Head and Neck

Frage	Antworten
What is the most common cell pathology of head and neck cancer?	Squamous cell carcinomas
Tumours of oropharynx: age, sex and aetiological factors	A: Mainly 50-70 but increasingly 30-40 S: M:F = 5-8:1 AF: Smoking, alcohol, betel-nut chewing, radiation, iron deficiency anaemia
Presenting symptoms/signs of tumours of the oropharynx	Sore throat Odynophagia, dysphagia Otalgia Bleeding Voice change Trismus Weight loss Mass in neck
Hypopharyngeal tumours: age, sex and aetiological factors	A: Increasing incidence with age S: Postcricoid is the only H&N cancer more common in women AF: Smoking, alcohol, betel-nut chewing, radiation, ID anaemia, HPV infection
Presenting symptoms of hypopharyngeal tumours	Sore throat, odynophagia, dysphagia Otalgia Haemoptysis Hoarseness, stridor Occasionally weight loss (advanced) Neck mass
Laryngeal cancer: age, sex and aetiological factors	A: Increasing incidence w age (rare <45yrs) S: M:F = 4:1 AF: Smoking, alcohol, neck radiation
Presenting symptoms of laryngeal cancer	Change of voice/hoarseness Dyspnoea/stridor Pain/odynophagia Dysphagia Neck mass
Minor salivary glands	600-1000 Beneath mucosa Named according to anatomical position e.g. buccal, lingual, tongue etc
Major salivary glands	3 paired structures Parotid, Submandibular, Sublingual Each situated outside oral cavity but connected to it by a duct/system of ducts
Non-salivary swellings	Hypertrophy of masseter Ageing Neuromas, aneurysms and cysts within parotid Lymphadenopathy Dental infections Mastoiditis
Causes of bilateral parotid swelling	Viruses: mumps Sarcoidosis Sjogren's syndrome Lymphoma Alcoholic liver disease
Causes of unilateral parotid swelling	Tumour: pleomorphic adenomas Stones Infection
Parotitis	Viral: mumps, echo and coxsackie. HIV Bacterial: often staphylococcal, tuberculosis Fungal (rare): candidiasis, immunosuppressed Other: sarcoid, drugs
Sialectasis	Dilatation, stenosis and necrosis of acini Forms cysts Initial event in calculus formation, majority affect submandibular gland duct
Sjögren's syndrome	Autoimmune disorder Parotid enlargement Xerostomia Keratoconjunctivitis sicca Bilateral, non tender enlargement of the gland 90% female Treatment is supportive Increased risk of subsequent lymphoma
Sjögren's syndrome: investigations	HLA AI, B8, DR3 Specifica antigens: SSA and SSB Schirmer's test Carisson-Crittendon (salivary flow) Lateral biopsy (diagnostic) 1 in 6 risk of N-H B-Cell lymphoma
Sarcoidosis: parotid involvement	Parotid involvement occurs in 6% of patients with sarcoid Bilateral in most cases Gland is not tender Xerostomia may occur Management of isolated parotid disease is usually conservative
Benign salivary tumours: % of them which are benign	80% tumours occur in parotid 80% of these are benign 60% of submandibular are benign 30% minor salivary gland tumours are benign
Types of benign salivary tumour	- Benign pleomorphic adenoma or benign mixed tumour - Warthin tumor - Monomorphic adenoma - Haemangioma
Pleomorphic adenomas	Most common parotid neoplasm (80%) Slow growing, lobular, and not well encapsulated Treatment: Parotid - superficial parotidectomy or tumour excision with complete cuff of normal tissue Prognosis: recurrence rate of 1-5% with excision, 2-10% malignant degeneration
Warthin's Tumour (adenolymphoma)	Soft, cystic masses in tail of parotid 5% of parotid neoplasms Most common bilateral benign neoplasm of the parotid Often in males >40yrs Lymphocytic infiltrate and cystic epithelial proliferation Incidence of bilaterality and multicentricity of 10% Malignant transformation v. rare
Hemangioma	Should be considered in the differential of a parotid mass in a child Accounts for 90% of parotid tumours in children less than 1 year of age Hypervascular on imaging Spontaneous regression may occur and malignant transformation is almost unheard of
Commonest types of malignant salivary tumours	Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma Adenocarcinoma Lymphoma
Mucoepidermoid carcinoma	Usually low potential for local invasiveness and metastasis (depends mainly on grade) 90% found in parotid, prevelence highest in 5th decade, more common in females Commonest salivary carcinoma in children Up to 30% recurrence
