COCLIA 88 Pediatric Neck Masses Ppt Powerpoint Presentation slides Anonymous Medical Slideshow Pediatric Neck Masses “Lumps and Bumps”

COCLIA 88 Pediatric Neck Masses

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Slide 1 :

Pediatric Neck Masses 4/21/2008

Slide 2 :

1. List congenital neck masses by their location in the neck. Branchial Cleft cysts: Comprise ~ 1/3 of CNM Definitive mechanism unclear (trapped cervical sinus vs. epithelial rests from Waldeyer's ring) Types: First: present near angle of mandible Work type I: a duplication of EAC; may be posterior Work type II: along EAC, middle ear cleft or nasopharynx medial or lateral to CN VII, terminate at level of ant. border of SCM, often open into EAC/below jaw

Slide 3 :

1. List congenital neck masses by their location in the neck. 2nd: deep to the anterior border of SCM; most common branchial anomaly (up to 95%) Type I- junction of middle and lower 1/3rd of muscle, deep to platysma Type II- in contact with great vessels Type III- pass between carotid branches Type IV-medial to great vessels at level of tonsil fossa 3rd: (rare) fistula opens along ant. border of SCM; courses posterior to carotid, superior to CN 12, inferior to CN 9, pierces thyrohyoid membrane 4th: (v. rare) originate at apex of pyriform sinus, lateral cervical cyst

Slide 4 :

1. List congenital neck masses by their location in the neck. Thyroglossal duct cysts: persistent epithelial tract remaining from thyroid descent midline neck, near level of hyoid (infrahyoid, suprahyoid). May also be intralingual, suprasternal, other. Paramedian location may lead to confusion with branchial cleft cyst crucial to differentiate from ectopic thyroid tissue Lymphatic malformation: Variable location; may occur anywhere in anterior or posterior neck. Microcystic often in tongue/FOM

Slide 5 :

1. List congenital neck masses by their location in the neck. Teratomas- usually anterolateral neck, extending from thyroid Dermoid Cysts- typically midline, usually in submental region. (also orbit, nose, np, oc) Laryngoceles- (abnl. dilation of laryngeal saccule) internal or external to thyrohyoid membrane Thymic cysts- (implant along descent of thymus into the chest). Almost all unilateral, L-sided SCM tumors of infancy- within SCM

Slide 6 :

2. Discuss the presentation and treatment of cervicofacial nontuberculous mycobacterial adenitis. Tunkel DE, Romaneschi KB. Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md, USA. Fifteen children with nontuberculous mycobacterial adenitis of the head and neck underwent surgical treatment between July 1991 and July 1994. Fine-needle aspiration for biopsy and culture allowed early diagnosis in nine children. Positive cultures grew Mycobacterium avium-intracellulare complex in 12 children and M. chelonei in one child. Total excision was performed in 10 cases with combinations of lymphadenectomy and salivary gland excision. Curettage was used to successfully treat five children. One patient required local flap coverage for primary wound repair. Two patients required more than one surgical procedure. Our approach to early diagnosis and surgical treatment of cervicofacial nontuberculous mycobacterial adenitis is presented.

Slide 7 :

2. Discuss the presentation and treatment of cervicofacial nontuberculous mycobacterial adenitis. Caused by M. avium-intracellulare, M. scrofulaceum, M. kansasii, M. fortuitum, M. haemophilum Definitively diagnosed by culture (takes several weeks) Most commonly in ant. sup. cervical region Tends to be unilateral (vs. b/l in TB) Suggested by painless, firm, enlarging mass in the face of ABX Management: antituberculous Rx, excision, incision and curettage

Slide 8 :

3. Give us a differential diagnosis for benign pediatric neck neoplasms. Lipomas: benign encapsulated fatty tumors; rare in head and neck. Rx: excision Thyroid adenomas: isolated mass within thyroid. Usually require excision Neurofibromas: arise from small cutaneous nerves; compsed of Schwann cells, nerve fibers, and fibroblasts. Rx: excision Pleomorphic adenomas: slow growing, painless. Rx: superficial parotidectomy

Slide 9 :

4. Give a differential diagnosis for malignant pediatric neck masses and specify the most common age group for each. Lymphoma- most common pediatric neck malignancy (60%) Hodgkins: more common in males of any age, but similar rates in adolescents. Biphasic incidence; teenagers and elderly Non-Hodkin's- peak incidence between ages 7-11 Rhabdomyosarcoma- most common soft-tissue sarcoma. Peak incidence, age 2-5 years; 15-19 years (13%) Thyroid carcinoma- uncommon, associated with exposure to ionizing radiation (10%) Saliary gland malignancies (2.5%) Neuroblastoma- 40% < 1 year, 35%, 1-2 years (5%) Nasopharyngeal carcinoma (5%)

Slide 10 :

5. Discuss the embryology and physical findings of 1st arch branchial cleft anomalies- type I and II. Aberrant development of the 1st branchial cleft may lead to formation of a cervical cyst or sinus in the region of the ear. Important distinction: Preauricular cysts/pits occur anterior to EAC, sup. to tragus..are inclusion cysts related to fusion of hillocks In contrast, true 1st branchial cleft anomalies are duplications of membranous EAC. May involve parotid, CN VII. Do not usually involve middle ear or TM Type I: ectoderm only Type II: ectoderm and mesoderm (also a duplication of cartilage)

Slide 11 :

