General oto benign neck masses Flashcards
Describe the condition of benign symmetric
lipomatosis.
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.
True or False. Most liposarcomas develop from a
preexisting benign lipoma.
False. Most liposarcomas develop de novo.
What is the most common type of monomorphic
adenoma?
Basal cell adenoma
What is the most common paraganglioma of the
head and neck?
Carotid body tumor, which develops within the adventitia of
the carotid bifurcation and are of neural crest origin
Describe the Lyre sign.
● 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.
What percentage of head and neck paragangliomas are functional?
Less than 3%
What cellular pattern is characteristically seen in paragangliomas?
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.
What percentage of head and neck paraganglio-
mas are malignant?
Less than 10%. Paragangliomas are determined by the
presence of lymph node metastasis, not by cellular atypia or
local invasion.
Familial paraganglioma syndromes are caused by a mutation in genes that encode for what enzyme?
Succinate dehydrogenase
True or false. Neural fascicles can be more easily spared during resection of a schwannoma compared with a neurofibroma.
True
What is the most common poststyloid paraphar-
yngeal space tumor?
Schwannoma of the vagus or sympathetic chain
Which benign salivary gland tumors have pro- nounced fluorodeoxyglucose (FDG) uptake on PET imaging?
Oncocytoma, and Warthin tumor. Both tumors are com-
posed of large eosinophilic granular cells containing high mitochondrial concentrations.
What is the most common type of tumor to arise within the prestyloid parapharyngeal space?
Benign salivary gland tumors
Describe the MRI findings of pleomorphic
adenoma.
Well-circumscribed mass with low intensity on T1- and
hyperintensity on T2-weighted sequences. Frequently
demonstrates homogeneous gadolinium uptake
What is the most common prestyloid parapharyngeal space tumor?
Pleomorphic adenoma is the most common overall.
Mucoepidermoid carcinoma is the most common malignancy.
What are the main access routes to the parapharyngeal space?
Cervical, submandibular/cervical, cervical parotid, cervical parotid with mandibular osteotomy, transoral (not recommended)
When should a mandibulotomy be considered for
parapharyngeal space tumors?
● Tumors > 5 cm
● Tumors with extensive skull base disease
● Extensive invasion
What are laryngoceles?
Air-filled dilations of the laryngeal ventricle that may be congenital or acquired
Describe the three types of laryngoceles.
● 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
What are plunging ranulas, and how do they differ
from nonplunging ranulas?
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.
Review the characteristic signs and symptoms of
Kawasaki (lymphomucocutaneous) disease.
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)
Describe the cardiac complications associated with
Kawasaki disease.
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.
Describe the clinical manifestation of Kikuchi-Fujimoto disease.
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.
Describe Castleman disease.
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.
