Case for Diagnosis
Pedunculated Papule and Fissure in the Anterior Midline of the Neck
Pápula pediculada y fisura en línea cervical anterior de recién nacido
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Arjona-Aguilera, G. Blasco-Morente, J. Tercedor-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Arjona-Aguilera" "email" => array:1 [ 0 => "cintiaarjona@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Blasco-Morente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Tercedor-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula pediculada y fisura en línea cervical anterior de recién nacido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 300 "Ancho" => 444 "Tamanyo" => 25749 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 3-month-old boy was seen for an exudative lesion in the anterior cervical region that had been present since birth. The gestation period had been normal and the child had been born at full term. The patient had no other medical or surgical history of interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a skin-colored pedunculated papule on the anterior midline of the neck. At the caudal end of the lesion, there was an orifice that connected to a small mucosal fistula measuring barely 2<span class="elsevierStyleHsp" style=""></span>mm in length (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion was not adhered to deeper tissues and showed no mobility when the patient swallowed or moved his tongue. A catheter was inserted into the orifice and reached a dead end after penetrating about 3-4<span class="elsevierStyleHsp" style=""></span>mm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopic examination revealed a pink pedunculated papule measuring 0.3<span class="elsevierStyleHsp" style=""></span>cm in diameter, at the inferior end of which was a fissure (barely visible to the naked eye) measuring 0.1<span class="elsevierStyleHsp" style=""></span>cm with a mild transparent exudate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Soft-tissue ultrasound examination revealed a round, well-defined hypoechoic superficial lesion that showed no evidence of a fistulous tract as well as a thyroid with a typical morphology and location. Complete blood count, biochemistry, and hormone panel were normal. An electrocardiogram (ECG) was carried out as a first step to rule out cardiac abnormalities.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Midline cervical cleft (MCC).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was assessed by the pediatric surgery department and an initial attitude of watchful waiting was adopted. Curative surgical treatment will be scheduled for when the boy is around 1 year of age.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">MCC is a rare congenital anomaly that causes a visible defect at the midline of the neck. Around 200 cases have been described in the international literature,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> mostly in plastic surgery or otorhinolaryngology journals. MCC appears sporadically and is slightly more common in girls.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> The clinical presentation is characterized by a linear vertical deepithelized plaque with a fibroepithelial papule at the cranial end that extends towards the caudal end, terminating in a blind sinus.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> The entity has no relationship to the thyroid or to the hyoid bone.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The lesion is generally limited to the skin, but there have been cases in which it extends to the subcutaneous tissue and underlying muscle.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> The size of the lesion can be highly variable and it can be located anywhere along the anterior midline from the lower lip to the suprasternal region.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The condition is generally detected at birth, but mild forms can go undetected or can be mistaken for remnants of the thyroglossal duct or branchial anomalies.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The differential diagnosis should include fistulas, sinus cysts of branchial origin, and bronchogenic cysts.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Branchial disease typically appears in the region anterior to the sternocleidomastoid muscle, and bronchogenic cysts tend to be located in the suprasternal notch.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> In case of doubt, ultrasound and computed tomography can be very useful in establishing a diagnosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The embryopathogenesis of MCC is not yet fully understood, and most authors consider it to be a mild form on the spectrum of congenital branchial anomalies.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,5</span></a> This would explain the occasional association of MCC with other anomalies such as thyroglossal duct cysts, dermoid cysts, bronchogenic cysts, cleft lip, and congenital cardiac anomalies.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,6</span></a> A full hormone panel and an ECG are also recommended as a first step to rule out associated comorbidities.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical course of MCC is benign with spontaneous scarring and the formation of a fibrous cord.