EDWARD WEISBERGER MD

OTOLARYNGOLOGY/HEAD AND NECK SURGERY

INDIANA UNIVERSITY MEDICAL CENTER

NECK MASS DIFFERENTIAL DIAGNOSIS

• INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

• CONGENITAL-THYROGLOSSAL DUCT CYST, LYMPHANGIOMA, DERMOID CYST, BRANCHIAL CLEFT CYST, TERATOMA

• NEOPLASM

AGE

• PEDIATRIC-INFLAMMATORY, CONGENITAL

• TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA

• ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA

NEOPLASTIC (BENIGN)

• NEUROGENIC (NEUROLEMMOMA)• VASCULAR (PARAGANGLIOMA OF

CAROTID BODY OR VAGAL BODY)• VASCULAR (ANEURYSM)• PAROTID (BENIGN MIXED TUMOR,

WARTHIN’S TUMOR)

• AYSYMETRICAL ENLARGEMENT OF CERVICAL LYMPH NODES IN AN ADULT ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

HAYES MARTIN 1952

NEOPLASTIC (MALIGNANT)

• METASTATIC SQUAMOUS CELL CARCINOMA

• LYMPHOMA• THYROID CANCER• METASTATIC MELANOMA• METASTIC TESTICULAR CANCER

CHARACTERISTICS OF A METASTAIC NECK MASS

• PAINLESS• UNILATERAL• ADULT AGE GROUP

EVALUATION OF A NECK MASS

• HX-HOARSNESS, DYSPHAGIA, PAIN ORAL CAVITY, TOBACCO USE

• PE-EXAM OF ORAL CAVITY AND OROPHARYNX DISCLOSES PRIMARY 50% OF TIME

• MIRROR OR FIBEROPTIC EXAM WILL FIND THE PRIMARY IN AN ADDITIONAL 35%

ORAL CAVITY ULCERATIVE LESION

FIBEROPTIC LARYNGOSCOPY

FIBEROPTIC LARYNGOSCOPY

FIBEROPTIC LARYNGOSCOPY

EVALUATION OF A NECK MASS

• LOCATION-UPPER NECK ANT. TO SCM-MOST COMMON FOR H & N PRIMARIES (SENTINAL NODE)

• POSTERIOR TRIANGLE-NASOPHARYNX

• SUPRACLAVICULAR-THYROID OR SITE BELOW THE CLAVICLES

CAROTID BODY TUMOR

• LOCATED CAROTID BIFURCATION• MORE DISCREET IN ANT/POSTERIOR

DIRECTION THAN SUPERIOR/INFERIOR

• SOMETIMES A BRUIT

EVALUATION OF A NECK MASS

• OFFICE BX. IF IN ORAL • FNA-MIGHT DIRECT WORK-UP; IF

LYMPHOMA OR THYROID CANCER • CT AND/OR PET SCAN• EXAMINATION UNDER ANESTHESIA-

PALPATE TONGUE BASE, VISUALIZE APEX OF PYRIFORM SINUS AND POST-CRICOID AREA

EVALUATION OF A NECK MASS

• IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS-TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS

TERATOMA

TERATOMA

LYMPHANGIOMA

LYMPHANGIOMA

VIRCHOW’S NODE

• LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM

VIRCHOW’S NODE

• AVOID ANTIBIOTIC THERAPY FOR A PAINLESS NECK MASS IN AN ADULT

• EXAMINE ORAL CAVITY• REFER FOR DEFINITIVE DIAGNOSIS

UNKNOWN PRIMARY

• MOST COMMON SOURCE-HYPOPHARYNX, TONSIL, BASE OF TONGUE

• IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)

UNKNOWN PRIMARY

HUMAN PAPILLOMA VIRUS

• INCREASINGLY COMMON ETIOLOGY• EXPLAINS INCREASING INCIDENCE OF

SCC OF THE HEAD AND NECK IN NON-SMOKERS

• INCREASED RISK OF HPV WITH SEXUAL PROMUSCUITY

• ? VACCINATE YOUNG MALES