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Clinical Challenge
Pathology
August 2016

A Young Woman With a Supraclavicular Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2016;142(8):801-802. doi:10.1001/jamaoto.2015.3775

A young woman presented with a 4-month history of a 2.0-cm mass in her right supraclavicular region. She had a cough and fatigue at the time, but no other symptoms of upper respiratory tract infection at onset. She attributed her fatigue to staying up late studying and had not tried any treatments, including antibiotics. She denied any trauma, night sweats, fever, chills, weight loss, generalized pruritus or lymphadenopathy in other areas of her body, any voice change, dysphagia, odynophagia, hoarseness, hemoptysis, hematemesis, or weight loss. Her family history was positive for breast cancer in her mother, and the patient was a lifelong nonsmoker. Physical examination revealed palpable nontender, freely movable mass in the right supraclavicular region. Palpation of the parotid, submandibular glands, and thyroid gland did not reveal any suspicious masses or tenderness. No mucosal lesions, scars, or masses were found on intraoral examination, with clear oropharynx. Computed tomography revealed a 2.0-cm, right-sided supraclavicular mass just anterior and superior to the right subclavian vein with central patches of hypoattenuation (Figure, A). Results from initial ultrasonography-guided fine-needle aspiration were nondiagnostic. Subsequent ultrasonography-guided core needle biopsy on supraclavicular aspirate showed a benign spindle cell proliferation arranged in a tissue-culture–like pattern with a myxoid to collagenous stroma (Figures, B and C). Immunohistochemical stains demonstrated the cells to be positive for actin and negative for cytokeratin and S100 protein.

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