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from lymphoma or leukemia or can be because of metastasis from an adjacent solid
tumor such as rhabdomyosarcoma, neuroblastoma, or nasopharyngeal carcinoma. It
can be difficult to distinguish the primary tumor mass from a lymph node in these
circumstances.
Clinical Assessment
Children with neck tumors, regardless of etiology, must be evaluated for impact on
the airway, breathing, and circulation. Clinicians should explicitly consider the
following:
Does the mass compress the airway?
Does the patient experience respiratory distress or is there a compromise to
breathing?
Does the mass interfere with circulation of the head and neck leading to SVC
syndrome (see “Tumors of the Thorax” section)?
Does the tumor threaten to compress the cervical spine (see “Tumors in and
Around the Spinal Cord” section)?
Following this assessment, a careful history should address the duration the mass
has been present and its rate of growth, any recent infectious illnesses, the patient’s
immunization status, cat exposure, medications, and the presence of systemic
systems. Physical examination should assess for other masses or lymphadenopathy
in the body. In evaluating nodes of the neck, reactive nodes are often small, mobile,
and soft, or while infected nodes may be enlarged, red, and tender. Characteristics
that make malignancy more likely include nontender masses, very firm/hard texture,
diameter more than 3 cm, adherence to other structures, irregular margins, and
absence of signs or symptoms of infection.
Management
Often radiographic imaging and laboratory evaluation is not needed. However, in the
case of suspected leukemia or lymphoma, laboratory studies should be obtained to
assess for hyperleukocytosis, cytopenias, and TLS (see preceding discussion on
leukemia). Radiographic imaging should be pursued if more information is needed
about the tumor’s position in relationship to the patient’s airway and other vital
structures of the head and neck. When indicated, this is best accomplished with a CT

scan. In addition, a chest x-ray should be obtained to explore whether the disease
could include a mass in the anterior mediastinum. Laboratory evaluation should
include a CBC with differential, ESR and LDH (which may be elevated in certain
lymphomas), testing for any relevant infectious etiologies, and consideration of
thyroid function testing.