Hertz Neck

Question 1

Branchial Cyst

Answer 1

Cervical Lymphoepithelial Cyst

*lateral

The vast majority of these cysts are thought to arise from remnants of the second branchial arch and are most commonly observed in young adults between the ages of 20 and 40

Question 2

Thyroglossal Duct Cyst

Answer 2

occurs midline
ciliated epithelium
thyroid remnants

a result of incomplete descent of the thyroid analog from the foramen cecum in the base of the tongue.

Question 3

Paraganglioma

Answer 3

Carotid Body Tumor

Paraganglia are clusters of neuroendocrine cells associated with the sympathetic and parasympathetic nervous sys­tems. As a result, these neoplasms can be seen in various regions of the body

Question 4

Paravertebral paraganglia

Answer 4

(e.g., organs of Zuckerkandl and, rarely, bladder). Such tumors have sympathetic connections and are chromaffin-positive, a stain that detects catecholamines.

Question 5

Paraganglia related to the great vessels of the head and neck

Answer 5

the so-called aorticopulmonary chain, including the carotid bodies (most common); aortic bodies; jugulotympanic ganglia; ganglion nodosum of the vagus nerve; and clusters located about the oral cavity, nose, nasopharynx, larynx, and orbit. These are innervated by the parasympathetic nervous system and infrequently release catecholamines.

Question 6

Salivary Glands

Answer 6

There are three major salivary glands—parotid, submandibular, and sublingual—as well as innumerable minor salivary glands distributed throughout the mucosa of the oral cavity. Inflammatory or neoplastic disease may develop within any of these

Question 7

Xerostomia

Answer 7

Dry mouth resulting from a decrease in the production of saliva

causes: drugs, chemotherapy, psychosomatic, radiotherapy, salivary gland diseases, systemic diseases

Question 8

Sialadenitis

Answer 8

inflammation of the salivary glands

Sialadenitis may be induced by trauma, viral or bacterial infection, or autoimmune disease.

Mucoceles are the most common type of inflammatory salivary gland lesion.

The most common form of viral sialadenitis is mumps, in which the major salivary glands, particularly the parotids, are affected.

Question 9

ranula

Answer 9

Ranula is a term reserved for epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged

Question 10

common causes of sialolithiasis and nonspecific sialadenitis

Answer 10

S. aureus

streptococcus viridans

Question 11

most common salivary gland tumor/ parotid tumor

Answer 11

pleomorphic adenoma

Question 12

most common bilateral salivary gland tumor

Answer 12

warthin’s tumor

Question 13

most common malignant salivary glad tumor

Answer 13

mucoepidermoid carcinoma

Question 14

The likelihood of a salivary gland tumor being malignant

Answer 14

is more or less inversely proportional to the size of the gland.

65% to 80% arise within the parotid, 10% in the submandibular gland, and the remainder in the minor salivary glands, including the sublingual glands. Approximately 15% to 30% of tumors in the parotid glands are malignant.

In contrast, approximately 40% of submandibular, 50% of minor salivary gland, and 70% to 90% of sublingual tumors are cancerous

Question 15

Pleomorphic adenomas are

Answer 15

benign tumors that consist of a mixture of ductal (epithelial) and myoepithelial cells, mixed tumors and therefore they show both epithelial and mesenchymal differentiation.

Question 16

clinical features of pleomorphic adenomas

Answer 16

These tumors present as painless, slow-growing, mobile, discrete masses within the parotid or submandibular areas or in the buccal cavity. The recurrence rate (perhaps months to years later) with parotidectomy is about 4% but, with simple enucleation approaches 25%

A carcinoma arising in a pleomorphic adenoma is referred to variously as a carcinoma ex pleomorphic adenoma or a malignant mixed tumor

Question 17

Warthin Tumor

Answer 17

(Papillary Cystadenoma Lymphomatosum)

This curious benign neoplasm with its intimidating histologic name is the second most common salivary gland neoplasm.

It arises almost exclusively in the parotid gland (the only tumor virtually restricted to the parotid) and occurs more commonly in males than in females, usually in the fifth to seventh decades of life. About 10% are multifocal and 10% bilateral. Smokers have eight times the risk of nonsmokers for developing these tumors

Question 18

Mucoepidermoid Carcinoma

Answer 18

These neoplasms are composed of variable mixtures of *squamous cells, mucus-secreting cells, and intermediate cells.

They represent about 15% of all salivary gland tumors, and while they occur mainly (60% to 70%) in the parotids, they account for a large fraction of salivary gland neoplasms in the other glands, particularly the minor salivary glands

Question 19

grading/ prognosis of mucoepidermoid carcinoma

Answer 19

The clinical course and prognosis depend on the grade of the neoplasm. Low-grade tumors may invade locally and recur in about 15% of cases, but only rarely do they metastasize and so yield a 5-year survival rate of more than 90%. *

By contrast, high-grade neoplasms and, to a lesser extent, intermediate-grade tumors are invasive and difficult to excise and so recur in about 25% to 30% of cases and, in 30% of cases, metastasize to distant sites. The 5-year survival rate in patients with these tumors is only 50%*

Question 20

Adenoid cystic carcinoma

Answer 20

is a relatively uncommon tumor, which in approximately 50% of cases is found in the minor salivary glands (in particular the palatine glands)

Although slow growing, adenoid cystic carcinomas are unpredictable tumors with a tendency to *invade perineural spaces, and they are stubbornly recurrent.

Eventually, 50% or more disseminate widely to distant sites such as bone, liver, and brain, sometimes decades after attempted removal. Thus, although the 5-year survival rate is about 60% to 70%, it drops to about 30% at 10 years and 15% at 15 years.

Neoplasms arising in the *minor salivary glands have, on average, a poorer prognosis than those that arise in the parotid glands

Question 21

Acinic cell carcinoma

Answer 21

Composed of cells resembling the normal serous acinar cells of salivary glands

The clinical course of these neoplasms is somewhat dependent on the level of pleomorphism. Overall, recurrence after resection is uncommon, but about 10% to 15% of these neoplasms metastasize to lymph nodes. The survival rate is in the range of 90% at 5 years and 60% at 20 years