1.What are the masses in the neck? The neck connects the head and chest, starting from the base of the skull and connecting to the entrance of the thoracic cavity, with 1-7 cervical vertebrae at the back. The neck includes the pharynx, larynx, trachea, esophagus, thyroid, cervical arteries and veins, vagus nerve and other important organs. Neck mass is a clinical sign, not a disease, but a symptom of many diseases. The neck is the seat of the upper respiratory tract and upper gastrointestinal tract, which is susceptible to external stimuli and injuries and infectious masses; the neck is the lymphatic summary of the head and the whole body, all parts of the body, especially head and neck malignant tumors are prone to the formation of metastatic masses; neck tissues are derived from the three embryonic tissues, which may form congenital masses in the process of embryonic development; the largest endocrine gland of the body is also located in the neck of the thyroid, which forms a thyroid gland mass; the neck is the most important organ in the body, which forms a thyroid gland mass; the neck is the most important organ in the body. Thyroid mass; the neck on the floor of the mouth, the root of the tongue, below the subclavian region, pleural aponeurosis and mediastinum, etc., these neighboring areas of swelling occurs, often spread to the neck, neck mass appears more diverse. Therefore, the etiology of neck mass is more complex, involving internal medicine, surgery, pediatrics, hematology, stomatology, otolaryngology, oncology, etc., which is easy to misdiagnose and mistreat, resulting in adverse consequences. Neck mass according to the cause of occurrence and pathology: divided into neoplastic mass, inflammatory mass, congenital mass three categories. 2.What is the “80% law” and “seven-word law” of neck mass? The incidence of neck mass accounts for about 3-4% of the whole body mass. The clinical manifestation of neck mass has certain regularity, Skandalakis proposed 80% law: adult neck mass is mostly benign tumors, accounting for about 80%, malignant tumors are rare; malignant tumors with lymph node metastasis, accounting for about 80%; malignant tumors metastasized to the middle and upper neck mostly come from the oral cavity, nasal cavity, pharynx and larynx, accounting for about 80%; malignant tumors metastasized to the lower 1/3 neck and supraclavicular area mostly come from the lower respiratory region, and the lower respiratory region mostly come from the upper respiratory region. The malignant tumors mostly from the lower respiratory tract, breast, urinary tract and other places account for about 20%. According to the duration of the disease Skandalakis summed up three 7 laws, namely, 7d more inflammation, 7 months more tumors, 7 years more congenital masses; these laws are only delineated a rough outline, can not be mechanically applied, and should be combined with all aspects of the information for comprehensive consideration. 3.Why should we be very alert to neck lumps? In adult neck lumps, 80% of malignant tumors are lymph node metastatic cancers, that is, cancers in other parts of the body are transferred to the neck, which is not an early stage of cancer when found. Among the lymphatic metastatic cancers in the neck, 80% of them are metastases from malignant tumors in the head and neck region, i.e., commonly mentioned nasopharyngeal carcinoma, laryngeal carcinoma, hypopharyngeal carcinoma, sinus carcinoma, thyroid carcinoma, and so on. Diagnosis of neck mass requires comprehensive and detailed physical examination to check the location, size, hardness, pulsation, pressure and radiating pain and mobility of neck mass. Based on the results of physical examination, ultrasound, CT and MRI of the neck can roughly determine the size, location and nature of the mass. Fine needle aspiration cytology is an important means of confirming the diagnosis of neck mass, those who can not confirm the diagnosis can be done to take a biopsy of the neck mass, slice pathology examination can clarify the nature of the lymph nodes, and provide the possible source of the primary focus. 