Parathyroid Adenoma Presenting as a Giant Cystic Neck Mass

We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.

Benign neck masses showing restricted diffusion: Is there a histological basis for discordant behavior?

Diffusion weighted imaging(DWI) evolved as a complementary tool to morphologic imaging by offering additional functional information about lesions. Although the technique utilizes movement of water molecules to characterize biological tissues in terms of their cellularity, there are other factors related to the histological constitution of lesions which can have a significant bearing on DWI. Benign lesions with atypical histology including presence of lymphoid stroma, inherently increased cellularity or abundant extracellular collagen can impede movement of water molecules similar to malignant tissues and thereby, show restricted diffusion. Knowledge of these atypical entities while interpreting DWI in clinical practice can avoid potential misdiagnosis. This review aims to present an imaging spectrum of such benign neck masses which, owing to their distinct histology, can show discordant behavior on DWI.

Supraclavicular Neck Mass as Sole Presenting Symptom for Seminoma in an Elderly Male

We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathological workup and how it influenced our decision-making. A review of the literature is also discussed and demonstrates how uncommon it is for seminomas to present in this manner.

Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung’s disease: A case report and review of literature

BACKGROUND Madelung’s disease(MD)is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head,neck,shoulders,back,trunk,and nerve roots of the upper and lower limbs.It is relatively rare in Asian individuals and is prone to misdiagnosis.Herein,we report a case of a patient with MD who had undergone surgical management at our hospital,and we discuss the pathogenesis,diagnosis,and treatment of MD.CASE SUMMARY We report a case of MD in a 65-year-old man of Han descent.The patient had multiple,painless progressive masses for more than five years in the neck and more than 30 years in the upper back.Because of neck mobility limitations and progressive cosmetic deformities caused by the masses,he was admitted to our hospital.He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years.Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated,subcutaneous fatty deposits.We prepared a staged operation plan.The patient was diagnosed with MD;he was advised to abstain from alcohol and was followed up regularly.After a 3-month follow-up,no recurrence of fat accumulation was found in the surgical areas.CONCLUSION This report presents a case of surgical treatment for MD to improve clinicians'understanding of the disease.

Multi-analysis with mathematic model of 3125 non-thyrogenous masses of the neck

Objective: To systematically analyze and summarize non-thyrogenous masses of the neck (NTMN) by consid-eration of new areas, a large sample size and multiple-aspect analysis. Methods: Our research involved 3125 NTMN cases. We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international clas-sification. The clinical traits such as sexual proportion and age, etc, were analyzed along with the unknown primary cervical metastatic carcinomas (UPCMC), and built up a mathematical model based on the data above. Results: There were 68 dif-ferent diseases identified. Among all the NTMN, the percentage of metastatic carcinomas was 63.3%. The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear. Moreover, other results almost supported the "rule of 80%". There was an obvious distribution of traits at every sub level. For example, there were 23 different diseases in level III, of which the most common was lymphoma. UPCMC made up 12.3% of all metastatic carci-nomas. The clinic cases could be analyzed by our model even to form a primary diagnosis which showed a high coincident rate with clinic diagnosis. Conclusion: NTMN are complex and various, with a definite distribution in each neck level. Data relating component character, sex ratio and UPCMC et al to the clinical traits of NTMN will provide vigorous support for clinical applications. The mathematical model could be an efficient method to synthetically analyze complicate data of NTMN.

Multi-Analysis of Non-Thyrogenous Masses of the Neck

OBJECTIVE To systematically analyze and summarize non-thyroge-nous masses of the neck(NTMN)by consideration of new areas,a large sample size and multiple-aspect analysis.METHODS Our research involved 3,125 NTMN cases.We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international classification.The clinical traits such as sexual proportion and age,etc,were analyzed along with the unknown pri-mary cervical metastatic carcinomas(UPCMC),multiple nodular NTMN and tubercular lymphadenitis.RESULTS There were 68 different diseases identified.Among all the NTMN,the percentage of metastatic carcinomas was 63.3%.The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear.Moreover,other results almost sup-ported the “rule of 80%”.There was an obvious distribution of traits at every sub level.For example,there were 23 different diseases in level III,of which the most common was lymphoma.UPCMC made up 12.3% of all metastatic carcinomas.Multiple NTMN were composed of lymphoma,metastatic car-cinoma and tubercular lymphadenitis,etc.For tubercular lymphadenitis pa-tients,the patients without tubercular toxic symptoms comprised 77.1% of all tubercular lymphadenitis patients.CONCLUSION NTMN are complex and various,with a definite distribu-tion in each neck level.Data relating the sex ratio,UPCMC,multiple nodular NTMN and tubercular lymphadenitis to the clinical traits of NTMN will provide support for clinical applications.

