[Organ transplant]] recipients
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Bilateral
* Bilateral
* Non-tender
* Non-tender
* Symmetrical
* Symmetrical
* Non-fluctuant
* Non-fluctuant
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Lymphadenopathy]]
*[[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Serology]] :  
* [[Serology]]: Positive [[IgG]] and [[IgM]] [[antibodies]]
Positive [[IgG]] and [[IgM]] [[antibodies]]
| align="left" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Follicular [[hyperplasia]]
* Follicular [[hyperplasia]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[MRI]]: Multiple rings enhanced [[lesions]]
* [[MRI]]: Multiple rings enhanced [[lesions]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Serology]]
* [[Serology]]
* [[Immunofluorescence]]
* [[Immunofluorescence]]
[[MRI]]
* [[MRI]]
* [[CT scan]]
* [[CT scan]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Sarcoidosis]]<ref name="urlSarcoidosis | National Heart, Lung, and Blood Institute (NHLBI)">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/sarcoidosis |title=Sarcoidosis &#124; National Heart, Lung, and Blood Institute (NHLBI) |format= |work= |accessdate=}}</ref><ref name="pmid28059621">{{cite journal |vauthors=Abdel Razek AAK, Mukherji S |title=Imaging of sialadenitis |journal=Neuroradiol J |volume=30 |issue=3 |pages=205–215 |date=June 2017 |pmid=28059621 |pmc=5480791 |doi=10.1177/1971400916682752 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Sarcoidosis]]<ref name="urlSarcoidosis | National Heart, Lung, and Blood Institute (NHLBI)">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/sarcoidosis |title=Sarcoidosis &#124; National Heart, Lung, and Blood Institute (NHLBI) |format= |work= |accessdate=}}</ref><ref name="pmid28059621">{{cite journal |vauthors=Abdel Razek AAK, Mukherji S |title=Imaging of sialadenitis |journal=Neuroradiol J |volume=30 |issue=3 |pages=205–215 |date=June 2017 |pmid=28059621 |pmc=5480791 |doi=10.1177/1971400916682752 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in African American women aged 20 - 40 years
* More common in African American women aged 20-40 years
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Family]] history of [[sarcoidosis]]
* [[Family]] history of [[sarcoidosis]]
* [[Fatigue]]
* [[Fatigue]]
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| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Swelling|Swollen]]
* [[Swelling|Swollen]]
* Non-tender [[parotid glands]]
* Non-tender [[parotid glands]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Erythema nodosum]]
* [[Erythema nodosum]]
* [[Lupus]] pernios
* [[Lupus]] pernios
* Bilateral [[lymphadenopathy]]
* Bilateral [[lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR]]
*Elevated [[ESR]]
* [[Angiotensin-converting enzyme|ACE]]
*Elevated [[Angiotensin-converting enzyme|ACE]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Necrotizing|Non-necrotizing]] [[epithelioid]] [[granuloma]]
* [[Necrotizing|Non-necrotizing]] [[epithelioid]] [[granuloma]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[CXR]]: B/L [[hilar]] [[adenopathy]]
* [[CXR]]: B/L [[hilar]] [[adenopathy]]
* [[MRI]]: B/L multiples enlarged [[cervical lymph nodes]]
* [[MRI]]: B/L multiples enlarged [[cervical lymph nodes]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Heerfordt's syndrome: [[uveitis]], [[facial nerve paralysis]], [[parotitis]]
* Heerfordt's syndrome: [[uveitis]], [[facial nerve paralysis]], [[parotitis]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Sjögren's syndrome|Sjögren syndrome]]<ref name="pmid24566651">{{cite journal |vauthors=Mavragani CP, Moutsopoulos HM |title=Sjögren syndrome |journal=CMAJ |volume=186 |issue=15 |pages=E579–86 |date=October 2014 |pmid=24566651 |pmc=4203623 |doi=10.1503/cmaj.122037 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Sjögren's syndrome|Sjögren syndrome]]<ref name="pmid24566651">{{cite journal |vauthors=Mavragani CP, Moutsopoulos HM |title=Sjögren syndrome |journal=CMAJ |volume=186 |issue=15 |pages=E579–86 |date=October 2014 |pmid=24566651 |pmc=4203623 |doi=10.1503/cmaj.122037 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Female]] to [[male]] ratio: 9 to 1
