Neck Masses Flashcards
how do you diagnose lateral neck masses that are suspected to be congenital?
CT scan: Will appear as a cystic mass medial to the sternocleidomastoid muscle at the level of the hyoid bone
Differential diagnosis for a neck mass.
“CCoNSuLLTSS”
C - Congenital - TBD, Thyroglossal duct cyst, Branchial cleft, Dermoid
C - Carotid Anerysm, Carotid body tumor
o
N - Neuroma, Neurofibroma
S - Soft Tissue - ‘PALS’ 1 tumor, Abscess, Lipoma, Sebaceous cyst
u
L - Lymph node - ‘MIRL’’ Mets, inflammatory, reactive, lymphoma
L - Lipoma
T - Thyroid: ‘CCG’ Cyst, Cancer, Goiter
S - Salivary - submandibular or preauricular
S - Supraclavicular - Lymphoma or metastatic tumor
What is the treatment for a congenital lateral neck mass?
(1) FNA to exclude cystic mets from squamous cell carcinoma or waldeyers tonsillar ring
(2) surgical excision is curative
Diagnosis for a central congenital neck mass?
Clinical – thyroglossal duct cyst
What is the treatment for a thyroglossal duct cyst?
Sistrunk procedure- excision with a segment of the hyoid bone
Treatment for inflammatory conditions?
Observation plus/minus abx
Infectious process in neck with HIV
FNA to rule out lymphoma
What tests should you order for the workup of a thyroid nodule?
(1) TSH if abnormal risk of malignancy < 5%
(2) ultrasound – cystic or solid?
(3) FNA – If cystic send fluid for cytology
Fine needle aspiration of thyroid nodule reveals cystic fluid. You send for cytology, what are the possible results and management?
Benign and cyst resolves -> f/u exam
Benign and solid component -> repeat FNA
Malignant-> treat as thyroid cancer, Partial or total thyroidectomy, lymph node dissection, radioactive iodine ablation
A fine needle aspiration is performed on a thyroid nodule. The mass is solid. What is the next step?
Send cells for cytology:
Benign -> Levothyroxin suppression, repeat FNA in six months
Suspicious 4 categories of types of cells: PAM F papillary, atypical (medullary), malignant, follicular
Fine needle aspiration is performed on a thyroid nodule. Cells are sent to pathology after a solid mass is found. Name the types of cells that would be suspicious, and the next steps and management?
Papillary – thyroid scan – if cold thyroid lobectomy
– If functioning, less than 1% risk for malignancy
Atypical – medullary cancer – calcitonin test
Malignant – treat as thyroid cancer
Follicular or hurthle cells – Thyroid lobectomy
If salivary nodule is suspected how do you diagnose?
CT scan of the neck
Treatment for salivary nodule?
FNA
Excise if malignant
Management of a cervical lymph node?
If suspicious primary site is present: pan endoscopy with biopsy of primary site and screening for secondary sites
Treatment – resection of primary site, en block removal of lymph nodes, radiation, chemotherapy
If no suspicious site: fine needle aspiration
Management of supraclavicular lymph node
Chest x-ray, bronchoscopy, Mammogram, upper G.I. series, CT of the abdomen looking for primary. If no primary, fine needle aspiration or excisional biopsy
How do you diagnose a carotid body mass?
History of nonpainful pulsatile mass at carotid bifurcation. Lyre sign on carotid angiogram
Biopsy contraindicated due to vasculature
Treatment for carotid body mass?
Excision
Preoperative embolization for masses greater than 3 cm
Diagnosis of carotid body aneurysm?
Doppler ultrasound, angiogram or MRA
What findings on CT of the neck with contrast would suggest a malignancy?
– Hypodense lucency to core
– Greater than 1.5 cm
– loss of edge sharpness
Tx for medullary cancer?
Total thyroidectomy + LN dissection
First diagnostic test for neck mass
CT with contrast of head and neck
Enlarged lymph node is found in neck. Next step?
Excisional biopsy. Tx is based on primary tumor
Gene for MEN1?
Menin gene, tumor suppressor gene, AD
MEN1 syndrome
Hyperparathyrodiism >90%,
pancreatic neuroendocrine tumors PNETS 70%, gastrinoma
Pituitary tumors 30%
