Head & Neck Imaging Flashcards
Pleomorphic adenoma on histology
50% of all salivary gland tumours (60% of parotid tumours)
Shows both epithelial and mesenchymal differentiation
Most common multifocal salivary gland tumour
Warthin tumour (2nd most common salivary gland tumour)
Usually 60M and 8X more common in smokers
Cystic spaces lined by eosinophilic epithelial cells with a lymphoid stroma (oncocytic appearance)
Which NPC is radiosensitive and what % present with nodal mets?
Undifferentiated carcinoma most radiosensitive
keratinising and non-keratinising less
90% have nodal mets at presentation
3 types of laryngeal cancer
Glottic (60%): arise from true vocal cords. Nodal mets rare and effectively treated with XRT
Supraglottic (30-35%): arise from false cords, epiglottis, arytenoid. Nodal mets in 40%
Subglottic (less than 5%): nodal mets and tracheal/ oesophageal invasion
Name 3 complications of head and neck infections
Epidural abscess
Osteomyelitis
Septic thrombophlebitis and lung abscess
Name the top 4 malignant salivary gland tumours
Mucoepidermoid (15% of all tumours)
Adenocarcinoma (10%)
Adenoid cystic carcinoma (5%)
Acinic cell carcinoma (5%)
Sudden SNHL after minor trauma
LVAS
Histology of inverting papilloma
Respiratory epithelium enclosed by basement membrane
Most common location of inverting papilloma
Lateral wall of nasal cavity related to middle turbinate and maxillary ostium
Nasopharyngeal tumour with intracranial extension- peritumoral cysts between it and the brain. Dx?
Enthesioneuroblastoma (bimodal- 20 years and 60 years)
Most common benign and malignant tumour of lacrimal gland?
Benign: pleomorphic adenoma
Malignant: adenoid cystic carcinoma
Most common organism to cause necrotizing otitis externa
Pseudomonas
Otosclerosis: 2 types
Fenestral: 80% fixation of stapes to oval window (CHL)
Retro-fenestral: 20% demineralisation of the cochlear capsule (SNHL)
Top 3 primary tumours of skull base
Meningioma
Chondrosarcoma
Chordoma
What causes epiglottis?
H. Influenza type B
How is NPC treated?
radiotherapy +- chemoRx
Surgery is only for histological Dx
What is Grisel syndrome?
Associated with RP abscess
Atlanto-axial subluxation due to inflammatory ligament instability
Most common organism to cause necrotizing otitis externa
Pseudomonas
Otosclerosis: 2 types
Fenestral: 80% fixation of stapes to oval window (CHL)
Retro-fenestral: 20% demineralisation of the cochlear capsule (SNHL)
Top 3 primary tumours of skull base
Meningioma
Chondrosarcoma
Chordoma
What causes epiglottis?
H. Influenza type B
How is NPC treated?
radiotherapy +- chemoRx
Surgery is only for histological Dx
What is Grisel syndrome?
Associated with RP abscess
Atlanto-axial subluxation due to inflammatory ligament instability
Pertechnetate and radioiodine for the 3 major thyroid ca
PTC: radioiodine but not pertechnetate
FTC: pertechnetate but not radioiodine
MTC: neither (arises from parafollicular cells)- Thallium 201
What do you do if FNA shows follicular adenoma?
Need excisional biopsy
Overlap between follicular adenoma, follicular carcinoma and FV PTC
Name 3 conditions associated with medullary thyroid ca.
MEN type 2
VHL
NF-1
Name 2 features of Gorlin-Goltz syndrome
Also called basal cell naevus syndrome
Multiple BCCs
Multiple KCOTs
Best Nuc Med test for MTC?
Octreotide scan
DMSA
Best Nuc Med test for phaeo?
MIBG
Coats disease
Retinal telangiectasia
Exudative retinal detachment
No calcification
Name 2 features of NPC on CT
Isodense to muscle
Infiltration of parapharyngeal space (T2) in 65-84%
Most common location for giant cell reparative granuloma?
Midline mandible
Name 3 features of Reidel thyroiditis
Autoimmune thyroiditis
Lymphocytic infiltration and replacement of whole gland by fibrous tissue (as opposed to Hashimoto where only capsule becomes fibrotic)
Only 30% have hypothyroidism (majority euthyroid)
Name 3 features of De Quervain thyroiditis
Post-viral granulomatous thyroiditis (self-limiting)
Hyperthyroidism (followed by hypo then return to normal)
LOW uptake on thyroid scan (Rx with radioiodine CI!)
Most common location of orbital haemangioma and signal characteristics on MR?
83% intraconal (most often lateral retrobulbar- slow painless proptosis)
Intermediate T1, high T2 and slow peripheral enhancement with delayed washout
What is Gradenigo syndrome and name 3 features
Head and neck infection from pseudomonas and enterococcus
Triad of:
Apical petrositis
CN VI palsy as it passes through Dorello canal
Retro-orbital pain or pain in V1-V2 distribution due to involvement of Meckel’s cave
PG vs SMG calculi. Which more common and which more likely to be radio-opaque?
SMG more common (80% vs 20%)
SMG more likely radio-opaque (95% vs 60%)
Name 4 conditions associated with Hashimoto
Turner syndrome
Primary thyroid lymphoma
Down syndrome
Other autoimmune disorders: SLE, RA, Sjögren
Macroscopic appearance of De Quervain
Unilateral or bilateral enlargement of lobes
FNA of parotid lesion shows lymphocytes and polygonal cells
Warthins (papillary cystadenoma lymphomatosum)
Normal radioactive iodine uptake value?
10-30% at 24 hours
If more and uniform, suggestive of Graves disease
Treatment for ameloblastoma and KCOT?
Surgical resection
NOT curettage as high risk of recurrence
Cholesteatoma- origin?
Chronic inflammation
Retraction pocket in pars flaccida of TM
Gives rise to cystic lesion with keratinising stratified squamous epithelium
Lethal midline granuloma?
NK-cell lymphoma involving nose
Poor Px
