Neck lumps Flashcards
Lateral neck lump in adults over 40?
as many as 75% of lateral neck lumps are malignant in over 40s about 80% are metastases and the rest are mostly
lymphomas.
In fact, in the absence of signs of infection, a lateral neck mass
in an adult is lymphadenopathy due to metastatic squamous cell carcinoma until proven otherwise.
T/F if the lump hasn’t always been there, this excludes a congenital neck lump
F
Note that congenital neck lumps have often
been present for some time, but do not have to have been present since
birth. For example, branchial cysts may ‘appear’ in adults following an episode of infection
Remember that a progressive increase in size of a malignant neck
lump may be reported as a sudden appearance by the patient
…
Which neck lumps might be painful?
Most neck lumps are not painful. The only lumps that are classically painful are acute infective lymphadenitis or an infected branchial
cyst.
What are the B symptoms associated with lymphoma
Weight loss, fever, drenching night sweats
What symptoms are associated with head and neck cancer
Head and
neck cancers are not usually associated with weight loss or malaise, but there
are a number of other suggestive features.
Dysphonia, stridor, stertor, breathing difficulty, dysphagia, odynophagia, globus, cough, haemopytsis, otalgia, unilateral hearing loss, nasal discahrge, epistaxis and lumps or ulcers on the head or face that have increased in size or started to bleed
Name a highly sensitive, but non specific symptom of carcinoma of the glottis
Change in voice/hoarseness
What is the causative organism in cat scratch disease
Cat-scratch disease is caused by the bacterium Bartonella henselae
symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes
Which lumps can we allocate to the anterior and which to posterior triangle of the neck
ANTERIOR:
Branchial cyst/sinus/fistula, carotid body tumour/aneurysm, salivary gland, laryngocele
Posterior: cystic hygroma, cervical rib, pharyngeal pouch, subclavian aneurysm
What is tuberculous lymphadenitis
Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercule).
Which type of lumps are usually warm/tender. What is the exception
e only neck lumps that are classically tender
and/or warm are infected or infl ammatory masses.
EXCEPTION: in progressive disease with tuberculous lymphadenitis, it can can present with a discharging sinus or a ‘cold’ abscess. (in the acute phase this may
present with painless lymphadenopathy and overlying erythema)
Differentials for following descriptions:
- Hard lump
- Rubbery lump
- Soft lump
- Fluctuant lump
Hard lumps: malignant lymph nodes
− Rubbery lumps: chronic infl ammatory lymph nodes (e.g. tuberculosis) or
lymphomatous nodes
− Soft lumps: acute infl ammatory lymph nodes
− Fluctuant lumps: branchial cysts, cystic hygromas, pharyngeal pouches,
laryngoceles, cold abscesses, epidermal cysts, dermoid cysts, lipomas.
Differentials for following descriptions:
- Mobile
- Tethered to adjacent structures
- Matted together
Th is question relates principally to lymphadenopathy. Th e
majority of lymph nodes are relatively mobile. Malignant lymph nodes may be
tethered to adjacent structures, while tuberculous nodes may appear matted
together.
What to examine other than the lump if the following is suspected:
- Infectious lymphadenopathy
- Malignant lymphadenopathy
- Infectious lymphadenopathy
− Examine the throat, paying particular attention to the tonsils.
− Systematically examine all lymph nodes of the head and neck. - Malignant lymphadenopathy
When might a facial nerve palsy result from parotid enlargement and why
Th is nerve sits between the
deep and superfi cial lobes of the parotid, and a palsy may result from an
invasive malignant tumour (but not from a benign adenoma, which is
non-invasive).
