1. A lump in the neck

2. Case 1 A 55yr old man presents to his GP with a progressively enlarging lump at the side of his neck by his jaw. What are the possible causes of a swelling in neck?

3. Possible causes Lymph nodes Lymph nodes Salivary glands - parotid Salivary glands - parotid Lipoma Lipoma Sebaceous cyst Sebaceous cyst Branchial cyst Branchial cyst Carotid body tumour Carotid body tumour Pharngeal pouch Pharngeal pouch Cervical rib Cervical rib Neuromas, nerve tumours, cystic hygroma (infants), larngocoele Neuromas, nerve tumours, cystic hygroma (infants), larngocoele

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

5. This was shown to be a parotid lump What else would you need to examine? What else would you need to examine? Parotid (Stensen’s) Duct Parotid (Stensen’s) Duct Opposite upper 2 nd molar tooth Opposite upper 2 nd molar tooth ? pus from opening ? pus from opening VII nerve VII nerve Regional lymph nodes Regional lymph nodes

6. Causes of parotid swelling Tumour Tumour Mixed tumours Mixed tumours 90% in parotid 90% in parotid Mostly benign Mostly benign Local recurrence big issue if badly excised Local recurrence big issue if badly excised Parotitis Parotitis Mikulicz’ syndrome Mikulicz’ syndrome In sarcoid, sjogren’s, TB In sarcoid, sjogren’s, TB Replacemnt of glandular tissue with lymphocytes Replacemnt of glandular tissue with lymphocytes

7. Case 2 A 24 yr old man presents with an enlarged lymph node in the right posterior triangle. It is painless but he hasn’t felt well, being tired, off his food, losing weight and getting awful night sweats. What are the possible causes of the enlarged node? What else would you need to examine?

8. Causes of lymphadonopathy Infection Infection Acute Acute Pyogenic infections Pyogenic infections Infectious mononucleosis Infectious mononucleosis Toxoplasmosis Toxoplasmosis Infected eczema Infected eczema CMV CMV Chronic Chronic TB TB Sarcoidosis Sarcoidosis Syphilis Syphilis HIV HIV

9. Causes of lymphadonopathy Malignancy Malignancy Primary Primary Hodgkins lymphoma Hodgkins lymphoma Non-Hodgkins lymphoma Non-Hodgkins lymphoma CLL CLL ALL ALL Secondary Secondary Nasopharngeal Nasopharngeal Thyroid Thyroid Lung Lung Breast Breast Stomach (“Troisier’s sign”) Stomach (“Troisier’s sign”)

10. Need to examine other sites for lymph nodes Need to examine other sites for lymph nodes Abdominal examination for hepatosplenomegaly Abdominal examination for hepatosplenomegaly

11. Examination of the neck lymph nodes Need systematic approach to cover all areas

13. Work out a plan and now practice on each other