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Clinical approach to pediatric neck masses: Retrospective analysis of 98 cases
Ozlem Unsal1, Pınar Soytas1, Seyhan Ozakkoyunlu Hascicek2
1Department of Otorhinolaryngology & Head and Neck Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Insights
Infectious causes are the most common pediatric neck masses, followed by congenital and neoplastic types. Excisional biopsy is recommended for diagnosis in children when initial assessments are inconclusive.
Area of Science:
- Otorhinolaryngology
- Pediatric Pathology
Background:
- Pediatric neck masses (PNMs) present unique diagnostic challenges compared to adults.
- Varied clinical approaches necessitate standardized evaluation methods.
Purpose of the Study:
- To review pediatric neck mass cases evaluated via open biopsy.
- To analyze histopathological diagnoses and clinical characteristics of PNMs.
Main Methods:
- Retrospective review of 98 pediatric patients' hospital records (8.5 months to 16 years).
- Evaluation of clinical history, physical exams, lab tests, imaging, and pathology results.
- Categorization of masses by etiology, imaging, size, and location.
Main Results:
- Infectious masses were most common (49%), followed by congenital (27.6%) and neoplastic (23.4%).
- Hodgkin lymphoma was the most frequent malignancy (39.1%). Thyroglossal and branchial cysts comprised 74.1% of congenital masses.
- Excisional biopsy was the primary method (91.8%); 67% of masses were solid, predominantly in lateral neck levels.
Conclusions:
- Diagnosis often relies on history and physical exam, supplemented by imaging and biopsy for non-specific findings.
- Ultrasound is the preferred initial imaging modality.
- Excisional biopsy is recommended over fine-needle aspiration for pediatric neck mass histopathology.
Objective:
Pediatric neck masses (PNMs) are a frequently encountered problem in otorhinolaryngology practice. The clinical approach to cervical masses in childhood varies from that of adults. Due to differences among clinicians in the assessment of a PNM, studies investigating this subject are significant contributions to the literature. For this reason, a review was conducted of pediatric PNM cases with an open biopsy (incisional/excisional) and a histopathological diagnosis.
Methods:
The hospital records of 98 (34 girls, 64 boys) pediatric patients aged between 8.5 months and 16 years were reviewed. The history, physical examination findings, blood tests, medical treatments, imaging reports, and the pathology and/or microbiology results of the patients were recorded and evaluated. The cervical masses were categorized according to the etiology, imaging features, size, and location.
Results:
Surgical biopsy was planned due to the suspicion of malignancy, typical clinical presentation or location, or size greater than 20 mm despite antibiotherapy for 2 to 6 weeks. Excisional biopsy (91.8%) was the first choice for histopathological sampling. Infectious masses were observed most commonly, followed by congenital and neoplastic masses, at a rate of 49%, 27.6%, and 23.4%, respectively. Hodgkin lymphoma was the most frequent type of malignancy (39.1%). Thyroglossal and branchial cysts constituted 74.1% of congenital masses. Sixty-seven percent of all masses were solid, and the lateral levels of the neck were the most affected locations (44.9%).
Conclusion:
In most cases, the diagnosis can be made with a detailed history and physical examination. In the presence of nonspecific findings, blood tests, imaging, and histopathological sampling are required. Ultrasound should be the first preference for imaging, and excisional biopsy is suggested rather than fine needle aspiration biopsy for histopathological sampling in pediatric neck masses.
