Differential diagnosis of cervical malignant lymphadenopathy among Iranian patients

OBJECTIVE: To investigate the differential diagnosis in cases referred with neck lumps suspicious to malignant nodal masses and its relation to demographic variants.

METHODS: Individuals who entered in this cross-sectional study conducted at the Department of Otolaryngology, Ghaem Medical Center, Mashdad, Iran from May 1995 to April 2005 were re-evaluated by history taking, physical examination and imaging studies. Fine needle aspiration was applied to obtain tissue sampling. Among the patients, 232 cases had malignant disease confirmed by pathology reports. Cases with unknown primary tumor underwent investigations including pan-endoscopy, and further imaging studies were carried out to determine the primary tumor site. Demographic data as gender, age, location, size, and pathology of tumor were considered.

RESULTS: The results of this study showed that 50% of patients which were referred with neck masses had malignant neoplasm. The most common pathology in patients younger than 40 years were lymphoma (55%) and thyroid cancer (26%), whereas, in patients older than 40 years squamous cell carcinoma (67%) was more common. The most involved lymph nodes were jugulodigastric chain. Larynx and hypopharynx are the most common sources of aerodigestive tract metastatic.

CONCLUSION: According to high incidence malignancy (50%) among neck lesions, an asymmetrical neck mass in adults should be considered malignant until proven otherwise. It seems that age is an important predictor of tumor pathology, and determination of further diagnostic investigations would be helpful.