Unilateral Progressively Growing Neck Mass in a Young Adult

B. Parathyroid cyst

The positive PTH staining of tissues inside the cyst combined with the homogenously dim image yielded by the NIRAF camera are clues for the parathyroid cyst diagnosis.

Benign thyroid nodules may be the first diagnosis that comes to mind in the differential diagnosis of a solitary neck mass given their high incidence compared with other possibilities. Thyroid nodules do not stain positive for PTH. In addition, imaging the thyroid with the autofluorescence camera, the thyroid nodules are more likely to look heterogeneous with both bright and dim spots, especially in multinodular goiter. The absence of recent fever or infection coupled with the 4-month history of the mass excludes most causes of reactive viral lymphadenopathy. Reactive lymphadenopathy typically lasts for up to 2 weeks. If caused by EBV, lymphadenopathy may persist for up to 6 weeks. Thyroglossal duct cysts are typically midline lesions occurring anywhere between the foramen cecum to the suprasternal notch, but most commonly are diagnosed at or just below the hyoid bone. They are frequently diagnosed during childhood in association with infection or a history of infection. However, physicians should not exclude thyroglossal duct cysts based by age alone because some patients may present for the first time during adulthood.