Sandbox:Maneesha

Differential diagnosis of neck masses

Differential diagnosis of neck masses include:

Category	Diseases		Benign or Malignant	Clinical manifestation								Paraclinical findings			Gold standard diagnosis	Associated findings
				Demography	History	Symptoms		Signs				Lab findings	Histopathology	Imaging
						Pain	Dysphagia	Mass exam	Skin changes	LAP	Others
Congenital	Branchial cleft cyst		Benign	Age: 1-15 yrs/ varies Familial occurence is noted	Lateral neck mass	-	+ Sometimes	Solitary Smooth Mobile Welldefined Nonpulsatile Fluctuant	A pit is found at the opening of the cyst	-		-	Squamous or ciliated epithelial lining Lymphoid tissue with germinal centers and subcapsular sinuses	CT: Well defined fluid attenuation with slight enhancement of the capsule Ultrasound: Typical features of a cyst are seen		Brachio-oto-renal syndrome Sinus Fistula
	Thyroglossal duct cyst		Benign	Age: 1-10 yrs/ varies	Midline neck mass	-	-	Mobile Moves upwards with tongue protrusion and swallowing		-	Mass moves upwards with tongue protrusion and swallowing	-	Squamous or ciliated pseudostratified columnar lining Foci of thyroid gland tissue Granulation tissue or giant cells if it gets infected	Ultrasound: Anechoic, thin walls, and heterogeneous with internal septae CT with contrast: Well circumscribed,homogeneous fluid attenuation, thin enhancing rim MRI: T1- dark, T2-bright images
	Haemangioma		Benign	Age: birth - 2 yrs Females>males	Usually present as a flat red or purple patch	-	-	Firm Rubbery Well-demarcated	Blanching Telangiectasias Erythematous patch	-		GLUT-1 VEGF Urinary BFGF	Lined by non atypical endothelial cells Vascular structures with RBC	Ultrasound: High flow with vascular channels MRI: With or without Gd is the modality of choice		POEMS and Castleman's disease
	Vascular malformations
	Lymphatic malformations
	Laryngocele
	Ranula
	Teratoma			Incidence: 1:20000 or 1:40000 per live births
	Dermoid cyst		Benign	Incidence: 3 per 10000 population Age: birth - 5 yrs	Presents as a slow growing mass or a sinus	-	-	Freely mobile/Fixed Solitary Rubbery Nonpulsatile Noncompressible	Usually normal/sometimes a pit or sinus is seen A tuft of hair at the center of the pit for nasal dermoid cyst	-		-	Keratinizing squamous epithelium Occasional remnants of hair follicles,adipose tissue, and sweat glands	Ultrasound: Thin walled, unilocular CT: With contrast well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
	Thymic cyst		Benign	Age: 1-10 yrs Males>Females	Presents as a soft mass, gradually enlarging, on left side of the neck(usual)	-	-	Soft Compressible		-		-	Squamous/cuboidal epithelium Lymphoid tissue in the cyst wall contains hassall corpuscles	Ultrasound: Unilocular cystic mass CT: Uni/multilocular, well circumscribed and nonenhancing
Category	Diseases		Benign or Malignant	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Inflammatory	Acute sialadenitis
	Chronic sialadenitis
	Reactive viral lymphadenopathy	CMV
		EBV
		HIV
		Viral URI
	Bacterial lymphadenopathy	Tularemia
		Brucellosis
		Cat-scratch disease
		Actinomycosis
		Mycobacterial infections
		Staphylococcal or streptococcal infection
	Parasitic lymphadenopathy	Toxoplasma gondii
	Sarcoidosis
	Amyloidosis
	Sjögren syndrome
	Castleman disease (angiofollicular lymphoproliferative disease)
	Kikuchi disease (histiocytic necrotizing lymphadenitis)
	Kimura disease
	Rosai-Dorfman disease
	Kawasaki disease
Category	Diseases		Benign or Malignant	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neoplasm	Primary thyroid tumor
	Salivary gland neoplasm	Pleomorphic adenoma	+
		Warthin's tumor	+
		Lymphoepithelioma	+
		Oncocytoma
		Monomorphic adenoma
		Mucoepidermoid carcinoma
		Adenoid cystic carcinoma
		Adenocarcinoma
		Salivary duct carcinoma
		Squamous cell carcinoma
	Parathyroid tumors
	Carotid body tumors
	Paraganglioma
	Schwannoma
	Lymphoma
	Liposarcoma
	Lipoma
	Glomus vagale, glomus jugulare tumors
	Metastatic head and neck carcinoma
Other	Hematoma
	Arteriovenous fistula
	Goiter
Category	Diseases		Benign	Demography	History	Pain	Dysphagia	Mass exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings