neck mass assessment of a neck mass assessment of a neck mass m. hosseini m.d. m. hosseini m.d. head...

NECK MASSNECK MASSNECK MASSNECK MASS Assessment of a neck massAssessment of a neck mass

M. Hosseini M.D.M. Hosseini M.D. Head & Neck SurgeonHead & Neck Surgeon

Rasool Akram HspitalRasool Akram Hspital

Iran UniversityIran University

Assessment of a neck massAssessment of a neck mass

M. Hosseini M.D.M. Hosseini M.D. Head & Neck SurgeonHead & Neck Surgeon

Rasool Akram HspitalRasool Akram Hspital

Iran UniversityIran University

Question :Question :Question :Question :

1- What structure is the neck mass arising from ?1- What structure is the neck mass arising from ?2- Is it a lymph node ?2- Is it a lymph node ?3- Is the mass arising from a normally occurring3- Is the mass arising from a normally occurring structure (thyroid – never – vessel – muscle) ?structure (thyroid – never – vessel – muscle) ?4- Abnormal structure (larngocele – brachial – 4- Abnormal structure (larngocele – brachial – cleft – cystic hygroma) ?cleft – cystic hygroma) ?5- Is the mass soft , fluctuant – mobile – fixed ?5- Is the mass soft , fluctuant – mobile – fixed ?6- Palsato6- Palsato7- Bruit7- Bruit8- Superficial – deep8- Superficial – deep9- Is it attached to the skin ?9- Is it attached to the skin ?10 - Tender10 - Tender

1- What structure is the neck mass arising from ?1- What structure is the neck mass arising from ?2- Is it a lymph node ?2- Is it a lymph node ?3- Is the mass arising from a normally occurring3- Is the mass arising from a normally occurring structure (thyroid – never – vessel – muscle) ?structure (thyroid – never – vessel – muscle) ?4- Abnormal structure (larngocele – brachial – 4- Abnormal structure (larngocele – brachial – cleft – cystic hygroma) ?cleft – cystic hygroma) ?5- Is the mass soft , fluctuant – mobile – fixed ?5- Is the mass soft , fluctuant – mobile – fixed ?6- Palsato6- Palsato7- Bruit7- Bruit8- Superficial – deep8- Superficial – deep9- Is it attached to the skin ?9- Is it attached to the skin ?10 - Tender10 - Tender

- Duration- Duration

- Growth rate ( M > B )- Growth rate ( M > B )

- Location (Congenital – Developmental)- Location (Congenital – Developmental)

- Duration- Duration

- Growth rate ( M > B )- Growth rate ( M > B )

- Location (Congenital – Developmental)- Location (Congenital – Developmental)

Risk Factor :Risk Factor :Risk Factor :Risk Factor :

TobaccoTobacco

AlcoholAlcohol

LeukoplakiaLeukoplakia

ErthroplakiaErthroplakia

Poor HygienePoor Hygiene

Submucosal fibrosisSubmucosal fibrosis

Local inflammation due to traumaLocal inflammation due to trauma

Trauma Trauma

TobaccoTobacco

AlcoholAlcohol

LeukoplakiaLeukoplakia

ErthroplakiaErthroplakia

Poor HygienePoor Hygiene

Submucosal fibrosisSubmucosal fibrosis

Local inflammation due to traumaLocal inflammation due to trauma

Trauma Trauma

-- Deletion of chromosomes 3p & 18qDeletion of chromosomes 3p & 18q

- Amplification of int – 2 and bcl -1- Amplification of int – 2 and bcl -1

- Mutation of p 53- Mutation of p 53

- Overexpression of transforming - Overexpression of transforming

growth factor – (TGF – growth factor – (TGF – αα))

- Epidermal growth factor receptor (EGF- Epidermal growth factor receptor (EGF11))

-- Deletion of chromosomes 3p & 18qDeletion of chromosomes 3p & 18q

- Amplification of int – 2 and bcl -1- Amplification of int – 2 and bcl -1

- Mutation of p 53- Mutation of p 53

- Overexpression of transforming - Overexpression of transforming

growth factor – (TGF – growth factor – (TGF – αα))

- Epidermal growth factor receptor (EGF- Epidermal growth factor receptor (EGF11))

