PERTINENT POSITIVES

MASS AT THE LATERAL ANTERIOR

NECK
ACUTE SUBACUTE CHRONIC

Common Uncommo Common Uncommo Rare Commo Uncomm Rare

n n n on
CMV infection Acute sialadenitis SCC of the upper Lymphoma Castlement Thyroid Brachial cleft cyst Liposarcoma
EBV infection AV Fistula aerodigestive Metastatic cancer disease pathology Carotid body Parathyroid
Staphylococcal or Hematoma tract Parotid tumor Kikuchi disease tumor carcinoma
Streptococcal HIV infection Kimura disease Glomus jugulare
infection Mycobacterial TB Rosai-Dorfman tumor
Toxoplasmosis infection disease Glomus vagale
Viral upper Parotid tumor
respiratory lymphadenopathy Laryngocele
infection Pseudoaneurysm Lipoma
Thyroglossal duct
cyst
 SUBACUTE DIFFERENTI
LYMPHOMA
METASTATIC CANCER
ALS
LYMPHOMA?

PAROTID TUMOR Painless Lymph

SQUAMOUS CELL CARCINOMA
node
Early constitutional
symptoms
Diffuse
Lymphadenopathy
Splenomegaly
 SUBACUTE DIFFERENTI
LYMPHOMA
METASTATIC CANCER
ALS
METASTASIS?
Constitutional
PAROTID TUMOR
SQUAMOUS CELL CARCINOMA
symptoms such as:
fever, chills, night
sweats, weight loss

Supraclavicular
lymphadenopathy:
FNAB reveals
malignancy in more
than half of cases
 SUBACUTE DIFFERENTI
LYMPHOMA
METASTATIC CANCER
ALS
PAROTID TUMOR?

PAROTID TUMOR
SQUAMOUS CELL CARCINOMA Unilateral
Asymtomatic
Slow-growing
Mobile masses
 SUBACUTE DIFFERENTI
LYMPHOMA
METASTATIC CANCER
ALS SCC?
nonhealing ulcers,
PAROTID TUMOR dysarthria, dysphagia,
SQUAMOUS CELL CARCINOMA
odynophagia, loose or
misaligned teeth, globus,
hoarseness, hemoptysis,
and oropharyngeal
paresthesias

Lymph nodes associated

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

provides valuable initial information regarding the size, extent,

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