Neck Mass

2020 ◽  
Author(s):  
Gerard M. Doherty
Keyword(s):  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Primary Concern ◽  
Cervical Lymph Nodes ◽  
Management Algorithm ◽  
Neck Masses ◽  
Specific Disorders

The evaluation of any neck mass begins with a careful, directed history focused on an appropriate differential diagnosis. Directed questions can narrow the diagnostic possibilities and focus subsequent investigations. For example, in younger patients, one might have an initial suspicion of congenital or inflammatory lesions, whereas in older adults, the primary concern is often neoplasia. The head and neck examination is challenging because much of the area to be examined is not easily seen. Patience and practice are necessary to master the special instruments and techniques of examination. Most neck masses in adults are abnormal and are often manifestations of underlying conditions that require treatment. In most cases, therefore, further diagnostic evaluation should be pursued. This review covers clinical evaluation, developing a differential diagnosis, investigative studies, and management of specific disorders associated with neck mass. Figures show cervical lymph nodes, a management algorithm for thyroid nodules, and the course of the thyroglossal duct from the foramen cecum to the pyramidal lobe of the thyroid gland. Tables list the etiology of neck mass, classification of cervical lymph nodes, and sonographic findings and size indications of biopsy of thyroid nodules. This review contains 4 figures, 9 tables, and 8 references. Key words: cervical adenopathy; cervical lymph nodes; congenital neck mass; enlarged lymph nodes; fine-needle aspiration; neck mass; thyroid disease; thyroid mass; thyroid nodule

scholarly journals Association of Ultrasonography and Ultrasound-guided Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules

2021 ◽  
Vol 6 (2) ◽  
pp. 1573-1578
Author(s):  
Binit Dev ◽  
Ajay Kumar Yadav ◽  
Sushil Taparia ◽  
Roshana Khadka ◽  
Shripad J Walavalkar
Keyword(s):  
Lymph Nodes ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Cervical Lymph Nodes ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
Benign Nodules

Introduction: Ultrasound (USG) is the most commonly used imaging method to evaluate thyroid nodules. The sonographic features of thyroid nodules are very important to determine whether the nodule is benign or malignant. Fine Needle Aspiration Cytology (FNAC) is the gold standard to determine whether the nodule is benign or malignant. Objective: The purpose of this study was to compare ultrasound and color Doppler features of thyroid nodules with ultrasound-guided FNAC results to determine the relative importance of these features in predicting the risk of malignancy. Methodology: This prospective cross-sectional study was conducted in Birat medical college teaching hospital in Tankisinuwari, Morang, Nepal. The study was conducted from September 2019 to April 2021.  In total sixty-one patients with thyroid nodules were evaluated for sonographic characteristics. Finally, USG guided FNA for cytopathological examination was performed. Both descriptive and inferential statistics were used to analyze the result. Results: Out of the 61 patients, 34 (55.7%) were females and 27 (44.2%) were males. Majority of the malignant nodules were solid 11 (91.6%), whereas cystic and mixed nodules were predominantly seen in benign nodules 18 (36.7%) and 30 (61.2%) respectively. In malignant nodules 10 (83.3%) were heterogeneous and 2 (16.6%) were isoechoic. In benign nodules 29 (59.1%) were heterogeneous and 15 (30.6%) were anechoic with comet-tail artifact and 5 (10.2%) were isoechoic. Among 12 malignant cases, internal and peripheral vascularity were equally present in six cases each. Benign nodules showed peripheral vascularity in 48 (97.9%) and internal vascularity was noted in only one nodule. All of the malignant nodules showed calcification. None of the benign nodules showed micro-calcification. In malignant cases, cervical lymph nodes were present in 7 (58.3%) and absent in 5 (41.6%). In benign cases, cervical lymph nodes were present in 4 (8.1%) and absent in 45 (91.83%). Conclusion: The ultrasound features associated with malignancy in thyroid nodules are predominantly solid component, presence of micro-calcifications and internal vascularity. Enlarged cervical lymph nodes are good predictors for malignancy. USG guided FNAC confirms the suspicious features of thyroid nodules seen on USG.

scholarly journals Immunohistochemical Features of Primary Pure Squamous Cell Carcinoma in the Thyroid: An Autopsy Case

