Neck Masses (Lumps in the neck)
1. What Causes Lumps In The Neck In Children?
The most common neck mass in children is an enlarged lymph node, due to a chronic infection with bacteria, virus or some other usual organism.

The next most common group of neck masses in children are those which are congenital (or present since birth). These masses are due to a problem during development. Some of the more common congenital neck masses include branchial cleft cysts, thyroglossal duct cysts, dermoid cysts, hemangiomas and lymphangiomas.

Branchial cleft cysts can occur anywhere from just below the jawbone to just above the collarbone. Sometimes alittle dimple in the skin is present which may drain mucous. This type of cyst is due to the failure of tissues in the front of the neck to completely fuse with the tissues in the back of the neck.

These cysts generally slowly increase in size but they can occasionally enlarge and shrink with viral infections.

Thyroglossal duct cysts usually are found directly in the midline of the neck anywhere from the windpipe to the jawbone. During development, the thyroid gland is located in the back of the mouth and later travels to its final location in the neck. The tract formed when the thyroid gland moves usually seals closed. If the tract does not completely seal itself, thyroglossal duct cyst may develop. Surgery removal of these cysts is the recommended treatment.

Hemangiomas are abnormally developed blood vessels, which form a mass, which tends to grow quickly for the first year and then slowly shrink. They will often go away totally without any specific treatment. Sometimes surgery is performed on hemangiomas that are 4 or 5 years old and have not totally gone away. This surgery is usually for cosmetic reasons.

Lymphangiomas are abnormally developed lymphatic vessels. Lymphatic vessels are tubes which travel next to blood vessels and carry extra fluid in our tissues back into the blood stream so that our tissues are not swollen. Lymphangiomas tend to continue to grow throughout life and often cause pressure on the windpipe, swallowing tube and tongue. They often will rapidly enlarge with colds and may develop into a cystic hygroma.

Cystic hygromas are lymphangiomas, which can become massive in size due to the development of dilated large cystic cavities throughout the mass. Surgery is required to decompress the cysts and remove the growth.

Tumors in children may be cancer or non-cancer. Some of the more common non- cancerous neck tumors in children include nerve tumors, thyroid tumors, and fat cell tumors called lipomas. The most common neck cancer in children under the age of 15 years is the lymphoma. A lymphoma is a cancer of the lymph node. There are several types and are usually treated with chemotherapy and radiation therapy.

Other neck cancers include rhabdomyosarcoma (cancer of the muscle), neuroblastoma (cancer of the nerve) and thyroid cancer. Although neck cancers in children are uncommon, all neck masses found in children must be carefully evaluated to insure the correct the correct diagnosis and treatment.

back to top
2. How Is The Cause Determined?
Specific questions your doctor may ask include the age of your child, how long the mass has been present, any changes in the size of the mass (larger or smaller), any pain, associated skin change over or around the mass, history of any injuries, fever, weight loss, change in energy level, excessive sweating, any animal exposure, especially to cats, recent travel, tuberculosis exposure, and family history of diseases, especially cancers and other tumors. The examination of your child will include the mass itself, its relationship to nearby structures and every other region in the head and neck which is associated with masses in the particular location as your child's mass.

The mass is evaluated for its ability to move underneath the skin and over the muscle, which it sits upon. Any tenderness of the mass or changes in the overlying skin is also noted.

back to top
3. What Tests Can Be Done?
X-rays, ultrasound, CT scans or MRI scans may be useful to evaluate the mass.

Laboratory studies which may be useful include a white blood cell count (which reflects evidence of infection), a sed rate or C reactive protein level (which are both related to your child's body's response to an infection), mononucleosis test, and tests for cat scratch fever (a disease which is often obtained from cats and causes enlarged lymph nodes).

A fine needle placed into the mass can withdraw tissue, which can culture the infecting bacteria or show possible signs of cancer.

Some children are able to tolerate this procedure in the office while others need heavy sedation or possibly even general anesthesia.

back to top
4. Does The Lump Have To Be Removed?
After the history is obtained, physical exam performed, and lab studies evaluated, the cause for the neck mass may still be unclear. Conservative management, including antibiotics should be tried. If no significant resolution of the mass occurs, a biopsy should be performed. Depending upon the size of the mass and its location, the biopsy may remove the entire mass or only a sample portion of it.

back to top