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NECK MASSES

NECK MASSES. Neck masses - Introduction. Common in children Lymphadenopathy – response to infection Less common in adults Malignant until proven otherwise. Neck masses - Children. Larger lymphoid mass Brisk lymphoreticular response

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NECK MASSES

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  1. NECK MASSES

  2. Neck masses - Introduction • Common in children Lymphadenopathy – response to infection • Less common in adults Malignant until proven otherwise

  3. Neck masses - Children • Larger lymphoid mass • Brisk lymphoreticular response • Present with lymphadenopathy after minor infections • Nodes may continue to enlarge after initiation of treatment and resolution of infection

  4. Neck masses - Children • Causes - benign 80% - bacterial - viral - TB - HIV (Drainage from throat, nose, ear, scalp) - malignant 20% - lymphoma

  5. Neck masses - Causes • Congenital (present at birth) • Developmental • Neck space infections • Salivary glands • Thyroid

  6. Causes - Congenital • Lymphangiomata : Simple and cavernous Cystic hygroma • Dermoids : Epidermoid True dermoid Teratoid • Thyroglossal cysts : along tract of thyroglossal duct 90% midline may be only functioning thyroid tissue

  7. Causes - Developmental • Branchial cysts - various theories - can become infected - treat with aspiration and antibiotics - excision when infection settled

  8. Causes – Neck space infections • Parapharyngeal abscesses : - tonsillitis, quinsy, lower 3rd molar abscess - swelling posterior to sternomastoid - stridor • Prevertebral / retropharyngeal abscess - acute suppurative otitis media

  9. Causes – Salivary gland, Thyroid • Salivary gland : - mumps - recurrent parotitis of childhood - HIV • Thyroid : - pubertal goitre

  10. Management • Clinical history and examination • Masses requiring investigation : - clinically suspicious - not responding after appropriate treatment (4 – 6 weeks) • Fine Needle Aspiration

  11. Neck masses - Adults • Always presents as a pathological condition • History and clinical evaluation will lead to disease diagnosis in most cases • Neck masses usually related to diseases of the lymph nodes (80 % malignant) • Incidence of neoplasia increases with age

  12. Metastatic neck node – N3

  13. Neck masses - Epidemiology • Heavy smoking • Heavy smoking and alcohol abuse • Adult male population ( > 40 years ) • Painless, slow growing mass ( level II/III ) • Radiation exposure in the past • Curative treatment in the distant past for other malignancy

  14. Neck masses – History taking • Otalgia • Blocked nose • Epistaxis • Unilateral hearing loss • Dysphagia / Odynophagia • ( Hoarseness / Dysphonia, Stridor )

  15. Lymph drainage - Neck

  16. Neck mass - Levels • Levels I to VI, Robbins (1991) • Level I – submental and submandibular • Level II – upper jugular • Level III – middle jugular • Level IV – lower jugular • Level V – posterior triangle • Level VI – anterior compartment

  17. Levels of the neck

  18. Neck masses - Causes • 80 % of neck masses in adults (>40) are malignant • Of those, 80% will be squamous cell carcinoma • Of those, in 80% the primary will be found • Of those, 80% will be in the head and neck region

  19. Neck mass – work-up • Careful head and neck examination • In majority of cases a primary will be found • Examination should include the following areas : oral cavity, nasopharynx, oropharynx, larynx, hypopharynx • Examination under anaesthetic • Examine skin, thyroid, salivary glands

  20. THE MOST ACCEPTABLE TEST TO ESTABLISH THE DIAGNOSIS IS FINE NEEDLE ASPIRATION CYTOLOGY

  21. Neck masses - Cytology • Squamous cell carcinoma undifferentiated carcinoma : ENT examination EUA CT scan MRI

  22. Neck masses - Cytology • Adenocarcinoma : ENT examination EUA CT scan, MRI (including abdomen) thyroid / kidneys /adrenals lungs examination of breast, prostate, endometrium

  23. Neck mass – Cytology (cont) • Non-Hodgkin’s lymphoma : ENT examination, EUA with guided biopsies, CT scan thorax and abdomen, bone marrow biopsy, excision of single node for histological examination • Melanoma : ENT examination, dermatological and ophthalmological examination, CT/ MRI head and neck

  24. Neck masses - Summary • Commonest cause in children is infective • Give 4 – 6 weeks to resolve • Commonest cause in adults is malignant • FNA Cytology the only diagnostic tool

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