What Is a Neck Mass?

Neck masses are more common clinically. The source of the neck mass is complex, with different biological characteristics and different treatment options. According to Skandalakis statistics, in non-thyroid goiters, 80% of neck masses are tumors; in tumors, 80% are malignant; in malignant tumors, 80% are metastatic; in metastatic malignant tumors, 80% are primary Located on the collarbone.

Basic Information

Visiting department: Oncology
Common causes: Congenital disease, inflammatory mass, tumor

Common symptoms: Redness and pain
Contagious: no

Causes of neck masses

Neck masses can be classified into congenital diseases, inflammatory masses, and tumors according to their etiology.

Clinical manifestations of neck mass

The course of cervical inflammatory masses is 7 days, the tumor masses of necks are 7 months, and the congenital malformations of necks are 7 years.

In terms of age, infants and young children are mostly congenital masses, such as thyroglossal duct cysts, branchial cleft cysts, cystic hydromas, etc .; adolescent patients are mostly inflammatory lymphadenopathy; young and middle-aged patients should be alert to malignant tumor ; The elderly are mostly metastatic malignancies.

From the point of view, the thyroid hyoid cyst and goiter are often located in the midline area of the neck. Gill cleft cysts, salivary gland tumors, cervical schwannomas, carotid body tumors are often located in the cervical side, lymphangiomas, lungs And digestive tract-derived metastatic cancer is often located in the posterior neck area.

From the nature of the tumor, neck malignancies are generally stiff and have poor mobility. Multiple tumors can appear in metastatic neck cancer, and tenderness is not very obvious. Benign masses in the neck are generally of medium texture, with well-defined borders and good mobility. Branchial fissure cysts, cystic hydromas, and epidermoid cysts are cystic masses, but some thyroid metastatic cancers can also be cystic.

The inflammatory mass in the neck has the symptoms of redness, swelling and pain, and the acute ones have systemic symptoms, including fever, fatigue, loss of appetite, and an increase in the number of white blood cells. When an abscess is formed, there are obvious tender points and swollen edema in the local skin. Superficial abscesses can detect obvious fluctuations.

Congenital masses in the neck, including thyroglossal cysts and branchial cleft cysts. Thyroglossal cysts are mostly located in the anterior midline of the neck, mostly in the thyroid hyoid periosteum and thyroid cartilage; the mass is cystic and moves up and down with swallowing. Branchial cleft cysts and fistulas are mostly unilateral, and a few are bilateral. Some patients are detected at birth, but most patients are usually not found until the cyst is enlarged or infected by adolescents. The mass is relatively soft and fluctuating, and it forms an abscess when it is infected with infection, which can rupture on its own and become a draining sinus. In cases with branchial fistula, the external mouth is usually small, located at the anterior edge of the sternocleidomastoid muscle, and intermittent milk-like, mucus-like, or pus-like matter can be seen from the external mouth. The location and movement of branchial fissure cysts and fistulas vary according to the source of the branchial fissure or gill sac. Cervical schwannomas grow slowly and have a long history. Cervical schwannomas are usually round or oval, sometimes lobulated, and are relatively tough, with well-defined boundaries and smooth surfaces. The mass can move left and right along the nerve axis, but cannot move up and down. Carotid body tumors can be asymptomatic in the early stages, and as the tumor grows, there can be pain and swelling. The mass is mostly located in front of the mandibular angle, and a few bulge to the pharynx. The mass is round or oval, with clearer boundaries and tough texture. The surface of the mass can touch the carotid pulse, and auscultation can ask about vascular noise. When the tumor invades or compresses the vagus nerve, hoarseness and eating cough may occur; involving the sympathetic nerve may cause the pupil on the affected side to shrink, the eyelid fissure to become smaller, and the affected side to sweat less or no sweat; if the hypoglossal nerve is damaged, Affected tongue muscle atrophy occurs, and the tongue is biased to the healthy side when the tongue is extended. A malignant mass in the neck is common in cervical lymph node metastases. Cervical lymph nodes Cervical lymph node metastatic cancers mostly occur in middle-aged and older adults. Presented as a painless mass with progressive enlargement of one or both necks. In the early stage of onset, most of them are single, with smaller mass, harder quality, and poor mobility. With the development of the disease, the number of tumors increases and merges with each other. The lump is adhered and fixed to the skin. Large masses cause corresponding symptoms and signs when they compress the organs, esophagus, and nerves. Some squamous cell carcinomas and thyroid carcinomas can become cystic due to tissue necrosis and liquefaction in metastatic masses. In some cases, skin ulceration, bleeding, and secondary infections may occur due to mass invasion of the skin.

