Shown here are the preoperative MRI (axial and coronal) scans from a 60-year-old nonsmoking Caucasian man (patient 2) who presented with a slow-growing lump in the left
supraclavicular fossa that was noticed by the patient approximately 1 year earlier.
These additional heads made the SCM muscle thick and bulky to an extent that caused extreme reduction in the size of the lesser
supraclavicular fossa. The left SCM was found to be without any variation.
The two clavicular heads of origin of sternocleidomastoid muscle were separated by a wider triangular interval (compared to the interval between the sternal head and normal clavicular head), which corresponds to one more surface depression, the additional lesser
supraclavicular fossa. The additional slip is also supplied by a branch from the spinal part of the accessory nerve.
Arm A patients had received 50 Gy in 25 fractions to chest wall and 50 Gy in 25 fractions to
supraclavicular fossa. Arm B patients received 40 Gy in 15 fractions to chest wall and 45G y in 15 fractions to
supraclavicular fossa.
Computed tomography showed a well defined, multilocular, cystic lesion in the right
supraclavicular fossa (Figure-1a).
Metastases from the tracheobronchial tree and the genitourinary and gastrointestinal systems are the most common malignant lesions of the
supraclavicular fossa. Liposarcomas in this region, as primary tumors, are rarely encountered.
The neck was supple without cervical adenopathy, but an ill-defined, very tender mass at the right base of the neck extended into the
supraclavicular fossa. Lungs were clear, there were no cardiac murmurs, the abdomen was benign without hepatosplenomegaly, and a questionable right-sided costovertebral angle tenderness was noted.
Physical examination revealed a soft, smooth and mobile mass measuring about 10 cm, in the left
supraclavicular fossa and left lateral side of neck.
He was first diagnosed in 1983 and had been treated with primary radiotherapy: 7,000 rads to the right neck, 5,400 rads to the right
supraclavicular fossa, and 6,600 rads to the ear and upper neck.
Examination revealed a 12 x 10-cm nontender soft-tissue mass with indistinct margins in the right
supraclavicular fossa. Findings on fine-needle aspiration biopsy were consistent with a lipoma, but contrast-enhanced computed tomography (CT) of the neck identified a heterogenous 4 x 5-cm enhancing mass deep to an overlying lipomatous component that measured approximately 10 x 6 cm in the right lower jugular chain (figure 1).
Surgical exploration revealed that an encapsulated, fibrofatty nodular mass extended from the hyoid bone down to the
supraclavicular fossa. Throughout the dissection, the presence of a very intense network of feeding vessels was noted; they were either ligated or cauterized without difficulty.
(2) Fibromatosis of the head and neck accounts for 11 to 12% of all cases of extraabdominal desmoid; of these cases, 85% involve the neck (especially the
supraclavicular fossa) and 15% involve the face and scalp.