I. Muscle & fibrous tissueI. Muscle & fibrous tissueI. Muscle & fibrous tissueI. Muscle & fibrous tissue

A. Congenital / developmental – fibromatosis colliA. Congenital / developmental – fibromatosis colliB. Inflammatory – myositisB. Inflammatory – myositisC. NeoplasticC. Neoplastic 1. Benign – rhabdomyoma1. Benign – rhabdomyoma 2. Aggressive – fibromatoses2. Aggressive – fibromatoses 3. Malignant – rhabdomyosarcoma3. Malignant – rhabdomyosarcomaD. MiscellaneousD. Miscellaneous 1. Benign masseter muscle hypertrophy1. Benign masseter muscle hypertrophy 2. Compensatory muscle hypertrophy (often seen after2. Compensatory muscle hypertrophy (often seen after R . N . D)R . N . D)

A. Congenital / developmental – fibromatosis colliA. Congenital / developmental – fibromatosis colliB. Inflammatory – myositisB. Inflammatory – myositisC. NeoplasticC. Neoplastic 1. Benign – rhabdomyoma1. Benign – rhabdomyoma 2. Aggressive – fibromatoses2. Aggressive – fibromatoses 3. Malignant – rhabdomyosarcoma3. Malignant – rhabdomyosarcomaD. MiscellaneousD. Miscellaneous 1. Benign masseter muscle hypertrophy1. Benign masseter muscle hypertrophy 2. Compensatory muscle hypertrophy (often seen after2. Compensatory muscle hypertrophy (often seen after R . N . D)R . N . D)

II. Lymphatic & reticuloendothelialII. Lymphatic & reticuloendothelialsystems systems

II. Lymphatic & reticuloendothelialII. Lymphatic & reticuloendothelialsystems systems

A. Congenital – cystic hygroma , hamartomaA. Congenital – cystic hygroma , hamartomaB. Inflammatory lymphadenitisB. Inflammatory lymphadenitis 1. Viral 1. Viral a. Cat – scratch diseasea. Cat – scratch disease b. Infectious monoucleosisb. Infectious monoucleosis 2. Bacterial2. Bacterial a. Routine ( strept. Staph. )a. Routine ( strept. Staph. ) b. Syphilisb. Syphilis c. T.B.c. T.B. d. Actinomycosisd. Actinomycosis 3. Fungal3. Fungal a. Histoplasmosisa. Histoplasmosis b. Blastomycosisb. Blastomycosis 4. Parasitic4. Parasitic a. Toxoplasmosisa. Toxoplasmosis b. Leishmaniasisb. Leishmaniasis

A. Congenital – cystic hygroma , hamartomaA. Congenital – cystic hygroma , hamartomaB. Inflammatory lymphadenitisB. Inflammatory lymphadenitis 1. Viral 1. Viral a. Cat – scratch diseasea. Cat – scratch disease b. Infectious monoucleosisb. Infectious monoucleosis 2. Bacterial2. Bacterial a. Routine ( strept. Staph. )a. Routine ( strept. Staph. ) b. Syphilisb. Syphilis c. T.B.c. T.B. d. Actinomycosisd. Actinomycosis 3. Fungal3. Fungal a. Histoplasmosisa. Histoplasmosis b. Blastomycosisb. Blastomycosis 4. Parasitic4. Parasitic a. Toxoplasmosisa. Toxoplasmosis b. Leishmaniasisb. Leishmaniasis

II. Lymphatic & reticuloendothelialII. Lymphatic & reticuloendothelialsystems systems

II. Lymphatic & reticuloendothelialII. Lymphatic & reticuloendothelialsystems systems

C. Neoplastic (Primary & metastatic lymphnode)C. Neoplastic (Primary & metastatic lymphnode) 1. Sarcomas1. Sarcomas a. Lymphomas (Hodgkin’s & non- hodgkin)a. Lymphomas (Hodgkin’s & non- hodgkin) b. Soft part sarcomab. Soft part sarcoma c. Leukemiasc. Leukemias 2. Carcionomas ( all – metastatic)2. Carcionomas ( all – metastatic) a. Squamous cella. Squamous cell b. Melanomab. Melanoma c. Thyroid malig.c. Thyroid malig. d. Salivary gland malig.d. Salivary gland malig.D. MiscellaneousD. Miscellaneous Drug reaction (Phenytoin)Drug reaction (Phenytoin)

