A 17-year-old white male patient was referred to the otolaryngology clinic with a 6-month history of a left-sided neck mass. His primary care physician initially obtained an ultrasonographic image, which demonstrated a left, level 2 lymph node measuring 4.0 × 1.5 × 2.8 cm. The patient then underwent several courses of antibiotic treatment, but the mass persisted. After a period of conservative management, he developed a sore throat and fever. He subsequently underwent a computed tomographic scan of the neck and chest with contrast, which demonstrated an isolated, enlarged, homogenously enhancing left-neck level 2B lymph node measuring 3.4 × 2.8 × 2.1 cm (Figure 1A). When he presented to our facility, he was found to have an asymptomatically enlarged left level 2/5A neck mass that was nontender and fixed. The patient had an unremarkable medical, surgical, and social history and no known infectious exposures. A white blood cell count and C-reactive protein level were both elevated, at 11 310 cells/μL (to convert to cells × 109 per liter, multiply by 0.001) and 56.2 mg/L (to convert to nanomoles per liter, multiply by 9.524), respectively. Studies for influenza A and B, HIV, cytomegalovirus, American foulbrood, Bartonella henselae, infectious mononucleosis, and Epstein-Barr virus had negative results. An ultrasonography-guided needle biopsy was performed. Fine-needle aspiration and flow cytometry had negative results for lymphoproliferative disorders or a malignant condition. A tissue culture had negative results. Given the inconclusive diagnosis, the patient underwent a left neck dissection of levels 2A, 2B, and 5A. Intraoperative frozen sections did not show a malignant process. On final analysis, a pathologic examination of the largest lymph node was performed (Figure 1B).
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Boochoon KS, Barbieri AN, Mohyuddin NG. An Abnormal Neck Mass in a Pediatric Patient. JAMA Otolaryngol Head Neck Surg. 2020;146(4):375–376. doi:10.1001/jamaoto.2019.4339
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: