Neck abscess as the initial manifestation of pharyngeal cancer

Abstract

Introduction: Pharyngeal carcinoma and neck abscesses are not uncommon, but neck infection as the initial presentation of primary head and neck cancer is rare, and these patients risk potential misdiagnosis.Case presentation: We report our experience with two patients who had an unusual first presentation of pharyngeal cancer -a deep neck infection and a relapsing abscess of the thyroid gland. Conclusion:Our case series demonstrates the need for meticulous physical examination of the head and neck in all patients presenting with neck abscess. It is important to consider malignant tumour as a possible cause of deep neck infection and an abscess of the thyroid gland. Diagnosis and subsequent treatment is delayed if malignancy is not clinically suspected.

Lymph Node Abscessation Secondary to Neoplasia in Two Dogs

“…Often in humans, squamous cell carcinoma of the head and neck has cervical metastases at the time of diagnosis. Cystic nodal metastases may arise from the nasopharynx, tonsil, or thyroid gland [ 12 ]. Abscessation has been hypothesized to occur from infection of the cystic metastases, as a result of central necrosis of the tumor, or direct tumor extension that has undergone necrosis [ 12 ].…”

An unusual first presentation of hypopharyngeal carcinoma as thyroid abscess: Case report of a diagnostic challenge

“…Thyroid gland is inherently resistant to infection due to its capsule, rich blood supply, extensive lymphatic drainage and high iodine content [ 7 ]. Hence, acute suppurative thyroiditis with progression to thyroid abscess is uncommon and constitutes less than 1% of all thyroid diseases [ 8 ]. They are frequently associated with immunodeficiency or congenital conditions such as branchial cleft anomalies or thyroglossal duct cyst [ 8 , 9 ].…”

“…Hence, acute suppurative thyroiditis with progression to thyroid abscess is uncommon and constitutes less than 1% of all thyroid diseases [ 8 ]. They are frequently associated with immunodeficiency or congenital conditions such as branchial cleft anomalies or thyroglossal duct cyst [ 8 , 9 ]. Adults presenting with thyroid abscess should be investigated for any underlying causes such as thyroglossal duct remnant, migratory foreign bodies or iatrogenic secondary to biopsy.…”

“…Adults presenting with thyroid abscess should be investigated for any underlying causes such as thyroglossal duct remnant, migratory foreign bodies or iatrogenic secondary to biopsy. Commoner causes of a tender thyroid swelling include de Quervain’s thyroiditis, acute haemorrhage into thyroid cyst, anaplastic thyroid carcinoma or radiation-induced thyroiditis [ 8 ].…”

“…In our patient, the gross right thyroid lobe enlargement with central necrosis mimicked a thyroid abscess and masked the underlying primary hypopharyngeal tumour. Uhliarova et al [ 8 ] reported a similar case in which the patient was initially diagnosed with recurrent thyroid abscess and subsequent nasendoscopy revealed an oedematous hypopharynx and reduced vocal cord mobility. The diagnosis of hypopharyngeal carcinoma was only established after further investigation spurred by persistence of abscess despite optimal therapy [ 8 ].…”