Parotid Stem#2 Flashcards
Stem: A 60-year-old female patient presented at the outpatient clinic with unilateral firm facial swelling raising the Rt ear lobe. Facial nerve examination was normal.
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Stem: A 60-year-old female patient presented at the outpatient clinic with
unilateral firm facial swelling raising the Rt ear lobe. Facial nerve examination was normal.
Q1: What’s the most probable diagnosis?
Q2: What’s the most common bengin parotid neoplasm?
Begnin parotid tumor
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Pleaomorphic adenoma
Q3: What’s the differential diagnosis of a unilateral parotid Swelling?
Obstruction by calculus
Neoplasm; Benign or malignant
Infection; Parotitis or mumps
Q4: What’s the meaning of pleomorphic?
Variety of histological features reflecting stromal and epithelial tissue elements
Describe pleomorphic adenoma appearance?
Benign tumor ch ch by presence of epithelial and myoepithelial cells that’s why it shows epithelial and mesenchymal differentiation
Q5: Can pleomorphic adenoma turn malignant? how? What’s the most common malignant parotid tumor?
Yes, it can, Carcinoma ex pleomorphic adenoma
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Mucoepidemoid carcinoma
Q6: From your examination, what clinical signs would make you suspect malignant transformation in a parotid swelling?
- Fixed to underlying tissue
- LN involvement
- Facial N affection
- Skin ulcer
- Rapid increasing in size
Q7: What are the characters of a malignant neoplasm in general?
Rapid incr. in size / Anaplasia / less differentiation / invasion of surrounding and distant Mets
Q8: Simple test in the clinic to help you differentiate?
x
FNAC
Q9: What are the cytological features that would raise concerns of malignancy
Invasion / Incr. mitotic rate / features of anaplasia – pleomorphism , loss of architecture hyperchromatic nuclei, increase cytoplasmic nuclei ratio
Q10. What are the main diff. btw cytology and histo? Adv of each?
C; study of cells – study only one or small group of cells (No background)
* Adv; simple, cost-effective, feasible, rapid
* Disadv; false negative, cannot differ btw in site and invasion
H; study of tissue – study architecture of tissue (there’s background)
* *Adv; *Avoid unnecessary excisional biopsy, Grading and staging
* Disadv; Expensive, operator dependent / Scar after sample
Q11: Can you interpret the following FNAC findings:
- Langerhans giant cell + lymphocytes + necrotic material?
- Brown pigmented cells + epithelioid cells?
- Reed Sternberg cell + lymphoid cells + blast cells?
- Langerhans giant cell + lymphocytes + necrotic material?
TB - Brown pigmented cells + epithelioid cells?
Malig. Melanoma - Reed Sternberg cell + lymphoid cells + blast cells?
Lymphoma (HL)
- FNAC has a sensitivity of about 81% and a specificity of around 98%.
Q12: What’s the meaning of: sensitivity, high sensitivity, specificity and high specificity?
Sens; ability of test to classify individuals with dis TRUE +VE
High S; Low false -VE
Sp; ability of test to detect non diseased subjs TRUE -VE
High Sp; Low false +VE
Sens; ability of test to classify individuals with dis TRUE +VE
High Sens; Low false -VE
**Sp; **ability of test to detect non diseased subjs TRUE -VE
High Sp; Low false +VE
Q13: How can you differentiate between carcinoma and lymphoma? What’s IHC in simple words?
By IHC
- IHC; study of Ag-AB recognition (Complement Fixation)
Examine Ag in tumor by Abs attached to enzyme or specific dye when reaction happen color of dye changes and can be detected under microscopy
Q14: How to rule out malignancy intraoperatively? How it’s done?
By Frozen Section
FROZEN SECTION; the surgeon takes a small piece of fresh tissue or tumour for Analysis, the pathologist freezes this sample and sections are immediately cut, the sections are stained and reported immediately by phoned back to theatre
Q15: While doing FNAC a needle stick injury was encountered, what would you do?
Clean thoroughly the injury and allow wound to bleed
assess pt whether he has blood borne inf. Take a sample for high risk pt after consent
Notify Occupational health dept. (May take a blood sample from you)
File incident report