2018 ◽  
Vol 11 (2) ◽  
pp. 418-424 ◽  
Author(s):  
Satoshi Koyama ◽  
Kazunori Fujiwara ◽  
Kanae Nosaka ◽  
Takahiro Fukuhara ◽  
Tsuyoshi Morisaki ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cervical Lymphadenopathy ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Thyroid Tumor ◽  
Cervical Lymph Nodes

Primary squamous cell carcinoma (SCC) in the thyroid is extremely rare and has been reported in < 1% of all thyroid cancer cases. Primary SCC in the thyroid was thought to be a transitional form derived from adenocarcinomas; therefore, the majority of reported cases have focused on the conjunction with other histological adenocarcinomas. A 73-year-old male presented to our hospital with bilateral vocal fold palsy and an anterior neck mass. Ultrasound sonography revealed a bulky tumor in the thyroid and bilateral cervical lymphadenopathy. We performed fine-needle aspiration cytology from the thyroid tumor, which revealed SCC. Positron emission tomography/computed tomography showed distant metastases in the lungs, mediastinal lymph nodes, and vertebra. We diagnosed the patient as having stage IVC SCC in the thyroid and administered weekly paclitaxel. Four and a half months after treatment initiation, the tumor progression resulted in aspiration pneumonia, which proved fatal. We performed an autopsy in accordance with the patient’s wishes. Pathological findings revealed that all carcinomas in the thyroid, cervical lymph nodes, and lungs were pure SCCs. Immunohistochemical examinations for PAX8, thyroglobulin, and TTF-1 were all negative. Differentiated thyroid carcinomas have 3 major positive markers – PAX8, thyroglobulin, and TTF-1 –, and PAX8 is also sometimes positive for SCC in the thyroid. PAX8 positivity of SCC in the thyroid might, however, be associated with conjunction with other histological adenocarcinomas such as papillary or follicular thyroid carcinoma; therefore, pure SCC in the thyroid might be negative for PAX8.

scholarly journals Thyroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases

2010 ◽  
Vol 54 (6) ◽  
pp. 550-554 ◽  
Author(s):  
André B. Zanella ◽  
Erika L. Souza Meyer ◽  
Letícia Balzan ◽  
Antônio C. Silva ◽  
Joíza Camargo ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Nodes ◽  
Papillary Thyroid Cancer ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Cervical Lymph Nodes ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Cancer Metastases ◽  
Thyroid Cancer Metastases

OBJECTIVE: The aim of this study was to evaluate the accuracy of the measurement of thyroglobulin in washout needle aspiration biopsy (FNAB-Tg) to detect papillary thyroid cancer (PTC) metastases. SUBJECTS AND METHODS: Forty-three patients (51.4 ± 14.6 years) with PTC diagnosis and evidence of enlarged cervical lymph nodes (LN) were included. An ultrasound-guided fine-needle aspiration of suspicious LN was performed, for both cytological examination and measurement of FNAB-Tg. RESULTS: The median values of FNAB-Tg in patients with metastatic LN (n = 5) was 3,419 ng/mL (11.1-25,538), while patients without LN metastasis (n = 38) showed levels of 3.7 ng/mL (0.8-7.4). Considering a 10 ng/mL cutoff value for FNAB-Tg, the sensitivity and specificity was 100%. There were no differences on the median of FNAB-Tg measurements between those on (TSH 0.07 mUI/mL) or off levothyroxine (TSH 97.4 mUI/mL) therapy (3.3 vs. 3.8 ng/mL, respectively; P = 0.2). CONCLUSION: The results show that evaluation of FNAB-Tg in cervical LN is a valuable diagnostic tool for PTC metastases that can be used independent of the thyroid status.

scholarly journals Combined quantitation of HMGA2 mRNA, microRNAs, and mitochondrial-DNA content enables the identification and typing of thyroid tumors in fine-needle aspiration smears

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sergei E. Titov ◽  
Mikhail K. Ivanov ◽  
Pavel S. Demenkov ◽  
Gevork A. Katanyan ◽  
Eugenia S. Kozorezova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Molecular Markers ◽  
Fine Needle Aspiration ◽  
Real Time Pcr ◽  
Thyroid Nodules ◽  
Nuclear Dna ◽  
Malignant Tumors ◽  
Needle Aspiration ◽  
Thyroid Tumors ◽  
Fine Needle