Neck mass examination

Ultrasound examination

Because of its simplicity, non-invasiveness, and reproducibility, it has become the preferred method for assisted examination of neck masses. This examination can be used to understand the size, location, and shape of the mass, its relationship with surrounding tissues, especially adjacent blood vessels; whether the mass is substantial or fluid; whether there are nodules, and whether the nodules border is regular. However, ultrasound imaging is still not ideal for the diagnosis of tumors, especially for the differentiation between benign and malignant tumors.

2.X-ray film

X-ray film of the front and side of the neck and chest can be used to observe the soft tissue mass of the neck and its calcification. For example, sand-like calcification is more common in papillary thyroid carcinoma; it is also possible to understand whether the trachea is compressed. Displacement, stenosis, and presence of primary or metastatic lungs.

3.CT, MRI examination

The location and identification of cervical masses are not only of diagnostic significance but also of guiding surgery. The anatomical structure and density changes of tissues and organs can be observed. The contrast between the density of the surrounding tissues and the mass is still small, and the contrast scan can be injected to enhance the resolution of the tumor. It has unique advantages in judging the benign and malignant masses, and understanding the relationship between the masses and surrounding tissues and large vessels in the neck.

4. Nuclide scanning

Can be used for the identification of goiter. In addition, for the anterior midline mass of the neck, it is of significance to exclude ectopic thyroid.

5. Laryngoscopy and nasopharyngoscopy

In lymph node metastatic malignancies, the primary focus mostly comes from the nasopharynx, oropharynx, laryngo-pharynx, and larynx. The laryngoscope and nasopharyngoscope (including fiber or electronic nasopharyngoscope and laryngoscope) are used to comprehensively analyze the above areas A careful examination is of great significance in finding the primary foci. If a suspicious primary lesion is found, a pathological biopsy should be performed to confirm the diagnosis.

6. Fine needle aspiration cytology

Fine needle aspiration cytology is currently used. After puncture, there is very little chance of needle-channel implant transfer. It can determine the tissue source and benign and malignant neck masses. It is widely used in clinical practice because of its simplicity, safety, high positive detection rate and high diagnostic accuracy.

7. Lumpectomy biopsy pathology

The mass should be removed as much as possible for biopsy. When wedge resection is not possible, the capsule should be sutured properly to prevent tumor implantation on the wound.

Neck mass diagnosis

A neck mass can be diagnosed based on medical history, physical examination, laboratory examination, imaging examination, and histopathological examination. The diagnosis of a neck mass depends on histopathological examination.

Neck Lump Treatment

The source of the neck mass is complex, with different biological characteristics and different treatment options. The treatment plan for inflammatory masses is anti-inflammatory therapy, which treats the primary lesions; when abscesses are formed, puncture and incision are needed to drain the pus. Specific inflammation needs to be treated for the cause, such as cervical lymph node tuberculosis should be treated with anti-tuberculosis. Congenital neck masses and benign neck masses are treated by surgical resection. Neck masses are malignant tumors, and treatment options vary depending on the source of the tumor. Treatment options for cervical malignant lymphoma include radiation and chemotherapy. Treatment methods for cervical lymph node metastasis include: surgical treatment, radiation therapy, surgery plus radiotherapy, radiotherapy plus chemotherapy and other treatment options. The specific treatment plan should be considered based on the pathological type of muscle differentiation, lymph node size, number, presence or absence of extracapsular invasion of the lymph nodes, the location of the primary tumor and the treatment of the primary tumor, and the overall condition of the patient. Except for undifferentiated thyroid cancer, the treatment of thyroid cancer is mainly surgical. I (iodine) isotope treatment can be used for thyroid cancer that cannot be resected or metastatic from distant metastases.

Prognosis of neck mass

Inflammatory neck masses and congenital neck masses can be cured. The prognosis of thyroid papillary carcinoma is good, and the 10-year survival rate of surgical treatment is more than 90%. Surgical treatment of cervical lymph node metastases has a 5-year survival rate of 30% to 50%. After planned comprehensive treatment of cervical malignant lymphoma, the efficacy has been significantly improved. The 5-year survival rate of early Hodgkin's lymphoma after radiotherapy has reached 90%, and non-Hodgkin's lymphoma can be relieved for more than 50%.