1. What is your clinical impression?

Differential Diagnosis TB adenopathyLymphoma 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 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

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

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

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

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

METASTATIC CARCINOMA FROM ORAL CAVITY CANCER Clinical Impression: