General oto benign neck masses

Question 1

Describe the condition of benign symmetric

lipomatosis.

Answer 1

This condition involves diffuse lipomatosis of the head,
neck, shoulders, and proximal upper extremities. It is more
common in men than in women. Patients often have a
history of alcoholism and diabetes.

Question 2

True or False. Most liposarcomas develop from a

preexisting benign lipoma.

Answer 2

False. Most liposarcomas develop de novo.

Question 3

What is the most common type of monomorphic

adenoma?

Answer 3

Basal cell adenoma

Question 4

What is the most common paraganglioma of the

head and neck?

Answer 4

Carotid body tumor, which develops within the adventitia of

the carotid bifurcation and are of neural crest origin

Question 5

Describe the Lyre sign.

Answer 5

● Splaying of the internal carotid artery and the external carotid artery at the carotid bifurcation
● Seen with carotid body tumors
● Glomus vagale and sympathetic chain paragangliomas on
the other hand displace the carotid system anteriorly.

Question 6

What percentage of head and neck paragangliomas are functional?

Answer 6

Less than 3%

Question 7

What cellular pattern is characteristically seen in paragangliomas?

Answer 7

Cells of Zellballen. Alveolar-like clumps of tumor cells are
surrounded by a network of thin-walled capillaries. Thick
bands of collagenous tissue divide the tumor. Five to 20
epithelial cells compose a nest or group of cells.

Question 8

What percentage of head and neck paraganglio-

mas are malignant?

Answer 8

Less than 10%. Paragangliomas are determined by the
presence of lymph node metastasis, not by cellular atypia or
local invasion.

Question 9

Familial paraganglioma syndromes are caused by a mutation in genes that encode for what enzyme?

Answer 9

Succinate dehydrogenase

Question 10

True or false. Neural fascicles can be more easily spared during resection of a schwannoma compared with a neurofibroma.

Answer 10

True

Question 11

What is the most common poststyloid paraphar-

yngeal space tumor?

Answer 11

Schwannoma of the vagus or sympathetic chain

Question 12

Which benign salivary gland tumors have pro-
nounced fluorodeoxyglucose (FDG) uptake on PET imaging?

Answer 12

Oncocytoma, and Warthin tumor. Both tumors are com-

posed of large eosinophilic granular cells containing high mitochondrial concentrations.

Question 13

What is the most common type of tumor to arise within the prestyloid parapharyngeal space?

Answer 13

Benign salivary gland tumors

Question 14

Describe the MRI findings of pleomorphic

adenoma.

Answer 14

Well-circumscribed mass with low intensity on T1- and
hyperintensity on T2-weighted sequences. Frequently
demonstrates homogeneous gadolinium uptake

Question 15

What is the most common prestyloid parapharyngeal space tumor?

Answer 15

Pleomorphic adenoma is the most common overall.

Mucoepidermoid carcinoma is the most common malignancy.

Question 16

What are the main access routes to the parapharyngeal space?

Answer 16

Cervical, submandibular/cervical, cervical parotid, cervical parotid with mandibular osteotomy, transoral (not recommended)

Question 17

When should a mandibulotomy be considered for

parapharyngeal space tumors?

Answer 17

● Tumors > 5 cm
● Tumors with extensive skull base disease
● Extensive invasion

Question 18

What are laryngoceles?

Answer 18

Air-filled dilations of the laryngeal ventricle that may be congenital or acquired

Question 19

Describe the three types of laryngoceles.

Answer 19

● Internal: Connects the ventricle with the paraglottic
space, false cord, and aryepiglottic fold

● External: Ventricular dilation extends through the thyro-
hyoid membrane to the lateral neck.

● Combined: Both internal and external extension

Question 20

What are plunging ranulas, and how do they differ

from nonplunging ranulas?

Answer 20

Plunging ranulas form from obstructed sublingual gland
ducts leading to the formation of an epithelial-lined
retention cyst. A plunging ranula requires that the cyst
extend through the mylohyoid, most commonly to the
submandibular space.

Question 21

Review the characteristic signs and symptoms of

Kawasaki (lymphomucocutaneous) disease.

Answer 21

Fever for more than 5 days with at least four of the
following five findings:
● Bilateral nonsuppurative conjunctivitis
● One or more changes of the mucous membranes of the
upper respiratory tract, including pharyngeal injection,
fissured or erythematous lips, and “strawberry” tongue
● One or more changes of the extremities, including
peripheral erythema or edema and periungual and
generalized desquamation
● Polymorphous rash
● Cervical lymphadenopathy > 1.5 cm in diameter (usually
unilateral)

Question 22

Describe the cardiac complications associated with

Kawasaki disease.

Answer 22

Coronary artery aneurysms occur in up to 25% of untreated
patients. Death may occur secondary to coronary artery thrombosis or aneurysm rupture. An ECG and echocardio-
gram should be obtained in all patients suspected of having Kawasaki disease.

Question 23

Describe the clinical manifestation of Kikuchi-Fujimoto disease.

Answer 23

A benign, self-limiting necrotizing lymphadenitis that most commonly affects young Japanese women. Initial symp-
toms may include malaise, fever, fatigue, arthralgias, weight loss, and hepatosplenomegaly.

Question 24

Describe Castleman disease.

Answer 24

Castleman disease is a rare lymphoproliferative disorder that can manifest with localized or multicentric disease. It is commonly associated with human immunodeficiency virus
(HIV) and human herpes virus (HSV) 8.