Approach to Neck Masses & Thyroid Nodule
Transcript of Approach to Neck Masses & Thyroid Nodule
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Approach to Neck Masses &Thyroid NoduleBy: Amir Reza Honarmand (Chief Stager of Surgery )
Shariati Hospital Tehran
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Inflammatory Lesions
InfectiousBacterial strep/staph, cat scratch (bartonella), TB
Fungal actinomycosis
Viral (HIV, EBV, mumps)
Parasitic toxoplasmosis
Inflammatory
Granulomatous disease sarcoid
Reactive
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Lymphadenopathy
Normal nodes
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Drainage Patterns and NeckLevels
Level I (Submandibular / Submental)drain lip, oral cavity and submandibular gland
Level II (Upper jugular)
drain nasopharynx, oropharynx, parotid, and
supraglottic larynx
Level III (Mid jugular)
drain oropharynx, hypopharynx, and supraglottic
larynx
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Drainage Patterns and NeckLevels
Level IV (Lower jugular)
drain subglottic larynx, hypopharynx,esophagus,
and thyroid
Level V (Posterior triangle)drain nasopharynx and oropharynx
Level VI (Paratracheal)
drain thyroid and larynx
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Clinical Evaluation of NeckMass History
age (kids 80% benign, adults over 40
80% malignant), duration, growth,
fluctuation, tenderness, B symptoms,
oral/nasal/ear, skin, voice change, cough,
weight loss, SOB, dysphagia
Smoking Hx, Personal Ca History,
Previous irradiation, Family Ca Hx
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Fine Needle Aspiration ofNeck Masses
Sensitivity of 85 97% for tumours
Specificity of 88 98%
Non diagnostic 8 16%
Useful even for salivary lesions
to rule out
non-salivary pathology
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Laboratory Investigations
Base on suspicion from Hx and Px
CBC, LDH PPD
CXR for lower neck mass or lymphoma
Serology (toxoplasma, cat scratch, EBV)
US node character lucency, shape, hilar fat
Other imaging function of FNA result, eg CT with
SCC, or MRI if unlocalized primary
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Treatment of Metastatic
Squamous Cervical Cancer of
Unknown Primary
Indication for primary radiotherapy
Radical neck dissection may be
indicated when open biopsy proven
metastatic squamous carcinoma