* [[Female]] to [[male]] ratio: 9 to 1
* May happen at any [[age]]
* May happen at any [[age]]
* Mean age: 40-50
* Mean age: 40-50
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* History of [[RA]], [[SLE]], and [[Non-Hodgkin lymphoma|non-hodgkin B-cell lymphoma]]
* History of [[RA]], [[SLE]], and [[Non-Hodgkin lymphoma|non-hodgkin B-cell lymphoma]]
* Dry [[mouth]], dry [[eyes]]
* Dry [[mouth]], dry [[eyes]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Firm,
* Firm mass
* B/L enlarged [[parotid glands]]
* B/L enlarged [[parotid glands]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Pruritis]]
* [[Pruritis]]
* [[Rashes]]
* [[Rashes]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR|↑ ESR]]
*Elevated [[ESR]]
* Anti-SSA/Ro: +
* Anti-SSA/Ro: +
* Anti-SSB/La: +
* Anti-SSB/La: +
* [[Cytopenia]]
* [[Cytopenia]]
* Wetting <5 mm on [[Schirmer's test]]
* Wetting <5 mm on [[Schirmer's test]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Hyperactivity]] of [[B]] [[cells]] and [[lymphocytes]] which lead to [[Infiltration (medical)|infiltration]] of the [[exocrine glands]]
* [[Hyperactivity]] of [[B-cells]] and [[lymphocytes]] which lead to [[Infiltration (medical)|infiltration]] of the [[exocrine glands]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Ultrasound|US]]: Hypoechoic and inhomogeneous [[salivary glands]]
* [[Ultrasound|US]]: Hypoechoic and inhomogeneous [[salivary glands]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Castleman's disease|Castleman disease]] ([[Angiofollicular lymph node hyperplasia|angiofollicular lymphoproliferative disease]])<ref name="pmid22791417">{{cite journal |vauthors=Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM |title=The clinical spectrum of Castleman's disease |journal=Am. J. Hematol. |volume=87 |issue=11 |pages=997–1002 |date=November 2012 |pmid=22791417 |pmc=3900496 |doi=10.1002/ajh.23291 |url=}}</ref><ref name="pmid23071471">{{cite journal |vauthors=Saeed-Abdul-Rahman I, Al-Amri AM |title=Castleman disease |journal=Korean J Hematol |volume=47 |issue=3 |pages=163–77 |date=September 2012 |pmid=23071471 |pmc=3464333 |doi=10.5045/kjh.2012.47.3.163 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Castleman's disease|Castleman disease]] ([[Angiofollicular lymph node hyperplasia|angiofollicular lymphoproliferative disease]])<ref name="pmid22791417">{{cite journal |vauthors=Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM |title=The clinical spectrum of Castleman's disease |journal=Am. J. Hematol. |volume=87 |issue=11 |pages=997–1002 |date=November 2012 |pmid=22791417 |pmc=3900496 |doi=10.1002/ajh.23291 |url=}}</ref><ref name="pmid23071471">{{cite journal |vauthors=Saeed-Abdul-Rahman I, Al-Amri AM |title=Castleman disease |journal=Korean J Hematol |volume=47 |issue=3 |pages=163–77 |date=September 2012 |pmid=23071471 |pmc=3464333 |doi=10.5045/kjh.2012.47.3.163 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Mean [[age]]: 30-40 years
* Mean [[age]]: 30-40 years
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Asymptomatic]] at early onset
* [[Asymptomatic]] at early onset
* B-symptoms
* B-symptoms
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Non tender [[Cervical|cervical node]]
* Non tender [[Cervical|cervical node]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
** [[Papule]]
* [[Papule]]
** Cherry [[hemangioma]]
* Cherry [[hemangioma]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR]]
*Elevated [[ESR]]
* [[CRP]]
*Elevated [[CRP]]
* [[Anemia]]
* [[Anemia]]
* [[Polyclonal]] [[hypergammaglobulinemia]]
* [[Polyclonal]] [[hypergammaglobulinemia]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Hyaline]] [[vascular]] variant
* [[Hyaline]] [[vascular]] variant
* [[Plasma]] [[cell]] variant
* [[Plasma]] [[cell]] variant
* Mixed variant
* Mixed variant
