We analysed 2, 521 outpatients who had visited our clinic in Kumamoto University Hospital between January 1 and December 31, 1983. The number of patients with swelling of the neck was 173 (6.9%). In the 30- to 49-year-old group, females were more numerous than males, while males exceeded females between 50 and 69 years old. Benign diseases accounted for 94 cases (54.3%) and malignant diseases 61 cases (35.2%). Malignant diseases increased in patients over 40 years old, and exceeded the number of benign diseases in those over 50 years old. Patients with metastatic cervical tumors comprises the largest group (39 cases, 22.5%), followed by those with thyroid tumors (33 cases, 19.1 %), parotitis (23 cases, 13.3%) and parotid tumors (15 cases, 8.7%). Among metastatic cervical tumors, there were 13 cases of oral cancer and 10 of mesopharyngeal cancer. Metastatic cervical tumors were frequently found in the lateral neck. The eighty-eight percent of the patients (152 out of 173 cases) with neck swelling were referred to our clinic by other institutes or departments. Fifty-nine patients (34.1%) visited our clinic within 1 month and over half the number visited within 3 months after noticing the first symptom. Patients with benign diseases were mainly referred by oto-laryngologists, internists, and radiologist, while those with malignant diseases were mainly referred by otolaryngologists, surgeons, and dentists. Patients with metastatic cervical tumor were frequently referred by otolaryngologists and dentists, while those with thyroid tumors were referred more frequently by surgeons than by otolaryngologist.

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We analysed 7, 307 outpatients who had visited our clinic in the Dokkyo University School of Medicine Hospital between 1974 and 1987. The number of patients with swelling of the neck was 346 (4.8%). Benign disease accounted for 218 cases (62.1%) and malignant disease 133 cases (37.9%). Malignant disease increased in patients over 50 years old, and exceeded the number of benign disease in those over 60 years old.
There were 171 cases of thyroid disease (35 malignant cases and 136 benign cases) and 180 cases of non-thyroid disease. The latter included 44 cases of inflammation (24.4%), 105 cases of tumors (58.3%) and 31 cases of congenital disease and miscellaneous (17.2%). Out of 105 tumor cases, primary malignant tumors were found in 13 cases, metastatic tumors below the clavicle were in 8 cases, metastatic tumors above the clavicle were in 73 cases, primary benign tumors were in 7 cases and primary unknown malignant tumors were in 4 cases.
In the frontal neck region, almost 80% of neck masses were benign disease and almost 90% were thyroid disease. In the lateral neck region, almost 60% were malignant disease. In the sternocleidomastoideus area, over 90% were metastatic tumors. The metastatic neck masses from the head and neck region were found in the upper and median parts of the neck. Metastatic tumors below the clavicle were found only in the lower part of the neck.
Almost 70% of the patients (230 out of 334 cases) with cervical masses were referred to our department by other departments or institutes. The patients were referred to our department slightly more than one year after noticing the first symptoms. The patients were first treated or diagnosed by referring doctors for a period of 44 days. We wish to enlighten the general public and doctors in other departments about these cervical masses.

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　症例は60歳男性で,胃内視鏡検査にて胃角部大彎に粘膜下腫瘍を指摘され入院となった.超音波内視鏡(EUS)では,胃壁第4層に連続する径10mmの境界明瞭な低エコー腫瘤に隣接して,径28mmのやや高エコーで内部に嚢胞状病変を有する類円形腫瘤像がみられた.EUS上低エコーに描出された部分は平滑筋腫類似の紡錘形細胞がみられたが,やや高エコーに描出された壁外性腫瘤部は上皮細胞類似の類円形細胞により構成されており平滑筋芽細胞腫と診断した.自験例を加えた本邦報告125例の文献的検討でも,平滑筋芽細胞腫は固有筋層由来で,出血・壊死・嚢胞形成のいずれかを69%に認めており,74.2%に平滑筋腫様部分が併存していた.　従ってEUSにて描出される粘膜下腫瘍のうち,胃壁第4層由来で,低エコー部とやや高エコーの部分が併存し,内部に嚢胞状病変がみられる症例は,平滑筋腫瘍の中でも平滑筋芽細胞腫である可能性が高いと考える.

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