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Date of last update: 10/21/2017.

Forum Name: Lymphoma

Question: Hard lump in the back of the neck, biopsied today


 christie321 - Thu Oct 27, 2005 6:59 pm

About two weeks ago I found a hard lump on the back of my neck, directly above C7. I went to my physician who measured it to be about 2cm. He recommended a CT Scan and a needle aspiration biopsy. I had both of those procedures done today. The radiologist said he "didn't see much" on the CT scan. He then proceeded to do the biopsy. As he was doing it he said he was having "a lot of trouble getting anything out of it" as the mass was a lot harder than he initially thought. He had to do the biopsy twice. He said he would send what he got to pathology, but thought I would probably have to have the lump removed for it to be fully biopsied. Now I wait. I am hoping someone has some insight into what this could possibly be. I don't have any other symptoms that I'm aware of.

I should also say that I had papillary thyroid carcinoma about 20 years ago. I had a subtotal thyroidectomy followed by radioactive iodine treatment. The cancer was only diagnosed after it had spread to a local lymph node. Nothing was ever palpable in the thyroid because the tumor was behind it. I don't know if this is a recurrence of that, something else sinister or just an innocuous bump. Any insight, whether you think it's nothing or something bad (I won't freak out) would be greatly appreciated.
 Dr. Tamer Fouad - Sat Dec 17, 2005 4:00 pm

User avatar Dear christie321,
I hope the results of the biopsy turned out good for you.
Let me first say that at the C7 the normal bony protuberance of the vertebra is more pronounced than its neighbouring vertebrae. I would assume that your doctors would easily be able to identify with that by examination and certainly by radiography.
It does not appear to be the site of lymph node enlargement, the suboccipital lymph node being a little higher than the area you described.
I understand that you are concerned about your past history of thryoid cancer and that is probably why your doctors are proceeding with more investigations.
Please let us know the results of your investigation if a definitive decision has been made.
Best regards,
 christie321 - Sat Dec 17, 2005 5:53 pm

Thank you for your response. The needle biopsy was inconclusive according to the doctor so I had an MRI. The MRI showed a hypointensity between C3 and C5 on T2 and STIR images. The radiologist and my doctor are unable to identify what it is for sure so I am scheduled for surgery to remove it in January. Everyone seems pretty stumped by this thing. Any additional information you could give me would certainly be appreciated.
 Dr. Tamer Fouad - Sun Dec 18, 2005 3:30 am

User avatar Hello Christie321,
Although very rare, there is a clinical entity called vertebral pseudotumor.
Its not a real tumor but appears to be so in both the clinical and radiological settings.
Vertebral pseudotumors may be classified into those of vertebral origin and those of disk-space origin. Those of vertebral origin, as cited in the literature, include those related to spinal tuberculosis; synovitis, hyperostosis, and osteitis (SAPHO) syndrome; fibrous dysplasia; and osteoporotic vertebral collapse [1].
Tuberculous pseudotumors can present as destructive vertebral masses that may not radiographically appear to be of infectious origin.
The SAPHO syndrome may mimic vertebral tumors (eg, sclerotic bone tumors) because of the erosive changes with adjacent sclerosis and the hyperostosis that can appear similar to blastic vertebral metastasis [1]. In cases of SAPHO, additional lesions can be identified with conventional radiography, bone scintigraphy, CT, or MR imaging. Again, the findings may be suggestive of metastatic disease when this disease process is actually benign.
Space-occupying masses are seen in fibrous dysplasia. In such cases, T1-weighted MR images may show decreased signal intensity, and T2-weighted images may show variable signal intensity, depending on the degree of lesion ossification. Chordoma, a mass that arises from a remnant of the notochord, can also appear as a disk-space mass. These tumors occur chiefly in the occipital-cervical and sacrococcygeal regions, and they less frequently appear in the lumbar, cervical, and thoracic regions [2].

References:
===========
1. Laredo JD, Quessar AE, Bossard P, et al. Vertebral tumors and pseudotumors. Radiologic Clinics of North America 2001; 39 :137 –163.
2. Bjornsson J, Wold LE, Ebersold MJ, et al. Chordoma of the mobile spine: a clinicopathologic analysis of 40 patients. Cancer 1993; 71 :735 –740.
 christie321 - Sun Dec 18, 2005 9:24 am

Thank you again for your response. It was very informative. In my research on this topic I have come across chordoma, but had never heard of a pseudotumor.

So with the MRI results I described does that pretty much guarantee me that it's not a recurrence of the thyroid cancer? Thank you again for providing this service to the many many people in the world with questions about their health.
 Dr. Tamer Fouad - Sun Dec 18, 2005 1:21 pm

User avatar Hi christie321,
Thank you for your kind words.
Its more than likely that its not related to the thyroid cancer. That's my impression. First, although papillary cancer of the thyroid is an indolent disease it commonly spreads to the lymph nodes and distant spread (to lungs or bones) is very uncommon. If suspicious the doctor could order a thyroglobulin test, although I do not really see the merit in doing this.
Second this is not a common site of metastasis in the vertebra whether be it from thyroid cancer or any other cancer. The cervical spine is the least often involved by spinal metastases (10%), followed by the lumbar spine (20%), and the thoracic spine (70%).[1]
I think the excisional biopsy will be more definitive and I strongly suspect one of the pseudotumors above (including chordoma).
Please keep us posted.
Best regards,

References:
===========
1. Atanasiu JP, Badatcheff F, Pidhorz L: Metastatic lesions of the cervical spine. A retrospective analysis of 20 cases. Spine 18: 1279-1284, 1993.
 christie321 - Sat Jan 14, 2006 1:14 pm

I just wanted to give you an update. I had the surgery and the mass was found to be a tumor consisting of "benign fibromuscular tissue and chondroid tissue." The benign part is definitely a relief. My question now is is this something that is likely to recur? If so, is it something I'll need to have removed again or is it something (as long as it's asymptomatiic) that I should just live with?

Thank you again for your help and information.
 Dr. Tamer Fouad - Sat Jan 14, 2006 2:43 pm

User avatar Christie,

First of all congratulations. So it did turn out to be a pseudotumor! Well I am also relieved that its only benign. I wouldn't worry about it. I don't think it should return and if it does you just need to follow up with an MRI to make sure that everything is alright.

You will need nothing more than follow up for this case should it recur.

Best regards.
 christie321 - Sun Jan 15, 2006 7:55 am

Thank you so much for all of your insight and encouragement. Way to go on the diagnosis too!!! This is a wonderful service you and your colleagues are providing.

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