AS PACES Lumps Flashcards
Dercum’s disease
Multiple, painful lipomas
Assoc peripheral neuropathy
Obese PM women
DDx Lipoma
Benign tumour of mature adipocytes, occur anywhere fat can expand
Dercum’s disease
Familial Multiple Lipomatosis
Epidermal cyst vs trichilemmal cyst
Epidermal from hair follicle infundibulum
Trichilemmal cyst - ?AD, often multiple arising from hair follicle epithelium
Gardener’s syndrome
Thyroid tumours
Osteomas
Dental abnormalities
Epidermal cysts
Mx Ganglion
Conservative - watch and wait
Non surgical - aspiration followed by 3wks immobilisation
Excision - 50% recur, risk of neuromuscular damage
NF1 - O/E
Neurofibromas (nerve sheath from schwann cells), pedunculated Pressure --> parasthesia Cafe au Lait Lisch nodules (eye) Axillary freckling CN VII BP
Papilloma - def
Overgrowth of all layers of skin with central vascular core
Dermoid cyst - congenital vs acquired
Congenital –> along line of skin fusion (midline neck and nose, medial/lateral eyebrows)
Acquired –> can be 2* to trauma
Smooth spherical swelling, SNT, SC
CT will establish extent, surgical Ex
Keratoacanthoma
Benign overgrowth of hair follicle cells. Cytology similar to well differentiated SCC
Fast growing, dome shaped keratin plug, intradermal
Excision to reduce scar and obtain histology
DDx Exopthalmos
Grave’s
Orbital cellulitis
Trauma
Meningioma, glioma
DDx goitre
Diffuse smooth –> simple colloid goitre, graves, thyroiditis (Hashimoto’s, Riedel’s, de Quervains)
Diffuse nodular –> MNG, multiple adenomas
Solitary nodule –> MNG, adenoma, malignancy, cyst
Multinodular goitre
Commonest in UK, middle aged women, +FH, may cause hyperthyroid, malignant change 5% if untreated
Medical: Thyroxine (suppress TSH, regresses 50-70%); propranolol + carbimazole, RI
Surgical if malignant, obstructive, cosmetic, medical therapy fails –> total thyroidectomy
Plummer’s vs Graves
P: Older, nodular, no extra features, AF 40%, no AI disease
G: Diffuse enlargement, eyes/derm/nail signs, AF uncommon, AI disease
Simple colloid goitre
Physiological hyperplasia 2* to TSH
Iodine def (worldwide most common)
Increased demand (pregos/puberty)
Goitrogens: Li, uncooked cabbage
Grave’s Disease
0.5% prevalence, 60% cases of thyrotoxicosis, F9>1M, 40-60 years
Opthalmopathy –> oedema, lid lag (sympathetic stimulation), exophthalmos (antiTSH ab, opthalmoplegia (esp upper gaze), optic neuropathy (RAPD and reduced acuity)
Dermopathy –> pretibial myxoedema
Acropachy
Ass –> T1DM, vitiligo, pernicious anaemia
Rx –> Propranolol + carbimazole / PTU; RI, surgery
Which thyroid Ca is only one to spread via blood?
Follicular to bone and lungs
MEN1
Pituitary adenoma
Parathyroid hyperplasia / adenoma
Pituitary endocrine tumour
MEN2
Medullary thyroid
Phaeochromocytoma
A –> hyperparathyroid
B –> Marfanoid habitus
Complications of thyroid surgery
Preop –> render euthyroid but stop drugs 10 days before as cause hypervascularity, laryngoscopy pre and post op
Early –> Haematoma, RLN palsy, hypocalcaemia, thyroid storm
Late –> Hypothyroidism and hypoparathyroidism, recurrence, keloid
Neck lumps
Midline –> Ectopic thyroid, thyroid isthmus mass, inclusion dermoid, thyroglossal cyst
Ant triangle –> LN, chemodectoma, goitre, parotid, branchial cyst, laryngocele
Post triangle –> LN, cervical rib, pancoast tumour, cystic hygroma, pharyngeal pouch
Thyroglossal cyst - Ant T
Thyroglossal duct marks developmental descent of thyroid from foramen caecum
Ectopic tissue can be found anywhere along this path, cysts can contain thyroid tissue - can undergo malignant change (papillary Ca)
40% in first decade, M=F, infection/sinus/Ca/recurrence
Sistrunk’s operation (inject tract with dye, excise cyst and patent tract
Branchial cyst - Ant T
Failed fusion of 2nd and 3rd branchial arches, lined by squamous epithelium, “glary” fluid and cholesterol crystals.
Ant SCM junction of middle/upper thirds
Infection/sinus/recurrence
Surgical –> Bonney’s blue dye injected into fistula allowing accurate excision, close proximity of carotids
Chemodectoma - Ant T
Tumour of paraganglion cells of carotid bodies (measure pH/PaCO2/PaO2)
Ant triangle @ angle of jaw, pulsatile, moves laterally not vertically
Pressure –> syncope
Ix: Duplex US, angiography, CT/MRI
Cystic hygroma - post T
Congenital multicystic lymphatic malformation
Transiluminate brilliantly, + in size on cough/cry, cyst may extend into retropharyngeal space
Obstruction of swallow / reps
Surgery
Pharyngeal Pouch - post T
Kilian’s dehiscence - between thyro and crico pharyngeal muscles which form inferior constrictor
Hallitosis, gurgling, regurg, dysphagia, aspiration,
Ix –> Barium swallow
Surgical –> endoscopic stapling
Cervical rib
Overdevelopment of transverse process of C7
1:150
Vascular - sublavian A compression, subclavian steal, Raynaud’s
Neuro - mower roots of brachial plexus, T1, wasting of intrinsic hand muscles, parasthesia
DDx cervical lymphadenopathy
Lymphoma / Leukaemia
Infection (tonsils / dental abscess / TB / Bartonella henselae (cat scratch) / EBV / HIV)
Sarcoidosis
Tumours (ENT / Breast / Lung / Gastric)
DDx Parotid swelling
Diffuse –> parotitis, Sjorgen’s, sarcoid, CLD, DM, bulimia
Local –> calculus, lipoma, neoplasm, ALL
Salivary gland neoplasms
80% benign, 80% pleomorphic adenomas, Warthin’s tumour in smokers >50
80% parotid gland
80% sublingual malignant
Malignant features of salivary gland swelling
VII palsy
Rapid growth and pain
Hyperaemic, hot skin
Hard and tethered
Management of salivary neoplasms
Benign –> superficial / deep parotidectomy
Malignant –> total parotidectomy ± adjuvant radiotherapy
Complications of parotid surgery
Immediate –> VII palsy, haemorrhage
Early –> temp VII weakness, salivary fistula, loss of pinna sensation (greater auricular nerve)
Late –> Frey’s syndrome (gustatory sweating due to re innervation of divided sympathetic nerves by fibres from secretomotor branch of CNV3