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,5,6</span></a> However, because there is considerable risk of infection, cervical contracture, and limitation of mobility, MCC should be managed with surgery around the age of 1 year and no later than 2 years.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> The preferred technique is complete excision followed by Z-plasty closure<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–6</span></a> to prevent the recurrence of fibrosis, which can occur following direct closure.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Finally, periodic follow-up of the patient throughout infancy is recommended because of the risk of retraction and hypertrophic scarring.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, we have described a case of mild <span class="elsevierStyleGrantSponsor" id="gs1">MCC</span> in which the typical atrophic plaque was not evident and the diagnosis was supported by physical examination, dermoscopy, and ultrasound. Other congenital anomalies are rarely associated with <span class="elsevierStyleGrantSponsor" id="gs2">MCC</span> and should be ruled out during the diagnostic process. Treatment of the condition should be mainly surgical.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arjona-Aguilera C, Blasco-Morente G, Tercedor-Sánchez J. Pápula pediculada y fisura en línea cervical anterior de recién nacido. Actas Dermosifiliogr. 2016;107:681–682.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 300 "Ancho" => 444 "Tamanyo" => 25749 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 450 "Ancho" => 366 "Tamanyo" => 26157 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polarized light, original magnification ×10.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Midline cervical cleft: Review of an uncommon entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Puscas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/209418" "Revista" => array:5 [ "tituloSerie" => "Int J Pediatr" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "209418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25983756" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fisura cervical media: Reporte de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.E. Remolcois" 1 => "Q.P. Larraguibel" 2 => "V.G. López" 3 => "C.J.A. 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Hashimoto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "1099" "paginaFinal" => "1101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12861550" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000008/v2_201704100057/S1578219016301548/v2_201704100057/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000008/v2_201704100057/S1578219016301548/v2_201704100057/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301548?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 84 | 31 | 115 |
| 2024 September | 109 | 25 | 134 |
| 2024 August | 117 | 54 | 171 |
| 2024 July | 98 | 27 | 125 |
| 2024 June | 92 | 36 | 128 |
| 2024 May | 74 | 35 | 109 |
| 2024 April | 99 | 26 | 125 |
| 2024 March | 76 | 29 | 105 |
| 2024 February | 75 | 33 | 108 |
| 2024 January | 58 | 35 | 93 |
| 2023 December | 61 | 16 | 77 |
| 2023 November | 67 | 46 | 113 |
| 2023 October | 66 | 60 | 126 |
| 2023 September | 57 | 40 | 97 |
| 2023 August | 46 | 24 | 70 |
| 2023 July | 57 | 40 | 97 |
| 2023 June | 62 | 25 | 87 |
| 2023 May | 75 | 29 | 104 |
| 2023 April | 50 | 22 | 72 |
| 2023 March | 65 | 22 | 87 |
| 2023 February | 67 | 19 | 86 |
| 2023 January | 56 | 30 | 86 |
| 2022 December | 68 | 55 | 123 |
| 2022 November | 32 | 27 | 59 |
| 2022 October | 31 | 19 | 50 |
| 2022 September | 30 | 32 | 62 |
| 2022 August | 25 | 39 | 64 |
| 2022 July | 46 | 38 | 84 |
| 2022 June | 36 | 27 | 63 |
| 2022 May | 47 | 34 | 81 |
| 2022 April | 49 | 27 | 76 |
| 2022 March | 40 | 48 | 88 |
| 2022 February | 35 | 29 | 64 |
| 2022 January | 47 | 42 | 89 |
| 2021 December | 49 | 34 | 83 |
| 2021 November | 47 | 40 | 87 |
| 2021 October | 44 | 41 | 85 |
| 2021 September | 27 | 37 | 64 |
| 2021 August | 43 | 31 | 74 |
| 2021 July | 30 | 21 | 51 |
| 2021 June | 43 | 18 | 61 |
| 2021 May | 55 | 42 | 97 |
| 2021 April | 152 | 41 | 193 |
| 2021 March | 65 | 19 | 84 |
| 2021 February | 47 | 25 | 72 |
| 2021 January | 31 | 21 | 52 |
| 2020 December | 28 | 11 | 39 |
| 2020 November | 35 | 22 | 57 |
| 2020 October | 30 | 17 | 47 |
| 2020 September | 38 | 12 | 50 |
| 2020 August | 36 | 13 | 49 |
| 2020 July | 21 | 9 | 30 |
| 2020 June | 26 | 26 | 52 |
| 2020 May | 20 | 12 | 32 |
| 2020 April | 21 | 15 | 36 |
| 2020 March | 31 | 16 | 47 |
| 2020 February | 5 | 1 | 6 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 1 | 1 | 2 |
| 2019 April | 2 | 4 | 6 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 5 | 0 | 5 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 28 | 3 | 31 |
| 2018 January | 31 | 7 | 38 |
| 2017 December | 56 | 6 | 62 |
| 2017 November | 31 | 7 | 38 |
| 2017 October | 26 | 4 | 30 |
| 2017 September | 27 | 7 | 34 |
| 2017 August | 27 | 10 | 37 |
| 2017 July | 26 | 4 | 30 |
| 2017 June | 32 | 13 | 45 |
| 2017 May | 35 | 7 | 42 |
| 2017 April | 33 | 7 | 40 |
| 2017 March | 19 | 9 | 28 |
| 2017 February | 24 | 9 | 33 |
| 2017 January | 17 | 11 | 28 |
| 2016 December | 35 | 19 | 54 |
| 2016 November | 28 | 20 | 48 |
| 2016 October | 124 | 27 | 151 |
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