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Paediatric neck masses--a diagnostic dilemma
1Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, UK.
Insights
This study analyzed 360 pediatric head and neck masses, finding benign lesions like pilomatrixomata and thyroglossal cysts most common. Clinical diagnosis showed high accuracy for benign masses but was less reliable for lymph node content.
Area of Science:
- Pediatric Surgery
- Head and Neck Pathology
- Diagnostic Cytology
Background:
- Head and neck masses are common in children.
- Accurate diagnosis is crucial for appropriate management and reducing morbidity.
- Previous studies highlight the diversity of pediatric head and neck lesions.
Purpose of the Study:
- To review the types and frequency of pediatric head and neck masses excised.
- To evaluate the diagnostic accuracy of clinical assessment compared to histopathology.
- To assess the time to excision and inpatient stay for these masses.
Main Methods:
- Retrospective analysis of 360 pediatric patients undergoing mass excision.
- Data collection on patient demographics, lesion type, clinical diagnosis, and histopathology.
- Comparison of clinical diagnosis with histopathological findings.
Main Results:
- Benign lesions, including pilomatrixomata/sebaceous cysts (34%) and thyroglossal cysts (13%), were most frequent.
- Lymphadenopathy comprised reactive hyperplasia (60%), Mycobacterium infection (21%), and lymphomas (12%).
- High diagnostic accuracy (90-100%) for benign non-lymph node masses and tumors; lower for lymph node content (66%).
Conclusions:
- Pilomatrixomata and thyroglossal cysts are common pediatric head and neck masses.
- Clinical diagnosis is reliable for benign masses but less so for lymph node pathologies.
- Fine needle aspiration cytology may improve diagnostic accuracy and reduce patient morbidity.
Abstract:
Three hundred and sixty children who had a head and neck mass excised during 1987 to 1992 at the Royal Hospital for Sick Children, Glasgow were studied. There were 210 males and 150 females with a mean age of 60.7 months (0.5 to 198 months). Pilomatrixomata/sebaceous cysts (34 per cent), thyroglossal cysts (13 per cent), branchial remnants (nine per cent) and dermoids (nine per cent) accounted for almost two-thirds of the 264 non-lymphadenomatous benign lesions excised. Ninety-three lymphadenopathy masses consisted of 60 with reactive hyperplasia, 21 with Mycobacterium infection and 12 lymphomas. There were three solid malignant tumours, two were rhabdomyosarcomata and one disseminated round cell tumour. The correlation between clinical diagnosis and histopathology of benign non-lymph node masses and solid tumours was 90 per cent and 100 per cent respectively, in benign lymph nodes, 66 per cent, but was poor in differentiating lymph node content. The mean time from presentation of a swelling to its excision was almost a year and the mean in-patient stay for excision of a mass was almost five days. The role of fine needle aspiration cytology (FNAC) in arriving at a diagnosis and reducing patient morbidity is discussed.