Head & Neck Module
By: Ralph Jacinto P. Pinat MD
Fellow Philippine Society of General Surgeons
Fellow Philippine College of Surgeons
Learning Objectives:
1.
To help the student develop an understanding of the diagnosis and treatment of
primary cancers of various head & neck sites
2.
To enable the student to develop an approach to a neck mass and to be able to
discuss diagnostic methods and treatment
3.
To develop an understanding of thyroid malignancies and their cells of origin
4.
To be able to develop a plan diagnosis and treatment salivary gland tumors
CASE:
A 48-year-old man is seen at your office. He noted a lump in the anterior neck
while shaving a week ago; the lump is not painful or tender and has not changed. He
has been completely well. On examination, you find a 2-cm-diameter lump just to the
left of the midline, at the anterior margin of the sternocleidomastoid muscle. The lump is
moderately firm, and it moves up when he swallows. The lump seems to be in the edge
of the thyroid lobe.
1.
History and PE
A.
What history directed questions are asked to narrow down the diagnostic
possibilities and focus subsequent investigations?
B.
How do you examine tumors in the head and neck?
2. What initial diagnostic workup is needed to provide further information for your
diagnosis?
3. What is your Initial Impression
A.
What is your basis for ruling it in?
B.
What are your differential diagnosis?
C.
Discuss shortly the different primary tumors of the head and neck
D.
Discuss shortly the different diagnostics and treatment of each primary
tumors
4. Fine Needle Cytology was done, Microscopic examination of aspirate from the
anterior neck mass shows clusters of cuboidal cells forming a papillary architecture. The
nuclei are overlapping and characterized by optically clear chromatin pattern. Some
nuclei exhibit nuclear grooves (folding of redundant nuclear membrane) eosinophilic
intranuclear inclusions. Occasional psammoma bodies are also seen.
A.
B.
C.
What is now your working diagnosis?
What are the appropriate diagnostic work-up in a patient with a thyroid nodule?
What is your definitive treatment plan for the patient?
Head & Neck Module
D.
What are your Post-operative follow-up and monitoring plan?
5. Make an algorithm of the case given, outlining the management and the definitive plan