成人侧颈区孤立囊性肿块的诊断经验

Diagnostic experience for solitary cystic massesin the lateral neck of adults

摘要:

目的：成人侧颈区孤立囊性肿块可能造成诊断困难。头颈部恶性肿瘤的颈部转移灶可表现为囊性,这与颈部良性囊肿不易区分,尤其当原发灶不明时,更容易造成误诊误治。本文的目的是通过回顾性分析北京友谊医院耳鼻咽喉头颈外科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月至2021年12月期间于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): HPV相关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=0.003,0.005)。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 : Solitary cystic masses of the lateral neck in adults may cause difficulties in diagnosis. Malignancy must be ruled out since cervical lymphatic metastases arising from head and neck cancers may mimic the presentation of benign cystic masses, especially when the primary lesion is unknown. The purpose of this paper is to retrospective analyze the clinicopathological data of adult patients with initially diagnosed as benign cervical cysts in the ENT department of Beijing Friendship Hospital, explore the differential diagnosis points between benign and malignant masses, improve the accuracy of preoperative diagnosis. Methods:Retrospective review of the clinical, radiological and pathological records of all adult patients between 1/2014–12/2021 in ENT department of Beijing Friendship Hospital,the initial clinical diagnosis was branchial cleft cysts or cystic hygroma. Result: 37 patients were diagnosed as cervical benign cysts ,the overall rate of malignancy was 13.5 % ( 5 / 37 ): Cervial lymphatic metastases from oropharyngeal squamous cell carcinoma in two patients , from papillary thyroid carcinoma in two patients. The presence of septa and uneven thickening of cystic wall in the cervical masses was an independent predictor of malignant metastatic lymph nodes in solitary cystic masses of the lateral neck in adults (P=0.003,0.005). Conclusion: Solitary cystic masses of the lateral neck in adults need to be vigilant for unknown primary cervical carcinoma. For adults with solitary cystic masses in the lateral neck, especially for those with septa and uneven thickening of cystic wall in the cervical masses, multiple diagnostic methods should be combined to exclude unknown primary cervical carcinoma.