The authors have reviewed 203 children under 16 years of age who presented with a mass in the head and neck area between 1 January 1978 and 31 December 1982. The results of their analyses are here summarized.
1) The largest proportion of the masses was inflammatory, comprising 48.3% of all cases. Following these in order were benign tumors (25.6%), congenital lesions (14.3%), and malign-ant tumors (11.3%).
2) Among the inflammatory lesions, non-specific lymphadenitis was the most common, followed by tuberculous lymphadenitis.
3) Thyroid adenoma was the most frequent benign neoplasm. Lymphoma and thyroid cancer were the commonest malignant lesions; metastatic cancer was rare.
4) The commonest congenital lesion were cystic hygroma and thyroglossal cyst.
5) Males had non-specific adenitis twice as often as females, but in the case of tuberculous lymphadenitis the male-female ratio, was 1: 2.3. Thyroid neoplasms, both benign and malignant predominated in females, the male-female ratio being 1: 2.7. On the other hand lymphoma predominated in male children by a ratio of 10: 1.
6) In the neonatal and infantile period, hemangioma, non-specific adenitis and cystic hygroma were the commonest lesions. After age 7, non-specific and tuberculous lymphadenitis had become the most frequently occurring lesions.
7) The lesions were analyzed by the anatomical presentation and by consistency (Table 6) as an aid to diagnosis. Lesions which were unilateral and cystic were hygromas in 66.7% of cases. If unilateral and solid, the diagnosis was most likely thyroid adenoma or carcinoma (66.7%). If unilateral and inflammatory, tuberculous or non-specific adenitis was the diagnosis in 96.1%. Lesions which were bilateral and solid were most likely to be lymphoma(66.7), lesions which were bilateral and inflammatory were most likely to be non-specific adenitis pathologically (78. 4%). Central cystic lesions were most commonly thyroglossal cyst (69.2%). Central solid lesions were adnomas of the thyroid most frequently (66. 7%) or if inflammatory, thyroiditis.
8) Analysis by size at the time of presentation revealed that masses under 2cm were more likely to be inflammatory or benign neoplasms, whereas those over 2 cm were more often malignant tumors. Expressed differently, inflammatory lesions were less than 2 cm in size in 72.4% of inflammatory cases whereas malignant neoplasms were larger than 2 cm in 78.3%. Thyroid neoplasms, whehter benign or malignant, measured between 2 and 4 cmm in 59% of cases. Cystic hygroma was most often over 4 cm in size at the time of presentation.
9) Thirty-nine patients with lesions presenting as cystic masses were analyzed separately. Cystic hygroma and thyroglossal cyst were equally common(25. 6% each), followed by epide-rmal cyst(12.8%) and dentigerous cyst(9.7%).
10) Of the eleven patients whose masses were confirmed to be lymphoma, nine were non-Hodgkin´s and 54.5% were poorly differentiated lymphoma.
11) In terms of treatment guidelines, biopsy was considered adequate treatment when tube-rculosis or lymphoma could be demonstrated by frozen section. Large cystic hygromas some-times required radical procedures. Thyroid lobectomy was the procedure of choice for adeno-mas but when thyroid cancer was confirmed, 75% of the patients received radical neck dissection, the youngest at age 7. Of 8 thyroid cancers in this study, 7(87.5%) were papillary adenocarcinoma. The proportion of cancer in thyroid masses in this age group is substantially higher than in adults studied previously at our hostpital of all thyroid masses, 32% were cancer as compared to 18.4% for adults studied in 1980.
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