Sandbox:Qurrat: Difference between revisions

Jump to navigation Jump to search
Line 929: Line 929:
|-
|-
! align="center" style="background:#DCDCDC;" |Mucoepidermoid carcinoma
! align="center" style="background:#DCDCDC;" |Mucoepidermoid carcinoma
<ref name="pmid21243374">{{cite journal |vauthors=Chenevert J, Barnes LE, Chiosea SI |title=Mucoepidermoid carcinoma: a five-decade journey |journal=Virchows Arch. |volume=458 |issue=2 |pages=133–40 |date=February 2011 |pmid=21243374 |doi=10.1007/s00428-011-1040-y |url=}}</ref>
| align="center" style="background:#F5F5F5;" |Malignant
| align="center" style="background:#F5F5F5;" |Malignant
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
Line 936: Line 937:
*  
*  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Painlesss mass
| align="center" style="background:#F5F5F5;" |
* Swelling in oral cavity
| align="center" style="background:#F5F5F5;" |
* Lympadenopathy
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |+/-
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |+/-
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Cystic and solid mass
| align="center" style="background:#F5F5F5;" |Normal
 
| align="center" style="background:#F5F5F5;" |+/-
| align="center" style="background:#F5F5F5;" |Association with CMV
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Macroscopic findings:
| align="center" style="background:#F5F5F5;" |Macroscopic findings:
Line 948: Line 953:
* Bosselated  
* Bosselated  
* Cystic
* Cystic
| align="center" style="background:#F5F5F5;" | cystic component with variable appearance
| align="center" style="background:#F5F5F5;" | Gross:
cystic and solid component with variable appearance
 
Microscopic:
 
Encapsulated  squamous and glandular components


| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" | Incisional biopsy and histopathological examination
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
|-
|-

Revision as of 22:50, 7 February 2019


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

tab

Differential diagnosis of neck masses

Differential diagnosis of neck masses include:

Category Diseases Benign or Malignant Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Skin changes LAP Others
Congenital Branchial cleft cyst[1]
  • Benign
  • Age: 1-15 yrs/ varies
  • Familial occurence is noted
  • Lateral neck mass
- +/-
  • Solitary
  • Smooth
  • Mobile
  • Welldefined
  • Nonpulsatile
  • Fluctuant
  • A pit is found at the opening of the cyst
- - -
  • Squamous or ciliated epithelial lining
  • Lymphoid tissue with germinal centers and subcapsular sinuses
  • CT: Well defined fluid attenuation with slight enhancement of the capsule
  • Ultrasound: Typical features of a cyst are seen
  • Brachio-oto-renal syndrome
  • Sinus
  • Fistula
Thyroglossal duct cyst[2][3]
  • Benign
  • Age: 1-10 yrs/ varies
  • Midline neck mass
- -
  • Mobile
  • Moves upwards with tongue protrusion and swallowing
- - - -
  • Squamous or ciliated pseudostratified columnar lining
  • Foci of thyroid gland tissue
  • Granulation tissue or giant cells if it gets infected
  • 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
-
Haemangioma[4]
  • Benign
  • Age: birth - 2 yrs
  • Females>males
  • Usually present with a flat red or purple patch
- -
  • Firm
  • Rubbery
  • Well-demarcated
  • Blanching
  • Telangiectasias
  • Erythematous patch
- -
  • GLUT-1
  • VEGF
  • Urinary BFGF
  • Lined by non atypical endothelial cells
  • Vascular structures with RBC
  • Ultrasound: High flow with vascular channels
  • MRI: With or without Gd is the modality of choice
  • POEMS and Castleman's disease
Vascular malformations
Lymphatic malformations
Laryngocele[5][6][7]
  • Benign
  • More common in adults
  • Male: female = 5:1
  • Present with a neck swelling, hoarseness, stridor and globus sensation
  • Episodic in nature
- +/-
  • Soft
  • Reducible
  • Increase in size on valsalva
- -
  • Common in glass blowers, trumpet players
-
  • Lined by pseudostratified ciliated epithelium
  • X-ray, CT: Fluid and air containing cystic masses
  • CT is the preferred one
  • CT scan is the gold standard imaging for diagnosis
-
Ranula[8]
  • Benign
  • Age: 1st and 2nd decade
  • Female: male=1:1.4
  • Present with a blue colored swelling in the floor of the mouth
- -
  • Well circumscribed
  • Fluctuant
  • Soft
-
Teratoma Incidence: 1:4000 births High ALP levels
Dermoid cyst[9][10]
  • Benign
  • Incidence: 3 per 10000 population
  • Age: birth - 5 yrs
  • Presents as a slow growing mass or a sinus
- -
  • Freely mobile/Fixed
  • Solitary
  • Rubbery
  • Nonpulsatile
  • Noncompressible
  • Usually normal/sometimes a pit or sinus is seen
  • A tuft of hair at the center of the pit for nasal dermoid cyst
- -
  • Keratinizing squamous epithelium
  • Occasional remnants of hair follicles,adipose tissue, and sweat glands
  • Ultrasound: Thin walled, unilocular
  • CT: With contrast well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
Thymic cyst[11]
  • Benign
  • Age: 1-10 yrs
  • Males>Females
  • Presents as a soft mass, gradually enlarging, on left side of the neck(usual)
- -
  • Soft
  • Compressible
- -
  • Squamous/cuboidal epithelium
  • Lymphoid tissue in the cyst wall contains hassall corpuscles
  • Ultrasound: Unilocular cystic mass
  • CT: Uni/multilocular, well circumscribed and nonenhancing
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis [12]
  • Benign
  • No sex predilection
  • Occurs in all age groups
  • Presents with an unilateral erythematous swelling
  • Bad breath
  • Fever with chills
+ -
  • Tender
  • Firm
  • Purulent discharge expressed from the duct
  • Smooth
  • Redness
+
  • More common in people with bad oral hygiene
  • ↑ ESR
  • Leukocytosis
  • Ultrasound: Hypoechoic with ductal dilatation
  • CT: Diffuse homogeneous enlargement
Chronic sialadenitis
  • Benign
  • No sex predilection
  • Occurs in all age groups
  • Presents with an unilateral swelling
  • Recurrent episodes common
+ -
  • Non-tender
  • Firm
  • Smooth
  • Mostly due to obstruction by a stone or stricture
  • ↑ ESR
  • Leukocytosis
Reactive viral lymphadenopathy CMV[13]
  • Age: 10-35 yrs mainly
  • No sex predilection
  • Flu-like illness
- -
  • Non-tender
  • Soft
  • Generalized/cervical
  • H&E stain: Typical owl-eye inclusions(nuclear)
  • Basophilic cytoplasmic inclusions
  • FNAC & serology
EBV[14][15]
  • Age: Mainly adolescents
  • Sex: No sex predilection
  • Sore throat
  • Fever
  • Malaise
  • Lymphadenopathy
- -
  • Non-tender
  • Firm
  • B/L posterior cervical, axillary, inguinal
  • Atypical lymphocytosis
  • + Monospot test
  • IgM & IgG antibodies
  • CD8+ lymphocytes
  • Tissue necrosis
  • B lymphocyte blasts
  • FNAC & serology
HIV
  • Flu-like illness
  • Rash
Viral URI
Bacterial lymphadenopathy Tularemia
Brucellosis
Cat-scratch disease
Actinomycosis
Mycobacterial infections
Staphylococcal or streptococcal infection
Parasitic lymphadenopathy Toxoplasma gondii
Sarcoidosis
Amyloidosis
Sjögren syndrome
Castleman disease (angiofollicular lymphoproliferative disease)
Kikuchi disease (histiocytic necrotizing lymphadenitis)
Kimura disease
Rosai-Dorfman disease
Kawasaki disease
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Primary thyroid tumor
Salivary gland neoplasm Pleomorphic adenoma +
Warthin's tumor +
Lymphoepithelioma +
Oncocytoma

