Differential Diagnosis for an 11-Year-Old Man with a Level 2 Neck Mass
Single Most Likely Diagnosis
- Nasopharyngeal Carcinoma (NPC): The presence of a level 2 neck mass, medialized tonsil, and slight fullness of the postnasal space, along with facial palsy and CNXII palsy, are highly suggestive of NPC. This condition often presents with neck lymphadenopathy, but its absence does not rule out the diagnosis, especially in early stages.
Other Likely Diagnoses
- Deep Lobe Parotid Adenocarcinoma: Although less common, a deep lobe parotid tumor can present with facial nerve palsy and can extend into the parapharyngeal space, causing medialization of the tonsil and symptoms related to the postnasal space.
- Jugular Paraganglioma: This tumor can cause facial palsy and lower cranial nerve palsies due to its location in the jugular foramen. It might also lead to a neck mass, although the primary complaint is often related to the cranial nerve deficits.
Do Not Miss Diagnoses
- Malignant Change of Vagal Schwannoma: Although rare, schwannomas of the vagus nerve can undergo malignant transformation. Given the potential for significant morbidity and mortality, it's crucial not to miss this diagnosis, especially with symptoms suggesting lower cranial nerve involvement.
Rare Diagnoses
- Other rare tumors or conditions that could potentially present with similar symptoms include metastatic disease to the neck from an unknown primary, lymphoma, or other sarcomas. However, these would be less likely given the specific constellation of symptoms and findings presented.