| align="center" style="background:#F5F5F5;" | [[CT scan]]:
| align="left" style="background:#F5F5F5;" | [[CT scan]]:
* [[Matted]] [[lymphadenopathy]]
* [[Matted]] [[lymphadenopathy]]
* [[Solitary]], [[noninvasive]] [[mass]]
* [[Solitary]], [[noninvasive]] [[mass]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Kaposi's sarcoma-associated herpesvirus|HHV-8]]
* [[Kaposi's sarcoma-associated herpesvirus|HHV-8]]
* [[Kaposi's sarcoma|Kaposi sarcoma]]
* [[Kaposi's sarcoma|Kaposi sarcoma]]
Line 898: Line 898:
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inflammatory
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inflammatory
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kikuchi disease]] ([[histiocytic necrotizing lymphadenitis]])<ref name="pmid16722618">{{cite journal |vauthors=Bosch X, Guilabert A |title=Kikuchi-Fujimoto disease |journal=Orphanet J Rare Dis |volume=1 |issue= |pages=18 |date=May 2006 |pmid=16722618 |pmc=1481509 |doi=10.1186/1750-1172-1-18 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kikuchi disease]] ([[histiocytic necrotizing lymphadenitis]])<ref name="pmid16722618">{{cite journal |vauthors=Bosch X, Guilabert A |title=Kikuchi-Fujimoto disease |journal=Orphanet J Rare Dis |volume=1 |issue= |pages=18 |date=May 2006 |pmid=16722618 |pmc=1481509 |doi=10.1186/1750-1172-1-18 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* High [[prevalence]] in Japan
* High [[prevalence]] in Japan
* More common in young adults <30 years old
* More common in young adults < 30 years old
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Fever]]
* [[Fever]]
* [[Flu]]-like prodrome
* [[Flu]]-like prodrome
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Tender [[Cervical|cervical nodes]]
* Tender [[Cervical|cervical nodes]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Rash|Skin rash]]
* [[Rash|Skin rash]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR]]
* Elevated [[ESR]]
* [[Liver enzymes|Abnormal liver enzymes]]
* [[Liver enzymes|Abnormal liver enzymes]]
* [[leucopenia]]
* [[Leukopenia]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Irregular paracortical areas of [[coagulative]] [[necrosis]] with abundant karyorrhectic debris
* Irregular paracortical areas of [[coagulative]] [[necrosis]] with abundant karyorrhectic debris
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Hashimoto's thyroiditis|Hashimoto thyroiditis]]
* [[Hashimoto's thyroiditis]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kimura disease]]<ref name="pmid26905356">{{cite journal |vauthors=AlGhamdi FE, Al-Khatib TA, Marzouki HZ, AlGarni MA |title=Kimura disease: No age or ethnicity limit |journal=Saudi Med J |volume=37 |issue=3 |pages=315–9 |date=March 2016 |pmid=26905356 |pmc=4800898 |doi=10.15537/smj.2016.3.14448 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kimura disease]]<ref name="pmid26905356">{{cite journal |vauthors=AlGhamdi FE, Al-Khatib TA, Marzouki HZ, AlGarni MA |title=Kimura disease: No age or ethnicity limit |journal=Saudi Med J |volume=37 |issue=3 |pages=315–9 |date=March 2016 |pmid=26905356 |pmc=4800898 |doi=10.15537/smj.2016.3.14448 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in Asian males.
* More common in Asian males
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* History of painless [[cervical]] lump
* History of painless [[cervical]] lump
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Large
* Large
* Non-tender [[Cervical|cervical node]]
* Non-tender [[Cervical|cervical node]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Itching]]
* [[Itching]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Eosinophils]]
* Elevated [[Eosinophils]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Conserved [[Lymph nodes|lymph node]] structure
* Conserved [[Lymph nodes|lymph node]] structure
* [[Eosinophilic]] [[Infiltration (medical)|infiltration]]
* [[Eosinophilic]] [[Infiltration (medical)|infiltration]]
* High [[Capillary|postcapillary]] [[venules]]
