Lumps in the neck Flashcards
Why should an excision or incision biopsy of neck lumps be avoided
It may jeopardize subsequent treatment
Describe the 6 anatomical regions of the neck
1- Submandibular gland, nodes, thyroglossal duct, plunging ranula
2- upper jugular nodes, carotid body tumour, aneurysm, branchial cyst, pharyngeal pouch
3- mid jugular nodes, branchial cyst
4- inferior jugular nodes, virchow Trossier node
5- nodes
6- thyroid, parathyroid, thryroglossal duct cyst, nodes
Prinicpal differential diagnosis for central mass
- Thyroglossal duct remnant
- Dermoid cyst
- Cervical lymphadenopathy
- Lipoma
- Haemangioma
- Fibroma
Causes of supraclavicular nodes
- Secondary to disease in the chest, breasts, oesophagus or abdominal malignancy
Causes of cervical adenopathy
Lymphoma, TB or AIDs
Where may a thyroglossal duct cyst develop
- Can develop anywhere from the foramen caecum at the base of the tongue to the isthmus of the thyroid gland
- usually appears as a smooth, well- circumscribed upper midline non tender mass in the region of the hyoid bone.
Possible sequelae of an infected thyroglossal duct cyst
An infected cyst may become adherent to the overlying skin, through which spontaneous rupture may occur. After rupture or surgical drainage, a persistent thyroglossal duct sinus is formed
What happens to a thyroglossal duct cyst when the tongue is protruded
The cystic mass can usually be seen to rise in the neck
What is the treatment of a thyroglossal duct cyst
Treatment is by excision of the cyst, together with the body of the hyoid bone and a core of tongue up to the foramen caecum (Sistrunk operation)
How do inclusion dermoid cysts present
- These cysts may present in the midline between the cricoid bone and the suprasternal notch and are usually found in children or young adults
- Firm, non-tender and smooth
- Difficult to distinguish clinically from a thyroglossal cyst or a nodule of the thyroid isthmus
What may Branchial cleft remnants give rise to
- Branchial cysts, sinuses or fistulae
- It may present as lateral neck swelling or draining sinus/fistula anywhere between the pre-auricular area and the clavicle along the medial border of the sternocleidomastoid
When do branchial cysts most often present
Can present in childhood, most often in the third decade of life though
What is a branchial cyst made up of
Cyst contains cholesterol crystals and is lined by squamous epithelium. its contents varying from clear fluid to a cheesy substance
Treatment of branchial cysts
The cyst/ sinus should be excised together with any embryonic remnants
Commonest complication of a branchial cyst
Infection following an upper respiratory infection or tonsillitis
How do cystic hygromas present
- Present at birth or within the first year of life
- May be located in the anterior or posterior triangles of the neck and may extend into the mouth
- The lesions are soft, irregular, transilluminate and compressible
Cause of a pharyngeal pouch
Hypertension of the crico-pharyngeus sphincter
Presentation of a pharyngeal pouch
- Dysphagia, regurgitation, food inhalation
- Mass felt on the side of the neck
- Diagnosis established by barium swallow
Presentation of a carotid body tumour
- Asymptomatic mass at the angle of the jaw
- It moves from side to side and transmits pulsation
Causes of acute (pyogenic) lymphadenitis
secondary to dental, tonsillar, ear and scalp infections
How does Cervical tuberculous lymphadenitis present
The glands are matted and may have overlying oedema. In late disease, caseation may occur producing fluctuation, and after breakdown, sinus formation, which has the characteristic appearance of neck masses with suppurating sinuses
when Cervical tuberculous lymphadenitis, what tests should be performed
Pus swab (looking for acid fast bacilli), chest radiograph, FNAC (when pus is not evident
Consistency of glands in lymphoma
Glands have characteristic firm, rubbery consistency
Investigations to be done in suspected lymphoma
FNAC to exclude inflammatory lymphadenitis,
followed by excisional biopsy to
characterise the lymphoma
