Evaluating Neck Masses in Adult and Pediatric Patients

Gordon H. Sun, MD, MS

Disclosures

April 16, 2019

Neoplastic Neck Masses

Clinicians must always keep in mind the fact that the majority of neck masses in adults are neoplasms, and malignant neoplasms exceed any other etiology.[1,2] An asymptomatic neck mass may be the only clinically apparent suggestion that there is head and neck cancer.

Although no definitive data on the incidence of persistent neck mass exist, available statistics suggest that roughly 30,000 patients per year will present with a malignant neck mass.[2] The majority of malignant neck masses in adults are attributable to squamous cell carcinoma (SCC); however, lymphoma, thyroid cancer, and salivary gland cancer are among several other possible etiologies. Notably, even though oral, laryngeal, and hypopharyngeal SCC have declined in recent decades owing to decreased tobacco use, there has been a concurrent increase in oropharyngeal SCC due to the increasing prevalence of high-risk human papillomavirus (HPV) infection (eg, HPV subtype 16).[2]

Bilateral Neck Masses in an Adult Patient

A 33-year-old female accountant presented to her family nurse practitioner (NP) for evaluation of bilateral neck masses. The patient stated that she first noticed the masses 6 weeks before presentation, noting that they had been growing rapidly since that time. She also informed the NP that she recently had begun waking up at night in a cold sweat and often felt tired during the day despite getting an adequate amount of sleep.

The patient denied dysphagia, dyspnea, dysphonia, and fevers. Her surgical history was positive for appendectomy, but there was no other pertinent medical or family history. She denied any history of smoking, alcohol, or other recreational drug use. Her only medication was oral contraceptives. She had no known drug, food, or environmental allergies.

Physical examination demonstrated a thin woman in no apparent distress and with normal vital signs. There was no audible stridor or dysphonia. The head and neck examination was remarkable for two palpable, nontender, fixed lateral neck masses, one on each side. The larger of the two masses measured approximately 3 x 2 cm in diameter. There were no overlying skin changes. The intraoral examination demonstrated 3+ tonsils without exudate or erythema and no visible mucosal lesions. No neurologic deficits were observed. The chest was clear to auscultation and percussion. No palpable supraclavicular or axillary lymphadenopathy was noted. A urine pregnancy testing was negative.

On the basis of the patient's history and physical exam findings, the NP ordered imaging and selected laboratory studies.

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