儿童脓肿型与非脓肿型颈部感染性肿块的临床及影像特征分析

目的 回顾性分析脓肿型与非脓肿型颈部感染性肿块患儿的临床及影像学特征,对比脓肿型与非脓肿型患儿颈部感染性肿块的诊治及预后差异。方法 收集2016年1月至2023年8月广州医科大学附属妇女儿童医疗中心收治的71例儿童颈部感染病例,根据有无脓肿形成分为脓肿组(49例)和非脓肿组(22例),对比分析两组患儿的临床与影像特征及治疗方法与预后效果差异。结果 脓肿组患儿中,31例有发热症状,42例C反应蛋白(C-reactive protein,CRP)升高;49例均可触及颈部肿块,21例肿块质地软,41例活动度欠佳,18例皮温升高,36例边界模糊;36例累及3个及以上颈部间隙。非脓肿组患儿中,6例有发热症状,9例CRP升高;19例可触及颈部肿块,10例肿块质地韧,16例活动度欠佳,5例皮温升高,8例边界模糊;10例累及3个及以上颈部间隙。脓肿组与非脓肿组颈部感染患儿在是否触及肿块(P=0.008)、肿块质地(P=0.027)、活动度(P=0.031)、皮温是否升高(P=0.022)、CRP是否升高(P<0.001)和病灶边界是否清晰(P=0.003)等临床表现、实验室指标和影像特征的差异有统计学意义。患儿颈部感染原因以梨状窝瘘、淋巴结炎及淋巴管畸形多见。手术治疗结果显示,脓肿组(4.1%)和非脓肿组(9.1%)术后并发症发生率均较低。结论 脓肿型颈部感染患儿在发热症状、CRP水平、肿块质地、肿块活动度与皮温、肿块边界不清和颈部间隙受累数量等方面与非脓肿型患儿存在显著差异,CT或MRI增强可为儿童颈部感染的诊断、鉴别诊断及临床治疗方法的选择提供重要参考依据。

Head and Neck Cancer Early Identification of Malnutrition High Risk Patients and Quality of Life Optimization

Malnutrition in Head and neck cancer (HNC) patients can be present at the moment of diagnosis. The nutritional status is determinant for the treatment success and quality of life of the patients. The nutritional status gradually declines during treatment and the majority of patients undergoing treatment will need nutritional therapy. On the other hand, HNC, like other cancers, can induce a paraneoplastic syndrome that leads to cachexia. This cachexia status is most of the times the cause of death or the cause of treatment failure. So, early identification of malnutrition high risk patients is crucial to start an adequate nutrition support intervention in HNC patients. This study aims to identify HNC patients who present malnutrition or higher risk of malnutrition;to signalize variables that support early identification of high-risk patients of becoming malnourished and to establish a dynamic relationship between malnutrition risk in these patients and Quality of Life (QoL) impacts. For six months consecutive outpatients with HNC admitted at the Head & Neck Unity of Oncology Portuguese Institute—Porto were asked to participate in the research (n = 114). The European Organisation for Research and Treatment of Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30 and Malnutrition Universal Screening Tool, MUST were used. At the moment of first presentation, 32 patients (28.1%) presented high-risk of malnutrition. HNC patients with oral cavity and oropharynx tumour locations, older, with low literacy or with BMI under 18.5 at the moment of diagnosis, represent a high-risk group. When HNC is considered, a dynamic and bi-directional connection between malnutrition and QoL is observed. A significant (p Emotional and social functional scales and all symptom scales—including pain, presented significant differences between high and medium risk of malnutrition patients. Fatigue, pain, insomnia, appetite loss and financial difficulties were domains directly related to high risk of malnutrition patients. Pain scores were significantly higher (43.23) in the high-risk patients when compared to medium risk patients (11.67). Nutrition support should be considered at any stage of the pathway —especially in high risk group—in order to optimize tumour treatment results, reduction of adverse effects of therapy and improving both QoL and survival.

