A Pedunculated Cervical Mass: A Case Report

Abstract

Introduction: A congenital cervical mass is a considerable health problem worldwide; however, accessory tragus (AT) in the neck is extremely rare. The cervical variant of AT or congenital cartilaginous rest of the neck (CCRN) is a rare anomaly related to the branchial arch located at the lateral of the neck that typically presents as an asymptomatic papule or nodule along the anterior border of sternocleidomastoid (SCM) muscle. It is detected since birth or in the first few years of life. Diagnosis is based on the clinical characteristics of the lesion, surgical findings, and histopathologic studies.

Case report: A young man with no underlying diseases or known congenital anomaly was referred by a dermatologist for an asymptomatic pedunculated papule in the left mid-cervical area. Physical examination reveals a firm and mobile papule with a size of 1*1 cm on the anterior middle 1/3 border of the SCM. Radiologic findings illustrated a mass nearby the SCM with a long tract beneath it extending upward. The lesion was finally resected, and during surgery, a long tract was discovered, and histopathologic examination confirmed the diagnosis of a CCRN.

Conclusions: Although rare, the cervical variant of AT or CCRN should be considered in a differential diagnosis of benign masses in the neck.

Keywords: Accessory tragus; Branchial arch; Congenital cartilaginous rest of the neck; Sternocleidomastoid.

Fig 1

Macroscopic findings showing a pedunculated and firm papule located at the left lateral of the neck

YAour text hereFig 2. A

Spiral neck CT scan, axial view. The lesion with central cartilaginous density has been shown with an arrow

Fig 2. B

Spiral neck CT scan, coronal view. The sinus tract has been shown with an arrow as a low-density area just beneath the lesion

Fig 2 C

Spiral neck CT scan, coronal view. The tract extended superficially through SCM (the arrow)

Fig 3

Sonographic findings showing the lesion (the asterisk) and sinus tract (the arrow)

Fig 4

Left: Intraoperative findings illustrating a tract just beneath the lesion extending upward along the anterior border of the sternocleidomastoid muscle. The mass was excised via elliptical incision, the tract followed and ligated nearby the anterior belly of the digastric muscle. Right: Surgical excision of the lesion and tract

Fig 5

A: Epidermis (the large arrow), the dermis contains pilosebaceous follicles, sweat glands (the small arrow), and hyaline cartilage beneath (the asterisk). Left: Straight muscle (the large arrow) and neuron bundles (the small arrows) around cartilage tissue (the asterisk)