C. Neoplastic (Primary & metastatic lymphnode)C. Neoplastic (Primary & metastatic lymphnode) 1. Sarcomas1. Sarcomas a. Lymphomas (Hodgkin’s & non- hodgkin)a. Lymphomas (Hodgkin’s & non- hodgkin) b. Soft part sarcomab. Soft part sarcoma c. Leukemiasc. Leukemias 2. Carcionomas ( all – metastatic)2. Carcionomas ( all – metastatic) a. Squamous cella. Squamous cell b. Melanomab. Melanoma c. Thyroid malig.c. Thyroid malig. d. Salivary gland malig.d. Salivary gland malig.D. MiscellaneousD. Miscellaneous Drug reaction (Phenytoin)Drug reaction (Phenytoin)

III. Salivary glandsIII. Salivary glandsIII. Salivary glandsIII. Salivary glands

A. Congenital – cystsA. Congenital – cysts

B. InflammatoryB. Inflammatory

1. Acute viral sialoadenitis (mumps)1. Acute viral sialoadenitis (mumps)

2. Acute bacterial sialoadenitis2. Acute bacterial sialoadenitis

3. Chronic sialoadenitis3. Chronic sialoadenitis

C. Enlargement secondary to systemic disease – obesity , C. Enlargement secondary to systemic disease – obesity , alcoholism, malnutritionalcoholism, malnutrition

A. Congenital – cystsA. Congenital – cysts

B. InflammatoryB. Inflammatory

1. Acute viral sialoadenitis (mumps)1. Acute viral sialoadenitis (mumps)

2. Acute bacterial sialoadenitis2. Acute bacterial sialoadenitis

3. Chronic sialoadenitis3. Chronic sialoadenitis

C. Enlargement secondary to systemic disease – obesity , C. Enlargement secondary to systemic disease – obesity , alcoholism, malnutritionalcoholism, malnutrition

III. Salivary glandsIII. Salivary glandsIII. Salivary glandsIII. Salivary glands

D. NeoplasticD. Neoplastic

1. Benign – hemangioma, mixed tumor, warthin’s1. Benign – hemangioma, mixed tumor, warthin’s

2. Malignant – nucoepidermoid ca. , adenoid cystic ca.2. Malignant – nucoepidermoid ca. , adenoid cystic ca.

E. Obstructive enlargementE. Obstructive enlargement

1. Sialolithiasis1. Sialolithiasis

2. Ductal stricture2. Ductal stricture

F. Miscellaneous enlargements of salivary glandsF. Miscellaneous enlargements of salivary glands

1. Sjogren’s synd.1. Sjogren’s synd.

2. Drug reaction (iodine)2. Drug reaction (iodine)

D. NeoplasticD. Neoplastic

1. Benign – hemangioma, mixed tumor, warthin’s1. Benign – hemangioma, mixed tumor, warthin’s

2. Malignant – nucoepidermoid ca. , adenoid cystic ca.2. Malignant – nucoepidermoid ca. , adenoid cystic ca.

E. Obstructive enlargementE. Obstructive enlargement

1. Sialolithiasis1. Sialolithiasis

2. Ductal stricture2. Ductal stricture

F. Miscellaneous enlargements of salivary glandsF. Miscellaneous enlargements of salivary glands

1. Sjogren’s synd.1. Sjogren’s synd.

2. Drug reaction (iodine)2. Drug reaction (iodine)

IV. Vascular systemIV. Vascular systemIV. Vascular systemIV. Vascular system

A. Developmental / degenerative / traumaticA. Developmental / degenerative / traumatic

1. Aneurysm1. Aneurysm

2. Arteriovenous malf.2. Arteriovenous malf.

3. Tortuous arteries3. Tortuous arteries

4. Hematoma4. Hematoma

B. NeoplasticB. Neoplastic

1. Hemangiomas1. Hemangiomas

2. Angiosarcomas2. Angiosarcomas

3. Hemangiopericytoma3. Hemangiopericytoma

4. Carotid body tumor4. Carotid body tumor

A. Developmental / degenerative / traumaticA. Developmental / degenerative / traumatic

1. Aneurysm1. Aneurysm

2. Arteriovenous malf.2. Arteriovenous malf.

3. Tortuous arteries3. Tortuous arteries

4. Hematoma4. Hematoma

B. NeoplasticB. Neoplastic

1. Hemangiomas1. Hemangiomas

2. Angiosarcomas2. Angiosarcomas

3. Hemangiopericytoma3. Hemangiopericytoma

4. Carotid body tumor4. Carotid body tumor

V. Nervous systemV. Nervous systemV. Nervous systemV. Nervous system

A. BenignA. Benign

1. Neurofibroma1. Neurofibroma

2. Neuroma2. Neuroma

3. Neurilemmoma (schwannoma)3. Neurilemmoma (schwannoma)

4. Paragangliomas (carotid body, vagal body, &4. Paragangliomas (carotid body, vagal body, &

glomus jugulare tumors)glomus jugulare tumors)

B. Malignant (rare)B. Malignant (rare)

1. Neurogenous sar.1. Neurogenous sar.

2. Neuroepithelioma2. Neuroepithelioma

3. Malig. schwannoma3. Malig. schwannoma

A. BenignA. Benign

1. Neurofibroma1. Neurofibroma

2. Neuroma2. Neuroma

3. Neurilemmoma (schwannoma)3. Neurilemmoma (schwannoma)

4. Paragangliomas (carotid body, vagal body, &4. Paragangliomas (carotid body, vagal body, &

glomus jugulare tumors)glomus jugulare tumors)

B. Malignant (rare)B. Malignant (rare)

1. Neurogenous sar.1. Neurogenous sar.

2. Neuroepithelioma2. Neuroepithelioma

3. Malig. schwannoma3. Malig. schwannoma

VI. Thyroid glandVI. Thyroid glandVI. Thyroid glandVI. Thyroid gland

A. Congenital / developmental – cystsA. Congenital / developmental – cysts

B. InflammatoryB. Inflammatory

1. Acute thyroiditis1. Acute thyroiditis

2. Subacute (de Quervain’s)2. Subacute (de Quervain’s)

3. Chronic thyroiditis3. Chronic thyroiditis

a. Lymphocytic (Hashimoto’s)a. Lymphocytic (Hashimoto’s)

b. Fibrous/ ligneous (Riedel’s)b. Fibrous/ ligneous (Riedel’s)

A. Congenital / developmental – cystsA. Congenital / developmental – cysts

B. InflammatoryB. Inflammatory

1. Acute thyroiditis1. Acute thyroiditis

2. Subacute (de Quervain’s)2. Subacute (de Quervain’s)

3. Chronic thyroiditis3. Chronic thyroiditis

a. Lymphocytic (Hashimoto’s)a. Lymphocytic (Hashimoto’s)

b. Fibrous/ ligneous (Riedel’s)b. Fibrous/ ligneous (Riedel’s)

VI. Thyroid glandVI. Thyroid glandVI. Thyroid glandVI. Thyroid gland

C. NeoplasticC. Neoplastic 1. Benign – adenomas1. Benign – adenomas 2. Malignant 2. Malignant a. Papillary car.a. Papillary car. b. Follicular car.b. Follicular car. c. Medullary car.c. Medullary car. d. Poorly diff. car.d. Poorly diff. car.D. MiscellaneousD. Miscellaneous 1. Diffuse colloid goiter1. Diffuse colloid goiter 2. Diffuse goiter with hyperthyroidism2. Diffuse goiter with hyperthyroidism 3. Nodular goiter3. Nodular goiter

C. NeoplasticC. Neoplastic 1. Benign – adenomas1. Benign – adenomas 2. Malignant 2. Malignant a. Papillary car.a. Papillary car. b. Follicular car.b. Follicular car. c. Medullary car.c. Medullary car. d. Poorly diff. car.d. Poorly diff. car.D. MiscellaneousD. Miscellaneous 1. Diffuse colloid goiter1. Diffuse colloid goiter 2. Diffuse goiter with hyperthyroidism2. Diffuse goiter with hyperthyroidism 3. Nodular goiter3. Nodular goiter

VII. MiscellaneousVII. Miscellaneous soft tissue neop.soft tissue neop.VII. MiscellaneousVII. Miscellaneous soft tissue neop.soft tissue neop.