The Presenting Symptom of Metastatic Prostate Carcinoma: Case of a Large Supraclavicular Mass and Review of Literature

Prostate cancer is the most common noncutaneous malignancy of American males and typically presents with genitourinary symptoms, however, head and neck extension is a rare finding. We present a case of a 53-year-old male initially presenting with a large supraclavicular mass as the only complaint. After an initial non-diagnostic FNA biopsy, PSA levels, histology and immunohistochemical findings were consistent with metastatic prostatic adenocarcinoma. The patient was started on anti-hormonal treatment after diagnosis. Due to the increasing reports of such cases, we suggest PSA levels and appropriate immunohistochemical staining should be obtained on all unknown neck masses.

Frequency and severity of OSAHS in Mexican adolescents. The role of BMI and neck circumference

Background: Overweight and obesity are major public-health issues in Mexico. Sleep breathing disorders directly impact the health of affected subjects. The aim of this study was to describe the frequency and severity of obstructive sleep apnea/hypopnea syndrome (OSAHS) in Mexican adolescents grouped by weight status. Secondary objectives were to describe the influence of body mass index (BMI) and neck circumference (NC) as predictive factors of OSAH. Method: Somatometric, demographic data and full-night polysomnography were done. Linear and logistic regression models described the relationship between BMI and NC with OSAHS presence and severity. Receiver-Operating-Characteristics (ROC) curves showed different sensitivity and specificity performances of BMI and NC cutoff-values. Results: OSAHS frequency and severity were significantly greater in obese and extremely-obese adolescents (8% vs 22% vs 67%;p < 0.001). Linear regression showed an AHI increase of 0.940 events/hour for every centimeter-increase in NC and 0.696 events/hour for every1 kg/m2-increase in BMI. Logistic-regression showed extreme-obesity as the main risk factor (OR 9.9) for diagnosis of OSAHS. ROC curves showed an area under the curve (AUC) of 0.83 for BMI defined cutoff-values, and of 0.80 for BMI percentile-for-age cutoff-values. The AUC of NC ROC curve was 0.8043. Conclusion: This is the largest study made on Latin-American population evaluating the frequency and severity of OSAHS with full-night polysomnography. We showed that obese and extremely-obese Mexican-adolescents are at highest risk for OSAHS. Increasing BMI and NC showed positive correlation with AHI. Different BMI cut-off values showed similar diagnostic performance. Extreme-obesity increases 8 times the risk association for OSAHS.

Update on current diagnosis and management of anaplastic thyroid carcinoma

Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%.However,the undifferentiated or anaplastic type accounting for<0.2%,usually in elderly individuals,exhibits a dismal prognosis with rapid growth and disappointing outcomes.It is the most aggressive form of thyroid carcinoma,with a median survival of 5 mo and poor quality of life(airway obstruction,dysphagia,hoarseness,persistent pain).Early diagnosis and staging are crucial.Diagnostic tools include biopsy(fine needle aspiration,core needle,open surgery),high-resolution ultrasound,computed tomography,magnetic resonance imaging,[(18)F]fluoro-D-glucose positron emission tomography/computed tomography,liquid biopsy and microRNAs.The BRAF gene(BRAF-V600E and BRAF wild type)is the most often found molecular factor.Others include the genes RET,KRAS,HRAS,and NRAS.Recent management policy is based on surgery,even debulking,chemotherapy(cisplatin or doxorubicin),radiotherapy(adjuvant or definitive),targeted biological agents and immunotherapy.The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients.Anti-programmed death-ligand 1 antibody immunotherapy,stem cell targeted therapies,nanotechnology achievements and artificial intelligence implementation provide novel promising alternatives.Genetic mutations determine molecular pathways,thus indicating novel treatment strategies such as anti-BRAF,anti-vascular endothelial growth factor-A,and anti-epidermal growth factor receptor.Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care.This neoadjuvant treatment followed by surgery ensures a twoyear overall survival of 80%.Prognostic factors for improved outcomes have been found to be younger age,earlier tumor stage and radiation therapy.A multidisciplinary approach is necessary,and the therapeutic plan should be individu alized based on surveillance and epidemiology end results.

