Transcript 1. What is your clinical impression?

1. What is your clinical
impression?
Differential Diagnosis
TB adenopathy
Lymphoma
Lymphadenitis
from aphthous
ulcer
Metastatic
carcinoma from
oral cavity cancer
TB adenopathy
• … in developing countries…
• Tuberculosis: most common cause of cervical lymph node
enlargement
• Peripheral lymph node tuberculosis is the most common form
of extrapulmonary tuberculosis
• Cervical tuberculous lymphadenopathy (scrofula) is still the
most common cause of persistent cervical lymph node
enlargement
– unilateral, with little or no pain, advanced disease may suppurate
and form a draining sinus
• diagnosis is established by fine-needle aspiration or surgical
biopsy
– AFB are seen in up to 50% of cases
– cultures are positive in 70 to 80%
– histologic examination shows granulomatous lesions
http://pmj.bmj.com/cgi/content/full/77/905/185#SEC3
http://www.javeriana.edu.co/Facultades/Medicina/pediatria/revis/
eMedicine%20-%20Tuberculosis%20%20Article%20by%20Thomas%20Herchline,%20MD.htm
Lymphoma
• Lymphoma may be nodal or extranodal
• A quarter of all extranodal lymphomas occur
in the head and neck
– Extranodal lymphoma is usually NHL
• 8% of findings on supraclavicular fine-needle
aspirate biopsy yield a diagnosis of lymphoma
• Lymphoma is the second most common
primary malignancy occurring in the head and
neck
• Incidence of aggressive non-Hodgkin
lymphoma has risen steadily over recent
decades
http://emedicine.medscape.com/article/854110-overview
Non-Hodgkin’s Lymphoma
• May manifest in the cervical region and lymphoid
tissue of the Waldeyer ring
• Appears as a mass in the oropharynx or nasopharynx
• Unilateral tonsillar enlargement is highly suggestive of
malignancy.
• Usually arises in the tongue base
• In contrast to squamous cell carcinoma, NHL is bulky,
fleshy, and nonulcerating
• Some patients with indolent NHLs may have large
asymptomatic abdominal masses
– Splenic or hepatic enlargement
http://emedicine.medscape.com/article/854110-overview
Lymphadenitis from Aphthous ulcer
• lymphadenitis is an infection of the lymph nodes; a
complication of bacterial infection
• swollen glands are usually found near the site of an
underlying infection, tumor, or inflammation 
apthous ulcer
– Apthous ulcer also known as APHTHOUS STOMATITIS
– painful open sore inside the mouth, caused by a break in
the mucous membrane
– Etiology is unknown
• Lymphadenitis may occur after skin infections or other
bacterial infections, particularly those due to
streptococcus or staphylococcus
Metastatic Carcinoma from oral cavity
cancer
• 5% percent of all cancers reported yearly
– 30% of these cancers occur in the oral cavity
• squamous cell carcinoma- (most common) 95% of oral
cavity cancer
• Risk Factors:
– use of tobacco/ smoking
• 80% of patients with oral SCC
• risk of developing malignancy is 5-9 times greater for smokers than
nonsmokers
– Alcohol- 3-9 times greater risk of developing cancer
– of alcohol and tobacco combined may convey a risk
greater than 100 times the general population
– HPV types 16 and 18 may be found in approximately 22%
and 14% of oropharyngeal tumors
http://www.ahns.info/patienteducation/docs/oralcavity.php
http://emedicine.medscape.com/article/847678-overview
Metastatic Carcinoma from oral cavity
cancer
• Symptoms
• most common presentation of cancer of the floor of the
mouth is a painless inflamed superficial ulcer with poorly
defined margin
• Intermittent bleeding may occur
• Advanced cases: complaints may include new or increased
pain, pain on swallowing, ear pain, a change in speech,
uncoordinated swallowing, or a lump in the neck
• sores in the mouth, whether they are related to trauma or
to a variation of canker (apthous) sores, should fully heal
within three weeks
http://www.ahns.info/patienteducation/docs/oralcavity.php
Metastatic Carcinoma from oral cavity
cancer
• Metastatic neck disease is the most important
factor in the spread of head and neck
squamous cell carcinoma (SCC) from primary
sites
• most commonly involved primary sites
– larynx, oropharynx, hypopharynx, and oral cavity
• Malignant tumors of the oral cavity grow
rapidly, with frequent and early metastasis to
the surrounding regional lymph nodes
http://emedicine.medscape.com/article/850195-overview
Clinical Impression:
METASTATIC CARCINOMA FROM ORAL
CAVITY CANCER