Neck mass can be an initial finding of many diseases at any age. The differential diagnosis is broad and includes inflammatory, congenital and neoplastic lesions. We retrospectively analyzed charts of the 145 patients with neck mass and without known primary malignancy whose diagnoses were confirmed with histopathologic and serologic examination between July 2003 and July 2008. Twenty-six patients (17.9%) were diagnosed with tularemia. Before 2004, serologic testing for tularemia was not a part of our workup for patients with an inflammatory neck mass. Otolaryngologists should be familiar with head and neck manifestations of tularemia and consider the disease in the differential diagnosis of neck masses. The tularemia outbreak in central Black Sea region, Turkey in 2004 changed our approach to a patient presenting with neck mass.
iposarcoma, the second most common soft tissue sarcoma, is rarely localized in the head and neck region.1 To our knowledge, there are only seven other reports of a liposarcoma occuring in the retropharyngeal space. [2][3][4][5][6][7] The clinical and pathologic characteristics of these tumors are mainly obtained from studies of liposarcoma cases arising from other parts of the body rather than the head and neck. Therefore, it is difficult to make rational treatment plan for the head and neck liposarcomas. In this report, a case of well-differentiated liposarcoma of the retropharyngeal space is reported and discussed in the light of the current literature. A AB BS S T TR RA AC CT T Liposarcoma is a common soft tissue malignant tumor, although it is rare in the head and neck region. In particular, there have been only a few cases of liposarcoma arising in the retropharyngeal space. Those tumors cause special diagnostic and therapeutic difficulties. In this case, a well-differentiated liposarcoma of the retropharyngeal space in a 51-year-old woman is reported. The tumor continued to grow slowly over a period of four years. We were unable to make a proper diagnosis of this tumor prior to surgery although the radiographic findings resembled the tumors containing fatty component. In the present case, total excision of the tumor with free margins was performed. Although surgical excision with a wide margin is appropriate, it was difficult to resect the tumor completely. Herein, recommendations for earlier and correct diagnosis and treatment of this neoplasm are discussed with a review of the literature.K Ke ey y W Wo or rd ds s: : Liposarcoma; hypopharyngeal neoplasms Ö ÖZ ZE ET T Liposarkomlar yetişkinlerde sık görülen yumuşak doku tümörlerinden biri olmasına rağmen baş boyun bölgesinin nadir görülen tümörlerinden biridir. Literatürde şimdiye kadar çok az sayıda retrofaringeal bölgeden köken alan liposarkom olgusu yer almaktadır. Ayrıca, retrofaringeal bölgeden köken alanlarda tanı ve tedavi oldukça zordur. Bu makalede, 51 yaşında bir kadın hastada retrofaringeal bölgede yerleşim gösteren iyi diferansiye liposarkom olgusu tartışıldı. Dört yıllık bir dönem içinde yavaş yavaş büyüme gösteren tümörde, radyolojik bulgular tümörün yağ komponentleri içerdiğini göstermekle birlikte, tümörün kesin tanısı cerrahi sonrası konulabildi. Tedavi olarak tümör serbest cerrahi sınırlarla birlikte total olarak çıkartıldı. Liopsarkomlarda tedavi tümörün geniş emniyet marjinleriyle çıkarılması olmakla beraber bu her zaman mümkün olmamaktadır. Burada nadir görülen bu tümörün erken ve doğru tanısı ve tedavisi için öneriler literatür ışığında tartışıldı.
Bu çalışmada baş ve boyun kitlelerinde ince iğne aspirasyon biyopsilerini histopatolojik sonuçlar ile karşılaştırıp, diagnostik olarak sensitivite ve spesifitesini saptamayı hedefliyoruz. Ağustos 2008-Temmuz 2010 tarihleri arasında kliniğimize baş boyun bölgesinde yerleşik kitle yakınması ile başvuran ve cerrahi eksizyon öncesi İnce İğne Aspirasyon Biyopsisi (İİAB) uygulanan 50 hasta retrospektif olarak incelendi. Araştırma kapsamına alınan 50 hastanın 26'sı (% 52) erkek, 24'ü (% 48) kadındı. Ortalama yaş: 54,3±17,8 ve median yaş: 55 (18 yaş-84 yaş) idi. Histopatolojik olarak malign etiyoloji saptanan 29 (% 58) hastanın; 10'unda (% 34,4) İİAB tanısı "malignite pozitif", 4 hastada (% 13,7) "malignite negatif" ve 15 hastada (% 51,7) ise "kategorize edilemeyen " ve/ veya "değerlendirme için yetersiz" olarak raporlandı. Yirmi bir hastada (% 42) benign histopatolojik sonuç elde edilmekle birlikte, bu hastaların hiçbirinde malignite yönünden pozitif İİAB sonucu izlenmedi. On iki hastada (% 57,1) "malignite negatif" sonuç bulunurken, 9 hastada (% 42,8) "kategorize edilemeyen" ve/veya "değerlendirme için yetersiz" olarak saptandı. İİAB ile tanı konabilen malign etiyolojilerden en sık yassı hücreli kanser, benign etiyolojilerden ise nonspesifik inflamasyon izlendi. İİAB'in duyarlılığı % 71,4, spesifitesi % 100 ve doğrululuk oranı ise % 84,6 olarak bulundu. Literatür ile karşılaştırıldığında düşük düzeyde duyarlılık ve doğruluk oranları saptanması; İİAB değerlendirilmesinde yeterince yetkinleşilememesinden, biyopsilerin farklı kişilerce alınmasından ve görüntüleme yöntemlerinden faydalanılmamasından kaynaklanıyor olabilir.J. Exp. Clin. Med., 2012; 29:131-133
ABSTRACTThe aim of this study was to compare the histopathological results of fine needle aspiration biopsy (FNAB)s in head and neck masses, and to evaluate the specifity and sensitivity for diagnosis. Data were obtained retrospectively from 50 patients who referred to our clinic with head and neck masses before surgery between August 2008 and July 2010. Twenty six patients (52%) were male and 24 (48%) were female. The mean and median ages of the patients were 54.3±17.8 and 55 respectively. Twenty nine patients (58%) had malignant histopathological etiology; in 10 patients (34.4%) FNAB was reported as "positive malignity", 4 patients (13.7%) were reported as "negative malignity" and 15 patients (51.7%) were reported as "non-categorize" and/or "insuficient for assesment". Twenty one patients (42%) had benign etiology; in 12 patients (57.1%) FNAB was reported as "negative malignity", 9 patients (42.8%) were "non-categorize" and/or "insufficient for assessment". There were no positive malignant reports obtained in the benign group. Squamous cell carcinoma is the most common diagnosis in malignant etiologies and nonspecific inflammation is the most common diagnosis in benign etiologies, which could be diagnosed with FNAB. FNAB method sensitivity was 71.4% , specifity was 100% and accuracy rate was found 84.6% . When compared with the literature, determination of the l...
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