Chapter 55 - Pediatric H/N Tumors

Question 1

3 common viruses that can lead to lymphadenopathy

Answer 1

rhinovirus
adenovirus
enterovirus

Question 2

Bacterial causes of lymphadenitis

Answer 2

S Aureus, Str Pyogenes

Atypical mycobacteria, TB, bartonella henslae (cat-scratch)

Question 3

History and PE features suggesting neck mass is infection

Answer 3

fever, pain, acute swelling, erythema, decreased ROM, odynophagia
Sick contacts, URI, foreign travel, animal exposure

Question 4

Should you I/D an infected congenital neck mass?

Answer 4

Try ABx first rather than I/D since much better to remove a congenital mass after the infection and to resect it fully.

Question 5

4 midline congenital neck masses

Answer 5

TDC- from foramen cecum to cricoid, elevate with tongue protrusion

Dermoid- neck, nose, OC, orbit, NP, due to entrapment of epithelial cells along fusion lines, usually have sweat gland/hair, adherent to skin, may have sinus

Teratoma- firm

Laryngocele- external herniate through thyrohyoid membrane

Question 6

Histopathological finding of thymic cyst

Answer 6

Hassall corpuscles (concentric epithelioreticular cells/macrophages in medulla)

Usually L neck

Question 7

Atypical mycobacterial infxn: presentation, treatent, prognosis

Answer 7

firm nontender submandibular/preauricular mass, violaceous skin
Neg/Ind tuberculin test
Surgical resect/ABx/I&D purulent portion
Clarithromycin, Azithromycin, Ethambutol, Ritabutin, but no studies showing ABx are efficacious
Resolves spont over months (most gone by 1 yr)

Question 8

DDx for inflammatory non-infectioys LAD

Answer 8

Kawasaki - <5, high fever 5d plus acute cervical LAD/nonexudative conjunct/strawberry tongue/lip fissure/rash/red palm or sole/edema hand feet, desquamate. IVIg, Aspirin

PFAPA- recurrent high fever, usually <5 yo, no URI Sx, tx steroids/cimetidine/tonsillectomy

Castleman disease- giant LN hyperplasia…excisional Bx

Rosai-Dorfman- massive LAD, <10yo, sinus histiocytosis. Surg/Rad/Chemo

Kikuchi-Fujimoto- necrotizing lymphadenitis, 20-40 yo

Question 9

Reassuring U/S LN findings

Answer 9

Hypoechoic to muscle, flat/oval, short:long <0.5, echogenic hilum, hilar vascularity, surrounding edema, sharp margins

Question 10

Malignant U/S

Answer 10

markedly hypoechoic to muscle (except PTC), round (parotid/SMG nodes may be NL round), no echogenic hilus, coag necrosis, eccentric cortical hypertrophy, cystic necrosis, ill-defined borders, peripheral/mixed vascularity, calcification (MTC), no surrounding inflammation

Question 11

Viral causes of sialadenitis

Answer 11

coxsackie, CMV, PIV, mumps

Question 12

Treatment of sialadenitis

Answer 12

hydration, warm compress, massage, sialogogue (sour candy)

Question 13

How much can 2-3 head CT scans increase risk of brain cancer?

Answer 13

threefold

Question 14

How much can 5-10 head CTs increase risk of leukemia?

Answer 14

threefold