Neck mass

颈部肿块
  • 文章类型: Editorial
    甲状腺癌是一种复杂的疾病,有几种类型,最常见的是分化良好和未分化。后者,“未分化癌”,也称为间变性甲状腺癌(ATC),是一种高度侵袭性的恶性肿瘤,占所有甲状腺癌的0.2%以下,预后不良,中位生存期为5个月。BRAF基因突变是与这种类型的甲状腺癌相关的最常见的分子因素。靶向生物制剂的最新进展,免疫疗法,干细胞疗法,纳米技术,达布拉非尼/曲美替尼联合治疗,免疫检查点抑制剂(ICI)和人工智能提供了新的治疗选择。达拉非尼和曲美替尼的联合治疗是目前BRAF-V600E基因突变患者的标准治疗方法。此外,达布拉非尼/曲美替尼联合治疗,单独使用或与靶向疗法结合使用的ICI为改善这种致命疾病的预后带来了一些希望。年龄更小,早期肿瘤分期和放疗都是预后改善的预后因素.最终,治疗方案应根据监测和流行病学数据针对个体患者量身定制,多学科方法至关重要。
    Thyroid carcinoma is a complex disease with several types, the most common being well-differentiated and undifferentiated. The latter, \"undifferentiated carcinoma\", also known as anaplastic thyroid carcinoma (ATC), is a highly aggressive malignant tumor accounting for less than 0.2% of all thyroid carcinomas and carries a poor prognosis with a median survival of 5 months. BRAF gene mutations are the most common molecular factor associated with this type of thyroid carcinoma. Recent advances in targeted biological agents, immunotherapy, stem cell therapy, nanotechnology, the dabrafenib/trametinib combination therapy, immune checkpoint inhibitors (ICI) and artificial intelligence offer novel treatment options. The combination therapy of dabrafenib and trametinib is the current standard treatment for patients with BRAF-V600E gene mutations. Besides, the dabrafenib/trametinib combination therapy, ICI, used alone or in combination with targeted therapies have raised some hopes for improving the prognosis of this deadly disease. Younger age, earlier tumor stage and radiotherapy are all prognostic factors for improved outcomes. Ultimately, therapeutic regimens should be tailored to the individual patient based on surveillance and epidemiological data, and a multidisciplinary approach is essential.
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  • 文章类型: Case Reports
    膈神经神经鞘瘤是一种偶发的轴突肿瘤,大多无症状。
    方法:在本报告中,一个脖子上有一个无痛肿块的男人是主题。他的诊断过程包括神经鞘瘤的记录。随访期间手术切除膈神经鞘瘤,无任何并发症。
    对患者进行全身麻醉下的手术切除,外科医生观察到,神经鞘瘤起源于颈膈神经。通过囊内摘除技术将宫颈肿块从the神经上精确解剖。
    结论:神经鞘瘤的膈受累极为罕见,大多表现为无痛性肿块。此外,完整的手术切除是一种有效的方法。
    UNASSIGNED: Phrenic nerve schwannoma is an occasional axonal tumor that is mostly asymptomatic.
    METHODS: In this report, a man with a painless lump in his neck was the subject. His diagnostic process included the recording of schwannoma. Phrenic schwannoma was removed by surgery without any complication during follow-up.
    UNASSIGNED: Surgical excision under general anesthesia was done for the patient and during the surgical explore, the surgeon observed that, the schwannoma arose from the cervical phrenic nerve. The cervical mass was dissected from the phrenic nerve precisely by intracapsular enucleation technique.
    CONCLUSIONS: The phrenic involvements of schwannomas are extremely rare and mostly presented as a painless mass. Additionally, complete surgical excision of them is an efficient method.
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  • 文章类型: Case Reports
    通常,甲状腺被认为是转移性疾病较少的器官,甲状腺结直肠转移(CMT)的报道很少,尤其是,甲状腺转移瘤的临床体征是主诉。CMT发生在晚期结直肠癌中,与预后差和生存期短有关。
    在这种情况下,我们报道了一例以颈部肿块征象为CMT首发表现的患者.患者于2019年6月接受了甲状腺部分切除术,甲状腺癌的免疫组织化学发现提示胃肠道腺癌的可能性。该患者于2019年7月接受了结肠镜检查,发现结肠肿块。病理检查诊断为直肠腺癌。患者接受新辅助化疗,手术治疗,术后辅助化疗和靶向治疗。患者于2022年6月死亡。
    转移疾病根本不会被忽视,当病人抱怨颈部肿块的迹象时。Further,结直肠癌患者一旦发生甲状腺结节,应考虑转移癌的可能性。尽管原发肿瘤的生物学特征和分期对预后有重要影响,积极的标准化治疗也有帮助。
    UNASSIGNED: Commonly, the thyroid gland is regarded as an organ with fewer metastatic diseases, and colorectal metastasis to the thyroid (CMT) is rarely reported, especially, with that the clinical sign of thyroid metastasis nidus is the chief complaint. The CMT occurs in advanced colorectal cancer and is associated with poor prognosis and short survival.
