Presentation on theme: "1. Advantages of ultrasound imaging include:"— Presentation transcript:
1 1. Advantages of ultrasound imaging include: A. Imaging modality of choice for thyroidB. Doppler sonography can be used for assessment of blood flowC. Scanning in the sagittal plane offers optimal visualizationD. A and BE. All of the aboveD Transverse/axial plane better for visualization
2 2. Features suggestive of malignancy in a thyroid nodule include all of the following EXCEPT: A. HyperechoicB. MicrocalcificationsC. Increased blood flow on DopplerD. Tail shapeE. Irregular borderA. Also hypoechoic, absence of halo, tail shape
3 3. Parathyroid imaging on ultrasound: A Is less accurate than sestamibi scans in localizing a solitary adenomasB. Normal parathyroid glands can be visualized with high resolution ultrasonographyC. Parathyroid adenomas are hyperechoic relative to the thyroid glandD. Superior parathyroid glands are on a deeper plane than the inferior glandsE. Ectopic parathyroid gland may be visualized on ultrasound in the posterior mediastinumD. US accurate in localizing PTH adenoma in 90%, normal glands <40 mg not visualized with US of 7-15 Mhz, adenomas hypoechoic, unable to visualize posterior mediastinum with US, superior PTH gland deep to recurrent nerve (inf thyroid artery or posterior sfc of common carotid)
4 4. Ultrasound imaging of salivary glands: A. Is useful for differentiating sialadenitis from neoplasms and lymphadenopathyB. Is useful for imaging deep lobe parotid tumorsC. Shows similar echogenicity to the thyroidD. A and CE. All of the aboveD. Unable to image deep lobe and parapharyngeal space due to mandible
5 5. Ultrasound characteristics of salivary malignancies include: A. CalcificationsB. Smooth shapeC. Increased vascularity on Doppler imagingD. Ovoid lesion with short axis less than 5 mmE. Homogeneous echostructureCNormal lymph node– ovoid hypoechoic lesion with echogenic hilum, short axis less than 5-6 mm
6 6. Ultrasound imaging for head and neck cancer: A. Can detect metastatic lymph nodes not detected by CT or MRIB. Round shape of lymph node suggests malignancyC. Intranodal cystic degeneration suggests malignancyD. Can be used to avoid elective neck dissection in NO necksE. All of the aboveE
7 7. Ultrasound-guided fine needle aspiration: A. Is done using a 27 gauge needleB. Aspiration is performed firstC. Bevel of the needle is pointed away from the transducerD. Needle should be irrigated with fixative prior to insertionE. The needle should be used to shave cells along the needle pathE.22 G needle, capillary action 1st , (Hold needle in place to allow for capillary action, also rotate tip), bevel toward the transducer to increase echogenicity of the tip, after irrigation of needle with fixative should be discarded
8 Sagittal US image of nodule (arrowheads) containing multiple fine echogenicities (arrow) with no comet-tail artifact. These are highly suggestive of malignancy. FNA and surgery confirmed papillary carcinoma.
10 Sagittal image of solid nodule (arrowheads), which proved to be papillary carcinoma.
11 Sagittal image of predominantly solid nodule (arrowheads), which proved to be benign at cytologic examination
12 Transverse image of mixed solid and cystic nodule (calipers), which proved to be benign at cytologic examination
13 Sagittal image of predominantly cystic nodule (calipers), which proved to be benign at cytologic examination
14 Sagittal image of cystic nodule (arrowheads) Sagittal image of cystic nodule (arrowheads). FNA of this presumed benign lesion was not performed
15 Transverse gray-scale image of predominantly solid thyroid nodule (calipers).
16 Addition of color Doppler mode shows marked internal vascularity, indicating increased likelihood that nodule is malignant. This was a papillary carcinoma.
17 Abnormal cervical lymph nodes Abnormal cervical lymph nodes. (a) Sagittal US image of enlarged node (calipers) with central punctate echogenicities, consistent with microcalcifications, shows mass effect on internal jugular vein (V). Node was proved to be metastatic papillary carcinoma
18 Sagittal US image of enlarged node (calipers) with cystic component Sagittal US image of enlarged node (calipers) with cystic component. Node was proved to be metastatic papillary carcinoma.
19 8. Normal paraganglia contain all of the following EXCEPT: A. Sustentacular cellsB. Cells which stain positively with S-100C. Schwann cellsD. Chief cellsE. Catecholamine-containing cellsc
20 9. The following is true about paragangliomas: A. The most common type is the pheochromocytomaB. 10% occur in the head and neckC. Secretion of epinephrine from head and neck paragangliomas may occurD. Vagal paragangliomas are more common than jugulotympanic paragangliomas.E. Familial paragangliomas occur in MEN 1, Carney’s triad, and von Hippel-Lindau diseaseA 90% of paragangliomas arise from adrenal gland, remaining 10% extra-adrenal (abdomen 85%, thorax 12%, H&N 3%), H&N paragangliomas lack the enzyme to convert norepinephrine to epinephrine (phenylethanolamine-N-methyltransferase), Carotid body>jugulotympanic>vagal, MEN2a and b, NF1, vHL (retinal angiomas, cerebellar hemangioblastomas, Carney (gastric leiomyosarcoma, pulmonary chondroma, paraganglioma)
21 10. Carotid body tumorsA. A positive Fontaine’s sign indicates movement of a lateral neck mass laterally but not verticallyB. Increased mitotic rate and capsular invasion indicate malignancyC. Malignancy is determined by histologyD. Diagnosis can be made radiographically by posterior displacement of the internal and external carotid arteriesE. Classification of tumors is based on sizeAShamblin Classification –group 1 localized, minimal attachment to carotid, group II adherent or partially surrounding carotid, Group III completely encasing carotid
22 11. Recommended treatment of carotid body tumors: A. Requires preoperative embolization before surgical removalB. Results in permanent cranial nerve deficit(s) in 50% of casesC. Observation is an option for some patients with carotid body tumors.D. Radiation therapy can reduce the size of the tumor.E. Surgical resection is preferred over radiation therapy for multicentric tumorsCCN deficits in 15-20%XRT arrests growthTry to save vagus and hypoglossal on 1 side, baroreflex failure syndrome after removal of bilateral CB tumors
23 12. Vagal paragangliomas: A. Arise from the inferior vagal ganglionB. Arise from the nodose ganglionC. Arise from the jugular ganglionD. A and BE. All of the aboveEInferior= nodose most commonSuperior=jugular ganglion
24 13. Peripheral nerve neoplasms: A. Neurofibromas are encapsulated and may occur singly or multiplyB. Schwannomas most commonly occur in the head and neck regionC. Antoni type A areas contain loosely arranged hypocellular zonesD. Malignant transformation is more common in multiple neurofibromas than in solitaryE. Cranial neuropathies are rare following resection of schwannomasDHalf occur in H&N, Antoni A compact spindle cells, verocay bodies—palisading of nuclei
25 14. Metastatic disease to the neck: A. Location of the metastatic node in level 5 are most commonly associated with a hypopharyngeal primaryB. Fine needle aspiration biopsy diagnosis of adenocarcinoma indicates a primary in a salivary glandC. The most common distant site to metastasize to the neck is from a lung primaryD. B and CE. All of the aboveCLevel 5-nasopharynx, adenoca—possible GI, breast or prostate source--rare
26 15. Sarcomas of the neck:A. 80% of head and neck sarcomas are derived from soft tissues of the neckB. Occur most commonly in childrenC. Staging for bone sarcomas is based on sizeD. Staging for soft tissue sarcomas is based on site of originE. The most common sarcoma in the head and neck is the malignant fibrous histiocytomaA. 20% are from bone80% occur in adults, staging for bone—within or beyond cortexStaging for soft tissue based on size, Most common type of H&N sarcoma in children is RMS, adults- osteo, angio, MFH, fibro
27 16. Rhabdomyosarcoma A. Accounts for 50% of sarcomas in all age groups B. Most common site in the head and neck is in the neckC. Metastatic disease is present in 80% of cases at presentationD. Primary treatment is surgical resectionE. Highest incidence occurs in first decade of lifeEA (20% in all age groups), b (face, orbit, nasal), c 33%, d combined modality
28 17. Rare sarcomas of the neck: A. Osteosarcoma of the mandible frequently metastasizes to the neckB The most common site of fibrosarcoma in the head and neck is in the neckC. Alveolar soft part sarcoma is associated with the fusion gene ASPL-TFE3D. Epithelioid hemangioendothelioma exhibits extremely aggressive behaviorE. Liposarcoma is the most common soft tissue sarcoma in the head and neck in adultsCB(paranasal sinus), d(range from benign to aggressive), e (Osteo is most common)
29 18. Rarer sarcomas of the neck: A. Malignant hemangiopericytoma (MPC) arise from the cells of Zimmerman, around capillaries and postcapillary venulesB. Majority of HPCs occur in the paranasal sinusesC. Malignant peripheral nerve sheath tumor (MPNST) can occur either spontaneously or with NF-1D. MPNST has recurrence rates of more than 40% despite aggressive treatmentE. All of the abovee
30 19. Review these before the in-service A. Synovial sarcomaTypically arises in the hypopharyngeal and retropharyngeal regionB. Malignant giant cell tumorRadiation induced after treatment for a benign giant cell tumor, sinonasal region and mandible most common sitesC. Ewing’s sarcomaDerived from primitive neuro-ectoderm, 2nd most common bone tumor in children, mandible, maxilla, skullD. Solitary Fibrous TumorDesmoid fibromatosis frequent in head and neck, in children, high local recurrence rate but low mortality