Sandbox neck mass differential diagnosis

Differential Diagnosis	Similar Features	Differentiating Features
Multinodular goiter	On physical exam multinodular goiter demonstrates as painless mass in the neck also observed in thyroid cancer.	On physical exam multinodular goiter demonstrates large multiple nodules of more than 1 cm that distinguish it from thyroid cancer. On biopsy multinodular goiter demonstrates hyperplastic or adenomatous nodules with varying degree of cystic/liquefactive degeneration that distinguish it from thyroid cancer.
Branchial cleft cyst	On physical exam branchial cleft cyst demonstrates as painless mass in the neck also observed in thyroid cancer.	On physical exam branchial cleft cyst demonstrates origin from lateral part of the neck that distinguish it from thyroid cancer. On biopsy branchial cleft cyst demonstrates squamous or columnar cells on the cyst wall with lymphoid infiltrate, often with prominent germinal centers, granular and keratinaceous cellular debris, and cholesterol crystals in the fluid extracted from a branchial cyst distinguish it from thyroid cancer.
Thyroglossal duct cyst	On physical exam thyroglossal duct cyst demonstrates as painless mass in the neck that may move with swallowing and classically elevates on tongue protrusion also observed in thyroid cancer.	On CT exam; thyroglossal duct cysts are thin walled, smooth, well defined homogeneously attenuating lesions with an anterior midline or para-midline location that distinguish it from thyroid cancer. On biopsy thyroglossal duct cyst demonstrates epithelial lined cells varying from stratified squamous epithelium to thyroidal acinar epithelium on the cyst wall that distinguish it from thyroid cancer.
Hemangiomas	On physical exam hemangiomas demonstrates as painless mass in the neck also observed in thyroid cancer.	On physical exam hemangiomas demonstrates ripe strawberry color and has progressive growth that distinguish it from thyroid cancer. On color doppler hemangiomas demonstrates may show peripheral feeding vessels that distinguish it from thyroid cancer.
Laryngocele	On physical exam laryngocele demonstrates as painless mass in the neck also observed in thyroid cancer.	On physical exam laryngocele demonstrates lateral compressible neck mass that increases in size with intralaryngeal pressure On CT exam laryngocele demonstrates air filled cavity that communicates with with laryngeal cavity that distinguish it from thyroid cancer.
Ranula	On physical exam ranula demonstrates as painless mass in the neck also observed in thyroid cancer.	On CT exam ranula demonstrates air filled cavity that communicates with with laryngeal cavity that distinguish it from thyroid cancer. On biopsy ranula demonstrates a connection to the sublingual space that distinguish it from thyroid cancer.
Teratoma	On physical exam teratoma demonstrates as painless mass in the neck also observed in thyroid cancer.	On CT exam teratoma demonstrates fat (areas with very low Hounsfield values), fat-fluid level, calcification (sometimes dentiform), Rokitansky protuberance, and tufts of hair that distinguish it from thyroid cancer. On biopsy teratoma demonstrates several different types of tissue such as skin, muscle, and bone that distinguish it from thyroid cancer.
Thymic cyst	On physical exam thymic cyst demonstrates as painless mass in the neck also observed in thyroid cancer.	On CT exam thymic cyst demonstrates multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level that distinguish it from thyroid cancer. On biopsy thymic cyst demonstrates The cyst contained numerous cholesterol clefts with subepithelium showing fibrocartilagenous tissue, foreign body corpuscles, and Hassall’s corpuscles that distinguish it from thyroid cancer.
Hydatid cysts	On physical exam hydatid cysts demonstrates as painless mass in the neck also observed in thyroid cancer.	ELISA study detects echinococcus antigen in hydatid cyst disease that distinguish it from thyroid cancer On CT exam, hydatid cysts demonstrates fluid density cyst, with frequent peripheral focal areas of calcification. Septation and daughter cysts may be visualized that distinguish it from thyroid cancer.
Parathyroid cysts	On physical exam parathyroid cysts demonstrates as painless mass in the neck also observed in thyroid cancer.	On fine needle aspiration cytology, parathyroid cysts demonstrates water-clear liquid, aqueous and slightly bloody, predominantly acellular, with rare inflammatory cells or macrophages that distinguish it from thyroid cancer. The analysis of intra-cyst liquid of parathyroid cysts demonstrates high levels of parathyroid hormone portion C-terminal alone or combination of parathyroid hormone portion N-terminal with high serum level that distinguish it from thyroid cancer.
Cystic hygromas	On physical exam cystic hygromas demonstrates as painless mass in the neck also observed in thyroid cancer.	On CT exam, cystic hygromas demonstrates well circumscribed fluid filled cyst that distinguish it from thyroid cancer. On MRI exam, cystic hygromas demonstrates large multicystic mass occupying almost the whole of the left cervical region, encasing the carotid sheath and displacing to the right and significantly attenuating it that distinguish it from thyroid cancer.
Carotid body tumor(Chemodectoma)	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Glomus jugulare tumor	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Glomus vagale tumor	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Lipoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Infective lymphadenitis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Infectious mononucleosis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Chondroma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Lymphoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Salivary gland tumor	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Metastasis of gastrointestinal cancer, breast cancer, lung cancer and genitourinary tract.	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Metastasis of unknown primary	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Toxoplasmosis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Cat-scratch disease	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Actinomycosis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Castleman's disease	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Anaplastic Thyroid Carcinoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Follicular Thyroid Carcinoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Graves Disease	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Hurthle Cell Carcinoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Medullary Thyroid Carcinoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Parathyroid carcinoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Parathyroid adenoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Thyroid adenoma	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Hashimoto's thyroiditis	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On physical exam Multinodular goiter demonstrates large nodules of more than 1 cm , [feature 2], [feature 3] that distinguish it from [disease name]. On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].