neck lumps Flashcards
(41 cards)
Categories of neck lumps
- Lymph nodes - reactive lymphadenopathy, granulomatous lymphadenitis, lymphoma, mets lymphadenopathy
2.Thyroid gland- MNG, thyroid adenoma, papillary carcinoma, follicular carcinoma, medullary carcinoma, anaplastic carcinoma, unspecificed thyroid swelling - Parathyroid gland- parathyroid adenoma, parathyroid carcinoma
- Salivary glands- pleomorphic adenoma, warthin’s tumor, mucoepidermoid carcinoma, adenoid cystic carcinoma
5.congenital/developmental lumps- thyroglossal duct cyst, bbrachial cyst, cystic hygroma, pharyngeal pouch - vascular lumps- carotid artery aneurysm, cervical rib
Reactive lymphadenopathy - definition, cause, pathology, distinguishing features
benign enlargement of nodes due to immune stimulation- Viral (EBV, CMV), Bacterial (strep), infalmmatory.
Unilateral- typically bacterial: s.aureus, Group A streptococcus, oral anerobes, Group B strep
Bilateral - URTI viral: adenovirus, enterovirus, influenza, Group A strep
Pathology: follicular hyperplasia, sinus histiocytosis
Disting: soft, tender, mobile, resolves with infection
granulomatous lymphadenitis - definition, cause, pathology, distinguishing features
chronic lymph node inflammation with granulomas- TB, sarcoidosis, cat scratch disease
Patho: granuloma formation
Disting: firm, slow growing, may have systemic symptoms
lymphoma - definition, cause, pathology, distinguishing features
def: malignancy of lymphoid tissue
Causes: EBV, immunodef
Patho: Reed sternberg cells (hodgkin), non hodgkin- variable
Distingu: firm, rubbery, painless nodes. B symptoms - fever, night sweats, weight loss
mets lymphadenopathy - definition, cause, pathology, distinguishing features
def: secondary spread of ca to lymph nodes
Cause: head neck primary ca- oral cavity, thyroid
Patho: neoplastic infiltration of node
Distingu: hard, fixed, irregular, often unilateral in older adults
multinodular goiter - definition, cause, pathology, distinguishing features
def: benign thyroid enlargement with multiple nodules
Cause- iodine def, TSH overstimulation
patho: follicular hyperplasia with colloid
Distingu: diffuse or nodular enlargement, moves with swallowing
thyroid adenoma- definition, cause, pathology, distinguishing features
Def: benign encapsulated tumor
Cause: unknown
Pathology: well circumscribed follicular proliferation
Dist: solitary, firm nodule: may be hot on scan
papillary carcinoma - definition, cause, pathology, distinguishing features
Def: mc thyroid cancer
Cause: radiation, BRAF/RET mutation
Path: orphan Annie nuclie, psammoma bodies
Disting: slow growing, cervical lymph spread
follicular carcinoma - definition, cause, pathology, distinguishing features
Def: malignant follicular tumor
Cause: Iodine def
Path: capsualr and vascular invasion
Dist: hematogenous spread to lungs/ bone
Rarely multi focal
Good prognosis
40-60yo
medullary carcinoma - definition, cause, pathology, distinguishing features
def: malignancy of parafollicular C cells
Cause: MEN2, sporadic
Path: calcitonin secretion, amyloid deposits
Dist: diarrhea, flushing, elevated calcitonin
anaplastic carcinoma - definition, cause, pathology, distinguishing features
def: agressive, undiffereniated thyroid tumor
Cause: elderly
Path: highly pleomorphic, rapidly invasive
dist: hard, fixed mass, rapid growth and poor prognosis, compression symptoms
Very poor prognosis - lymphatic and hematoma nous spread
parathyroid adenoma - definition, cause, pathology, distinguishing features
Def: benign parathyroid tumor
cause: sporadic, MEN1
Path: chief cell prolieration
dist: MCC of hypercalcemia
parathyroid carcinoma - definition, cause, pathology, distinguishing features
Def: rare malignant tumor
unknown cause
path: invasice, mitotic parathyroid tumor
dist: palpable neck mass, severe hypercalcemia
pleomorphic adenoma - definition, cause, pathology, distinguishing features
Def: benign mixed tumor
cause: radiation exposure
path: epithelial and mesenchymal cells
dist: painless, slow growing parotid mass
warthin’s tumor- definition, cause, pathology, distinguishing features
def: benign cystic tumor
cause: smoking
path: cystic with lymphoid stroma
dist: bilateral, older male smokers
mucoepidermoid carcinoma - definition, cause, pathology, distinguishing features
def: MC malignant salivary tumor
cause: often de novo
path: mucinous and squamous cells
dist: parotid mass +/- facial palsy
thyroglossal duct cyst - definition, cause, pathology, distinguishing features
Midline neck cyst from persistent thyroglossal tract
COngenital
Path: lined by resp/ squamouis epithelium
dist: midline, moves with tongue protrusion
Adenocystic carcinoma - definition, cause, pathology, distinguishing features
def: malignnat tumor with nerve involvement
unkown cause
path: cribiform/ swiss cheese pattern
dist: painful, perineural invasion common
brachial cyst - definition, cause, pathology, distinguishing features
def: lateral cyst from 2nd branchial cleft
congenital
path: cyst lined by squamous epithelium
dist: lateral to SCM; Often becomes infected
cystic hygroma - definition, cause, pathology, distinguishing features
def: lymphatic malformation (lymphangioma)
congenital
path: cavernous lymphatic channels
dist: soft, transilluminates, often posterior triangle in infants
pharyngeal pouch - definition, cause, pathology, distinguishing features
outpouching of posterior pharynx
cause: weakness in Killian’s dehisence
path: pulsion diverticulum
dist: dysphagia, regurgitation, gurgling mass in older men
carotid artery aneurysm - definition, cause, pathology, distinguishing features
def: focal dilation of carotid artery
cause: atherosclerosis, trauma
path: weakening of arterial wall
dist: pulsatile mass, bruit present, risk of stroke
cervical rib - definition, cause, pathology, distinguishing features
def: extra rib from c7 vertebrae
congenital
path: bony or fibrous rib compressing structures
dist: supraclaviular mass, thoracic outles syndrome
Which neck lumps can be left alone if confirmed to be benign
reactive lymphadenopathy - <2cm, <3weeks, mobile, tender and resolving
Multinodular goiter (tirads 2-3) monitor if asx/euthyroid
Warthin tumor - if confirmed by FNA and asx, no need to tx
Thyroglossal duct cyst- if asx, monitor until infection or cosmetic concern arises
brachial cyst- confirm by imaging and if no signs of ca or inf, then monitor
cervical rib - is asx and incidental