Abstract Background Analysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Nonetheless, in clinical practice, applications of existing diagnostic solutions based on the detection of somatic mutations or analysis of gene expression are limited by their high cost and difficulties with clinical interpretation. The aim of our work was to develop an algorithm for the differential diagnosis of thyroid nodules on the basis of a small set of molecular markers analyzed by real-time PCR. Methods A total of 494 preoperative FNA samples of thyroid goiters and tumors from 232 patients with known histological reports were analyzed: goiter, 105 samples (50 patients); follicular adenoma, 101 (48); follicular carcinoma, 43 (28); Hürthle cell carcinoma, 25 (11); papillary carcinoma, 121 (56); follicular variant of papillary carcinoma, 80 (32); and medullary carcinoma, 19 (12). Total nucleic acids extracted from dried FNA smears were analyzed for five somatic point mutations and two translocations typical of thyroid tumors as well as for relative concentrations of HMGA2 mRNA and 13 microRNAs and the ratio of mitochondrial to nuclear DNA by real-time PCR. A decision tree–based algorithm was built to discriminate benign and malignant tumors and to type the thyroid cancer. Leave-p-out cross-validation with five partitions was performed to estimate prediction quality. A comparison of two independent samples by quantitative traits was carried out via the Mann–Whitney U test. Results A minimum set of markers was selected (levels of HMGA2 mRNA and miR-375, − 221, and -146b in combination with the mitochondrial-to-nuclear DNA ratio) and yielded highly accurate discrimination (sensitivity = 0.97; positive predictive value = 0.98) between goiters with benign tumors and malignant tumors and accurate typing of papillary, medullary, and Hürthle cell carcinomas. The results support an alternative classification of follicular tumors, which differs from the histological one. Conclusions The study shows the feasibility of the preoperative differential diagnosis of thyroid nodules using a panel of several molecular markers by a simple PCR-based method. Combining markers of different types increases the accuracy of classification.

The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules

2017 ◽  
Vol 45 (2) ◽  
pp. 251-259 ◽  
Author(s):  
Jun You ◽  
Juan Chen ◽  
Feixiang Xiang ◽  
Yue Song ◽  
Simai Khamis ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Cervical Lymph Nodes

scholarly journals A Case Report Demonstrating How the Clinical Presentation of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Can Mimic Benign Riedel’s Thyroiditis

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Jennifer Walsh ◽  
Tomas P. Griffin ◽  
Carmel B. Ryan ◽  
James Fitzgibbon ◽  
Patrick Sheahan ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Inflammatory Cells ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Papillary Thyroid ◽  
Riedel’S Thyroiditis ◽  
Diffuse Sclerosing Variant ◽  
Riedel's Thyroiditis

A 44-year-old female presented with a two-month history of a neck mass, sore throat, hoarseness, and intermittent dysphagia. Examination revealed a “woody” hard swelling arising from the right lobe of the thyroid. Clinically this was felt to be classical Riedel’s thyroiditis (RT). Thyroid ultrasound showed a diffusely enlarged, low echogenicity thyroid with a multinodular goitre. An abnormal nodule extending across the isthmus was noted. Following a nondiagnostic fine needle aspiration, an open core biopsy was performed. This showed dense sclerotic fibrosis punctuated by nodular mononuclear inflammatory cells, which obscured follicular epithelial cells consistent with a fibrosing thyroiditis (Riedel’s thyroiditis). A biopsy of pretracheal lymph nodes showed a sclerotic process throughout the lymph nodes and nests of epithelium bands with squamous differentiation obscured by a fibrous process. These findings raised the differential diagnosis of diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) with metastasis to lymph nodes. A total thyroidectomy and pretracheal lymph node dissection were performed. The final histological diagnosis was DSV-PTC. When managing a patient with presumed RT it is important to consider malignancy in the differential. DSV-PTC is one of the more aggressive forms of thyroid cancer but with early diagnosis and appropriate treatment patients may have excellent outcomes.

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