PERTINENT POSITIVES

MASS AT THE LATERAL ANTERIOR NECK

ACUTE SUBACUTE CHRONIC

Common Uncommon Common Uncommon Rare Common Uncommon Rare

SCC of the upper Lymphoma Castlement disease Thyroid pathology Brachial cleft cyst Liposarcoma
CMV infection Acute sialadenitis aerodigestive tract Metastatic cancer Kikuchi disease Carotid body tumor Parathyroid
EBV infection AV Fistula Parotid tumor Kimura disease Glomus jugulare carcinoma
Staphylococcal or Hematoma Rosai-Dorfman tumor
Streptococcal HIV infection disease Glomus vagale tumor
infection Mycobacterial TB Laryngocele
Toxoplasmosis infection Lipoma
Viral upper Parotid Thyroglossal duct cyst
respiratory infection lymphadenopathy
Pseudoaneurysm
 SUBACUTE DIFFERENTIALS
LYMPHOMA?
LYMPHOMA
METASTATIC CANCER
PAROTID TUMOR Painless Lymph node
SQUAMOUS CELL CARCINOMA
Early constitutional
symptoms
Diffuse Lymphadenopathy
Splenomegaly
 SUBACUTE DIFFERENTIALS
METASTASIS?
LYMPHOMA
METASTATIC CANCER Constitutional symptoms
PAROTID TUMOR
SQUAMOUS CELL CARCINOMA
such as: fever, chills, night
sweats, weight loss

Supraclavicular
lymphadenopathy: FNAB
reveals malignancy in
more than half of cases
 SUBACUTE DIFFERENTIALS
PAROTID TUMOR?
LYMPHOMA
METASTATIC CANCER
PAROTID TUMOR
SQUAMOUS CELL CARCINOMA Unilateral
Asymtomatic
Slow-growing
Mobile masses
 SUBACUTE DIFFERENTIALS
SCC?
LYMPHOMA
METASTATIC CANCER nonhealing ulcers, dysarthria,
PAROTID TUMOR dysphagia, odynophagia, loose
SQUAMOUS CELL CARCINOMA
or misaligned teeth, globus,
hoarseness, hemoptysis, and
oropharyngeal paresthesias

Lymph nodes associated with

malignancy are usually firm,
fixed, and matted
DIAGNOSTICS
 SOFT TISSUE CT SCAN
A neck soft tissue CT scan with contrast provides superior
anatomical definition of any neck lump while also imaging the
remainder of the neck tissues. If there are metastatic nodes, this
procedure may also facilitate localisation of the primary tumour

provides valuable initial information regarding the size, extent,

location, and content or consistency of the mass. Additionally,
contrast media may help identify malignant lymph nodes that
are not enlarged and distinguish vessels from lymph nodes
 FNAB
most accurate diagnostic tool for investigating neck lumps
Although the accuracy of FNAB is high (approximately 90%),
false negatives do occur and hence a suspicious neck mass
should always be referred for comprehensive evaluation.
For example, an FNAB of a cystic nodal metastasis may reveal
degenerate benign-looking squamous debris from the central
fluid component while missing the solid peripheral tumour rim of
the lymph node.
 TISSUE BIOPSY
Any suspicious areas should be biopsied. Incisional or brush biopsy can be
done depending on the surgeon's preference
A tissue biopsy of the tumor is performed and sent to a laboratory for a
pathological examination. A pathologist examines the biopsy under a
microscope
Examination of the biopsy under a microscope by a pathologist is considered
to be gold standard in arriving at a conclusive diagnosis
Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The
pathologist then decides on additional studies depending on the clinical
situation