Prevalence and pattern of neck masses in pediatric patient: in Aseer Central Hospital, KSA

INTRODUCTION

Neck masses are a common complaint in children worldwide, and constitute a major indication for surgical consultation in many pediatric surgical centers.^1,2 Most of the neck masses in children are benign in their nature and clinical course. The broad spectrum of etiology of neck masses that ranged from congenital benign to acquired neoplastic lesions is varied and related to multiple factors.^3-5 The demographic characteristics of children presented with neck masses varied with the location and residency of patients.^5,6 Clinical and radiographic evidences are enough to establish accurate diagnoses in pediatric neck masses except in cases of nonspecific clinical conditions as in inflammatory lymphadenopathy or malignancies in which open biopsy is required.⁷ Surgical excision is the optimal choice of treatment in neck lesions, for aesthetic reasons and for the prevention of recurrent infections in addition to the potential danger of malignancy.⁸ In our study we studied the prevalence and pattern of neck masses in pediatric group in southern region in KSA at Aseer central hospital.

This retrospective study was conducted to assess the distribution of neck masses in pediatric patient related to gender, age, pathology, and anatomical location of neck masses in Aseer central Hospital.

METHODS

After getting approval from IRB the study was conducted during the period from 2011-2016. Medical records of 62 patients with neck masses were collected from the department of pathology at Aseer Central Hospital, KSA. The cases were reviewed for data on gender, age, the type of origin tissue, the type of lesion, and the anatomical location. Comparison between genders, age groups, and tissue origins were performed. We divided the age to 3 categories: from 1 to 5 years, from 6 to 10 years, and from 11 to 14 years. All statistical tests were performed with SPSS software.

Inclusion criteria

Patients with all neck masses (age less than 15 years) underwent excisional or incisional biopsy under local or general anesthesia from 2011 to 2016, those patient whose receive antibiotic treatment before biopsy.

Exclusion criteria

Patients with thyroid, parathyroid and salivary gland masses and adult patients more than 14 years.

RESULTS

Over a period of 5 years, a total of 62 patients (33 men 53.2% and 29 women 46.8%. had neck masses) resected for pathological assessments (Table 1). The age of presentation was ranging from 1 to 14 years, the most cases was developed in age 6 to 10 years and in age 11 to 14 years both 38.7% (Table 2). The histopathological diagnosis of the neck masses was found to be congenital 40.3%, inflammatory 33.9%, and malignant tumor 25.8% (Table 3).

Congenital mass

Thyroglossal duct cyst was the most common congenital mass observed in 15 (24.2%) cases, followed by branchial cleft cyst, lymphangioma and finally dermoid (Table 4).

Inflammatory lesion

Lymphadenitis was the most common inflammatory lesion seen in 13 (21%) cases, then TB and finally toxoplasmosis (Table 4).

In malignant tumor

The most common malignant tumor seen was Hodgkin lymphoma in 13 (21%) cases, then non Hodgkin lymphoma (Table 4).

Regarding site distribution

Right side of neck: 17.2% congenital, 44.9% inflammatory, and 37.9% malignant tumor. Left side of neck: 23.5% congenital, 47.1% inflammatory, and 29.4% malignant tumor Midline: all are congenital (Table 5).

DISCUSSION

Swellings in the head and neck region are very common in children and may be due to a variety of causes. Al-Mayoof et al found inflammatory category was the main group accounting 57.8%, reactive non-suppurative lymphadenitis 40.6%, then suppurative lymphadenitis 15.6%, followed by the congenital category 25%, thyroglossal duct cyst 9.3%, then branchial cleft anomalies 7.8%, neoplastic 12.5%, and then the non-inflammatory non neoplastic 4.7%.⁹ Ragesh et al studied neck masses in children in India they found inflammatory category was the main group accounting 54%, tuberculous lymphadenitis 28%, reactive lymph node hyperplasia 20%, and chronic non-specific lymphadenitis 6%, followed by the congenital category 30%,and neoplastic 16%.¹⁰ Lucumay et al studied pediatric neck masses in Northwestern Tanzania they found inflammatory category was the main group accounting 43.9%. Most common lesions are reactive lymph node hyperplasia 28.3%, followed by the congenital category 38.5% cystic hygroma most common 18.2% then thyroglossal cyst 14.9%, neoplastic 14.9%, and traumatic 2.1%.¹¹

In our study the most common masses are congenital 40.3%, thyroglossal duct cyst most common congenital mass 24.2%, then branchial cleft cyst 8.1%, lymphangioma 6.5%, and dermoid 1.6% and inflammatory 33.9%, lymphadenitis the most common inflammatory lesion 21%, TB 9.7%, and finally toxoplasmosis 3.2% and malignant tumor 25.8%. The most common malignant tumor Hodgkin lymphoma 21%, and Non Hodgkin lymphoma 4.8%.

Ragesh et al in their study noticed that 64% cases were males and the rest 36% were females.¹⁰ Lucumay et al found 71.6% were males and 28.4% were females.¹¹ In our study male was 53.2% while females are 46.8%.

CONCLUSION

The differential diagnosis of the pediatric neck mass includes a wide array of congenital, inflammatory, benign and malignant lesions. The initial evaluation is the history and physical which should be used to place the mass into one of these categories if a definitive diagnosis is not possible. In our study the most common masses in pediatric patient thyroglossal duct cyst, all midline masses are congenital.

Limitations

• • It is a retrospective cohort study based on quality of records keeping in hospital.
• • Our study based only in one center.
• • Small numbers of cases.

ACKNOWLEDGMENTS

We would like to thank all doctors and nurses working in histopathology department in Aseer central hospital.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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