chapter  20
Maldevelopmental, Inflammatory, and Neoplastic Pathology in Children
ByLouis P. Dehner, Samir K. El-Mofty
Pages 46

Whether one’s surgical pathology practice is in the setting of a general or children’s hospital, the perspective on head and neck pathology in children is limited or dominated by small scraps of keratotic tissue from a middle ear cholesteatoma or paranasal sinus contents in a child with chronic or allergic sinusitis, an important distinction to be made pathologically for purposes of clinical management. Most masses in the head and neck region of children are one or other congenital lesion, often cystic, or an inflammatory process presenting with enlarged lymph nodes (1-9). Approximately 50% to 60% of neck masses in children are congenital cystic lesions such as the dermoid cyst, branchial cleft cyst, or thyroglossal duct cyst (TGDC); 25% to 30% are inflammatory and reactive lymphadenitis in most cases; 5% are benign neoplasms represented mainly by melanocytic nevi, hemangiomas, and lymphangiomas or cystic hygromas; and 5% to 10% are malignancies especially in pediatric referral institutions with lymphoma and rhabdomyosarcoma (RMS) as the most common tumor types (8,10,11). One of the variables in the proportion of malignant tumors in the head and neck of children is the inclusion or exclusion of lymphomas (1).