![]() ![]() Examination revealed a soft, mobile, nontender, and well-circumscribed 5 × 7-cm lesion extending medially from the left SCF deep to the SCM. (B) The cystic lymphangioma was removed en bloc with levels IV and V lymph nodes and surrounding adipose tissue.Ī 25-year-old man with a history of successfully treated testicular cancer presented with a 6-month history of an asymptomatic, enlarging left supraclavicular neck mass. (A) Intraoperative image revealing a mass situated in the right SCF. Final pathology was consistent with cystic lymphangioma. Pathologic gross sectioning of the mass revealed cystic tissue with hemorrhagic fluid. All critical neurovascular structures were preserved. ![]() The mass was removed en bloc with levels IV and V lymph nodes and surrounding adipose tissue ( Fig. A tail of the mass extended posteroinferiorly into the superior mediastinum anterior to the prevertebral fascia. The patient underwent elective surgical excision of the mass through a low lateral neck incision ( Fig. FNA of the lesion produced only nondiagnostic serosanguinous fluid. Head and neck examination revealed only soft, nontender fluctuant right supraclavicular fullness without overlying skin changes. Prior imaging revealed the mass to be cystic with moderate rim enhancement and a deep medial component abutting the right thyroid lobe with an inferior tail extending to the superior mediastinum. Final pathology revealed cystic hygroma.Ī 58-year-old woman presented with an asymptomatic right supraclavicular neck mass progressively enlarging over a period of several months. Intraoperative frozen section demonstrated a hemorrhagic cyst wall with a denuded lining and fibrous capsule. Surgical excision of the lesion as well as selective neck dissection of levels II to V revealed a dark, cystic mass that was excised with surrounding lymph nodes and adipose tissue. FNA revealed scant epithelial cells without evidence of malignancy. Imaging with contrast-enhanced computed tomographic (CT) and magnetic resonance imaging (MRI) revealed a multiloculated, cystic, T2-bright, nonenhancing lesion posterior and lateral to the SCM and anterior to the scalene muscles. The lesion was soft, nontender, and without involvement of overlying skin. Examination was unremarkable expect for a diffuse fullness in left SCF extending from the sternocleidomastoid muscle (SCM) 10 cm laterally and from the clavicle to the mid jugular region. A review of the literature focused on cystic pathology of the SCF is presented along with an anatomical description and a clinical diagnostic strategy using imaging and fine needle aspiration (FNA) to guide management and therapy.Ī 49-year-old woman presented with an asymptomatic, slowly enlarging left supraclavicular neck mass. We present 7 cases of supraclavicular cystic masses demonstrating the breadth of lesions within this region. Although somewhat less common, the cystic mass of the SCF has an especially interesting differential diagnosis. Because SCF masses may represent benign or malignant, congenital or acquired, and localized or systemic processes, a thorough and structured evaluation and workup should be used to facilitate diagnosis and guide medical and surgical intervention. The variety of structures both within and adjacent to the SCF contribute to the multiplicity of pathology found in this region. A well-defined algorithm allows successful management of benign and malignant lesions in the SCF.īy virtue of location, masses in the supraclavicular fossa (SCF) present one of the broadest differential diagnoses in the head and neck. All patients achieved complete resolution of signs and symptoms of the mass.Įffective evaluation of a cystic lesion within the SCF mandates a thorough understanding of the anatomy and differential diagnosis. Surgical intervention was used for definitive therapy in 6 cases. Aspirates accurately differentiated benign from malignant lesions in 6 cases, identified the offending pathology in 3 cases, and provided inoculum for culture-directed antibiotic therapy in 1 case. Diagnostic and therapeutic interventions are described.Ĭross-sectional imaging and needle aspiration or biopsy were obtained in all 7 cases. Seven cases of treated cystic masses of the SCF were identified. A review of the literature and diagnostic and therapeutic algorithms are also provided.Ī retrospective study of an academic tertiary care head and neck cancer center was done. This study describes the presenting symptoms, radiologic findings, medical and surgical management, and posttreatment outcomes of various cystic mass presenting in the SCF. The diverse anatomical structures within the SCF create an extended differential diagnosis for any mass arising in the SCF. Cystic masses of the supraclavicular fossa (SCF) are uncommon. ![]()
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