* High [[Capillary|postcapillary]] [[venules]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Nephrotic syndrome]]
* [[Nephrotic syndrome]]
* [[Hypercoagulable state]]
* [[Hypercoagulable state]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Rosai-Dorfman disease]]<ref name="urlRosai-Dorfman disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/7588/rosai-dorfman-disease |title=Rosai-Dorfman disease &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref><ref name="pmid2180012">{{cite journal |vauthors=Foucar E, Rosai J, Dorfman R |title=Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): review of the entity |journal=Semin Diagn Pathol |volume=7 |issue=1 |pages=19–73 |date=February 1990 |pmid=2180012 |doi= |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Rosai-Dorfman disease]]<ref name="urlRosai-Dorfman disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/7588/rosai-dorfman-disease |title=Rosai-Dorfman disease &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref><ref name="pmid2180012">{{cite journal |vauthors=Foucar E, Rosai J, Dorfman R |title=Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): review of the entity |journal=Semin Diagn Pathol |volume=7 |issue=1 |pages=19–73 |date=February 1990 |pmid=2180012 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in [[children]]
* More common in [[children]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Fever]]
* [[Fever]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Non-tender enlarged [[cervical lymph nodes]]
* Non-tender enlarged [[cervical lymph nodes]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Itching|Erythema]]
* [[Erythema]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR]]
* Elevated [[ESR]]
* [[Polyclonal]] [[hypergammaglobulinemia]]
* [[Polyclonal]] [[hypergammaglobulinemia]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
Line 976: Line 976:
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kawasaki disease]]<ref name="urlAbout Kawasaki Disease | Kawasaki Disease | CDC">{{cite web |url=https://www.cdc.gov/kawasaki/about.html |title=About Kawasaki Disease &#124; Kawasaki Disease &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlKawasaki Disease | National Heart, Lung, and Blood Institute (NHLBI)">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/kawasaki-disease |title=Kawasaki Disease &#124; National Heart, Lung, and Blood Institute (NHLBI) |format= |work= |accessdate=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Kawasaki disease]]<ref name="urlAbout Kawasaki Disease | Kawasaki Disease | CDC">{{cite web |url=https://www.cdc.gov/kawasaki/about.html |title=About Kawasaki Disease &#124; Kawasaki Disease &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlKawasaki Disease | National Heart, Lung, and Blood Institute (NHLBI)">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/kawasaki-disease |title=Kawasaki Disease &#124; National Heart, Lung, and Blood Institute (NHLBI) |format= |work= |accessdate=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in children < 5 years old
* More common in children < 5 years old
* Highest [[incidence]] in Japan
* Highest [[incidence]] in Japan
* Most leading cause of acquired [[heart disease]] in U.S
* Most leading cause of acquired [[heart disease]] in U.S
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* High [[fever]]
* High [[fever]]
* B/L [[conjunctivitis]]
* B/L [[conjunctivitis]]
Line 991: Line 991:
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Large, single palpable [[Cervical|cervical node]]
* Large, single palpable [[Cervical|cervical node]]
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[ESR]]
* Elevated [[ESR]]
* [[CRP]]
* Elevated [[CRP]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Inflammation]] of medium sized [[arteries]] and [[organs]].
* [[Inflammation]] of medium sized [[arteries]] and [[organs]]
| align="center" style="background:#F5F5F5;" | [[Echocardiography]]:
| align="left" style="background:#F5F5F5;" |
* [[Coronary artery]]  
* [[Echocardiography]]: [[Coronary artery]] dilation