6. What are the physical findings and clinical features of Pendred syndrome? How do you diagnose? congenital profound SNHL and goiter autosomal recessive disorder (defective pendrin protein leading to partial failure of iodine organification) Approx 50% euthyroid, 50% hypothyroid Diagnosed by clinical findings and perchlorate test

Slide 12 :

7. Name common types of lymphoma in children and treatment regimens (+side effects) for each. Classified into low, intermediate, high-grade (90% have high-grade disease at presentation) High grade types: Large cell, lymphoblastic, and small cell non-cleaved Multidrug therapy: cyclophosphamide, doxorubicin, vincristine, and prednisone

Slide 13 :

8. Describe the course of 2nd and 3rd arch anomalies with specific relation to pertinent neurovascular structures. 2nd arch:

Slide 14 :

9. Describe preoperative workup and considerations for thyroglossal duct cysts, treatment and success rates. Preop: thyroid ultrasound and radionucleotide scanning to differentiate from ectopic thyroid tissue Sistrunk: removal of cyst along with a cuff of tissue including the center portion of the hyoid bone. Avoid I&D. Recurrence 5-10% if uncomplicated (vs. nearly 50% for simple cyst excision Other considerations: thyroid Ca in gland- what to do?

Slide 15 :

10, 11. Describe the etiology, physical exam findings, and treatment options for cystic hygromas with success rates (hint: surgical and non-surgical treatment). Etiology- failure of lymphatics to connect to the venous system, abnormal budding of tissue, and sequestered embryonic rests that can penetrate adjacent structures 75% occur in head and neck; more frequently left-sided, involving posterior triangle. Typically soft, painless, compressible on exam. Treatment: Surgical treatment: complete excision (only possible in <50%). Should spare vital structures, as lesion is benign. Non-surgical treatment: sclerotherapy with OK-432, bleomycin, alcohol, interferon

Slide 16 :

12. Give the differential diagnosis and treatment for inflammatory/infectious pediatric neck masses. Viral lymphadenopathy (adenoviruses, rhinovirus, enterovirus, EBV, etc.) Rx: observation Bacterial lyphadenopathy (S. aureus, group A strep) Rx: oral/IV ABX; I&D if failure Cat-Scratch disease- (B. henselae; usually <20 years, h/o feline contact). Rx: azithromycin, aminoglycoside, or cipro. Surgery rarely Toxoplasmosis (poorly cooked meat; lymphadenitis over 90%; confirmed with serology) Rx: pyrimethamine or sulfonamides Sialadenitis Also mycobacterial, tularemia, brucellosis, fungal

Slide 17 :

12. Give the differential diagnosis and treatment for inflammatory/infectious pediatric neck masses. Noninfectious Kawasaki disease (multisystem vasculitis; nonpurulent cervical LAD) Rx: ASA, gamma- globulin Drug-induced (esp. phenytoin, pyrimethamine, allopurinol Sinus Histiocytosis (Rosai-Dorfman disease) massive nontender cervical LAD similar to mono or lymphoma; may be abnormal response to viral cause biopsy shows dilated sinuses, plasma cells, histocytes Rx: observation

Slide 18 :

13. When is surgical vs. nonsurgical treatment indicated for rhabdomyosarcoma? What is nonsurgical therapy? Management includes combination of surgery, XRT, chemo. Treatment determined by site, extent, and presence of recurrence If tumor can be resected completely, pt can avoid radiotherapy Radiotherapy to the primary site given at 5000-6000 Gy if >3 years, less in younger 2/3 with long-term survival or cure

Slide 19 :

14. What is MEN II a and b? What is the chromosomal abnormality and what is the role of elective thyroidectomy in this population? MEN IIA (Sipple syndrome) medullary thyroid Ca (bilateral, multifocal disease), hyperparathyroidism, pheochromocytoma, lichen planus amyloidosis, Hirschsprung's disease. Medullary Ca seen in nearly all; other features have variable penetrance. Autosomal dominant. Elective thyroidectomy recommended in all patients, as young as 5 years. MEN IIB Medullary thyroid Ca (more aggressive than IIA), mucosal neuromas, pheochromocytoma, often marfanoid habitus Thyroidectomy in infancy if RET identified RET proto-oncogene: codes for tyrosine-kinase receptor at chromosoe 10q11.2

Slide 20 :

16. Review pediatric parotid masses. Arch Otolaryngol Head Neck Surg 2000;126:177. Parotid masses were identified in 118 children (60 boys and 58 girls). At diagnosis, the ages of patients were from birth through 18 years, and 72 (61.0%) were aged 10 years and older. An asymptomatic mass was the most common presentation. Forty-three patients (36.4%) had infectious or inflammatory lesions, 56 (47.5%) had benign lesions, and 19 (16.1%) had malignant lesions. The most common benign lesions were pleomorphic adenoma (22.9%) and hemangioma (10.2%). The most common malignant lesions were mucoepidermoid carcinoma (6.8%) and acinic cell carcinoma (3.4%). The most common treatment was total parotidectomy (40.7%). Surgical complications included temporary facial nerve weakness in 22 (18.6%) patients, permanent facial weakness in 11 (9.3%), and permanent paralysis in 2 (1.7%). Pleomorphic adenoma recurred in 4 (14.8%) of 28 patients and mucoepidermoid carcinoma in 3 (37.5%) of 8 patients. One patient with adenoid cystic carcinoma died of the tumor.

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