[16]

Benign
  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
  • Growing palpable painless mass
  • Facial swelling
  • Lymphadenopathy (if transformed to malignant)
+/- +/- Firm, multilobulated and mobile mass
  • Normal
  • Redness
  • Swelling
  • Skin ulceration
-
  • Normal
  • Anemia
Epithelial cells with eosinophilic granular cytoplasm rich in mitochondria
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
Incisional biopsy and histopathological examination
Monomorphic adenoma [17][18][19] Benign
  • Age: From 26 to 76 years
  • Rare in children
  • Sex: No sex predilection
  • Growing palpable painless mass on jaw or in oral cavity
  • Facial swelling
  • Lymphadenopathy (if transformed to malignant)
  • Pain and ulceration (in later stage)
+/- +/- Nodular and fluctuant swelling
  • Normal
  • Redness
  • Skin ulceration
+/- Normal
  • Straw colored fluid on aspiration
Ultrasound:
  • Used to biopsy the lesion
  • May show cystic an solid components

CT:

  • useful for lesions with calcification and venous pleboliths

MRI:

  • Test of choice
  • Differentiate benign from malignant
  • Defines tumor extent
  • Shows perineural spread
Incisional biopsy and histopathological examination
Mucoepidermoid carcinoma

[20]

Malignant
  • Age:: Mean age of 59
  • Gender: Female predilection
  • Painlesss mass
  • Swelling in oral cavity
  • Lympadenopathy
+/- +/- Cystic and solid mass Normal +/- Association with CMV Macroscopic findings:
  • Firm
  • Tan-white to yellow
  • Bosselated
  • Cystic
Gross:

cystic and solid component with variable appearance

Microscopic:

Encapsulated squamous and glandular components

Incisional biopsy and histopathological examination
Adenoid cystic carcinoma
Adenocarcinoma
Salivary duct carcinoma
Squamous cell carcinoma
Parathyroid tumors
Carotid body tumors
Paraganglioma
Schwannoma
Lymphoma
Liposarcoma
Lipoma
Glomus vagale, glomus jugulare tumors
Metastatic head and neck carcinoma
Other Hematoma
Arteriovenous fistula
Goiter
Category Diseases Benign Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

