Question:medium
A middle-aged man has a swelling over the neck since childhood, with the overlying skin not intact, which had a bag-of-worms or worm-like appearance with a black spot in the middle. What will be the diagnosis?
A middle-aged man has a swelling over the neck since childhood, with the overlying skin not intact, which had a bag-of-worms or worm-like appearance with a black spot in the middle. What will be the diagnosis?
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A lifelong 'bag of worms' mass with cafe-au-lait spots points to a nerve sheath tumour of NF-1.
Updated On: Jun 23, 2026
- Cirsoid aneurysm
- Varicocele
- Plexiform neurofibroma
- Lymphangioma
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The Correct Option is C
Solution and Explanation
Buzzword decode: 'Bag of worms' on the body wall plus lifelong history equals plexiform neurofibroma.
This lesion is a rare form of neurofibromatosis type 1. Tumours sprout along several nerve trunks at once, swelling and distorting them so the mass feels like a tangle of ropes or worms under the skin, often with overlying skin changes. Because it is part of NF-1, hunt for the company it keeps: many small cutaneous neurofibromas and brown cafe-au-lait macules scattered over the trunk and arms.
Distinguish the look-alikes: A varicocele also feels like a bag of worms, but it lives in the scrotum, not the neck, so it is out. A cirsoid aneurysm is a pulsatile, compressible tangle of vessels, classically on the scalp, and would thrill on palpation. A lymphangioma or cystic hygroma is a soft cystic neck lump that lights up brightly on transillumination, unlike a solid nerve tumour. Hence plexiform neurofibroma.
Ref: NF-1 plexiform neurofibroma literature.
This lesion is a rare form of neurofibromatosis type 1. Tumours sprout along several nerve trunks at once, swelling and distorting them so the mass feels like a tangle of ropes or worms under the skin, often with overlying skin changes. Because it is part of NF-1, hunt for the company it keeps: many small cutaneous neurofibromas and brown cafe-au-lait macules scattered over the trunk and arms.
Distinguish the look-alikes: A varicocele also feels like a bag of worms, but it lives in the scrotum, not the neck, so it is out. A cirsoid aneurysm is a pulsatile, compressible tangle of vessels, classically on the scalp, and would thrill on palpation. A lymphangioma or cystic hygroma is a soft cystic neck lump that lights up brightly on transillumination, unlike a solid nerve tumour. Hence plexiform neurofibroma.
Ref: NF-1 plexiform neurofibroma literature.
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