Neck masses in toddlers and later in childhood are most commonly reactive lymphadenopathy. Periodic fever with lymph node enlargement, pharyngitis, and stomatitis should raise the suspicion of Marshall syndrome. Pediatric head and neck masses with a stable duration of months or years are likely congenital lesions or benign inflammatory processes. A history of trauma to the area with or without secondary infection may be found under this sudden presentation. The first presentation of a congenital mass such as lymphatic malformation, thyroglossal cyst, or branchial cleft cyst may also be sudden with rapid enlargement due to infection or hemorrhage.
TABLE 105.1 HEAD AND NECK MASSES IN CHILDREN
multiple endocrine neoplasia (MEN) syndromes. While the former often presents with branchial cleft abnormalities in addition to otologic malformations, hearing loss, and renal malformations, the latter may be associated with neuroblastoma or thyroid cancer. A family history for childhood malignancy should alert the clinician for a possible increased risk of malignancy as well.
with regard to inflammatory lesions, and therefore are not be discussed in this chapter.
are suspicious for malignancy. Unusually large masses, those that continue to enlarge after the initial presentation, masses located in the supraclavicular area, or those associated with pain, fever, or weight loss should undergo a thorough workup and open biopsy (10). When there is a high suspicion for malignancy, an open biopsy should be performed, even if there has been a prior negative FNAB. A hematology-oncology consultation may be useful if there is a high suspicion of malignancy.
parasitic, or opportunistic infections. Additionally, congenital neck masses may also present with an acute infection of the congenital mass.
TABLE 105.2 INFECTIOUS ETIOLOGIES FOR INFLAMMATORY HEAD AND NECK MASSES IN CHILDREN