[[dilation]]
* [[Coronary artery aneurysm]]
* [[Coronary artery]] [[aneurysm]]
| align="left" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Clinical|Clinical findings]]
* [[Clinical|Clinical findings]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
Line 1,025: Line 1,024:
! rowspan="5" align="center" style="background:#DCDCDC;" |[[Salivary gland neoplasm]]
! rowspan="5" align="center" style="background:#DCDCDC;" |[[Salivary gland neoplasm]]
! align="center" style="background:#DCDCDC;" |[[Pleomorphic adenoma]]<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref><ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Pleomorphic adenoma]]<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref><ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* More common in females
* More common in females
* [[Incidence]] increase with [[age]]
* [[Incidence]] increase with [[age]]
* [[Incidence]] : 2-3.5 cases per 100,000 [[population]]
* [[Incidence]]: 2-3.5 cases per 100,000 [[population]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* History of [[swelling]]
* History of [[swelling]]
* [[Dysphagia]]
* [[Dysphagia]]
Line 1,037: Line 1,036:
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Palpable [[mass]] of deep [[lobe]] of [[parotid gland]]
* Palpable [[mass]] of deep [[lobe]] of [[parotid gland]]
* Firm
* Firm
Line 1,043: Line 1,042:
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Proliferation of [[epithelial cells]] and [[stromal]] [[matrix]] in the [[ducts]]
* Proliferation of [[epithelial cells]] and [[stromal]] [[matrix]] in the [[ducts]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[MRI]]: Homogenous on T1
* [[MRI]]: Homogenous on T1
* Abundant myxochondroid [[stroma]] on T2
* Abundant myxochondroid [[stroma]] on T2
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
|-
|-
! align="center" style="background:#DCDCDC;" |[[Warthin's tumor]]<ref name="pmid24376295">{{cite journal |vauthors=Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP |title=Warthin's tumour of the parotid gland: our experience |journal=Acta Otorhinolaryngol Ital |volume=33 |issue=6 |pages=393–7 |date=December 2013 |pmid=24376295 |doi= |url=}}</ref><ref name="urlWarthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/8569/warthin-tumor |title=Warthin tumor &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Warthin's tumor]]<ref name="pmid24376295">{{cite journal |vauthors=Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP |title=Warthin's tumour of the parotid gland: our experience |journal=Acta Otorhinolaryngol Ital |volume=33 |issue=6 |pages=393–7 |date=December 2013 |pmid=24376295 |doi= |url=}}</ref><ref name="urlWarthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/8569/warthin-tumor |title=Warthin tumor &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
* [[Benign]]
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Male]] to female ratio : 4:1
* [[Male]] to female ratio: 4:1
* More common in people aged 60 to 70 years old
* More common in people aged 60-70 years old
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* History of [[Swelling|swollen]] [[salivary gland]]
* History of [[Swelling|swollen]] [[salivary gland]]
* [[Jaw]] pain
* [[Jaw]] pain
Line 1,064: Line 1,063:
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Non tender
* Non tender
* Mobile
* Mobile
Line 1,071: Line 1,070:
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Papillae]]
* [[Papillae]]
* [[Fibrous]] [[capsule]]
* [[Fibrous]] [[capsule]]
* [[Cystic]] spaces
* [[Cystic]] spaces
| align="center" style="background:#F5F5F5;" | [[CT|Neck CT]]:  
| align="left" style="background:#F5F5F5;" |  
* [[Cystic]] lesion posteriorly within the [[parotid gland]]
*[[CT|Neck CT]]: [[Cystic]] lesion posteriorly within the [[parotid gland]]
[[MRI]]:  
*[[MRI]]: B/L heterogeneous lesions
* B/L heterogeneous lesions
| align="left" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Biopsy]]
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −

Revision as of 02:53, 20 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Neck masses must be differentiated from congenital abnormalities, inflammatory, and malignant lesions.

Differentiating neck masses from other Diseases

Neck masses must be differentiated from 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[1]
  • 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[2][3]
  • Age: 1-10 years old
  • Midline neck mass
Hemangioma[4]
  • Presents with a flat red or purple patch
  • Regress gradually with age
  • Firm
  • Rubbery
  • Well-demarcated
Vascular malformation[5][6]
  • Incidence: 1 in 2000 to 5000 births
  • Sex: 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[7][8]
  • Age: Birth-5 years old
  • Sex: No predilection
+
Laryngocele[9][10][11] +
  • Soft
  • Reducible
  • Increase in size on valsalva
  • Common in glass blowers and trumpet players
Ranula[12][13]
  • 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[14][15]
  • Incidence: 1:4000 births
  • Sex: No predilection
  • Presents as a firm lateral neck mass
  • Firm
  • Non-tender
  • High ALP levels
Dermoid cyst[16][17]
  • 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[18]
  • 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[19]
  • Age: Occurs in all age groups
  • Sex: No predilection
+ -
Chronic sialadenitis[20]
  • Age: Occurs in all age groups
  • Sex: No predilection
  • Presents with an unilateral swelling
  • Recurrent episodes common
+
  • Non-tender
  • Firm
  • Smooth
Reactive viral lymphadenopathy CMV[21]
  • Age: 10-35 years old
  • Sex: No predilection
  • Flu-like illness
  • Non-tender
  • Soft
  • Usually not necessary
EBV[22][23]
  • Age: Mainly adolescents
  • Sex: No predilection
  • Non-tender
  • Firm
  • Usually not necessary
HIV[24]
  • Non-tender mass
  • Usually not necessary
Viral URI[25]
  • 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[26][27]
  • Age: Affects all age groups
  • Sex: No predilection
+
  • No specific findings
Brucellosis[28]
  • Flu-like illness
+
  • No specific findings
Cat-scratch disease[29][30]
  • More common in the Southern of U.S among children and young adults
+
Actinomycosis[31][32]
  • 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[22][33][34]
Streptococcal infection[21][35] + +
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Parasitic lymphadenopathy Toxoplasma gondii[36][37]
  • 6 years old and older adults are more affected in U.S.
  • Seen in hot climates
+
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
Sarcoidosis[38][19]
  • More common in African American women aged 20-40 years
Sjögren syndrome[39]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
+
Castleman disease (angiofollicular lymphoproliferative disease)[40][41]
  • Mean age: 30-40 years
CT scan:
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)[42]
  • High prevalence in Japan
  • More common in young adults < 30 years old
+
Kimura disease[43]
  • More common in Asian males
Rosai-Dorfman disease[44][45]
Kawasaki disease[46][47]
  • 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[48][49] +
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
Warthin's tumor[50][51]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
+
Oncocytoma

[52]

Benign
  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
± ± Firm, multilobulated and mobile mass Epithelial cells with eosinophilic granular cytoplasm rich in mitochondria
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
Incisional biopsy and histopathological examination
Monomorphic adenoma [53][54][55] Benign or malignant
  • Age: From 26 to 76 years
  • Rare in children
  • Sex: No sex predilection
± ± Nodular and fluctuant swelling
  • Normal
  • Redness
  • Skin ulceration
  • May have lymphadenopathy
Normal Ultrasound:
  • Used to biopsy the lesion
  • May show cystic an solid components

CT:

MRI:

Incisional biopsy and histopathological examination
Mucoepidermoid carcinoma

[56]

Malignant
  • Age:: Mean age of 59
  • Female predilection
± ± Cystic and solid mass
  • May have lymphadenopathy
Gross findings:
  • Firm
  • Tan-white to yellow
  • Bosselated
  • Cystic

Microscopic findings:

cystic and solid component with variable appearance Incisional biopsy and histopathological examination 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 [57] Malignant Age: 40s to 60s

Gender: Female predominance

± ± Solid mass Gross findings: Tubular, cribriform and solid pattern of growth

Microscopic findings: Components of large cells with pleomorphic nuclei increased mitotic activity, and focal necrosis.

Imaging reveal dimensions of the tumor, local spread and distant metastasis Biopsy and histopathological examination
Adenocarcinoma

[58]

Malignant Age: young age predilection Its a tumor of minor salivary glands so may present as small ulceration or nodules in oral cavity Small nodules and oral cavity with or without lymphadenopathy Can be normal or may show anemia and blood cell disorders with distant bone invasion On histology it is confused with Adeocyctic carcinoma with components of gland and cyst formations.

It has more perineural invasion.

CT and MRI both can be used to visualize the tumor. MRI being more accurate for adjacent tissue involvement and lymphadenopathy. Biopsy and histopathological examination
Salivary duct cancer

[59][60][61]

Malignant

(Highly aggressive)

Incidence: 1% to 3%

Gender: Men Mean age: 55 to 61 years

  • Rapidly growing mass with jaw involvement
± ±
  • Painless, hard and non-compressible mass
  • In case of facial nerve involvement may present with facial paralysis
Pathomorphologically tumor of salivary ducts resembles tumor of breast ducts, and that where it name is derived from Gross findings:

Microscopic finding:

  • Microscopically it resembles ductal carcinoma of breast
  • Intraductal components invading surrounding tissues
  • Intra-ductal component of tumor arrange in several forms: cribriform, papillary, solid with comedo-like central necrosis
Non-specific features on CT and MRI but it can show neural and jaw involvement. Biopsy and histopathological examination
Squamous cell carcinoma

[62][63]

Malignant Incidence: rare tumor

Age: Old age , 61 to 68 years Male predilection

Present as painful growing mass on jaw + Submandibular gland predilection

Thinning and discoloration of skin

Past radiation exposure is a strong risk factor Gross findings: Shows skin tissue and thinning of skin

Microscopically findings: Nest and solid sheets of tumor cells arranged in glandular pattern. It is derived from epidermoid cells of salivary gland. May show vascular invasion and inflammatory infiltrate. Immunohistochemical staining can be used to mark the squamous and keratin component.

Tumor dimension can be delineated using both CT and MRI Biopsy and histopathological examination
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[64][65][66]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common: Japan, India, Iran
+ Neck CT scan:

MRI:

  • Tumors are hypointense on T1 and hyperintense on T2
Parathyroid cancer

[67][68][69]

Malignant Incidence: Rare

Mean age : 44 to 54 years Gender: Female predilection

+ + Lower neck mass Microscopic findings:Tumor shows trabecular growth pattern with high mitosis and surrounding thick fibrous bands. Capsular involvement and vascular invasion is common Biopsy and histopathological examination
Carotid body tumors

[70][71][72][73]

Benign
  • Age: 26-55 years
  • Male predominance
+ May show Increased catecholamine levels Microscopically they are extra- adrenal paragangliomas Histopathology analysis and catecholamine levels
Paraganglioma

[74][75][76]

Benign (Majority)

Malignant (rare)

  • Age 50-70 years
  • More in females
May be an accidental finding depending on their secretory nature or present with following symptoms:

Catecholamine secreting paragangliomas present with :

No visible mass as they are located deep in the the neck along the glossopharyngeal and vagal nerves. Associated with some hereditary syndromes and MEN2B syndrome, Neurofibromatosis type 1 and VHL disease Biochemical testing may show catecholamine metabolites in serum or urine samples These are highly vascular tumors that involves nerves around vessels

Gross findings:

Microscopic findings: Round or polygonal cells arranged inside capsule in the form of nests or forming trabecular structures. Differentiation between benign or malignancy form is done depending microscopic features of invasion and high mitotic index

Following imaging techniques can be used to diagnose the tumor:

As these are secretory tumors further testing with following techniques can confirm diagnoses:

Imaging and serum catecholamine analysis
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma

[77][78][79]

Benign Rare tumor

Incidence: 1% to 10%

Slow growing mass presents with the localized neural deficit depending on the site of peripheral nerve involved.

Vagal involvement:

Sympathetic nerve involvement may present as Horner's syndrome:

Vestibular Schwannoma (most common):

+ ± Multiple slow growing nodules on the skin Associated with neurofibromatosis type II.

Most common nerve involved in vestibular nerve

May be normal

vagus nerve or superior cervical sympathetic chain being most common locations.

