What is the management for a rubbery, non-tender mass in the posterior neck that has increased in size over the past year?

From the Guidelines

The management for a rubbery, non-tender mass in the posterior neck that has increased in size over the past year involves a thorough evaluation to determine the underlying cause, with a strong emphasis on ruling out malignancy.

Key Considerations

• The mass's characteristics, such as being rubbery and non-tender, and its location in the posterior neck, are important factors in the evaluation process.
• The fact that the mass has increased in size over the past year suggests the need for a detailed assessment to identify potential malignancy or other serious conditions.

Evaluation Process

• Imaging Studies: According to 1, neck computed tomography (CT) or magnetic resonance imaging (MRI) with contrast is recommended for patients with a neck mass deemed at increased risk for malignancy.
• Targeted Physical Examination: As stated in 1, a targeted physical examination, including visualization of the mucosa of the larynx, base of tongue, and pharynx, should be performed for patients with a neck mass deemed at increased risk for malignancy.
• Fine-Needle Aspiration (FNA): 1 and 1 suggest that FNA should be performed instead of open biopsy for patients with a neck mass deemed at increased risk for malignancy when the diagnosis remains uncertain.

Important Recommendations

• Clinicians should avoid routine antibiotic therapy unless there are signs and symptoms of bacterial infection, as recommended in 1 and 1.
• Patients with a neck mass deemed at increased risk for malignancy should be educated on the significance of their condition and the recommended diagnostic tests, as stated in 1 and 1.

Next Steps

• Based on the evaluation results, further testing or referral to a specialist may be necessary to determine the underlying cause of the neck mass and to develop an appropriate treatment plan.
• It is crucial to continue evaluating patients with a cystic neck mass until a diagnosis is obtained, as recommended in 1 and 1.

From the Research

Diagnosis and Evaluation

The management of a rubbery, non-tender mass in the posterior neck that has increased in size over the past year involves a thorough medical history, physical examination, and diagnostic tests.

• A complete blood count, purified protein derivative test for tuberculosis, and measurement of titers for various infections may be performed as part of the workup 2.
• Imaging studies such as ultrasonography or computed tomography with intravenous contrast media may be used to evaluate the mass 2, 3.
• Fine-needle aspiration cytology (FNAC) may also be used as a diagnostic tool to form a diagnosis and guide management 4.

Possible Causes

The mass could be a congenital developmental mass, such as a branchial cleft cyst or a dermoid cyst, or a benign neoplastic lesion, such as a lipoma or a fibroma 2.

• A giant epidermoid cyst of the posterior neck is also a possible cause, as reported in a case study where a 49-year-old man presented with a painless, gradually enlarging mass on his right posterior neck 5.
• Other possible causes include inflammatory or infectious processes, such as reactive lymphadenopathy or lymphadenitis 2, 6.

Management

The management of the mass depends on the underlying cause, which can be determined through diagnostic tests and evaluation.

• If the mass is found to be a congenital developmental mass or a benign neoplastic lesion, surgical excision may be recommended to prevent potential growth and secondary infection 2, 5.
• If the mass is found to be an inflammatory or infectious process, antibiotic therapy or other medical management may be indicated 2, 3.