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Clinical Challenge
February 2016

Rapidly Growing Lateral Neck Mass

Author Affiliations
  • 1Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
  • 2Division of Surgical Pathology, Department of Pathology, Medical University of South Carolina, Charleston
  • 3Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston

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JAMA Otolaryngol Head Neck Surg. 2016;142(2):185-186. doi:10.1001/jamaoto.2015.2928

A man in his 50s presented with a 2-month history of a rapidly enlarging mass on the left side of the neck. He reported a recent 5-kg weight loss and had no history of tobacco or alcohol use. Clinical examination revealed a fixed lower neck mass extending through levels 3, 4, 5b, and 6, measuring 7 × 8 cm (Figure, A). Flexible laryngoscopy revealed reduced movement of the left vocal cord and asymmetry with surrounding edema. Computed tomographic imaging revealed a well-vascularized mass of the paratracheal region invading surrounding the surrounding structures (Figure, B). Two fine-needle aspiration samples were obtained, but results from pathological analysis were inconclusive. The tumor was removed in a piecemeal fashion because it surrounded the trachea and esophagus and invaded into the strap muscles, internal jugular vein, the first tracheal ring, and the recurrent laryngeal nerve. At the end of the procedure all margins were clear. On pathologic examination, the tumor was semifirm with a necrotic central portion. The hematoxylin-eosin–stained specimen revealed many mitotic figures along with large, multinucleated giant cells. Lymphovascular and perineural invasion was present (Figure, C). Immunohistochemical staining of the main specimen was cytokeratin AE1/AE3 negative and thyroid transcription factor (TTF-1) negative (Figure, D). Of 12 lymph nodes, none contained carcinoma.

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