Pathology of head and neck

Question 1

Posterio and anterio triangles are separated by which muscle

Answer 1

Sternocleidomastoid muscle

Question 2

List the anterio triangle differentials

Answer 2

1. Enlarged lymph nodes
2. Thyropglossal cyst
3. Thyroid pathology
4. Carotid body tumour
5. Sternocleidomasctoid tumor
6. Submandibular salivary gland swelling
7. Goiter
8. Parathyroid gland masses

Question 3

List the posterio triangle differentials

Answer 3

Enlarged lymph nodes
Cystic hygroma
Zenker’s diverticulum

Question 4

Lymph node enlargement

Answer 4

Lymphadenopathy

Question 5

List causes of cervical lymph gland enlargement

Answer 5

Malignancy (e.g., lymphomas) Primary neoplasms of lymph nodes/metastatic
An enlarged supraclavicular lymph gland commonly indicates intra-abdominal or thoracic disease. This gland is called Virchow’s gland; its presence is Troisier’s sign.
Children: enlarged supratrochlear LN Significant
Infection (e.g., TB),
Autoimmune disease (e.g sarcoidosis)
Iatrogenic eg dye for sentinel lymph node
Reactive hyperplasia

Question 6

Portion of which duct that remains patent in Thyroglossal cyst

Answer 6

Thyroglossal ducts

Question 7

where do we find Thryglossal cyst in the neck

Answer 7

Between the isthmus of the thyroid gland and the hyoid bone, and just above the hyoid bone.
Presents as midline swelling :Painless prominent lump

Question 8

The thyroglossal cyst is found in which group of people

Answer 8

Age is Between 15 and 30 years old.
Common in females

Question 9

The thyroglossal cyst moves when?

Answer 9

Protruding of the tongue

Question 10

the thryoglossal cyst needs surgery because?

Answer 10

Important risk of cancer

Question 11

Histology of Thyroglossal cyst

Answer 11

Histologically, TGDCcontains an epithelial lining of squamous or pseudostratified ciliated columnar epithelium and ectopic thyroid gland tissue in the duct wall. TGD-associated malignancy is rare, and the majority ispapillary thyroid carcinoma(PTC).

Question 12

1. What is the branchial cyst
2. Location?
3. Size?
4. componens of cyst
5. Age group of people who are affected

Answer 12

Remnant of the second and third branchial cleft.
Behind the anterior edge of the upper third of the sternomastoid muscle
Between 5 and 10 cm long.
Filled with golden yellow fluid and shimmers with fat globules and cholesterol crystals
Mostly between the ages of 15 and 25 years

Question 13

Differentiate between Branchial fistula and sinus tract

Answer 13

Rare congenital abnormality.
● Fistula: An abnormal connection between two epithelium-lined surfaces.
● Sinus tract: an abnormal channel that originates or ends in one opening

Question 14

Characteristics of branchial fistula, cyst and sinus

Answer 14

Tethering of the skin upon swallowing

Question 15

Histology of branchial cleft cyst

Answer 15

Lining of the cyst is usually a stratified squamous epithelium or columnar ciliated epithelium.
Often there are marked inflammatory changes and the epithelium overlying the lymphoid tissue is attenuated/absent

Question 16

History of carotid body tumour (chemodectoma)

Answer 16

○ Between the ages of 40 and 60 years.
○ Benign, Painless & slowly growing lump.
○ Symptoms of transient cerebral ischaemia

Question 17

Rare tumour of the chemoreceptor tissue in the carotid body

Answer 17

Carotid body tumour(chemodectoma)

Question 18

Explain the carotid tumour :
1. Lateral neck swelling:
2. Size:
3. Appearance:

Answer 18

Lateral neck swelling: upper part of the anterior triangle of the neck, level with the hyoid bone and beneath the anterior edge of the sternomastoid muscle.
●Size : Vary from 2–3 cm to 10 cm in diameter.
● Solid and hard, dull to percussion and do not fluctuate, Sometimes they pulsate.

Question 19

Explain the cystic hygroma: Iatrogenic

Answer 19

Iatrogenic
● Found around the base of the neck, usually in the posterior triangle.
● Diffuse swelling, not tender, not hot & normal skin.

Question 20

Where does the trancucence occurs

Answer 20

commonly occur near the root of the arm and the leg

Question 21

Explain the congenital cystic hygroma

Answer 21

Congenital
Pediatric (Cystic hygroma) Congenital
○ Adults (Lymph cyst and lymphocele)
● Congenital collection of lymphatic sacs in underdeveloped lymphatic channels that contain clear, colourless lymph.

Question 22

what is a cervical rib?

Answer 22

basically it is additional rib from lower cervical vertebra adherent to the first rib by fibrous bands

Question 23

what does the cervical ribs causes

Answer 23

1. Narrowing of the thoracic outlet
2. compression:
   subclavian artery
   Brachial plexus

Question 24

What does the cervical ribs results to?

Answer 24

Although a cervical rib can cause serious neurological and vascular symptoms in the upper arm , clinical examination of the neck does not usually reveal any abnormalities (Discovered by x-ray)

Question 25

Pharyngeal pouch is known as what?

Answer 25

Zenker’s diverticulum

Question 26

what is zenker’s diverticulum?

Answer 26

Pulsion’ diverticulum of the pharynx between the cricopharyngeus muscle below and the lowermost fibres of the inferior constrictor muscle above.

Question 27

Explain the microscopic evaluation of the zenker’s diverticulum

Answer 27

Microscopic evaluation of the pouchusually shows a sac containing stratified squamous epithelium, and the submucosa lining often shows fibrous tissue. Rarely, ulcerations or evidence of cancer, squamous cell or carcinoma in situ, may be present

Question 28

Explain the history of zenker’s diverticulum

Answer 28

History
○ Long history of halitosis
○ regurgitation of froth and undigested food.
○ It can be compressed and sometimes emptied with gurgling sounds