甲状腺核素显像联合SPECT/CT融合显像诊断甲状舌管囊肿的临床价值

目的探讨SPECT/CT融合显像对甲状舌管囊肿的诊断价值及影像学表现。方法回顾性分析2017年至2022年西安交通大学第一附属医院耳鼻喉头颈外科经病理证实为甲状舌管囊肿的37例患者影像资料,采用Fisher精确检验分析法,比较甲状腺平面显像与SPECT/CT融合显像在诊断甲状舌管囊肿阳性率和排除异位甲状腺准确率的差异,并对超声和CT在甲状舌管囊肿形态、毗邻位置的差异进行比较分析。结果甲状腺平面显像、SPECT/CT融合显像、超声诊断甲状舌管囊肿的阳性率分别为:0.00%、100.00%、89.19%;SPECT/CT融合显像和甲状腺平面显像对甲状舌管囊肿诊断阳性率的差异具有统计学意义(P<0.01),两者在排除异位甲状腺阳性率的差异无统计学意义(P>0.05);超声和CT在明确甲状舌管囊肿形态和毗邻位置的差异具有统计学意义(P<0.05)。结论SPECT/CT融合显像可实现一次成像,分析颈部包块的代谢状态和解剖结构,对甲状舌管囊肿的诊断和治疗更具指导价值。

基于孟德尔随机化探索肥胖与多囊卵巢综合征的关系

目的使用双样本双向孟德尔随机化(MR)方法探索肥胖与多囊卵巢综合征(PCOS)是否存在因果关联。方法利用公开可用的欧洲人群体重指数(BMI)、腰围(WC)、髋围(HC)、颈围(NC)和PCOS全基因组关联研究的汇总统计数据进行双样本双向MR分析。选取与BMI相关的367个单核苷酸多态性(SNP)、与WC相关的312个SNP、与HC相关的241个SNP、与NC相关的3个SNP以及与PCOS相关的4个SNP作为遗传工具变量。采用逆方差加权法评估上述肥胖指标与PCOS的因果关联。为了检验结果的可靠性,进一步敏感性分析包括MR-Egger回归法、加权中位数法、多效性残差与离群值法、Cochran's Q检验及留一性分析。结果在纳入的指标中,遗传预测的BMI和WC与PCOS发病存在因果关联。没有发现HC和NC与PCOS发病相关的证据;没有证据表明罹患PCOS将增加肥胖发生率。结论BMI和WC可能在PCOS发病中发挥作用。

老年股骨颈骨折患者全髋关节置换术后发生假体脱位的影响因素

目的:分析老年股骨颈骨折患者全髋关节置换术后发生假体脱位的影响因素。方法:回顾性分析2018年10月至2021年10月于该院行全髋关节置换术治疗的188例老年股骨颈骨折患者的临床资料。术后随访1年,记录患者假体脱位发生情况,对股骨颈骨折患者全髋关节置换术后发生假体脱位的相关因素进行单因素和多因素分析。结果:两组性别,手术时间,合并高血压、糖尿病、高脂血症情况比较,差异均无统计学意义(P>0.05);脱位组年龄、BMI、骨密度、手术入路、股骨头假体直径、股骨柄前倾角度与未脱位组比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,年龄≥75岁、BMI≥24 kg/m^(2)、骨密度降低、后外侧入路、股骨头假体直径<30 mm、股骨柄前倾角度>15°是老年股骨颈骨折患者全髋关节置换术后发生假体脱位的独立危险因素(OR>1,P<0.05)。结论:年龄≥75岁、BMI≥24 kg/m^(2)、骨密度降低、后外侧入路、股骨头假体直径<30 mm、股骨柄前倾角度>15°是老年股骨颈骨折患者全髋关节置换术后发生假体脱位的独立危险因素,临床可据此采取针对性的预防措施。

胎儿颈部肿块的分娩期子宫外产时治疗(附1例报道)

目的探讨小儿外科畸形早期外科干预的一种新途径,即分娩时子宫外产时治疗的可行性。方法通过文献复习及对近期开展的1例产前超声诊断胎儿颈部肿块成功进行分娩期子宫外产时治疗。结果在维持母-儿循环时给患儿进行气管插管,建立机械通气,出生后8d切除颈部肿瘤,手术获得成功。结论及时产前诊断胎儿气道梗阻,通过分娩时子宫外产时治疗,在维持母-胎循环时使患儿获得气道通畅,改善了围产结局。

