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1. What is your clinical impression?

1. What is your clinical impression?. Differential Diagnosis. TB adenopathy. … in developing countries… Tuberculosis: most common cause of cervical lymph node enlargement Peripheral lymph node tuberculosis is the most common form of extrapulmonary tuberculosis

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1. What is your clinical impression?

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  1. 1. What is your clinical impression?

  2. Differential Diagnosis

  3. TB adenopathy • … in developing countries… • Tuberculosis: most common cause of cervical lymph node enlargement • Peripheral lymph node tuberculosis is the most common form of extrapulmonary tuberculosis • Cervical tuberculous lymphadenopathy(scrofula) is stillthe most common cause of persistent cervical lymph node enlargement • unilateral, with little or no pain, advanced disease may suppurate and form a draining sinus • diagnosis is established by fine-needle aspiration or surgical biopsy • AFB are seen in up to 50% of cases • cultures are positive in 70 to 80% • histologic examination shows granulomatous lesions http://pmj.bmj.com/cgi/content/full/77/905/185#SEC3 http://www.javeriana.edu.co/Facultades/Medicina/pediatria/revis/ eMedicine%20-%20Tuberculosis%20%20Article%20by%20Thomas%20Herchline,%20MD.htm

  4. Lymphoma • Lymphoma may be nodal or extranodal • A quarter of all extranodal lymphomas occur in the head and neck • Extranodal lymphoma is usually NHL • 8% of findings on supraclavicular fine-needle aspirate biopsy yield a diagnosis of lymphoma • Lymphoma is the second most common primary malignancy occurring in the head and neck • Incidence of aggressive non-Hodgkin lymphoma has risen steadily over recent decades http://emedicine.medscape.com/article/854110-overview

  5. Non-Hodgkin’s Lymphoma • May manifest in the cervical region and lymphoid tissue of the Waldeyer ring • Appears as a mass in the oropharynx or nasopharynx • Unilateral tonsillar enlargement is highly suggestive of malignancy. • Usually arises in the tongue base • In contrast to squamous cell carcinoma, NHL is bulky, fleshy, and nonulcerating • Some patients with indolent NHLs may have large asymptomatic abdominal masses • Splenic or hepatic enlargement http://emedicine.medscape.com/article/854110-overview

  6. Lymphadenitis from Aphthous ulcer • lymphadenitis is an infection of the lymph nodes; a complication of bacterial infection • swollen glands are usually found near the site of an underlying infection, tumor, or inflammation  apthous ulcer • Apthous ulcer also known as APHTHOUS STOMATITIS • painful open sore inside the mouth, caused by a break in the mucous membrane • Etiology is unknown • Lymphadenitis may occur after skin infections or other bacterial infections, particularly those due to streptococcus or staphylococcus

  7. Metastatic Carcinoma from oral cavity cancer • 5% percent of all cancers reported yearly • 30% of these cancers occur in the oral cavity • squamous cell carcinoma- (most common) 95% of oral cavity cancer • Risk Factors: • use of tobacco/ smoking • 80% of patients with oral SCC • risk of developing malignancy is 5-9 times greater for smokers than nonsmokers • Alcohol- 3-9 times greater risk of developing cancer • of alcohol and tobacco combined may convey a risk greater than 100 times the general population • HPV types 16 and 18 may be found in approximately 22% and 14% of oropharyngeal tumors http://www.ahns.info/patienteducation/docs/oralcavity.php http://emedicine.medscape.com/article/847678-overview

  8. Metastatic Carcinoma from oral cavity cancer • Symptoms • most common presentation of cancer of the floor of the mouth is a painless inflamed superficial ulcer with poorly defined margin • Intermittent bleeding may occur • Advanced cases: complaints may include new or increased pain, pain on swallowing, ear pain, a change in speech, uncoordinated swallowing, or a lump in the neck • sores in the mouth, whether they are related to trauma or to a variation of canker (apthous) sores, should fully heal within three weeks http://www.ahns.info/patienteducation/docs/oralcavity.php

  9. Metastatic Carcinoma from oral cavity cancer • Metastatic neck disease is the most important factor in the spread of head and neck squamous cell carcinoma (SCC) from primary sites • most commonly involved primary sites • larynx, oropharynx, hypopharynx, and oral cavity • Malignant tumors of the oral cavity grow rapidly, with frequent and early metastasis to the surrounding regional lymph nodes http://emedicine.medscape.com/article/850195-overview

  10. Clinical Impression: METASTATIC CARCINOMA FROM ORAL CAVITY CANCER

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