成人侧颈区孤立囊性肿块的诊断

Diagnosis of adult solitary cystic masses in the lateral neck

摘要:

目的 收集初诊为成人侧颈区良性囊肿患者的临床病理学资料，探讨良恶性的鉴别要点,提高术前诊断准确性。方法 回顾性分析2014年1月—2021年12月北京友谊医院耳鼻咽喉头颈外科诊治的成年患者，初步诊断为鳃裂囊肿或囊性水瘤。总结分析患者的临床、影像学以及病理学资料。结果 共37例初诊为颈部良性囊肿的患者中，最终总恶性率为13.5%(5/37)，其中口咽鳞状细胞癌颈淋巴结转移2例，甲状腺乳头状癌颈淋巴结转移3例。颈部肿块存在分隔或囊壁局限性增厚是成人侧颈区孤立囊性肿块最终诊断为颈部淋巴结转移癌的独立危险预测因素(P<0.05)。结论 成人孤立侧颈区囊性肿块需要警惕为颈部不明原发灶转移癌。对于成人侧颈区孤立囊性肿块，尤其当颈部肿块存在分隔或囊壁局限性增厚时，需要结合多种诊断方法，排除颈部不明原发灶转移癌。

Abstract:

Objective To explore the key points of differential diagnosis between benign and malignant masses in the lateral neck so as to improve the accuracy of preoperative diagnosis via retrospectively analyzing the clinicopathological data of adult patients with initially diagnosed as benign cervical cysts.Methods A retrospective study was performed to all adult patients with initial clinical diagnosis of branchial cleft cyst or cystic hygroma in our department from Jan 2014 to Dec 2021. The analyzed data included the clinical, radiological and pathological records of all cases.Results A total of 37 patients were diagnosed as cervical benign cysts, and the overall rate of malignancy was 13.5 % (5/37), including cervical lymphatic metastasis from oropharyngeal squamous cell carcinoma in two cases and papillary thyroid carcinoma in three. The presence of septa and uneven thickening of cystic wall in the cervical mass was an independent predictor of malignant metastatic lymph nodes in solitary cystic mass of the lateral neck in adults (P=0.003, 0.005).Conclusion Solitary cystic mass of the lateral neck in adults needs to be vigilant for cervical metastatic carcinoma of unknown primary site. Multiple diagnostic methods should be combined to exclude cervical metastatic carcinoma of unknown primary site in adults with solitary cystic mass in the lateral neck, especially for those with septa and uneven thickening of cystic wall.