Lump under Chin near Throat

Question:

Hi, before I ask my question, I thought it is only proper to give a description of my current profile.

I am a 24 year old male, social smoker (no more than 5 cigarettes a day), and occasional user of smokeless tobacco as well. I have an active sexual life and exercise sparingly.

I am currently on medication for a yeast infection on my scrotum and my lymph nodes do swell a bit.

My problem is a newly found bump under chin, strategically placed towards my upper throat. It is no bigger than a small jelly bean. Other than being mildly tender, it does not really hurt. It is not causing any other sensation or numbness in my face in the meantime. It moves around as I directed but my sense is that it seems to connect to some tissues beneath the skin surface, my best guess is muscle. It gives the impression of a soft tissue.

It has been with me for a while (though I can't quite recall when it started but it was at least some 5-6 years ago). There has been no subsequent growth since I first spotted it.

Now the question is: "Could this be a cyst?", and hopefully a harmless one at that?

Answer:

Before I dwell on the many possibilities for your condition, it is good to be mindful that there are loads of explanations for your description of your symptoms. Dependent on the outcome of a physical examination, it could be something as harmless as acne, or something horrible like cancer. It is definitely helpful that you list down the history of your medical and lifestyle background, as I believe my years in researching conditions that are related to early childhood and adolescence could offer interesting snippets for your consideration.

Possibility #1:

Thyroglossal Duct Cysts

The so-called thyroglossal duct is formed during the early stages of foetal development. It represents a temporary organ before the full development of the thyroid gland and the tongue (after which, this duct closes and disappears - typically by the time of birth). But there are odd occasions when a piece of the duct remains, and this over time will turn into a cyst, usually during childhood or adolescence. If this narrative fits you, it means that you will have to get rid of the remnants of this thyroglossal duct and cyst (including the connecting structure to the hyoid bone, which is located at the base of the tongue). If the removal is less than complete, the chances of the cyst recurring is high. If these cysts are left unchecked, they have the potential to turn cancerous in adulthood. A practical diagnostic test for this purpose can be an ultrasound scan on the neck area; this can pick up the existence of such duct and/or cyst.

Medical records collected so far do not necessarily indicate that thyroglossal duct cysts are dangerous, but there have been observations made where the cysts can get inflamed and a subsequent infection will require the use of antibiotics or even surgical intervention. It is also believed that infection could lead to the lymph nodes swelling.

Possibility #2:

Sebaceous Cysts

These are commonly manifested as lumps on or just directly below the skin surface. A sebaceous cyst generally refers to all benign and harmless growths that happen around the skin area and it tends to take on a smooth texture. With varying sizes, sebaceous cysts can be found on the scalp, face, ears, and genitals. Sebaceous glands lie beneath the skin surface and are responsible for producing sebum, a medium-thick fluid. When sebum is blocked from being released, sebaceous cysts start to form. Sebaceous cysts in general do not warrant medical treatment, as they tend to come and go of their own accord; but they will require treatment if they get infected and become painful and grow in size. If infection occurs, a doctor can drain the sebum and probably remove the cells that form the cyst wall. Even if the presence of sebaceous cysts is more a nuisance (e.g. for being irritating or simply on aesthetic grounds) rather than a health threat, you can always choose to remove them through a simple excision procedure.

As in the case of thyroglossal duct cysts, the usual compelling reason for removal of sebaceous cysts is either inflammation or infection. Most people choose not to have anything done to them until problems emerge or they become painful.

Possibility #3:

Dermoids

If you find lumps along the midline of the neck, chances are they could be dermoid cysts. These are slow-growing and benign tumors. When they congregate on the neck, dermoid cysts usually take the form of hard lumps beneath the skin surface.

Dermoid cysts can pose a greater problem when they manifest in the throat or mouth area. They rarely cause life-threatening conditions - not until they get infected or get too big in size (such that you have problems in swallowing or breathing).

And now the possible implications: As you mentioned, you observed a swollen lymph node as well - it could be related to this particular cyst. Lymph glands (as part of our lymphatic system) are among our shields of defense against infections. Swollen lymph glands are usually one of the indications that an infection has set in.

Allow me to expand further:

Our lymphatic system is made up of numerous ducts and nodes which are spread out through our entire body. Among the areas of concern here are the neck, jawline and below your chin. Inside the lymph itself, there is a collection of antigens, foreign objects (both infectious and non-infectious); all of which our body does keep a tight rein on. It acts as a sort of record keeper, and it preserves the good while fighting off the bad. It is equipped with 2 types of immunity arsenals: antibodies that leech on infectious elements, and macrophages that tackle the cornered cells and consume them.

You may wonder what this is all about. Well, even though lymph nodes are tasked with this important job to fight infection, there is every likelihood that they themselves could become inflamed in the course of their actions, as large amounts of antibodies need to be excreted. Expanding further on the possible causes of swelling on lymph nodes, other culprits that are seemingly trivial are:

  • a common cold,
  • a flu,
  • upper respiratory infection or
  • other minor problems.

But there are also more threatening contributors to lymph nodes swelling. These are:

  • cancer,
  • leukemia,
  • HIV,
  • lupus,
  • lymphoma,
  • rheumatoid arthritis, and
  • other lymphoproliferative disorders.

Even so, there is not really a lot of urgency required to deal with inflamed glands unless they become hard, immobile, or their size expands rapidly. Rather, it is the localized swelling on particular body parts that should raise an alarm bell, for example lump in chin as you observed it.

I am sorry to say this but I must admit your story does make you susceptible to cancer and a number of STDs (or sexually transmitted diseases) regardless of whether you use protection or not. The odds are against you; first that ongoing infection in your scrotum, coupled with your current glandular swelling, your record of tobacco consumption and sexual activity (I hazard a guess that you have multiple partners).

Having said all that, my best educated guess is that a thyroglossal duct cyst is probably the most logical deduction given your age, but your lifestyle choice would invariably tip the balance. I cannot stress this enough: your best bet is to look for a specialist to have a meaningful and effective diagnosis of your condition, and do this with all the urgency you can muster.