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__NOTOC__
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{{CMG}}; {{AE}}


== tab ==
{{CMG}}; {{AE}}{{Qurrat}}


==Differential diagnosis of neck masses==
Differential diagnosis of neck masses include:
{|
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant
! colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LAP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
|-
! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! colspan="2" align="center" style="background:#DCDCDC;" |Branchial cleft cyst<ref name="Nahata2016">{{cite journal|last1=Nahata|first1=Vaishali|title=Branchial cleft cyst|journal=Indian Journal of Dermatology|volume=61|issue=6|year=2016|pages=701|issn=0019-5154|doi=10.4103/0019-5154.193718}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Age: 1-15 yrs/ varies
* Familial occurence is noted
| align="center" style="background:#F5F5F5;" |
* Lateral neck mass
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | +/-
| align="center" style="background:#F5F5F5;" |
* Solitary
* Smooth
* Mobile
* Welldefined
* Nonpulsatile
* Fluctuant
| align="center" style="background:#F5F5F5;" |
* A pit is found at the opening of the cyst
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Squamous or ciliated epithelial lining
* Lymphoid tissue with germinal centers and subcapsular sinuses
| align="center" style="background:#F5F5F5;" |
* CT: Well defined fluid attenuation with slight enhancement of the capsule
* Ultrasound: Typical features of a cyst are seen
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Brachio-oto-renal syndrome
* Sinus
* Fistula
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Thyroglossal duct cyst<ref name="pmid30085599">{{cite journal |vauthors=Amos J, Shermetaro C |title= |journal= |volume= |issue= |pages= |date= |pmid=30085599 |doi= |url=}}</ref><ref name="pmid19718389">{{cite journal |vauthors=Deaver MJ, Silman EF, Lotfipour S |title=Infected thyroglossal duct cyst |journal=West J Emerg Med |volume=10 |issue=3 |pages=205 |date=August 2009 |pmid=19718389 |pmc=2729228 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Age: 1-10 yrs/ varies
| align="center" style="background:#F5F5F5;" |
* Midline neck mass
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Mobile
* Moves upwards with tongue protrusion and swallowing
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Squamous or ciliated pseudostratified columnar lining
* Foci of thyroid gland tissue
* Granulation tissue or giant cells if it gets infected
| align="center" style="background:#F5F5F5;" |
* Ultrasound:  Anechoic, thin walls, and heterogeneous with internal septae
* CT with contrast: Well circumscribed,homogeneous fluid attenuation, thin enhancing rim
* MRI: T1- dark, T2-bright images
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | -
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Haemangioma<ref name="Léauté-LabrèzePrey2011">{{cite journal|last1=Léauté-Labrèze|first1=C.|last2=Prey|first2=S.|last3=Ezzedine|first3=K.|title=Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities|journal=Journal of the European Academy of Dermatology and Venereology|volume=25|issue=11|year=2011|pages=1245–1253|issn=09269959|doi=10.1111/j.1468-3083.2011.04102.x}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Age: birth - 2 yrs


* Females>males
==Managemnet of Congenital melanocytic Nevi==
| align="center" style="background:#F5F5F5;" |
* Usually present with a  flat red or purple patch
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Firm


* Rubbery
https://www.uptodate.com/contents/congenital-melanocytic-nevi?search=melanocytic%20nevus%20pathophysiology&sectionRank=1&usage_type=default&anchor=H2&source=machineLearning&selectedTitle=1~44&display_rank=1#H2


* Well-demarcated
MANAGEMENT


| align="center" style="background:#F5F5F5;" |
Small/medium CMN — Small and medium-sized CMN are managed on an individual basis depending on factors that affect ease of monitoring (eg, color, thickness/topography, and location), clinical history, parents' anxiety, and cosmetic concerns [4]. As an example, a multinodular black CMN on the scalp that is partially obscured by dense hair growth would be difficult to follow clinically, whereas a thin light brown lesion on the face would be relatively simple to observe. However, the latter might be removed for cosmetic reasons, and the former may spontaneously lighten during childhood.
* Blanching


* Telangiectasias
Periodic evaluation of small- and medium-sized CMN is most important after puberty, since the risk of melanoma arising within these lesions during childhood is extremely low. Baseline photographs can be helpful, and dermoscopy represents a useful tool for assessing changes. (See "Dermoscopic evaluation of skin lesions".)


* Erythematous patch
Patients and parents should be instructed to perform skin self-examinations and to bring focal changes in color, border, or topography (eg, a red or black papule, nodule, or crust) to the clinician's attention. (See "Screening and early detection of melanoma in adults and adolescents", section on 'Patient self-examination'.)


| align="center" style="background:#F5F5F5;" | -
Large CMN — Early surgical removal is often desired for large CMN because of their cosmetic and psychosocial sequelae and concern for possible malignant transformation. Complete excision is difficult to achieve; however, resection of bulky and cumbersome portions of large CMN can be beneficial for some patients. Elimination of every nevus cell may be impossible because of the large area of skin affected, the anatomic site (eg, distal extremity, periocular area, genitalia), and involvement of deeper structures (eg, fat, fascia, muscle). Even theoretically complete surgical excision cannot completely eliminate future risk of melanoma, as some melanomas in these patients may develop in the CNS or retroperitoneum. In many cases, close clinical observation with no surgical removal of the lesion is a reasonable choice.
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* GLUT-1


* VEGF
Factors that affect the decision to perform surgery as well as to determine the timing of surgery include the size and location of the large CMN, the technical difficulty of the procedure(s) required, and anesthesia options. When possible, complete removal of large CMN usually necessitates staged excision with the use of tissue expanders and, occasionally, skin grafting [45].
 
* Urinary BFGF
 
| align="center" style="background:#F5F5F5;" |
* Lined by non atypical endothelial cells
 
* Vascular structures with RBC
| align="center" style="background:#F5F5F5;" |
* Ultrasound: High flow with vascular channels
 
* MRI: With or without Gd is the modality of choice
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* POEMS and Castleman's disease
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Vascular malformations
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Lymphatic malformations
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Laryngocele<ref name="pmid23881550">{{cite journal |vauthors=Werner RL, Schroeder JW, Castle JT |title=Bilateral laryngoceles |journal=Head Neck Pathol |volume=8 |issue=1 |pages=110–3 |date=March 2014 |pmid=23881550 |pmc=3950389 |doi=10.1007/s12105-013-0478-4 |url=}}</ref><ref name="pmid23120570">{{cite journal |vauthors=Prasad KC, Vijayalakshmi S, Prasad SC |title=Laryngoceles - presentations and management |journal=Indian J Otolaryngol Head Neck Surg |volume=60 |issue=4 |pages=303–8 |date=December 2008 |pmid=23120570 |pmc=3476818 |doi=10.1007/s12070-008-0108-8 |url=}}</ref><ref name="pmid28819622">{{cite journal |vauthors=Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M |title=Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection |journal=Iran J Otorhinolaryngol |volume=29 |issue=93 |pages=225–228 |date=July 2017 |pmid=28819622 |pmc=5554815 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* More common in adults
 
* Male: female = 5:1
 
| align="center" style="background:#F5F5F5;" |
* Present with a neck swelling, hoarseness, stridor and globus sensation
 
* Episodic in nature
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | +/-
| align="center" style="background:#F5F5F5;" |
* Soft
 
* Reducible
 
* Increase in size on valsalva
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
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* Common in glass blowers, trumpet players
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Lined by pseudostratified ciliated epithelium
| align="center" style="background:#F5F5F5;" |
* X-ray, CT: Fluid and air containing cystic masses
 
* CT is the preferred one
 
| align="center" style="background:#F5F5F5;" |
* CT scan is the gold standard imaging for diagnosis
| align="center" style="background:#F5F5F5;" | -
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Ranula<ref name="pmid29207849">{{cite journal |vauthors=Packiri S, Gurunathan D, Selvarasu K |title=Management of Paediatric Oral Ranula: A Systematic Review |journal=J Clin Diagn Res |volume=11 |issue=9 |pages=ZE06–ZE09 |date=September 2017 |pmid=29207849 |pmc=5713871 |doi=10.7860/JCDR/2017/28498.10622 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Age: 1st and 2nd decade
 
* Female: male=1:1.4
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* Present with a blue colored swelling in the floor of the mouth
 