    UNASSIGNED: In this case, we reported a patient with the sign of neck mass as the first manifestation of CMT. The patient underwent a partial thyroidectomy in June 2019, immunohistochemical findings of thyroid carcinoma suggested the possibility of adenocarcinoma of gastrointestinal tract. The patient underwent a colonoscopy in July 2019 and a colonic mass was found. Pathological examination diagnosed rectal adenocarcinoma. The patient underwent neoadjuvant chemotherapy, surgical treatment, postoperative adjuvant chemotherapy and targeted therapy. The patient died in June 2022.
    UNASSIGNED: The metastasis disease would not be ignored at all, when a patient complains at signs of neck mass. Further, the possibility of metastasis cancer should be considered once thyroid nodules occur in patients with colorectal cancer. Even though the biological characteristics and stage of the primary tumor have an important impact on the prognosis, positive standardized treatments can also be helpful.
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  • 文章类型: Case Reports
    Lemierre综合征是细菌性口咽感染后化脓性血栓性静脉炎的罕见临床综合征。Lemierre综合征可能难以识别,并且具有显着的发病率。我们报告了一个由化脓性链球菌引起的Lemierre综合征的年轻人的病例,对2周的β-内酰胺治疗反应良好。
    本病例报告总结了Lemierre综合征的主要表现特征,并结合南非背景提供了简短的文献综述。
    Lemierre\'s syndrome is a rare clinical syndrome of septic thrombophlebitis following a bacterial oropharyngeal infection. Lemierre\'s syndrome can be difficult to recognise and has significant morbidity. We report the case of a young man with Lemierre\'s syndrome caused by Streptococcus pyogenes, who responded well to 2 weeks of beta-lactam therapy.
    UNASSIGNED: This case report summarises the key presenting features of Lemierre\'s syndrome and provides a brief literature review considering the South African context.
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  • 文章类型: Journal Article
    颅外头颈部原发性脑膜瘤并不常见。由于细针抽吸术(FNA)通常是评估头颈部肿块的一线诊断方式,颅外脑膜瘤可造成FNA的重大诊断缺陷.我们报告了一例26岁女性的具有横纹肌样特征和BAP1丢失的脑膜瘤,沿着颈动脉鞘表现为一个大的颈部肿块。肿块的FNA活检显示高度细胞的标本,具有均匀的簇,上皮样细胞具有圆形到卵圆形的核和中等的核质比。在细胞块切片上进行的广泛的免疫组织化学面板显示肿瘤细胞为弱EMA阳性,孕激素受体为局灶性阳性,SSTR2A呈弥漫性和强阳性。BAP1免疫组织化学显示肿瘤细胞中表达的弥漫性丧失。细胞学诊断脑膜瘤后,进行了组织活检,诊断为具有横纹肌样特征和BAP1丢失的脑膜瘤。我们还对表现为颈部肿块并由FNA评估的脑膜瘤病例进行了文献综述。我们的案例强调了FNA上颅外脑膜瘤可能引起的重大诊断挑战,以及辅助研究避免诊断陷阱的重要性。
    Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.
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  • 文章类型: Case Reports
    甲状旁腺癌(PC)是一种罕见的内分泌肿瘤,通常表现为骨质减少/骨质疏松症,肾结石,虚弱,神经精神症状.我们描述了一个48岁女性的案例,表现为宫颈纵隔区域有很大的疼痛性血肿。颈部超声(US)显示40×80×55mm的实质性病变,明显的低回声,从甲状腺右叶延伸到纵隔。血液检查显示血清钙和甲状旁腺激素(PTH)浓度升高,符合高钙血症性原发性甲状旁腺功能亢进。患者进行了复水和速尿治疗,胆钙化醇,和双膦酸盐,接受了右下甲状旁腺切除术,右半甲状腺切除术,和右VI宫颈水平的淋巴结切除术。组织学检查诊断为非血管侵入性或神经侵入性PC,甲状腺叶是淋巴细胞性甲状腺炎的部位;所有切除的淋巴结均为良性。术后病程规律。术后颈部US显示左甲状腺叶低回声,右甲状腺床没有残留肿瘤的证据。由于血清促甲状腺激素浓度升高至18mcIU/mL(正常参考范围,0.35-4.0mIU/mL)。确诊8年后,病人一般情况良好,没有临床,生物化学,或疾病持续/复发的影像学证据。
    Parathyroid carcinoma (PC) is a rare endocrine neoplasm that typically presents with osteopenia/osteoporosis, nephrolithiasis, asthenia, and neuropsychiatric symptoms. We describe the case of a 48-year-old woman, presenting with a large painful hematoma in the cervicomediastinal area. The neck ultrasound (US) demonstrated a solid lesion measuring 40 × 80 × 55 mm, markedly hypoechoic, which extended from the right thyroid lobe to the mediastinum. The blood tests showed elevated serum calcium and parathyroid hormone (PTH) concentrations, consistent with hypercalcemic primary hyperparathyroidism. The patient was rehydrated and treated with furosemide, cholecalciferol, and bisphosphonate, and underwent right lower parathyroidectomy, right hemithyroidectomy, and lymphadenectomy of the right VI cervical level. Histological examination was diagnostic for nonangioinvasive or neuroinvasive PC, and the thyroid lobe was the site of lymphocytic thyroiditis; all removed lymph nodes were benign. The postoperative course was regular. Postoperative neck US showed a hypoechoic left thyroid lobe without evidence of residual neoplasm in the right thyroid bed. Levothyroxine therapy of 50 mcg/day was started because of serum thyrotropin concentrations elevated at 18 mcIU/mL (normal reference range, 0.35-4.0 mIU/mL). Eight years after diagnosis, the patient is in good general condition, with no clinical, biochemical, or imaging evidence of disease persistence/recurrence.
