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Workup of a neck mass includes a medical history and a physical examination, where important characteristics are location, size, shape, consistency, tenderness, mobility, and color. [4] When this is not conclusive, further workup includes: Blood tests; Medical imaging: Contrast CT is generally the initial study of choice for adults. [4]
Cervical thymic cyst is a very rare pathology that is often incidentally found due to its asymptomatic nature. The patient usually notices a neck mass that grows slowly which triggers them to see a clinician and be admitted to the hospital. [3] However, it can cause symptoms as it grows in size and compresses on other organs.
The cause is usually a developmental abnormality arising in the early prenatal period, typically failure of obliteration of the second, third, and fourth branchial cleft, i.e. failure of fusion of the second branchial arches and epicardial ridge in lower part of the neck. Branchial cleft cysts account for almost 20% of neck masses in children. [1]
Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages. [1] Thyroglossal cysts are the most common cause of midline neck masses and are generally located caudal to (below) the hyoid bone.
If the patient is asymptomatic and the mass is identified based upon radiologic findings, biopsy and/or resection may be avoided. [6] [9] Surgical removal of the mass is the definitive treatment for ectopic thymus tissue that is causing symptoms. [4] It has been reported that the ectopic thymus tissue can transform into cancerous tissue. [4]
The most usual signs and symptoms are the appearance of a chronic, painless mass in the neck, which is persistent and usually grows with time.The mass is referred to as a "cold abscess", because there is no accompanying local color or warmth and the overlying skin acquires a violaceous (bluish-purple) color.
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Stage II is a tumor extending in the local area, or that with any evidence of limited neck (nodal) disease. Stage III is a large tumor with or without neck disease, or a tumor with bilateral neck disease. Stage IV is a large tumor involving intracranial or infratemporal regions, an extensive neck disease, and/or any distant metastasis. [17]