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Clinical Problem Solving
Pathology
October 2013

A Painless Right Supraclavicular Mass

Author Affiliations
  • 1McMaster University, Hamilton, Ontario, Canada
JAMA Otolaryngol Head Neck Surg. 2013;139(10):1069-1070. doi:10.1001/jamaoto.2013.4403

An otherwise healthy, asymptomatic man in his 30s presented with a 5-week history of a painless right supraclavicular mass. There was no history of trauma, recent infection, travel, or contacts with individuals who were ill. He never smoked and was a social drinker. There was no history of radiation therapy.

Physical examination revealed a soft, nontender, semimobile mass in the right supraclavicular region measuring 5 × 6 cm. No cervical lymphadenopathy was detectable. Findings from flexible nasopharyngolaryngoscopy was normal. Fine-needle aspiration showed numerous dissociated cells with slightly irregular nuclei. A number of them possessed vacuolated cytoplasm. This was suggestive of a neoplasm, possibly liposarcoma (Figure, A). Computed tomographic (CT) imaging revealed a well-defined, 5.2 × 6.0 × 3.0-cm heterogeneous lesion with areas near fat density in the base of the right side of the neck clearly surrounded by a fat plane (Figure, B). Results from CT imaging of the chest, abdomen, and pelvis were negative for malignant disease.

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