A. BenignA. Benign

1. Lipoma1. Lipoma

2. Myxoma2. Myxoma

3. Hibernoma3. Hibernoma

B. MalignantB. Malignant

1. Synovial cell sarc.1. Synovial cell sarc.

2. Liposarcoma2. Liposarcoma

A. BenignA. Benign

1. Lipoma1. Lipoma

2. Myxoma2. Myxoma

3. Hibernoma3. Hibernoma

B. MalignantB. Malignant

1. Synovial cell sarc.1. Synovial cell sarc.

2. Liposarcoma2. Liposarcoma

VIII. Larynx, pharynx, & deep neckVIII. Larynx, pharynx, & deep neckstructuresstructures

VIII. Larynx, pharynx, & deep neckVIII. Larynx, pharynx, & deep neckstructuresstructures

A. DevelopmentalA. Developmental 1. Malformed laryngeal cartilage1. Malformed laryngeal cartilage 2. External laryngocele2. External laryngocele 3. Branchial cleft abnormalities3. Branchial cleft abnormalitiesB. InflammatoryB. Inflammatory 1. Deep neck infection / abscess1. Deep neck infection / abscess 2. Osteomyelitis of cervical spine 2. Osteomyelitis of cervical spine C. NeoplasticC. Neoplastic 1. Car. Of larynx & pharynx1. Car. Of larynx & pharynx 2. Chordoma of larynx2. Chordoma of larynx 3. Neoplasm of cervical spine3. Neoplasm of cervical spine

A. DevelopmentalA. Developmental 1. Malformed laryngeal cartilage1. Malformed laryngeal cartilage 2. External laryngocele2. External laryngocele 3. Branchial cleft abnormalities3. Branchial cleft abnormalitiesB. InflammatoryB. Inflammatory 1. Deep neck infection / abscess1. Deep neck infection / abscess 2. Osteomyelitis of cervical spine 2. Osteomyelitis of cervical spine C. NeoplasticC. Neoplastic 1. Car. Of larynx & pharynx1. Car. Of larynx & pharynx 2. Chordoma of larynx2. Chordoma of larynx 3. Neoplasm of cervical spine3. Neoplasm of cervical spine

IX. Other assorted lesionsIX. Other assorted lesionsIX. Other assorted lesionsIX. Other assorted lesions

A. Bezold’s (mastoid) abscessA. Bezold’s (mastoid) abscess

B. Cholesteatoma from mastoid B. Cholesteatoma from mastoid

C. ThymomaC. Thymoma

D. Epidermoid inclusion cystD. Epidermoid inclusion cyst

A. Bezold’s (mastoid) abscessA. Bezold’s (mastoid) abscess

B. Cholesteatoma from mastoid B. Cholesteatoma from mastoid

C. ThymomaC. Thymoma

D. Epidermoid inclusion cystD. Epidermoid inclusion cyst

AGE ( YEARS ) AGE ( YEARS )0 - 150 - 15

Inflammatory Neoplastic

Adenitis Lymphoma (AT/PT)

Bacterial (AT/PT) Thyroid Carcinoma (M)

Viral (AT/PT) Sarcoma (AT/PT)

Granlomatous (PT/AT)

Congenital

Branchial cyst (AT)

Thyroglossal cyst (M)

Vascular Lesion (PT)

Dermoid (M)

Inflammatory Neoplastic

Adenitis Lymphoma (AT/PT)

Bacterial (AT/PT) Thyroid Carcinoma (M)

Viral (AT/PT) Sarcoma (AT/PT)

Granlomatous (PT/AT)

Congenital

Branchial cyst (AT)

Thyroglossal cyst (M)

Vascular Lesion (PT)

Dermoid (M)

AGE ( YEARS ) AGE ( YEARS )16 - 4016 - 40

Inflammatory Neoplastic

Adenitis Lymphoma (AT/PT)

Viral (AT/PT) Thyroid Carcinoma (M)

Bacterial (AT/PT) Salivary (AT)

Granlomatous (PT/AT) Metastatic (AT/PT)

Aids (AT/PT) Vascular (AT/PT)

Congenital Neurogenic (AT)

Branchial cyst (AT)

Thyroglossal cyst (M)

Dermoid (M)

Inflammatory Neoplastic

Adenitis Lymphoma (AT/PT)

Viral (AT/PT) Thyroid Carcinoma (M)

Bacterial (AT/PT) Salivary (AT)

Granlomatous (PT/AT) Metastatic (AT/PT)

Aids (AT/PT) Vascular (AT/PT)

Congenital Neurogenic (AT)

Branchial cyst (AT)

Thyroglossal cyst (M)

Dermoid (M)

AGE ( YEARS ) AGE ( YEARS )40 +40 +

Neoplastic

Metastatic carcinoma (AT/PT)

Thyroid carcinoma (M)

Inflammatory

Adenitis

Viral (AT/PT)

Bacterial (AT/PT)

Granlomatous (PT/AT)