4.What are the congenital neck masses? (1) thyroglossal cyst and fistula: about 70% of the congenital neck mass, manifested as a cystic mass in the midline of the anterior neck, mostly located near the hyoid bone, the cyst moves up and down with swallowing, and the cyst is pulled upward when the mouth is open and the tongue is extended, and the combination of the infection can be red and swollen and ulcerated, and fistula can be formed in a long period of time. (2) Gill slit cyst and fistula: gill slit cyst is located in the lateral neck, mostly unilateral, along the anterior edge of the sternocleidomastoid muscle, which is cystic to the touch. Because the wall of the cyst is rich in lymphatic tissue, and with the pharyngeal lymphatic tissue interconnection, so when the pharynx or oral cavity infection, gill slit cysts with the infection and increase in size, pain and tenderness, and even cause respiratory distress. The cyst ruptures to form a fistula. (3) Cystic hydatid cyst: it is derived from embryonic lymphatic vessel development abnormality, 90% of it occurs in children less than 2 years old, with clinical manifestation of cystic swelling in the front part of the neck, fluctuating sensation, and translucent light. When the patient is asked to do swallowing, the swelling moves up and down with swallowing. Surgical resection can be cured. 5.What are the inflammatory masses in the neck? (1) Parapharyngeal abscess is a deep neck infection, involving the carotid sheath of the parapharyngeal space, with a history of pharyngeal infection, redness, heat and pain in the skin of the neck, swelling as hard as a plate, with difficulty in opening the mouth and difficulty in swallowing. (2) Otogenic neck abscess: history of otitis media mastoiditis, the infection spreads in the tip of the mastoid under the diastasis, forming a deep neck abscess. (3) Acute and chronic lymphadenitis: the primary foci of infection are mostly from the nose, tonsils, pharynx, teeth, etc., causing inflammation of cervical lymph nodes, local redness, swelling, pain, tenderness and leukocytosis. Chronic lymphadenitis has a long course and mild symptoms, often occurring in the deep neck of the submandibular region, with smaller lymph nodes, movable, and insignificant pressure pain. (4) Tuberculous lymphadenitis mostly occurs in young people, can be primary or secondary to tuberculosis foci in the lungs, abdominal cavity, etc., manifested as lymph node enlargement, perilymphadenitis, when more than one lymph node adherence to the caseous degeneration, fluctuation sensation on palpation, the formation of chilled abscesses, the formation of pustular fistulae and scarring after the broken legacy. Lymphatic tuberculosis mostly occurs in the submandibular, the posterior anterior border of the sternocleidomastoid muscle and the clavicle, and most of the patients have the toxic symptoms of tuberculosis such as malaise, low-grade fever, night sweats, and emaciation. (5) thyroiditis: there are three types of thyroiditis: ① acute suppurative thyroiditis, mostly secondary to degeneration and necrosis of thyroid nodules, gland swelling, tenderness, reflex otalgia and compression of tracheal symptoms; ② subacute thyroiditis, which often occurs in epiglottitis or mumps, and it may be viral infection; ③ chronic inflammation is a kind of autoimmune disease, and the auto-anti-transformation antibody of anti-thyroglobulin is elevated in blood, and the thyroid gland is infiltrated by a large number of lymphocytes. The tissue is infiltrated by a large number of lymphocytes, forming follicles, and the gland is diffusely enlarged with a smooth surface and hard texture. (6) Cervical carbuncle: it refers to the skin of the neck and neck area which is invaded by staphylococcus from hair follicles causing purulent infection. Due to the tough and thick skin in this area, the infection is extended to the cervical fascia along the fat column and spreads to the surrounding area, and enters into the hair follicles and occurs multiple pus heads, accompanied by severe pain and systemic symptoms of infection. 