neck mass

We introduce the third case reported in the literature of an atypical presentation of pleomorphic adenoma located in the nasal vestibule of a young patient who assisted at our clinic.

Case Report:

A young man with no important medical history consulted due to a painless mass-type slow-growth lesion associated with right nasal obstruction. He underwent surgical management and complete resection of the mass. The pathological study revealed a pleomorphic adenoma, confirmed by immunohistochemistry.

This case confirms that pleomorphic adenomas can occur anywhere in the head and neck, even in areas without upper air-digestive tract mucosa.

Primary nasopharyngeal tuberculosis (NPTB) is a rare disease but should not be missed as one of the differential diagnoses for cervical lymphadenopathy or nasopharyngeal mass. 

Case Report:

We describe a case of a 38 year old lady, who presented with bilateral cervical lymphadenopathy associated with intermittent fever. Nasoendoscopy examination and computed tomography scan of the neck revealed a centrally located mass predominantly at the left posterior nasopharyngeal wall without obliteration of both fossae of Rosenmuller. Typical histopathological features of necrotizing granulomatous lymphadenitis together with the common clinical presentation of cervical lymphadenopathy and nasoendoscopy findings of nasopharyngeal mass conclude the diagnosis of nasopharyngeal tuberculosis. With anti-tuberculous therapy, the cervical lymphadenopathy and nasopharyngeal mass were completely resolved.

Nasopharyngeal tuberculosis is an uncommon disease with great diagnostic challenges and with early diagnosis and adequate treatment, NPTB carries a good prognosis with complete disease resolution.

Papillary thyroid carcinoma (PTC) is considered as a relatively common type of malignancy showing a wide morphologic spectrum. Different variants of this tumor have been reported. Among PTC variants, PTC with nodular fasciitis-like stroma (PTC‑FLS) is rare. This variant consists of stromal components rich in spindle cells and accounts for 60-80% of tumors. In addition, there are small foci of epithelial components in PTC‑FLS though its features are similar to conventional PTC. In this case study, we present a new case with PTC‑FLS. The case is a 28-year-old female who was referred to the ENT clinic due to a painless mass on the anterior part of her neck. The mass showed a gradual increase in size over the 6 months prior to her referral. Thyroid test results were normal. Ultrasound imaging demonstrated an 84 × 36 mm heterogeneous nodule in the right thyroid lobe without calcifications but increased vascularity. There were also some reactive lymph nodes in both sub-mandibular areas. An ultrasound-guided fine-needle aspiration (FNA) biopsy of the right thyroid lobe nodule revealed a benign thyroid adenomatoid nodule. Following right thyroid lobectomy, final pathologic studies confirmed a diagnosis of PTC with exuberant fibromatosis-like stroma. In the 20-day post-surgery visit, the patient was found asymptomatic. Re-evaluation of the left thyroid lobe and follow-up were recommended. In this study, a diagnosis of a rare variant of PTC, i.e., PTC-FLS, was made through a combination of ultrasonography, fine needle aspiration cytology, and histological examination.

Job’s syndrome or hyper-immunoglobulin E (IgE) syndrome (HIES) is an extremely rare primary immunodeficiency disease with an approximate annual incidence of less than 1/1000000. It is characterized by recurrent cold staphylococcal infections, unusual eczematous dermatitis, severe lung infections, and extensively high concentrations of the serum antibody IgE.

A typical case of Job’s syndrome with a family history of Kawasaki disease is presented in this study aiming at identifying the clinical features, investigational procedures, and management strategy, as well as evaluating the role of the ear, nose, and throat specialist and highlighting the probable relation between Job’s syndrome and Kawasaki disease.

In general, early detection with proper care can prevent the progression of Job syndrome. In addition, the initiated treatment at the first signs of infection is mandatory for preventing long-term complications. There is a probable relation between Job and Kawasaki which requires more consideration.

 Primary hyperparathyroidism (PHPT) is a rare condition in the pediatric population. Parathyroid carcinoma (PC) is a very uncommon cause of PHPT, accounting for < 1% of pediatric PHPT cases. It is challenging to distinguish between parathyroid adenoma (PA), the most common cause of PHPT, and parathyroid carcinoma. In this report, we described a young female who presented with a history of progressive limping and was finally diagnosed with PC.

 A 15-year-old girl presented with progressive limping and bone pain for 8 years. She was referred by an orthopedic surgeon because of elevated intact parathyroid hormone (iPTH) for further evaluation. Physical examination revealed a large, firm, and non-tender neck mass, left hip tenderness, and limited range of motion. The initial biochemistry tests showed a borderline high calcium level of 10.8 mg/dl, an elevated iPTH level of 2876 pg/mL, and a decreased phosphorus level of 2.4 mg/dL. The 99mTechnetium (Tc) sestamibi scan displayed early intense activity in the right thyroid lobe persisting in the three-hour repeat scan, compatible with a parathyroid lesion. The patient underwent right-sided neck exploration and parathyroidectomy. Intraoperative and pathology findings confirmed the diagnosis of PC. Immunohistochemistry (IHC) staining revealed creatine kinase (CK) and CD31 in endothelial cells of the tumor. Ki67 staining was also positive in 2% - 3% of tumor cells. The whole exome sequencing (WES) study was negative for cell division cycle 73 (CDC73) and multiple endocrine neoplasia 1 (MEN1) genes.

 PC should be considered as a differential diagnosis of PHPT in the pediatric population, even in the presence of mild hypercalcemia.

Carotid sinus syndrome (CSS) is a hypersensitivity of the carotid sinus manifested by atrioventricular sinus bradycardia or decreased arterial pressure of at least 50 mmHg. Triggering factors can be neck movements, shaving of the beard or too-tight collars. CSS can be rarely caused by the presence of malignant or benign masses in the head and neck area.

Case Report: 

A 49 years-old white woman with a laterocervical mass presented recurrent episodes of sinus bradycardia related to head’s rotation. Neck CT scan revealed a right piolaryngocele and internal left laryngocele. Episodes of bradycardia were disappeared after endolaryngeal carbon dioxide laser assisted marsupialization.

Laryngocele should be sought in the differential diagnosis of patients with bradycardia episodes due to carotid sinus compression. Surgical treatment of laryngoceles can lead to the termination of such episodes.

A thyroglossal duct cyst (TDC) is the most common congenital neck mass. Seventy five percent of midline neck masses in children are TDCs. Malignant transformation occurs in 1% of benign cysts. The most common is papillary thyroid carcinoma (80 %). It usually presents in the third or fourth decade of life and is more common in women.

In this case report, we present the case of a 5-year-old boy with thyroglossal duct cyst carcinoma and review of management.

PTC occurs in TDC rarely, but the probability should be considered before surgery, especially in high risk groups. It is advisable to choose more conservative management plans for children to preserve their quality of life and prevent iatrogenic complications.