Aids (AT/PT)

Congenital

Neoplastic

Metastatic carcinoma (AT/PT)

Thyroid carcinoma (M)

Inflammatory

Adenitis

Viral (AT/PT)

Bacterial (AT/PT)

Granlomatous (PT/AT)

Aids (AT/PT)

Congenital

Branchial cyst (AT) Thyroglossal cyst (M)

Chronic infectionChronic infectionChronic infectionChronic infection

1- T.B1- T.B

2- Fungal2- Fungal

3- Syphilis3- Syphilis

4- Cat – scratch fever4- Cat – scratch fever

5- Aids5- Aids

6- Sarcoidosis6- Sarcoidosis

7- Mononucleosis7- Mononucleosis

1- T.B1- T.B

2- Fungal2- Fungal

3- Syphilis3- Syphilis

4- Cat – scratch fever4- Cat – scratch fever

5- Aids5- Aids

6- Sarcoidosis6- Sarcoidosis

7- Mononucleosis7- Mononucleosis

Infection – inflammation ( Fever – Pain – Tenderness )

T.B

Sarcoidosis

Fungal infection

Dental problems

Trauma to H. & N.

Cancer ( Skin lesion – Head & Neck Tumor )

Night sweats ( lymphoma )

Exposure to the sun ( Skin cancer )

Smoking or excessive alcohol consumption

( S.C.C of the fead & Neck )

Infection – inflammation ( Fever – Pain – Tenderness )

T.B

Sarcoidosis

Fungal infection

Dental problems

Trauma to H. & N.

Cancer ( Skin lesion – Head & Neck Tumor )

Night sweats ( lymphoma )

Exposure to the sun ( Skin cancer )

Smoking or excessive alcohol consumption

( S.C.C of the fead & Neck )

Nasal obstruction

Nasal bleeding

Otalgia

Odynophagia

Dyspahgia

Hoarseness

Nasal obstruction

Nasal bleeding

Otalgia

Odynophagia

Dyspahgia

Hoarseness

}Malignancy of upper aerodigestive tract

Exposure to low – dose therapeutic radiation ( risk factor for thyroid Cancer)

Biopsy 1- Preferred method

2- Cystic form solid

3- Often diagnose malignancy

4- Standard for making treatment decisions

in patiets with thyroid nodules

5- Bleeding from it make problem for CT & MRI

6- Fna is not valuable in :

Nodul of thyroid with History of Radiation,

Lymphoma.

1- Preferred method

2- Cystic form solid

3- Often diagnose malignancy

4- Standard for making treatment decisions

in patiets with thyroid nodules

5- Bleeding from it make problem for CT & MRI

6- Fna is not valuable in :

Nodul of thyroid with History of Radiation,

Lymphoma.

FNA

Thyroid NodulesThyroid NodulesThyroid NodulesThyroid Nodules

- Childern , young men , pregnant women ,- Childern , young men , pregnant women ,

radiation , family history of the thyroid cancer .radiation , family history of the thyroid cancer .

- Childern , young men , pregnant women ,- Childern , young men , pregnant women ,

radiation , family history of the thyroid cancer .radiation , family history of the thyroid cancer .

Imaging Studies

Ultrasonography

A - Solid – Cystic

B - Congenital – developmental ( cyst )

C - Vascular , thyroid & parathyroid abnormality

Ultrasonography

A - Solid – Cystic

B - Congenital – developmental ( cyst )

C - Vascular , thyroid & parathyroid abnormality

CT

A - Solid – Cystic

B- Mass is within or outside a gland or nodal chain

C- Small tongue – base , tonsillar mass that

have minimal mucosal component

A - Solid – Cystic

B- Mass is within or outside a gland or nodal chain

C- Small tongue – base , tonsillar mass that

have minimal mucosal component

MRI

T2 – Weighted gadolinium enhanced scans is

Useful for invasion of soft tissue by tumor.

T2 – Weighted gadolinium enhanced scans is

Useful for invasion of soft tissue by tumor.

