Cystic neck lesions: clinical, radiological and differential diagnostic considerations.
CONCLUSIONS
Metastatic disease should always be considered as a potential differential diagnosis in the adult patient with a cystic neck lesion.


OBJECTIVE
The most common cause of a cystic neck lesion in young adults is a branchial cleft cyst (BCC). In older patients metastatic lymph nodes may be easily misdiagnosed as BCC. This study aimed to investigate the incidence of unsuspected carcinoma in routinely excised cervical cysts at a tertiary care teaching hospital and to determine the characteristics of benign BCC and cystic malignancy in preoperative imaging.


METHODS
A total of 196 consecutive adult patients operated on with the initial diagnosis of benign lateral cervical cyst were identified and the hospital charts and imaging studies were reviewed. The mean age of the patients was 40 years (range 17-79 years).


RESULTS
Metastatic squamous cell carcinoma was demonstrated histologically postoperatively in six (3.1%) patients and metastatic papillary thyroid carcinoma in one (0.5%) patient. Therefore, the incidence of unsuspected carcinoma in the cystic neck lesions initially diagnosed as BCC was 3.6%. The preoperative imaging appearances of these lesions had been considered identical to that of BCC.
Pietarinen-Runtti
Petra
P
Department of Otolaryngology - Head & Neck Surgery, Helsinki University Central Hospital, PO Box 220, FIN-00029 HUCH, Helsinki, Finland.
Apajalahti
Satu
S
Robinson
Soraya
S
Passador-Santos
Fabricio
F
Leivo
Ilmo
I
Mäkitie
Antti A
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001935:Branchioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D015995:Prevalence; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult