A lump in the neckA lump in the neck

Case 1Case 1

A 55yr old man presents to his GP A 55yr old man presents to his GP with a progressively enlarging lump with a progressively enlarging lump at the side of his neck by his jaw.at the side of his neck by his jaw.

What are the possible causes of a What are the possible causes of a swelling in neck? swelling in neck?

Possible causesPossible causes

Lymph nodesLymph nodes Salivary glands - parotidSalivary glands - parotid LipomaLipoma Sebaceous cystSebaceous cyst Branchial cystBranchial cyst Carotid body tumourCarotid body tumour Pharngeal pouchPharngeal pouch Cervical ribCervical rib Neuromas, nerve tumours, cystic hygroma Neuromas, nerve tumours, cystic hygroma

(infants), larngocoele(infants), larngocoele

Examination revealed a non-tender, Examination revealed a non-tender, non-fluctuant fixed lump in front of non-fluctuant fixed lump in front of and below the tragus of the ear.and below the tragus of the ear.

This was shown to be a parotid This was shown to be a parotid lumplump

What else would you need to What else would you need to examine?examine?

Parotid (Stensen’s) Duct Parotid (Stensen’s) Duct Opposite upper 2Opposite upper 2ndnd molar tooth molar tooth ? pus from opening? pus from opening

VII nerveVII nerve Regional lymph nodesRegional lymph nodes

Causes of parotid swellingCauses of parotid swelling

TumourTumour Mixed tumoursMixed tumours

90% in parotid90% in parotid Mostly benignMostly benign Local recurrence big issue if badly excisedLocal recurrence big issue if badly excised

ParotitisParotitis Mikulicz’ syndromeMikulicz’ syndrome

In sarcoid, sjogren’s, TBIn sarcoid, sjogren’s, TB Replacemnt of glandular tissue with Replacemnt of glandular tissue with

lymphocyteslymphocytes

Case 2Case 2

A 24 yr old man presents with an A 24 yr old man presents with an enlarged lymph node in the right enlarged lymph node in the right posterior triangle. It is painless but he posterior triangle. It is painless but he hasn’t felt well, being tired, off his food, hasn’t felt well, being tired, off his food, losing weight and getting awful night losing weight and getting awful night sweats.sweats.

What are the possible causes of the What are the possible causes of the enlarged node?enlarged node?

What else would you need to examine?What else would you need to examine?

Causes of lymphadonopathyCauses of lymphadonopathy

InfectionInfection AcuteAcute

Pyogenic infectionsPyogenic infections Infectious mononucleosisInfectious mononucleosis ToxoplasmosisToxoplasmosis Infected eczemaInfected eczema CMVCMV

ChronicChronic TBTB SarcoidosisSarcoidosis SyphilisSyphilis HIVHIV

Causes of lymphadonopathyCauses of lymphadonopathy

MalignancyMalignancy PrimaryPrimary

Hodgkins lymphomaHodgkins lymphoma Non-Hodgkins lymphomaNon-Hodgkins lymphoma CLLCLL ALLALL

SecondarySecondary NasopharngealNasopharngeal ThyroidThyroid LungLung BreastBreast Stomach (“Troisier’s sign”)Stomach (“Troisier’s sign”)

Need to examine other sites for Need to examine other sites for lymph nodeslymph nodes

Abdominal examination for Abdominal examination for hepatosplenomegalyhepatosplenomegaly

Examination of the neck lymph Examination of the neck lymph nodesnodes

Need systematic approach to cover all Need systematic approach to cover all areasareas

Work out a plan and now practice on Work out a plan and now practice on each othereach other