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Differential diagnosis of cervical malignant lymphadenopathy among Iranian patients
Mohammad Naeimi1, Amin Sharifi, Youssef Erfanian
1Department of Otolaryngology, Ghaem Medical Center, Mashhad University of Medical Science, Mashhad, Iran. dr.naeimi@gmail.com
Insights
Neck lumps are frequently malignant, especially in adults. Age influences the type of neck cancer, with lymphoma and thyroid cancer common in younger patients and squamous cell carcinoma in older adults.
Area of Science:
- Otolaryngology
- Oncology
- Diagnostic Imaging
Background:
- Neck lumps are a common referral concern.
- Differentiating benign from malignant neck masses is crucial for patient management.
- Demographic factors may influence the prevalence and type of neck malignancies.
Purpose of the Study:
- To determine the differential diagnosis of neck lumps referred with suspicion of malignancy.
- To explore the relationship between demographic variables and neck mass pathology.
Main Methods:
- A cross-sectional study involving re-evaluation of patients with neck lumps.
- Utilized history taking, physical examination, imaging, and fine needle aspiration for diagnosis.
- Investigated 232 cases with confirmed malignant disease, including further workup for unknown primary tumors.
Main Results:
- 50% of referred neck masses were malignant neoplasms.
- In patients under 40, lymphoma (55%) and thyroid cancer (26%) were most common.
- In patients over 40, squamous cell carcinoma (67%) predominated; jugulodigastric nodes were most frequently involved.
Conclusions:
- Given the high malignancy rate, asymmetrical adult neck masses should be presumed malignant until proven otherwise.
- Age is a significant predictor of neck tumor pathology.
- Further diagnostic investigations are essential for accurate diagnosis and management.
Objective:
To investigate the differential diagnosis in cases referred with neck lumps suspicious to malignant nodal masses and its relation to demographic variants.
Methods:
Individuals who entered in this cross-sectional study conducted at the Department of Otolaryngology, Ghaem Medical Center, Mashdad, Iran from May 1995 to April 2005 were re-evaluated by history taking, physical examination and imaging studies. Fine needle aspiration was applied to obtain tissue sampling. Among the patients, 232 cases had malignant disease confirmed by pathology reports. Cases with unknown primary tumor underwent investigations including pan-endoscopy, and further imaging studies were carried out to determine the primary tumor site. Demographic data as gender, age, location, size, and pathology of tumor were considered.
Results:
The results of this study showed that 50% of patients which were referred with neck masses had malignant neoplasm. The most common pathology in patients younger than 40 years were lymphoma (55%) and thyroid cancer (26%), whereas, in patients older than 40 years squamous cell carcinoma (67%) was more common. The most involved lymph nodes were jugulodigastric chain. Larynx and hypopharynx are the most common sources of aerodigestive tract metastatic.
Conclusion:
According to high incidence malignancy (50%) among neck lesions, an asymmetrical neck mass in adults should be considered malignant until proven otherwise. It seems that age is an important predictor of tumor pathology, and determination of further diagnostic investigations would be helpful.
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