6.What are the benign neck masses? (1) Carotid body tumor: carotid body is a kind of chemoreceptor. Carotid body tumor grows slowly, mostly located in the anterior edge of the carotid triangle sternocleidomastoid muscle below the angle of the mandible, as a single round or oval mass, which looks like a hard rubber when touched, and can be moved left and right, but the up and down movement is limited, and the vascular pulsation can be touched and the vascular exhaustion murmur can be heard at times. (2) Nerve sheath tumor: it is a kind of benign tumor of nerve tissue, mostly from sympathetic nerve and vagus nerve, with slow growth. It is tough and painless, mostly located in the anterior cervical triangle, parapharyngeal and supraclavicular regions, with no adhesion to the skin and surrounding tissues. The tumor can compress the cervical sympathetic nerve to appear Horner’s syndrome, i.e., the affected side of the eyelid ptosis, pupil narrowing, eyeball invagination, the same side of the face flushing, less sweat and other symptoms. (3) Mixed tumor of salivary gland: mixed tumor of parotid gland is common, which is manifested as a mass in front of the ear and under the earlobe; mixed tumor of submandibular gland is located in the submandibular triangle, and the symptoms are not obvious, and it is often found by chance that the surface of the submandibular triangle is smooth and the patient consults the doctor. (4) Thyroid gland adenoma: mostly seen in females, most of them are single lumps, which can move up and down with swallowing, and most of the patients do not have any symptom, and clinically, most of them are follicular adenomas, but the increasing size of the tumor body can cause necrosis, calcification, hemorrhage and malignant transformation of the surrounding normal thyroid tissue. If the blood circulation of thyroid adenoma is insufficient, degenerative lesions occur in the nodule, causing cyst formation, which is called thyroid cystic adenoma; if the adenoma has papillary changes, it is called papillary adenoma, and its malignant transformation may be larger. 7.What are the characteristics of neck mass caused by malignant lymphoma? Malignant lymphoma is a malignant tumor originated from lymph nodes or other lymphatic tissues, which mostly occurs in children aged 5~12 years old. It is clinically characterized by painless progressive enlargement of superficial lymph nodes or accompanied by fever, emaciation and hepatosplenomegaly. According to the characteristics of tumor cells, it can be divided into two categories: Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Cervical lymph node enlargement is a common symptom of non-Hodgkin’s lymphoma, and the mass is painless and progressive enlargement. The lump is painless and progressive in size. It is hard and movable in the early stage, and in the later stage, the lymph nodes are fused into a mass, which is not easy to be pushed. Lymphoma occurring in tonsils, nasopharynx, root of tongue, etc., can produce nasal congestion, bloody mucus, difficulty in swallowing, hearing loss symptoms. The lymph node enlargement caused by Hodgkin’s lymphoma is mostly bilateral, and there are systemic symptoms such as fever, hepatosplenomegaly, emaciation and fatigue. 8. What are the characteristics of metastatic cancer mass in neck? Cancer cells metastasize via lymphatic fluid with a certain pattern. Nasopharyngeal cancer has the highest rate of cervical lymph node metastasis, which mostly transfers to the lymph nodes below the tip of ipsilateral mastoid process and between the posterior belly of diastasis, and then extends to the lymph nodes of internal jugular vein; whereas lymph node metastasis to the lymph nodes of ipsilateral submandibular region occurs in cancers of nasal cavity, sinus, oral cavity and oropharynx, which then extends to the upper area of internal jugular vein; laryngeal cancer of supravocalicular type has more chances to have cervical metastasis, which firstly transfers to the upper area of internal jugular vein, and then Thyroid cancer is more likely to metastasize to anterior cervical lymph nodes of tracheo-esophageal groove lymph nodes, and then metastasize to the middle and lower internal jugular vein; metastatic cancer of posterior cervical triangle behind the sternocleidomastoid muscle is relatively rare, and is occasionally seen in the case of tuberculous lymph node enlargement and malignant lymphoma. Supraclavicular region is the most frequent site of metastatic cancer, with the left side mostly originated from metastatic cancer of digestive tract, and the right side mostly seen in metastatic cancer of lung. Breast cancer mostly occurs in ipsilateral axillary and cervical lymph node enlargement. The local characteristics of metastatic lymph nodes are fixed mass, hard texture, rapid growth and adhesion to surrounding tissues.