  • Histology shows encapsulated neural tissue growth.
Imaging can diagnose the tumor. Its hard to discriminate Carotid body tumor from Schwannoma on CT. MRI and MRI angiography can confirm the diagnoses. Imaging is used for diagnoses
Lymphoma [80][81]

[82][83][84][85]

Benign/ malignant Age: Predilection for older age

Mean age: 55

±
  • Fine needle aspiration (FNA) with cytometry is used for screening.
  • Tissue biopsy is used for diagnose.
  • 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
Lymph node biopsy coupled with cytometry
Liposarcoma [86][87][88][89] Malignant Rare tumors

Age: Relatively in older age Gender: No gender predilection

Mobile masses with very few symptoms until they grow enough to compress the surrounding structures, which produces symptoms of neural deficit, pain, tingling or skin changes. ± Mobile soft mass with intact overlying skin and in some cases with blue discoloration due to intra-lesion hemorrhage
  • Intact skin and normal color
Normal Gross findings:

Bulk of yellow colored fat tissue. Microscopic features: Adipose tissue containing that containing lipoblasts atypical nucleus pushed to side by intracytoplasmic vacuoles. Tissue biopsy may show histological sub-groups:

  • Well-differentiated
  • Myxoid/round cell
  • Pleomorphic liposarcomas
Imaging is not usually used for diagnoses except to look for deeper invasion.

Ultrasound shows homogeneous hyperechoic mass.

Biopsy and histopathology analysis
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [90][91][92] Benign One or multiple soft, painless skin nodules.

May causes pain or compressive symptoms

± Mobile soft nodule with intact overlying skin
  • Intact skin and normal color
Normal Diagnoses is usually clinical but tissue biopsy may show

Bundle of well-demarcated lipocytes with single nuclei aligned to the side and intra-cytoplasimic fat granules.

Diagnoses is usually clinical but ultrasound is used to differentiate lipoma from other benign lesions such as epidermoid cyst or a ganglion.

Clinical evaluation

and tissue biopsy

Multiple lipomas are associated with familial multiple lipomatosis
Glomus vagale, glomus jugulare tumors

[93][94][95][96][97][98]

Benign

Rare tumor

± Secretory tumors are diagnosed by biochemical testing using Metaiodobenzylguanidine (MIBG) , followed by imaging to locate the tumor Normal
  • Imaging is important for the diagnosis.
  • Imaging of choice is MRI.
  • MRI may show typical appearance of the tumor along Vagus nerve.
  • USG may used to see the tumor but it is for early stage of diagnoses.
  • US shows isoechoic to hypoechoic well defined tumor.
  • CT can show vascularity of tumor.
  • Biochemical testing to see secretary nature of tumor
Imaging and MIBG testing
Metastatic head and neck cancer

[99][100]

Malignant Depends on the nature of metastatic tumor ± Non-tender mass in the neck or non-tender lymphadenopathy Majority of metastatic head and neck cancer metastatise from GIT and lungs and are squamous cell caners Vary depending on the underlying cancer Histology of primary cancer CT and MRI shows extend of the tumor and other regions of metastasis Biopsy and histopathology of the primary site of tumor
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer

[101][102]

Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
± ±

human papillomavirus (HPV) infection

HPV testing may show HPV infection FNA of neck mass followed by biopsy is done to diagnose laryngeal cancer. It show type cancerous cells. Laryngoscopy and biopsy
Arteriovenous fistula

[103][104]

Benign/Malignant Depends on the risk factors May be associated with vasculopathies and metastatic invasion of vessels and neck surgery Varies depending on the etiology MR angiography may be used to visualize the tract MR angiography
Thyroid nodule/ Goiter

[105][106][107][108]

Benign/ Malignant
  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
± ±
  • Painless non-tender and asymmetrical neck mass in front of neck with smooth overlying skin and nodular surface
  • Depending on the type may be mobile or adherent to the underlying structure
  • Lymphadenopathy in case of malignant features
Goiter is most commonly associated with iodine deficiency
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
FNA is done in case of goiter and core biopsy is performed if malignancy is suspected USG: Shows nodular or non- nodular lesions in Thyroid. US is better than CT.

Thyroid radionuclide imaging: Shows radioiodine uptake and is usually cold in case of malignancy and may be cold or hot in case of goiter.

Biopsy and histopathology of nodules
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

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