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CT scan of neck showed a cyst full of liquid. Biopsy report showed granulomatous process with no malignancy. Advice

Answered by
Dr. Ivan R. Rommstein

General Surgeon

Practicing since :2008

Answered : 11063 Questions

Posted on Tue, 19 Nov 2013 in Ear, Nose and Throat Problems
Question: Hi, my husband who is 40 years old has a granulomatous process on the right side of his neck. He has done CT Scan - showed is a cyst full of liquid, MRI - showed - lymph or cyst and needle biopsy - showed is granulomatous process. No malignancy showed in any on those test. What should we do next? Thank you
Answered by Dr. Ivan R. Rommstein 3 hours later
Brief Answer:
Hi and welcome to HCmM.

Detailed Answer:
First you should identify the exact cause of this lesion. it can be infectious( tuberculosis,bacterial, micotic) or non-infectious such as sarcoidosis, amiloidosis,autoimmune or congenital.
Of course,malignancy should always be ruled out but considering this report,there is no some risk of malignant neoplasm.
So I suggest to do more detailed blood tests and immunologic tests which can reveal is it infectious or autoimmune granuloma-
If this is infectious then antibiotics or antifungals may be necessary for treatment.
If this is autoimmune then steroids and other antiinflammatory medcines should be used.
In every case,if there is no improvement on therapy,you should cosnider surgical removal. This should be done also if this granuloma isnt close to vital neck structures(jugular vein, carotid artery, trachea or laryngeal and vagal nerve).this can be seen on MRI. So if this is subcutaneous lesion,it can be pretty easily removed in general anasthesia and then the entire granuloma can be sent to patohistologic anlaysis and malignancy can be ruled out 100%.
Wish you good health. Feel free to ask. Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ivan R. Rommstein 20 hours later
Thank you so much for your prompt response.
As a matter of fact, the cyst is misplacing the jugular vein (that is what the CTScan showed). What are the names of the immunologic tests that you would recommend to identify whether is infectious or autoimmune granuloma? Thank you
Answered by Dr. Ivan R. Rommstein 26 hours later
Brief Answer:

Detailed Answer:
Well, if this is only misplacing it ,not infiltrating then this is not bad sign and it can be safely surgically removed if necessary.
There are many blood tests such as XXXXXXX and ANA levels, sIL2R,Anti-topoisomerase antibodies,RF/rheumatoid factors whih are elevated in autoimmune diseases.
Infectious granulomas are mainly caused by tuberculosis,actinomyces,other mycobacterias or klebsiella or fungal infections. there are specific "serologic" blood tests which can identify did you have contact with these pathogenes.
If this is autoimmune it can be treated with steroids while infectious granuloma require antibiotics and antifungals. If nothing is helpful then you need surgical procedure performed by vascular surgeon and ENT,but I am sure it won be necessary and that you ll recover soon. Wish you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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