  1. Nahata, Vaishali (2016). "Branchial cleft cyst". Indian Journal of Dermatology. 61 (6): 701. doi:10.4103/0019-5154.193718. ISSN 0019-5154.
  2. Amos J, Shermetaro C. PMID 30085599. Missing or empty |title= (help)
  3. Deaver MJ, Silman EF, Lotfipour S (August 2009). "Infected thyroglossal duct cyst". West J Emerg Med. 10 (3): 205. PMC 2729228. PMID 19718389.
  4. Léauté-Labrèze, C.; Prey, S.; Ezzedine, K. (2011). "Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities". Journal of the European Academy of Dermatology and Venereology. 25 (11): 1245–1253. doi:10.1111/j.1468-3083.2011.04102.x. ISSN 0926-9959.
  5. Werner RL, Schroeder JW, Castle JT (March 2014). "Bilateral laryngoceles". Head Neck Pathol. 8 (1): 110–3. doi:10.1007/s12105-013-0478-4. PMC 3950389. PMID 23881550.
  6. Prasad KC, Vijayalakshmi S, Prasad SC (December 2008). "Laryngoceles - presentations and management". Indian J Otolaryngol Head Neck Surg. 60 (4): 303–8. doi:10.1007/s12070-008-0108-8. PMC 3476818. PMID 23120570.
  7. Mahdoufi R, Barhmi I, Tazi N, Abada R, Roubal M, Mahtar M (July 2017). "Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection". Iran J Otorhinolaryngol. 29 (93): 225–228. PMC 5554815. PMID 28819622.
  8. Packiri S, Gurunathan D, Selvarasu K (September 2017). "Management of Paediatric Oral Ranula: A Systematic Review". J Clin Diagn Res. 11 (9): ZE06–ZE09. doi:10.7860/JCDR/2017/28498.10622. PMC 5713871. PMID 29207849.
  9. Paradis, Josée; Koltai, Peter J. (2015). "Pediatric Teratoma and Dermoid Cysts". Otolaryngologic Clinics of North America. 48 (1): 121–136. doi:10.1016/j.otc.2014.09.009. ISSN 0030-6665.
  10. Gaddikeri S, Vattoth S, Gaddikeri RS, Stuart R, Harrison K, Young D, Bhargava P (2014). "Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation". Curr Probl Diagn Radiol. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. PMID 24629659.
  11. Gaddikeri, Santhosh; Vattoth, Surjith; Gaddikeri, Ramya S.; Stuart, Royal; Harrison, Keith; Young, Daniel; Bhargava, Puneet (2014). "Congenital Cystic Neck Masses: Embryology and Imaging Appearances, With Clinicopathological Correlation". Current Problems in Diagnostic Radiology. 43 (2): 55–67. doi:10.1067/j.cpradiol.2013.12.001. ISSN 0363-0188.
  12. Abdel Razek A, Mukherji S (June 2017). "Imaging of sialadenitis". Neuroradiol J. 30 (3): 205–215. doi:10.1177/1971400916682752. PMC 5480791. PMID 28059621. Vancouver style error: initials (help)
  13. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  14. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  15. Stuhlmann-Laeisz C, Oschlies I, Klapper W (December 2014). "Detection of EBV in reactive and neoplastic lymphoproliferations in adults-when and how?". J Hematop. 7 (4): 165–170. doi:10.1007/s12308-014-0209-0. PMC 4243011. PMID 25478033.
  16. Chen B, Hentzelman JI, Walker RJ, Lai JP (2016). "Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology". Case Rep Otolaryngol. 2016: 8719030. doi:10.1155/2016/8719030. PMC 5045990. PMID 27722003.
  17. Kim KH, Sung MW, Kim JW, Koo JW (July 2000). "Pleomorphic adenoma of the trachea". Otolaryngol Head Neck Surg. 123 (1 Pt 1): 147–8. doi:10.1067/mhn.2000.102809. PMID 10889498.
  18. Pramod Krishna B (June 2013). "Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child". J Maxillofac Oral Surg. 12 (2): 228–31. doi:10.1007/s12663-010-0125-5. PMC 3681990. PMID 24431845.
  19. Kessler AT, Bhatt AA (2018). "Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions". J Clin Imaging Sci. 8: 48. doi:10.4103/jcis.JCIS_46_18. PMC 6251244. PMID 30546932.
  20. Chenevert J, Barnes LE, Chiosea SI (February 2011). "Mucoepidermoid carcinoma: a five-decade journey". Virchows Arch. 458 (2): 133–40. doi:10.1007/s00428-011-1040-y. PMID 21243374.
Diseases Clinical manifestations Para-clinical findings Pap Smear Histopathology Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Menorrhagia Post Menstrual

Bleeding

Pelvic Pain Other

symptoms

Pelvic examination Abdominal examination Hb B-HCG CEA-19 Ultrasound MRI
Endometrial cancer + + +
Uterine

sarcoma

+/- + +
Uterine

lymphoma

+/- +/-

or

N

Uterine leiomyoma +/- +/-

or

N

Malignant mixed

Mullerian

tumour

(MMMT)

of the uterus

+/- +/-
Cervical cancer

with

uterine

invasion

+ +
Metastasis to the uterus from a

non-gynaecologcial

malignancy

+ +
Endometrial

polyp

+ + +

or

N

Endometrial

hyperpalsia

+ + +
Uterine

adenomyoma

- - +
Hematometra - - +
Gestational

trophoblastic

disease

Incomplete

abortion

Fetus No

Menstrual cycle

+/- -
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
Uterine cancer
Uterine sarcoma
Infection
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
Abscess
Septic emboli
Fungi
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