A middle-aged man with a swelling over the neck since childhood with the overlying skin not intact which had a bag or worm-like appearance with a black spot in the middle. What will be the diagnosis ?
The scenario described presents a specific set of clinical features: swelling over the neck since childhood, overlying skin not intact, appearing bag or worm-like with a black spot in the middle. These characteristics are crucial for diagnosis. Let's break down the options:
Cirsoid aneurysm: This is an abnormal connection between arteries and veins, leading to a vascular mass, occurring mostly in the face or scalp. The description doesn't fit the usual appearance or locations.
Varicocele: Generally found in the scrotal area, characterized by enlarged veins. This doesn't align with neck localization or description.
Plexiform neurofibroma: Associated with neurofibromatosis, these are nerve sheath tumors, often presenting as bag or worm-like masses. These tumors can occur anywhere but are common in the neck. The chronic nature and appearance with potential pigmentation (black spot) fit well.
Lymphangioma: Typically, a congenital malformation of lymphatic vessels, presenting as a soft, doughy mass. The description might partially fit, but the characteristic 'worm-like' appearance is more indicative of a plexiform neurofibroma.
Diagnosis: Given the details, the most fitting diagnosis is Plexiform neurofibroma, aligned with its classic presentation and characteristics as described in the provided image and text.