ArteriographyArteriographyArteriographyArteriography

A- evaluating vascular lesionsA- evaluating vascular lesions

B- fixation of tumor to the carotidB- fixation of tumor to the carotid

C- vascularity of massC- vascularity of mass

D- specific blood supplyD- specific blood supply

A- evaluating vascular lesionsA- evaluating vascular lesions

B- fixation of tumor to the carotidB- fixation of tumor to the carotid

C- vascularity of massC- vascularity of mass

D- specific blood supplyD- specific blood supply

Thyroglossal duct cystsThyroglossal duct cystsThyroglossal duct cystsThyroglossal duct cysts

1- 70% of all congenital abnormalities of the neck1- 70% of all congenital abnormalities of the neck

2- First decade of life2- First decade of life

3- Midline3- Midline

4- Move side to side but not up to down4- Move side to side but not up to down

5- 1% contain cancer ( papillary ca-S.c.c. )5- 1% contain cancer ( papillary ca-S.c.c. )

1- 70% of all congenital abnormalities of the neck1- 70% of all congenital abnormalities of the neck

2- First decade of life2- First decade of life

3- Midline3- Midline

4- Move side to side but not up to down4- Move side to side but not up to down

5- 1% contain cancer ( papillary ca-S.c.c. )5- 1% contain cancer ( papillary ca-S.c.c. )

Branchial cleft cystsBranchial cleft cystsBranchial cleft cystsBranchial cleft cysts

1- Five branchial arches & four clefts1- Five branchial arches & four clefts

2- Internal tract or opening is situated at pharyngeal2- Internal tract or opening is situated at pharyngeal

groove such as tonsil ( second Arch ) or piriformgroove such as tonsil ( second Arch ) or piriform

Sinus ( Third & fourth arches )Sinus ( Third & fourth arches )

3- The Second arch is the most common3- The Second arch is the most common

4- Anterior border of S.C.M4- Anterior border of S.C.M

5- Most are diagnosed in the first two decades of life5- Most are diagnosed in the first two decades of life

( any age )( any age )

6- Lateral neck ( smooth , painless , slowly enlarging6- Lateral neck ( smooth , painless , slowly enlarging

mass )mass )

1- Five branchial arches & four clefts1- Five branchial arches & four clefts

2- Internal tract or opening is situated at pharyngeal2- Internal tract or opening is situated at pharyngeal

groove such as tonsil ( second Arch ) or piriformgroove such as tonsil ( second Arch ) or piriform

Sinus ( Third & fourth arches )Sinus ( Third & fourth arches )

3- The Second arch is the most common3- The Second arch is the most common

4- Anterior border of S.C.M4- Anterior border of S.C.M

5- Most are diagnosed in the first two decades of life5- Most are diagnosed in the first two decades of life

( any age )( any age )

6- Lateral neck ( smooth , painless , slowly enlarging6- Lateral neck ( smooth , painless , slowly enlarging

mass )mass )

Cystic HygromaCystic HygromaCystic HygromaCystic Hygroma

1- Second year of life1- Second year of life

2- 80% in P.T.2- 80% in P.T.

3- Floor of the mouth- supraclavicular, root of3- Floor of the mouth- supraclavicular, root of

the neck , angle of the jaw – may involvedthe neck , angle of the jaw – may involved

parotid – tongue – larynx .parotid – tongue – larynx .

4-Diffuse , soft , doughy , irregular mass .4-Diffuse , soft , doughy , irregular mass .

5- Transilluminated5- Transilluminated

6- Aspiration yields straw – colored fluid 6- Aspiration yields straw – colored fluid

1- Second year of life1- Second year of life

2- 80% in P.T.2- 80% in P.T.

3- Floor of the mouth- supraclavicular, root of3- Floor of the mouth- supraclavicular, root of

the neck , angle of the jaw – may involvedthe neck , angle of the jaw – may involved

parotid – tongue – larynx .parotid – tongue – larynx .

4-Diffuse , soft , doughy , irregular mass .4-Diffuse , soft , doughy , irregular mass .

5- Transilluminated5- Transilluminated

6- Aspiration yields straw – colored fluid 6- Aspiration yields straw – colored fluid

( Lymphangiomas )( Lymphangiomas )

Vascular MalformationVascular MalformationVascular MalformationVascular Malformation

- Congenital- Congenital

- Bluish – purple coloration , increased warmth , - Bluish – purple coloration , increased warmth ,

compressibility , bruit , thrill – most of them compressibility , bruit , thrill – most of them

resolve spontaneouslyresolve spontaneously

- Congenital- Congenital

- Bluish – purple coloration , increased warmth , - Bluish – purple coloration , increased warmth ,

compressibility , bruit , thrill – most of them compressibility , bruit , thrill – most of them

resolve spontaneouslyresolve spontaneously

( Hemangiomas )( Hemangiomas )

