Rapidly Growing Lateral Neck Mass

Aman in his 50s presented with a 2-month history of a rapidly enlargingmass on the left side of the neck. He reported a recent 5-kg weight loss and had no history of tobacco or alcohol use. Clinical examination revealed a fixed lower neckmass extending through levels 3, 4, 5b, and6,measuring 7 × 8 cm (Figure, A). Flexible laryngoscopy revealed reduced movementof the leftvocalcordandasymmetrywithsurrounding edema. Computed tomographic imaging revealed a well-vascularizedmass of the paratracheal region invading surrounding the surrounding structures (Figure,B).Twofine-needleaspirationsampleswereobtained, but results from pathological analysis were inconclusive. The tumor was removed in a piecemeal fashion because it surrounded the trachea and esophagus and invaded into the strap muscles, internal jugular vein, the first tracheal ring, and the recurrent laryngeal nerve. At the end of the procedure all margins were clear. On pathologic examination, the tumorwas semifirmwith a necrotic central portion. The hematoxylin-eosin–stained specimen revealed many mitotic figures along with large, multinucleated giant cells. Lymphovascular andperineural invasionwas present (Figure, C). Immunohistochemical staining of themainspecimenwascytokeratinAE1/AE3negativeandthyroid transcription factor (TTF-1) negative (Figure, D). Of 12 lymph nodes, none contained carcinoma. Quiz at jamaotolaryngology.com Photograph of neck mass A Computed tomographic scan of neck B