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  • 文章类型: Case Reports
    无创通气的气道正压通气是许多患有呼吸窘迫的儿科患者的重要工具。我们介绍了一个未知的第三分支异常病例,该病例在持续气道正压通气(CPAP)充气后被诊断出来,这加剧了婴儿的呼吸窘迫。
    Positive airway pressure from noninvasive ventilation is an essential tool for many pediatric patients with respiratory distress. We present a case of an unknown third branchial anomaly that was diagnosed following inflation with continuous positive airway pressure (CPAP), which exacerbated the infant\'s respiratory distress.
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  • 文章类型: Case Reports
    颈部囊性水瘤,淋巴系统的先天性良性肿瘤,是新生儿气道阻塞导致喘鸣的潜在原因。细致的气道评估,案件适当的准备,使用先进的技术,包括视频喉镜和超声检查,可以促进困难气道的安全管理。
    Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway.
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  • 文章类型: Journal Article
    淋巴增殖性疾病包括一组以淋巴细胞不受控制产生为特征的异质性疾病。Castleman病(CD)是一种这样的疾病,包括一组罕见的疾病,涉及淋巴结肿大和广泛的炎症症状和实验室异常[1]。我们遇到了年轻的女孩,她在门诊部向我们介绍了这种疾病。在排除其他病理并通过组织活检确认诊断后,女孩接受了手术治疗,迄今为止没有疾病。
    Lymphoproliferative disorders comprise of a group of heterogenous diseases characterised by uncontrolled production of lymphocytes.Castleman disease (CD) is one such disease and comprises of a group of rare disorders that involve enlarged lymph nodes and a broad range of inflammatory symptoms and laboratory abnormalities [1]. We came across young girl who presented to us in the out patient department with this disease After ruling out other pathologies and confirming the diagnosis by doing a tissue biopsy the girl was treated surgically and is disease free till date.
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  • 文章类型: Journal Article
    高分化甲状腺癌预后良好,5年生存率超过95%。然而,未分化或间变性类型占<0.2%,通常在老年人中,表现出令人沮丧的预后,快速增长和令人失望的结果。它是甲状腺癌最具侵袭性的形式,中位生存期为5个月,生活质量差(气道阻塞,吞咽困难,声音嘶哑,持续性疼痛)。早期诊断和分期至关重要。诊断工具包括活检(细针穿刺,芯针,开放手术),高分辨率超声波,计算机断层扫描,磁共振成像,[(18)F]氟-D-葡萄糖正电子发射断层摄影/计算机断层扫描,液体活检和microRNA。BRAF基因(BRAF-V600E和BRAF野生型)是最常见的分子因子。其他包括RET基因,KRAS,HRAS,和NRAS。最近的管理政策是基于手术,甚至是剔除,化疗(顺铂或阿霉素),放射治疗(辅助或确定性),靶向生物制剂和免疫治疗。最后两种选择构成了新颖的有希望的管理方式,可改善这些原本受到谴责的患者的总体生存率。抗程序性死亡-配体1抗体免疫治疗,干细胞靶向治疗,纳米技术成就和人工智能实现提供了新的有希望的替代方案。基因突变决定了分子通路,因此表明了新的治疗策略,如抗BRAF,抗血管内皮生长因子A,和抗表皮生长因子受体。在BRAF-V600E基因突变的情况下,使用BRAF抑制剂dabrafenib和MEK抑制剂trametinib的组合进行治疗已获得食品和药物管理局的批准,目前是标准治疗。这种新辅助治疗后的手术确保了80%的两年总生存率。已发现改善预后的预后因素是年龄较小,早期肿瘤分期和放射治疗。多学科方法是必要的,治疗计划应根据监测和流行病学最终结果进行个体化.
    Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS. Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.
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