Salivary gland Tumors (B)Salivary gland Tumors (B)Salivary gland Tumors (B)Salivary gland Tumors (B)

- Complete submandibular resection &- Complete submandibular resection &

superficial parotidectomysuperficial parotidectomy

- Complete submandibular resection &- Complete submandibular resection &

superficial parotidectomysuperficial parotidectomy

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )16 - 4016 - 40

FREQUENCY OF DISEASE GROUPINGSFREQUENCY OF DISEASE GROUPINGS

INFLAMMATORY

CONGENITAL / DEVELOPMENTAL

NEOPLASTIC

MALIGNANT

BENIGN

TRAUMATIC

LOCATION Anterior triangle

INFLAMMATORY

CONGENITAL / DEVELOPMENTAL

NEOPLASTIC

MALIGNANT

BENIGN

TRAUMATIC

LOCATION Anterior triangle

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )40 +40 +

FREQUENCY OF DISEASE GROUPINGSFREQUENCY OF DISEASE GROUPINGS NEOPLASTIC

MALIGNANT

BENIGN

INFLAMMATORY

LOCATION Posterior triangle

NEOPLASTIC

MALIGNANT

BENIGN

INFLAMMATORY

LOCATION Posterior triangle

CONGENITAL / DEVELOPMENTAL

TRAUMATIC

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )0 - 150 - 15

FREQUENCY OF DISEASE GROUPINGSFREQUENCY OF DISEASE GROUPINGS

INFLAMMATORY

CONGENITAL / DEVELOPMENTAL

NEOPLASTIC

MALIGNANT

BENIGN

TRAUMATIC

LOCATION Midline and anterior neck

INFLAMMATORY

CONGENITAL / DEVELOPMENTAL

NEOPLASTIC

MALIGNANT

BENIGN

TRAUMATIC

LOCATION Midline and anterior neck

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )

16 - 4016 - 40

CAUSATIVE DISEASES BY LOCATIONCAUSATIVE DISEASES BY LOCATION

Congenital / Developmental

Thymic cyst

Sialadenopathy

Parotid

Submandibular

Congenital / Developmental

Thymic cyst

Sialadenopathy

Parotid

Submandibular

INFLAMMATORYINFLAMMATORY

Adenitis Sialadenitis Viral Parotid

Bacterial Submandibular

Granulomatus

Adenitis Sialadenitis Viral Parotid

Bacterial Submandibular

Granulomatus

NeoplasticNeoplasticMetastatic Lymphoma

Upper jugular (II) Primary vascular

Oropharynx Carotid body

Oral cavity Glomus

Oral cavity Hemangioma

Nasal sinus

Face

Mid – jugular (III)

Hypopharynx

Larynx

Traumatic

False aneurysm

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )

0 - 150 - 15

CAUSATIVE DISEASES BY LOCATIONCAUSATIVE DISEASES BY LOCATION

Congenital / Developmental

Thyroglossal duct cyst

Dermoid Laryngocele

Inflammatory Adenitis

Neoplastic Thyroid

Lymphoma Traumatic

Sternocleidomastoid

Hematoma / fibroma

Congenital / Developmental

Thyroglossal duct cyst

Dermoid Laryngocele

Inflammatory Adenitis

Neoplastic Thyroid

Lymphoma Traumatic

Sternocleidomastoid

Hematoma / fibroma

INFLAMMATORYINFLAMMATORY

Adenitis Sialadenitis Viral Parotid

Bacterial Submandibular

Granulomatus

Adenitis Sialadenitis Viral Parotid

Bacterial Submandibular

Granulomatus

PATIENT AGE ( YEARS )PATIENT AGE ( YEARS )40 +40 +

CAUSATIVE DISEASES BY LOCATIONCAUSATIVE DISEASES BY LOCATION

Congenital / Developmental

Lymphangiom Neoplastic

Inflammatory Lymphoma

Adenitis Metastatic (V)

Bacterial Superior

Viral

Lung

Gastrointestinal

Genitourinary

Gyneocologic

Congenital / Developmental

Lymphangiom Neoplastic

Inflammatory Lymphoma

Adenitis Metastatic (V)

Bacterial Superior

Viral

Lung

Gastrointestinal

Genitourinary

Gyneocologic

Nasopharynx

SCALP

Granulomatous

Supraclavicular

Traumatic

Breast

Neuroma