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Clinical Challenge
August 2017

A Supraclavicular Mass

Author Affiliations
  • 1Department of Otolaryngology, Kyoto-Katsura Hospital, Kyoto, Japan
  • 2Department of Diagnostic Pathology, Kyoto-Katsura Hospital, Kyoto, Japan
JAMA Otolaryngol Head Neck Surg. 2017;143(8):837-838. doi:10.1001/jamaoto.2016.4508

A man in his 70s presented with a 6-year history of a painless lump in his left supraclavicular region. Palpation detected a smooth, soft, and fluctuant mass in his left supraclavicular region. Fiberscopic examination of the pharynx and larynx revealed no abnormalities. Contrast-enhanced computed tomography (CT) demonstrated a poorly circumscribed, heterogeneous, and cystic mass near the sternocleidomastoid muscle (SCM). The SCM around the tumor was thickened, suggesting invasion of the SCM. There was no continuity between the tumor and the thyroid gland (Figure, A). Magnetic resonance imaging revealed a poorly marginated, heterogeneous, and partially tubular mass. Fine-needle aspiration cytology revealed cystic elements but no atypical cells. Positron emission tomography showed hypermetabolism (maximum standardized uptake value, 1.6) in the mass, but no other hypermetabolic foci. At surgery, the tumor was attached to the medial side of the origin of the left SCM. No extensive adhesions were observed, and dissection of the tumor from the adjacent tissues was straightforward. The lesion measured 2.5 × 3.0 × 4.0 cm, was a solitary well-circumscribed roundish nodule with a thin capsule, and its cut surface had a yellowish white homogeneous surface (Figure, B). Pathological examination revealed that the mass comprised an irregular combination of squamous epithelial and spindle cells, with a mature adipose tissue component (Figure, C and D). Immunohistochemical analysis revealed that the epithelial component was diffusely positive for cytokeratin AE1/AE3.

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