以颈部肿块为主要临床表现的颈段椎管内外交通性神经鞘瘤的诊断与治疗

目的:发生于颈段椎管的神经鞘瘤可沿椎间孔向外生长,表现为颈椎内外交通性肿块,但多因早期出现脊髓压迫症状而就诊于神经外科。本文报告2例以颈部肿块为主要临床表现而就诊于口腔颌面外科的颈椎内外交通性神经鞘瘤,旨在提高临床医师对本病的诊断与治疗水平。方法:对中南大学湘雅医院口腔颌面外科近期收治的2例以颈部肿块为主要临床表现的颈椎内外交通性神经鞘瘤患者的临床资料进行总结与随访,并结合相关文献,探讨其临床病理特征、手术方式与预后。结果:2例患者均以颈上部肿块为主要症状就诊,术前影像学检查显示颈椎内外交通性哑铃型肿块,采用颈后正中和颈外侧联合入路切除肿瘤并重建脊柱的稳定性,随访1a未见复发。结论:发生于颈椎的神经鞘瘤可表现为颈部肿块而脊髓压迫症状并不明显,详细的体格检查与影像学检查可以明确诊断,手术切除具有一定难度。

颈部非甲状腺肿块1166例分析

目的：总结颈非甲状腺肿块特点，以期有利于诊断水平的提高。方法：将1981年1月～1997年1月间，经病理确诊的1166例非甲状腺肿块住院病人的性别、年龄、发病时限、肿块性质进行统计及分析。结果：颈部非甲状腺肿块中，恶性肿瘤、炎性肿块及先天性肿块三类患者的性别、平均年龄、肿块出现的平均时限与国内外学者统计相近。结论：颈部非甲状腺肿块诊断一般不难，根据其临床特点及病理分型结合先进的辅助检查，可为临床诊断提供可靠的依据。

小金丹治疗肿瘤研究探讨

小金丹出自清代王维德《外科全生集》,是治疗外科疾病的一个有效方剂,有消岩散结、化瘀祛毒之功。临床应用小金丹治疗某些肿瘤,疗效肯定。研究发现小金丹提取物作用24 h后能明显抑制人乳腺癌MDA-MB-453细胞的运动和侵袭能力,作用呈现剂量依赖性关系。在消化系统疾病中,加减小金丹对胃癌术后患者高凝、低纤溶、低细胞免疫状态有良好的治疗作用;并推迟转移发生,延长胃癌术后患者生存时间。小金丹可显著影响人肝癌细胞信号转导基因的表达。小金丹联合其他中药,还可治愈胰腺癌。在呼吸系统疾病,特别是肺癌的治疗方面,小金丹观察组有效率高于对照组;对于咯血症状的肺癌,用小金丹以活血通络,化瘀止血,配合西药治疗,可共达止血之效。此外,还发现小金丹可以治疗脑肿瘤、颈部肿块、骨肿瘤、非霍奇金淋巴瘤,疗效肯定。小金丹诸药共用,化瘀、解毒、止痛、行气、散结等功效,将其用于肿瘤的治疗,可以取得较好的临床疗效。

颈部肿块血管造影诊断

目的：探讨颈部肿块的血管造影表现及其对颈部肿块的诊断价值。材料与方法：２８例颈部肿块患者，２５例经手术病理证实。血管性肿块１３例，其中假性动脉瘤７例，静脉瘤３例，动脉迂曲３例；非血管性肿块１５例，其中颈部动脉体瘤９例，神经鞘膜瘤４例，海绵状淋巴管瘤２例。分析其血管造影表现，并与临床、手术病理结果对比分析。结果：１３例血管性肿块和９例颈动脉体瘤因有典型的造影表现与病理结果一致，其余６例因缺少肿瘤血管或典型表现而误诊或诊断不明。血管造影诊断准确率为７８．６％，临床诊断准确率为５７．６％。结论：血管造影是颈部肿块影像学检查有效方法之一，对血管性肿块和颈动脉体瘤可以确诊，同时可了解Ｗｉｌｉｓ环功能及肿块周围动脉累及情况，指导外科手术方式。

内镜辅助耳后发际入路上颈良性肿物切除术

目的探讨内镜辅助耳后发际入路上颈良性肿物切除的可行性、指征和利弊。方法采用内镜辅助耳后发际入路对18例上颈良性肿物行手术治疗。术前行影像学(CT或MRI)评估病损大小、位置、毗邻,并行细针穿刺组织学活检明确病理。结果 18例患者均顺利完整切除肿物。术后2例(11.1%)出现暂时性耳垂麻木,1例(5.6%)出现暂时性面神经下颌缘支麻痹。所有病例无术后出血、无皮瓣坏死、无涎瘘等,随访6～18个月(平均12个月),未见复发。术后1个月所有患者客观美容满意度评分平均9.6分,对手术美容效果满意。结论内镜辅助耳后发际入路上颈良性肿物切除术安全、可行,优点切口隐蔽、美容效果确切、无明显并发症,是一种可供临床借鉴的美容术式。