Neck Lumps

Question 1

neck lumps in people up to 40 years

Answer 1

90% benign

Question 2

neck lumps in people over 40 years

Answer 2

rule of 80s
in an adult over 40 years with suspicious lateral neck mass
80% malignant
80% represent metastasis
80% of those metastasis are from above the clavicle

Question 3

required physical examination

Answer 3

complete head and neck examination including cranial nerve exam, otoscopy, neck palpation
emphasis on location, mobility and consistency

Question 4

diagnostic tests required

Answer 4

fine needle aspiration biopsy
ultrasonography
computed tomography
magnetic resonance imaging
radio nucleotide scanning

Question 5

using ultrasonography to investigate

Answer 5

ideal initial imaging investigation
identifies solid vs. cystic massess
identifies congenital cysts from solid nodes/tumours
non invasive

Question 6

FNA biopsy to investigate

Answer 6

standard of diagnosis
indicated for any neck mass that is not an obvious abscess or for diagnosis of inflammatory mass that persists after a two week course of antibiotics

Question 7

CT for investigation

Answer 7

distinguish cystic from solid
can tell extent of lesion
can tell vascularity if you use contrast
may detect primary cancer

Question 8

MRI investigation

Answer 8

similar information as CT
better for upper neck and skull base
vascular delineation with infusion

Question 9

types of congenital and developmental masses

Answer 9

epidermal and sebaceous cysts
branchial cleft cysts
thyroglossal duct cyst
vascular tumours

Question 10

branchial cleft cysts

Answer 10

present in older children or young adults often following URI
2nd cleft most common
1 cleft less common
3rd and 4th clefts rarely reported

Question 11

what does a branchial cleft cyst look like

Answer 11

smooth, fluctuant mass underlying the SCM
skin erythema and tenderness if infected

Question 12

how do you treat branchial cleft cysts

Answer 12

initial control of infection
surgical incision, including tract

Question 13

thyroglossal duct cyst

Answer 13

most common congenital neck mass
50% present before age 20

Question 14

what does a thyroglossal duct cyst look like

Answer 14

usually midline or near midline
usually just inferior to hyoid bone
elevates on swallowing/protrusion of tongue

Question 15

treatment of thyroglossal duct cyst

Answer 15

surgical removal after resolution of any infection

Question 16

lymphoma

Answer 16

more common in children and young adults
80% of children with Hodgkin’s have a neck mass

Question 17

signs and symptoms of lymphoma

Answer 17

lateral neck mass only
discrete, rubbery, non-tender
fever
hepatosplenomegaly
diffuse adenopathy

Question 18

lymphoma disgnosis

Answer 18

FNAB - first line diagnostic test
may require open excisions biopsy for sub typing of lymphoma
full workup - Ct scans of chest, abdomen, head and neck, bone marrow biopsy

Question 19

salivary gland tumours

Answer 19

enlarging mass anterior/inferior to ear or at the mandible angle
highly suspicious
benign ones will be asymptomatic except for the mass
malignant ones will have rapid growth, skin fixation and cranial nerve palsies

Question 20

lipoma

Answer 20

soft, ill defined mass
usually >35 years of age
asymptomatic
clinical diagnosis

Question 21

epidermal and sebaceous cysts

Answer 21

most common congenital/developmental mass
older age groups

Question 22

how to treat epidermal and sebaceous cysts

Answer 22

excisions biopsy

Question 23

vascular tumours

Answer 23

lymphangiomas and hemangiomas
usually within first year of life
hemangiomas often resolve spontaneously, while lymphangiomas remain unchanged
CT/MRI may help define extent of disease

Question 24

inflammatory disorders causing neck lumps

Answer 24

lymphadenitis and granulomatous lymphadenitis

Question 25

lymphadenitis

Answer 25

very common
tender node with signs of systemic infection

Question 26

FNAB indicators for lymphadenitis (paediatric)

Answer 26

actively infectious condition with no response
progressively enlarging
solitary and asymmetric nodal mass
supraclavicular mass
persistant nodal mass without active infection

Question 27

granulomatous lymphadenitis

Answer 27

infection develops weeks to months
minimal systemic complaints or findings
firm, relatively fixed node with infection of skin

Question 28

appearance of granulomatous lymphadenitis

Answer 28

firm, relatively fixed node with infection of skin

Question 29

common aetiologies of granulomatous lymphadenitis

Answer 29

TB, atypical TB, cat scratch fever, actinomycosis, sarcoidosis

Question 30

what is the main concern in an adult with a new lateral neck mass

Answer 30

malignancy

Question 31

name the most effective tool to determine aetiology of a lack mass

Answer 31

fine needle aspiration biopsy