1. Neck Masses Mohammed Mazhar Beddawi Raed Zakaria Al Bog Ahmmed Zaid Al Sabag

3. Some pearls:  90% of adult neck masses are malignant  90% of pediatric neck masses are infectious in nature  Know your anatomy then develop a differential diagnosis  Close observation  Generally, one course of a broad spectrum antibiotic is acceptable then …..

6.  It is never wrong to refer to a specialist for evaluation and probable biopsy  Imaging is important but tissue is everything  If you don’t get an answer with a FNA, repeat it up to three times. Consider ultrasound guided or CT guided FNA. REMEMBER

7. HISTORY  Age  Duration  Acute symptoms  Recent travel  Trauma  Insect bites, pets  Tobacco, alcohol, XRT

8. CONGENITAL  Central neck:  Thyroglossal duct cysts  Pyramidal lobe of thyroid  Sebaceous cysts  Hemangiomas  Laryngocele  Ectopic thyroid  Lateral neck:  Branchial cleft cysts  Cystic hygromas  Dermoids

9. Thyroglossal duct cyst

11. Branchial cleft cyst

12. Branchial cleft cysts

13. Branchial cleft cyst

14. Inflammation  Reactive lymphadenopathy  Sialoadenitis  Cervical adenitis

16. Infectious  Staph and strep  EBV – mono  TB  HIV  Cat scratch fever (Bartonella henselae)  Toxoplasmosis  Actinomycosis  Tick-borne: Rocky Mountain Spotted Fever  Lemierre’s Syndrome: septic thromb. IJV

17. Trauma  Hematoma  Acute and expanding  Chronic and organizing  AV fistula  Pseudoaneurysm

18. Metabolic, Idiopathic, Autoimmune  Castleman’s disease  Sarcoidosis  Kimura’s disease

19. Neoplasms  Benign:  Lipomas  Neuromas  Fibromas  Hemangiomas  Carotid body tumors  Angiomas

20. Neoplasms  Malignant  Thyroid  Squamous cell carcinoma (SCCA)  Lymphoma  Sarcoma  Salivary gland tumors  Metastasis:  SCCA, adenocarcinoma, undifferentiated carcinoma, melanoma

22. Management  1 course of broad spectrum antibiotics  Consider bloodwork and imaging  REFERAL

24. Pearls  Avoid excisional biopsies  Use CT but consider MRI for salivary gland problems  Role of ultrasound

25. THYROID

26. Evaluations of Nodular Thyroid Disease  History- symptoms, duration, familial  Physical findings, i.e. topography, firmness, surface, lymphadenopathy  Thyroid functions tests- TFT (s) - TSH

29. Diagnostic Studies- Thyroid Cancer Fine Needle Aspiration- Establishes Cytologic Diagnosis Thyroid function tests Technetium Scan- reflects trapping function, “hot nodule” Ultrasonography- reflects volume, composition, occult nodules

33. Thyroid Cancer- Diagnosis  Cytology  Scans  Technetium  Radioiodine  Sestamibi  MR/CT/PET  Ultrasound  Frozen Sections  Fixed Sections

34. Thyroid Cancers* Papillary80% Follicular11% Hürthle3% Medullary4% Anaplastic2%

35. Papillary Carcinoma  (Age, Distant Metastases, Extent, Size) AMES

37. Thank You