F HERAN Fondation Rothschild JP GUICHARD Hôpital Lariboisière

1. DIAGNOSIS OF A CERVICAL
TUMEFACTION
F HERAN Fondation Rothschild
JP GUICHARD Hôpital Lariboisière

2. PATIENT
Age : < 40 YO : inflammation, congenital
> 40 YO : often malignant
80 % persistent cervical masses in adult = tumor
Alcohol, smoker
Known neoplasia
LOCATION
ONSET Sudden or progressive occurrence, other clinical signs
(infection…)
ELEMENTS THAT HELP US FOR THE DIAGNOSIS
LOCATION : anatomy
STRUCTURE (signal, density, echogenicity)
CLINICAL DATA
IMAGING DATA

3. Adenopathy
Dermoïd cyst of the floor of the mouth
Ectopic thyroïd gland
Lipoma
Schwannoma
MIDDLINE LESIONS
CYSTIC
SOLID OR HETEROGENOUS
Thyroglossal duct cyst

4. Frequent : 40 % of the cervical congenital malformations
Failure to close the thyreoglossal canal (canal of Bochdalek)
Developed along the migration path of the thyroïd gland
Base of the tongue (foramen caecum) thyroïd gland
Median lesion, centered on, above or under the hyoid bone
body,
Often lateralized if it is located under it.
Cyst, with thin wall, sometimes compartimentalized
Acute inflammatory episodes
THYROGLOSSAL DUCT CYST (TDC)

5. Low CTD (under hyoïd bone)

7. DERMOID CYST

8. DERMOID: Development lesions found inside
normal organs or tissues
Defect in the fusion of the embryonic lateral
mesenchymatic mass  Inclusion of tissue
Traumatism
Floor of the mouth =1/5 of the dermoïd cyst of
head and neck
Upward displacement of the tongue, slurred
speech, and difficulty in swallowing,
 If located between the mylohyoid muscle
and the neck's cutaneous muscle:
geniohyoid cyst (resembles a double chin)
Surgery
Baliga M, Shenoy N, Poojary D, Mohan R, Naik R Epidermoid cyst of the floor of the mouth . Natl J
Maxillofac Surg. 2014 Jan;5(1):79-83.
Patient du Pr Guy Princ

9. LATERAL LESIONS
Plunging ranula
Cystic hemolymphangioma
Branchial cleft cyst
Lymphocele
Thymic cyst
Laryngocèle
CYSTIC

10. MUCOIDE CYST, SALIVAY CYST, RANULA
Sublingual gland salivary cyst due to retention within a
sublingual or accessory gland.
Superficial swelling over the floor of mouth, bluish appearance
(frog’s belly),
May extend through or around the mylohyoid muscle complex =
plunging ranula which presents as a neck lump
Former trauma or inflammatory episods.
US : Cyst
CT scan : hypodense with thin walls.
MRI : cystic, variation of the signal depending on the
composition (protids…)

11. RANULA

12. PLUNGING RANULA

13. Plunging ranula (salivary cyst)

14. CYSTIC LYMPHANGIOMA

17. Complex vascular malformation, association of abnormal lymphatic
and venous vessels.
First clinical signs before 20 YO
Multiloculated
ETN infections hemorrhage, new cysts, acute increase of size
Treatment
Punction of the hematoma
Embolization, sclerosis
CYSTIC LYMPHANGIOMA et
HEMOLYMPHANGIOMA
IRM 3DT2 FATSAT : extension

18. MALFORMATIONS OF THE BRANCHIAL CLEFTS
Abnormality in the obliteration of the clefts in
between the branchial arches
4 types
Cyst
Fistula
Both
Complications: mostly infections.

19. Most frequent (95 %)
Often young adult (20 - 30 YO), episode of infection,
Fistula: very seldom
Ovoid, well demarcated, thin wall (thickening if inflammation)
Content: depends on its composition
Infection, inflammation
Between
Submandibulary gland
Sternocleidomastoïd muscle
Carotid artery/ jugular vein
SECOND BRANCHIAL
CLEFT CYST
(Amygdaloïd cyst)
Harnsberger

22. LYMPHOMA

23. LATEROCERVICAL MASS
EVEN IF IT SEEMS TO BE A TYPICAL CYST
DIFFUSION
INJECTION

24. FIRST BRANCHIAL CLEFT CYST
Type I superficial periauricular
cyst
External Auditory Duct
Kyste type
II
Kyste type
I
Rare (<10 %)
Type II deep kyste (or
fistula) Parotid area
Harnsberger
Harnsberger

25. .
Fastenberg J, Nassar M First Branchial Cleft Cyst. N Engl J Med.2016 Oct 20;375(16):e33
Otoscopy
keratin debris and
purulence

26. Very seldom, located in the posterior cervical space
Fistula with the pyriform sinus
Deep infections
Between
Carotid artery/ jugular vein
Sternocleidomastoïd muscle
THIRD BRANCHIAL CLEFT CYST
Harnsberger

27. Very seldom
Lower anterior neck
Between pyriform sinus and left thyroid lobe
Recurrent abscesses or suppurative thyroiditis
Harnsberger
FORTH BRANCHIAL CLEFT CYST
(pyriform sinus fistula)

28. Schmidt K et al Rapidly enlarging neck mass in a neonate causing airway compromise. Proc (Bayl Univ Med
Cent).2016 Apr;29(2):183-4.
neck mass in a neonate
rhabdomyosarcoma
teratoma
venolymphatic malformations,
fibromatosis colli,
branchial cleft cyst

29. OTHERS
LYMPHOCELE OF NECK
Benign lymph-filled cysts
Leaking disrupted lymphatic channels
Along the jugular lymphatics
Supraclavicular fossa
THYMIC CYST
Benign lymph-filled cysts
Leaking disrupted lymphatic channels
Along the jugular lymphatics
Supraclavicular fossa

30. LATERAL LESIONS
Adenopathy
Salivary lesion (parotid or submandibular gland) lesion
Thyroïd gland tumor
Schwannoma
Paraganglioma
Lipoma
Malignant tumor (lymphoma, sarcoma, extension of a
pharyngolaryngeal tumor)
Fibromatosis of the head and neck
SOLID

31. SUBMANDIBULAR GLAND PEOMOPHIC ADENOMA
dynamic contrast-
enhanced T1-weighted MRI

32. SUBMANDIBULAR HEMOLYMPHANGIOMA

33. LIPOMA

34. Vascular mass splaying ECA and ICA
Rapid contrast uptake dynamic study
Salt and pepper
Between
Carotid artery/ jugular vein
Sternocleidomastoïd muscle
CAROTID BODY PARAGANGLIOMA

35. CAROTID BODY PARAGANGLIOMA

36. METASTASE (SYNOVIALOSARCOMA)

37. FIBROMATOSIS (DESMOID TUMOR)
Aggressive, ill-defined or sharp margins
Slow growing, painless
Strong enhancement
Most cases sporadic
May follow surgery, trauma
In adults, associated with polyposis syndromes
(Gardner, familial adenomatous polyposis)
Complete resection

38. SCHWANNOMA

40. LATERAL LESIONS
SOLID AND CYSTIC
Infections
Malignant tumor
Necrotic adenopathy
Cystic schwannoma
Vascular lesions
Malformations
Carotid artery aneuvrysm

41. POSTERIOR LESIONS
Muscular tumor
Adenopathy

42. SARCOMA

43. THE END
ANATOMY
STRUCTURE
CT SCAN
MRI