Adenoid Cystic Carcinoma	Unpredictable growth pattern Tendency for perineural spread - presents with palsies and pain Nerve growth may display skip lesions resulting in incomplete excision Distant metastasis more common (visceral rather than nodal spread) 5 year survival 35%
Acinic Cell tumours	Intermediate grade malignancy May show perineural invasion Low potential for distant metastasis 5 year survival 80% 99% parotid gland, middle-aged and elderly, more common in females
Adenocarcinoma	Develops from secretory portion of gland Risk of regional nodal and distant metastasis 5 year survival depends upon stage at presentation, may be up to 75% with small lesions with no nodal involvement
Adenocarcinoma	Highly malignant Several histological types 5 year survival = 10%
Lymphoma	Commonest - Non-Hodgkin's Usually 5th-7th decade Rubbery, painless lymphadenopathy Present as firm rapidly enlarging masses May be associated night sweats and splenomegaly Diagnosis - open biopsy
What are the 'B symptoms' of lymphoma?	Fever Drenching night sweats Weight loss: > 10% of body mass in previous 6 months
Complications of Partial Superficial Parotidectomy	Facial nerve palsy or paresis Frey's syndrome Fistula Numbness of ear lobe
Complications of Submandibular Gland Excision	Haemorrhage (reactionary) Marginal mandibular nerve damage (asymmetrical smile)
Epidermoid cysts	Firm Round nodules of various sizes Central punctum may be present Proliferation of epidermal cells within a circumscribed space of the dermis
Cystic hygromas	Soft Painless Transilluminate brightly Congenital lymphatic lesions Typically found in the neck and axilla region Predilection for the left side Majority present by 2 years of age
Branchial cleft cysts	Smooth Painless Do not transilluminate Typically present by early adulthood Develop due to failure of obliteration of the second branchial cleft in embryonic development
Deep cervical abscesses	Painful and tender swelling May be hot to touch. May also have other signs of infection such as fever, chills, aches, and pains Typically occur following a source of infection e.g. dental work
Thyroid swelling: what is a characteristic presentation?	May be hypo-, eu- or hyperthyroid symptomatically Moves upwards on swallowing
Thyroglossal cyst	More common in patients < 20 years old Usually midline, between the isthmus of the thyroid and the hyoid bone Moves upwards with protrusion of the tongue May be painful if infected
Pharyngeal pouch: what is it?	More common in older men Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Presentation of pharyngeal pouch	Usually not seen but if large then a midline lump in the neck that gurgles on palpation Dysphagia Regurgitation Aspiration Chronic cough
What is significant about 'mirror image nuclei'?	Indicates Reed-Sternberg cells RS cells are diagnostic of Hodgkin's lymphoma
Thyroid malignancy: papillary carcinoma	Commonest sub-type Accurately diagnosed on fine needle aspiration cytology - psammoma bodies and 'orphan Annie' nuclei Typically metastasise via the lymphatics and thus laterally located apparently ectopic thyroid tissue is usually a metastasis from a well differentiated papillary carcinoma
Thyroid malignancy: follicular carcinoma	May present as a discrete nodule Lymph node metastases uncommon Tend to spread haematogenously Cannot be accurately diagnosed on fine needle aspiration cytology - needs at least a hemi thyroidectomy
Thyroid malignancy: anaplastic carcinoma	Rend to occur in elderly females Disease is usually advanced at presentation and often only palliative decompression and radiotherapy can be offered
Thyroid maligancy: medullary carcinoma	Tumours of the parafollicular cells (C Cells) Serum calcitonin may be elevated May be familial Occur as part of the MEN-2A disease spectrum Spread may be either lymphatic or haematogenous Not responsive to radioiodine
Investigations for suspected salivary gland neoplasm	FNAC is used in most cases Plain x-rays - exclude calculi Sialography - delineate ductal anatomy Where malignancy is suspected the primary approach should be definitive resection rather than excisional biopsy

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	Erstellt von Liam Musselbrook vor fast 8 Jahre