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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER - PowerPoint PPT Presentation


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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER. NECK MASS DIFFERENTIAL DIAGNOSIS. INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

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EDWARD WEISBERGER MD

OTOLARYNGOLOGY/HEAD AND NECK SURGERY

INDIANA UNIVERSITY MEDICAL CENTER


Neck mass differential diagnosis
NECK MASS DIFFERENTIAL DIAGNOSIS

  • INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

  • CONGENITAL-THYROGLOSSAL DUCT CYST, LYMPHANGIOMA, DERMOID CYST, BRANCHIAL CLEFT CYST, TERATOMA

  • NEOPLASM


AGE

  • PEDIATRIC-INFLAMMATORY, CONGENITAL

  • TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA

  • ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA


Neoplastic benign
NEOPLASTIC (BENIGN)

  • NEUROGENIC (NEUROLEMMOMA)

  • VASCULAR (PARAGANGLIOMA OF CAROTID BODY OR VAGAL BODY)

  • VASCULAR (ANEURYSM)

  • PAROTID (BENIGN MIXED TUMOR, WARTHIN’S TUMOR)



Neoplastic malignant
NEOPLASTIC (MALIGNANT) ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • METASTATIC SQUAMOUS CELL CARCINOMA

  • LYMPHOMA

  • THYROID CANCER

  • METASTATIC MELANOMA

  • METASTIC TESTICULAR CANCER


Characteristics of a metastaic neck mass
CHARACTERISTICS OF A METASTAIC NECK MASS ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • PAINLESS

  • UNILATERAL

  • ADULT AGE GROUP


Evaluation of a neck mass
EVALUATION OF A NECK MASS ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • HX-HOARSNESS, DYSPHAGIA, PAIN ORAL CAVITY, TOBACCO USE

  • PE-EXAM OF ORAL CAVITY AND OROPHARYNX DISCLOSES PRIMARY 50% OF TIME

  • MIRROR OR FIBEROPTIC EXAM WILL FIND THE PRIMARY IN AN ADDITIONAL 35%


Oral cavity ulcerative lesion
ORAL CAVITY ULCERATIVE LESION ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Fiberoptic laryngoscopy
FIBEROPTIC LARYNGOSCOPY ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Fiberoptic laryngoscopy1
FIBEROPTIC LARYNGOSCOPY ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Fiberoptic laryngoscopy2
FIBEROPTIC LARYNGOSCOPY ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Evaluation of a neck mass1
EVALUATION OF A NECK MASS ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • LOCATION-UPPER NECK ANT. TO SCM-MOST COMMON FOR H & N PRIMARIES (SENTINAL NODE)

  • POSTERIOR TRIANGLE-NASOPHARYNX

  • SUPRACLAVICULAR-THYROID OR SITE BELOW THE CLAVICLES


Carotid body tumor
CAROTID BODY TUMOR ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • LOCATED CAROTID BIFURCATION

  • MORE DISCREET IN ANT/POSTERIOR DIRECTION THAN SUPERIOR/INFERIOR

  • SOMETIMES A BRUIT


Evaluation of a neck mass2
EVALUATION OF A NECK MASS ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • OFFICE BX. IF IN ORAL

  • FNA-MIGHT DIRECT WORK-UP; IF LYMPHOMA OR THYROID CANCER

  • CT AND/OR PET SCAN

  • EXAMINATION UNDER ANESTHESIA-PALPATE TONGUE BASE, VISUALIZE APEX OF PYRIFORM SINUS AND POST-CRICOID AREA


Evaluation of a neck mass3
EVALUATION OF A NECK MASS ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS-TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS


Teratoma

TERATOMA ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Teratoma1
TERATOMA ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Lymphangioma
LYMPHANGIOMA ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Lymphangioma1
LYMPHANGIOMA ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)


Virchow s node
VIRCHOW’S NODE ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

  • LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM


Virchow s node1
VIRCHOW’S NODE ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)



Unknown primary
UNKNOWN PRIMARY ADULT

  • MOST COMMON SOURCE-HYPOPHARYNX, TONSIL, BASE OF TONGUE

  • IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)



Human papilloma virus
HUMAN PAPILLOMA VIRUS ADULT

  • INCREASINGLY COMMON ETIOLOGY

  • EXPLAINS INCREASING INCIDENCE OF SCC OF THE HEAD AND NECK IN NON-SMOKERS

  • INCREASED RISK OF HPV WITH SEXUAL PROMUSCUITY

  • ? VACCINATE YOUNG MALES


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