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Well circumscribed
 
* Fluctuant
* Soft
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Teratoma
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| align="center" style="background:#F5F5F5;" |Incidence: 1:4000 births
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |High ALP levels
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Dermoid cyst<ref name="ParadisKoltai2015">{{cite journal|last1=Paradis|first1=Josée|last2=Koltai|first2=Peter J.|title=Pediatric Teratoma and Dermoid Cysts|journal=Otolaryngologic Clinics of North America|volume=48|issue=1|year=2015|pages=121–136|issn=00306665|doi=10.1016/j.otc.2014.09.009}}</ref><ref name="pmid24629659">{{cite journal |vauthors=Gaddikeri S, Vattoth S, Gaddikeri RS, Stuart R, Harrison K, Young D, Bhargava P |title=Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation |journal=Curr Probl Diagn Radiol |volume=43 |issue=2 |pages=55–67 |date=2014 |pmid=24629659 |doi=10.1067/j.cpradiol.2013.12.001 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Incidence: 3 per 10000 population
 
* Age: birth - 5 yrs
| align="center" style="background:#F5F5F5;" |
* Presents as a slow growing mass or a sinus
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Freely mobile/Fixed
 
* Solitary
 
* Rubbery
 
* Nonpulsatile
 
* Noncompressible
| align="center" style="background:#F5F5F5;" |
* Usually normal/sometimes a pit or sinus is seen
 
* A tuft of hair at the center of the pit for nasal dermoid cyst
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Keratinizing squamous epithelium
 
* Occasional remnants of hair follicles,adipose tissue, and sweat glands
| align="center" style="background:#F5F5F5;" |
* Ultrasound: Thin walled, unilocular
 
* CT: With contrast well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Thymic cyst<ref name="GaddikeriVattoth2014">{{cite journal|last1=Gaddikeri|first1=Santhosh|last2=Vattoth|first2=Surjith|last3=Gaddikeri|first3=Ramya S.|last4=Stuart|first4=Royal|last5=Harrison|first5=Keith|last6=Young|first6=Daniel|last7=Bhargava|first7=Puneet|title=Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation|journal=Current Problems in Diagnostic Radiology|volume=43|issue=2|year=2014|pages=55–67|issn=03630188|doi=10.1067/j.cpradiol.2013.12.001}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* Age: 1-10 yrs
 
* Males>Females
 
| align="center" style="background:#F5F5F5;" |
* Presents as a soft mass, gradually enlarging, on left side of the neck(usual)
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Soft
 
* Compressible
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Squamous/cuboidal epithelium
 
* Lymphoid tissue in the cyst wall contains hassall corpuscles
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* Ultrasound: Unilocular cystic mass
 
* CT: Uni/multilocular, well circumscribed and nonenhancing
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LAP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
| rowspan="21" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inflammatory
! colspan="2" align="center" style="background:#DCDCDC;" |Acute sialadenitis <ref name="pmid28059621">{{cite journal |vauthors=Abdel Razek AAK, Mukherji S |title=Imaging of sialadenitis |journal=Neuroradiol J |volume=30 |issue=3 |pages=205–215 |date=June 2017 |pmid=28059621 |pmc=5480791 |doi=10.1177/1971400916682752 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* No sex predilection
 
* Occurs in all age groups
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* Presents with an unilateral erythematous swelling
 
* Bad breath
* Fever with chills
 
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Tender
 
* Firm
 
* Purulent discharge expressed from the duct
* Smooth
| align="center" style="background:#F5F5F5;" |
* Redness
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
* More common in people with bad oral hygiene
| align="center" style="background:#F5F5F5;" |
* ↑ ESR
 
* Leukocytosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Ultrasound: Hypoechoic with ductal dilatation
 
* CT: Diffuse homogeneous enlargement
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Chronic sialadenitis
| align="center" style="background:#F5F5F5;" |
* Benign
| align="center" style="background:#F5F5F5;" |
* No sex predilection
 
* Occurs in all age groups
| align="center" style="background:#F5F5F5;" |
* Presents with an unilateral swelling
* Recurrent episodes common
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Non-tender
 
* Firm
 
* Smooth
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Mostly due to obstruction by a stone or stricture
| align="center" style="background:#F5F5F5;" |
* ↑ ESR
 
* Leukocytosis
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! rowspan="4" align="center" style="background:#DCDCDC;" |Reactive viral lymphadenopathy
! align="center" style="background:#DCDCDC;" |CMV<ref name="pmid247536382">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref>
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| align="center" style="background:#F5F5F5;" |
* Age: 10-35 yrs mainly
 
* No sex predilection
| align="center" style="background:#F5F5F5;" |
* Flu-like illness
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Non-tender
* Soft
 
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Generalized/cervical
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* H&E stain: Typical owl-eye inclusions(nuclear)
 
* Basophilic cytoplasmic inclusions
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* FNAC & serology
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |EBV<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid25478033">{{cite journal |vauthors=Stuhlmann-Laeisz C, Oschlies I, Klapper W |title=Detection of EBV in reactive and neoplastic lymphoproliferations in adults-when and how? |journal=J Hematop |volume=7 |issue=4 |pages=165–170 |date=December 2014 |pmid=25478033 |pmc=4243011 |doi=10.1007/s12308-014-0209-0 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Age: Mainly adolescents
 
* Sex: No sex predilection
| align="center" style="background:#F5F5F5;" |
* Sore throat
 
* Fever
 
* Malaise
 
* Lymphadenopathy
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
* Non-tender
* Firm
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* B/L posterior cervical, axillary, inguinal
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Atypical lymphocytosis
 
* + Monospot test
 
* IgM & IgG antibodies
 
| align="center" style="background:#F5F5F5;" |
* CD8+ lymphocytes
 
* Tissue necrosis
 
* B lymphocyte blasts
 
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* FNAC & serology
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |HIV
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Flu-like illness
 
* Rash
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Viral URI
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! rowspan="6" align="center" style="background:#DCDCDC;" |Bacterial lymphadenopathy
! align="center" style="background:#DCDCDC;" |Tularemia
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Brucellosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Cat-scratch disease
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Actinomycosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Mycobacterial infections
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Staphylococcal or streptococcal infection
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Parasitic lymphadenopathy
! align="center" style="background:#DCDCDC;" |Toxoplasma gondii
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Sarcoidosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Amyloidosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Sjögren syndrome
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Castleman disease (angiofollicular lymphoproliferative disease)
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Kikuchi disease (histiocytic necrotizing lymphadenitis)
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Kimura disease
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Rosai-Dorfman disease
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Kawasaki disease
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign or Malignant
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LAP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="20" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neoplasm
! colspan="2" align="center" style="background:#DCDCDC;" |Primary thyroid tumor
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! rowspan="10" align="center" style="background:#DCDCDC;" |Salivary gland neoplasm
! align="center" style="background:#DCDCDC;" |Pleomorphic adenoma
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Warthin's tumor
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Lymphoepithelioma
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Oncocytoma
<ref name="pmid277220032">{{cite journal |vauthors=Chen B, Hentzelman JI, Walker RJ, Lai JP |title=Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology |journal=Case Rep Otolaryngol |volume=2016 |issue= |pages=8719030 |date=2016 |pmid=27722003 |pmc=5045990 |doi=10.1155/2016/8719030 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | +/-
| align="center" style="background:#F5F5F5;" |
* Race: Caucasian patients predilection
* Gender: No gender preference
* Age: 50–70 years
| align="center" style="background:#F5F5F5;" |
* Growing palpable painless mass


* Facial swelling
When surgical excision is not feasible, cosmetic benefit may potentially be obtained from procedures such as curettage, dermabrasion, and ablative laser therapy (eg, carbon dioxide or erbium:yttrium aluminum garnet lasers, sometimes combined with pigment-directed lasers). During the neonatal period, there is a lower risk of excessive scarring following such interventions, and nevus cells are more accessible because they are concentrated in the upper dermis [46,47]. Curettage can be performed during the first two weeks of life, taking advantage of a cleavage plane between the upper and mid-dermis exclusive to neonatal skin. However, nevus cells remain in the dermis after all of these procedures, as evidenced by frequent repigmentation as well as several reports of the subsequent development of melanoma in treated areas [48-52]. This underscores the need for lifelong clinical observation.
* Lymphadenopathy (if transformed to malignant)
| align="center" style="background:#F5F5F5;" | +/-
| align="center" style="background:#F5F5F5;" | +/-
| align="center" style="background:#F5F5F5;" |Firm, multilobulated and mobile mass
| align="center" style="background:#F5F5F5;" |
* Normal


* Redness
Regardless of the treatments employed, patients with large CMN (or scars after their excision) should be followed with periodic skin and general physical examinations. Palpation of the nevus and/or scars is essential for detection of focal induration. Histologic evaluation is indicated for firm nodules or indurated areas. Even theoretically complete removal of a large CMN does not eliminate the risk of melanoma, since melanoma of the CNS and other visceral primary sites (eg, the retroperitoneum) may still occur [53].
* Swelling
* Skin ulceration
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Normal


* Anemia
Proliferative nodules that develop within large CMN during infancy can have histologic features of melanoma yet behave in a benign manner. Techniques such as comparative genomic hybridization can help to distinguish proliferative nodules (usually having no chromosomal aberrations or only numeric changes) from melanoma (typically demonstrating gains/losses of chromosomal fragments) [40]. Mass spectroscopy imaging proteomic analysis may also help differentiate proliferative nodules from melanoma [29]. (See 'Proliferative nodules' above.)
| align="center" style="background:#F5F5F5;" |Epithelial cells with eosinophilic granular cytoplasm rich in mitochondria
| align="center" style="background:#F5F5F5;" |
* '''CT:''' 
** Isodense expansive mass
** Enhancement after intravenous contrast
** Hypodense areas
* '''MRI:'''
** Isodensties on T1
** Mass is hyperintense on T2
** Enhancement on contrast
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Pleomorphic adenoma <ref name="pmid10889498">{{cite journal |vauthors=Kim KH, Sung MW, Kim JW, Koo JW |title=Pleomorphic adenoma of the trachea |journal=Otolaryngol Head Neck Surg |volume=123 |issue=1 Pt 1 |pages=147–8 |date=July 2000 |pmid=10889498 |doi=10.1067/mhn.2000.102809 |url=}}</ref><ref name="pmid24431845">{{cite journal |vauthors=Pramod Krishna B |title=Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child |journal=J Maxillofac Oral Surg |volume=12 |issue=2 |pages=228–31 |date=June 2013 |pmid=24431845 |pmc=3681990 |doi=10.1007/s12663-010-0125-5 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |Benign
| align="center" style="background:#F5F5F5;" |
* Age: From 26 to 76 years


* Sex: No sex predilection
Surveillance for neurocutaneous melanosis — Patients with a large CMN plus multiple (especially >20) satellite nevi or with multiple medium-sized CMN are at risk for NCM and should be followed with serial head circumference measurements, neurologic examinations, and developmental assessments [3,37,39]. This monitoring includes evaluation for signs and symptoms of increased intracranial pressure, mass lesions, and spinal cord compression [3,39].
| align="center" style="background:#F5F5F5;" |
* Growing palpable painless mass on jaw or in oral cavity


* Facial swelling
Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spine should be performed in any high-risk patient exhibiting neurologic symptoms, and we suggest that asymptomatic high-risk patients also be screened for NCM with gadolinium-enhanced MRI of the brain and spine, ideally during the first six months of life before myelination, which may obscure evidence of melanosis [42]. For very young infants, it may be possible to obtain initial high-quality MRI images without general anesthesia using "feed and wrap" techniques that allow a swaddled infant to sleep during the imaging procedure [54].
* Lymphadenopathy (if transformed to malignant)
* Pain and ulceration (in later stage)
*
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| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Mucoepidermoid carcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Adenoid cystic carcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Adenocarcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Salivary duct carcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! align="center" style="background:#DCDCDC;" |Squamous cell carcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Parathyroid tumors
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Carotid body tumors
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Paraganglioma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Schwannoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Lymphoma
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Liposarcoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Lipoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Glomus vagale, glomus jugulare tumors
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Metastatic head and neck carcinoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! colspan="2" align="center" style="background:#DCDCDC;" |Hematoma
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Arteriovenous fistula
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! colspan="2" align="center" style="background:#DCDCDC;" |Goiter
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Skin changes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LAP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Others
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|}


===References===
Given the poor prognosis, aggressive surgical procedures for CMN removal should be postponed in patients with symptomatic NCM. NCM in an asymptomatic patient does not necessarily preclude skin surgery.
{{reflist|2}}


{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Diseases</small>
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''<small>Clinical manifestations</small>'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Para-clinical findings</small>
| rowspan="4" |<small>'''Pap Smear'''</small>
! rowspan="4" |<small>Histopathology</small>
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''<small>Gold standard</small>'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Additional findings</small>
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''<small>Symptoms</small>'''
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Physical examination</small>
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Lab Findings</small>
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Imaging</small>
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Menorrhagia</small>


! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Post Menstrual</small>
<small>Bleeding</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Pelvic P</small><small>ain</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Other</small>
<small>symptoms</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Pelvic examination</small>
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Abdominal examination</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Hb</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>B-HCG</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>CEA-19</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Ultrasound</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>MRI</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Uterine cancer|Endometrial]]</small> <small>[[Uterine cancer|cancer]]</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine sarcoma|<small>Uterine</small>]]
[[Uterine sarcoma|<small>sarcoma</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma|<small>Uterine</small>]]
[[Lymphoma|<small>lymphoma</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]


<small>or</small>


<small>N</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>Uterine</small> <small>[[leiomyoma]]</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]


<small>or</small>


<small>N</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>Malignant</small> <small>mixed</small>
<small>Mullerian</small>
<small>tumour</small>
<small>(MMMT)</small>
<small>of the uterus</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Cervical cancer|Cervical]]</small> <small>[[Cervical cancer|cancer]]</small>
<small>with</small>
<small>uterine</small>
<small>invasion</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Metastasis]]</small> <small>to the</small> <small>uterus</small> <small>from a</small>
<small>non-gynaecologcial</small>
<small>malignancy</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial polyp|<small>Endometrial</small>]]
[[Endometrial polyp|<small>polyp</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
<small>or</small>
<small>N</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrial hyperplasia|<small>Endometrial</small>]]
[[Endometrial hyperplasia|<small>hyperpalsia]]
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyoma|<small>Uterine</small>]]
[[Adenomyoma|<small>adenomyoma</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|<small>Hematometra</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|<small></small>]]<small>[[Gestational trophoblastic disease|Gestational]]</small>
[[Hematometra|<small></small>]]
[[Hematometra|<small></small>]]<small>[[Gestational trophoblastic disease|trophoblastic]]</small>
[[Hematometra|<small></small>]]<small>[[Gestational trophoblastic disease|disease]]</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|<small></small>]]<small>[[Retained products of conception|Incomplete]]</small>
[[Hematometra|<small></small>]]<small>[[Retained products of conception|abortion]]</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Fetus]]</small>
| style="background: #F5F5F5; padding: 5px;" |<small>No</small>
<small>Menstrual cycle</small>
| style="background: #F5F5F5; padding: 5px;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematometra|<small></small>]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|}


{|
{|
Line 1,565: Line 67:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Uterine cancer]]</small>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,582: Line 84:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterine sarcoma|<small>Uterine sarcoma</small>]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infection
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,633: Line 135:
!Additional findings
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Abscess'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Septic emboli'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Fungi'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |

Latest revision as of 16:22, 17 May 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]


Managemnet of Congenital melanocytic Nevi

https://www.uptodate.com/contents/congenital-melanocytic-nevi?search=melanocytic%20nevus%20pathophysiology&sectionRank=1&usage_type=default&anchor=H2&source=machineLearning&selectedTitle=1~44&display_rank=1#H2

MANAGEMENT

Small/medium CMN — Small and medium-sized CMN are managed on an individual basis depending on factors that affect ease of monitoring (eg, color, thickness/topography, and location), clinical history, parents' anxiety, and cosmetic concerns [4]. As an example, a multinodular black CMN on the scalp that is partially obscured by dense hair growth would be difficult to follow clinically, whereas a thin light brown lesion on the face would be relatively simple to observe. However, the latter might be removed for cosmetic reasons, and the former may spontaneously lighten during childhood.

Periodic evaluation of small- and medium-sized CMN is most important after puberty, since the risk of melanoma arising within these lesions during childhood is extremely low. Baseline photographs can be helpful, and dermoscopy represents a useful tool for assessing changes. (See "Dermoscopic evaluation of skin lesions".)

Patients and parents should be instructed to perform skin self-examinations and to bring focal changes in color, border, or topography (eg, a red or black papule, nodule, or crust) to the clinician's attention. (See "Screening and early detection of melanoma in adults and adolescents", section on 'Patient self-examination'.)

Large CMN — Early surgical removal is often desired for large CMN because of their cosmetic and psychosocial sequelae and concern for possible malignant transformation. Complete excision is difficult to achieve; however, resection of bulky and cumbersome portions of large CMN can be beneficial for some patients. Elimination of every nevus cell may be impossible because of the large area of skin affected, the anatomic site (eg, distal extremity, periocular area, genitalia), and involvement of deeper structures (eg, fat, fascia, muscle). Even theoretically complete surgical excision cannot completely eliminate future risk of melanoma, as some melanomas in these patients may develop in the CNS or retroperitoneum. In many cases, close clinical observation with no surgical removal of the lesion is a reasonable choice.

Factors that affect the decision to perform surgery as well as to determine the timing of surgery include the size and location of the large CMN, the technical difficulty of the procedure(s) required, and anesthesia options. When possible, complete removal of large CMN usually necessitates staged excision with the use of tissue expanders and, occasionally, skin grafting [45].

When surgical excision is not feasible, cosmetic benefit may potentially be obtained from procedures such as curettage, dermabrasion, and ablative laser therapy (eg, carbon dioxide or erbium:yttrium aluminum garnet lasers, sometimes combined with pigment-directed lasers). During the neonatal period, there is a lower risk of excessive scarring following such interventions, and nevus cells are more accessible because they are concentrated in the upper dermis [46,47]. Curettage can be performed during the first two weeks of life, taking advantage of a cleavage plane between the upper and mid-dermis exclusive to neonatal skin. However, nevus cells remain in the dermis after all of these procedures, as evidenced by frequent repigmentation as well as several reports of the subsequent development of melanoma in treated areas [48-52]. This underscores the need for lifelong clinical observation.

Regardless of the treatments employed, patients with large CMN (or scars after their excision) should be followed with periodic skin and general physical examinations. Palpation of the nevus and/or scars is essential for detection of focal induration. Histologic evaluation is indicated for firm nodules or indurated areas. Even theoretically complete removal of a large CMN does not eliminate the risk of melanoma, since melanoma of the CNS and other visceral primary sites (eg, the retroperitoneum) may still occur [53].

Proliferative nodules that develop within large CMN during infancy can have histologic features of melanoma yet behave in a benign manner. Techniques such as comparative genomic hybridization can help to distinguish proliferative nodules (usually having no chromosomal aberrations or only numeric changes) from melanoma (typically demonstrating gains/losses of chromosomal fragments) [40]. Mass spectroscopy imaging proteomic analysis may also help differentiate proliferative nodules from melanoma [29]. (See 'Proliferative nodules' above.)

Surveillance for neurocutaneous melanosis — Patients with a large CMN plus multiple (especially >20) satellite nevi or with multiple medium-sized CMN are at risk for NCM and should be followed with serial head circumference measurements, neurologic examinations, and developmental assessments [3,37,39]. This monitoring includes evaluation for signs and symptoms of increased intracranial pressure, mass lesions, and spinal cord compression [3,39].

Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spine should be performed in any high-risk patient exhibiting neurologic symptoms, and we suggest that asymptomatic high-risk patients also be screened for NCM with gadolinium-enhanced MRI of the brain and spine, ideally during the first six months of life before myelination, which may obscure evidence of melanosis [42]. For very young infants, it may be possible to obtain initial high-quality MRI images without general anesthesia using "feed and wrap" techniques that allow a swaddled infant to sleep during the imaging procedure [54].

Given the poor prognosis, aggressive surgical procedures for CMN removal should be postponed in patients with symptomatic NCM. NCM in an asymptomatic patient does not necessarily preclude skin surgery.




Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 1
Differential Diagnosis 2
Differential Diagnosis 3
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

Table for Differential Diagnosis of Small Intestine Cancer

ABBREVIATIONS:

N/A: Not available, NL: Normal,

References