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Neck Masses
(Lumps in the neck)
DOES THE LUMP HAVE TO BE
REMOVED? 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. 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. 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.
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. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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Copyright © 2008 Atlanta Children's ENT. | |
