NECK MASS—-DANIEL TODD, MD
DIFF Dx:
CONGENITAL/DEVELOPMENTAL:
GROOVES=CLEFTS (EXTERNAL)=ECTODERM
POUCHES=(INTERNAL)=ENDODERM
GENERALLY DIFFERENTIATE INTO GLANDULAR ORGANS
EACH POUCH HAS A VENTRAL AND DORSAL WING
THE FOURTH POUCH HAS AN ADDITIONAL ACCESSORY WING—ULTIMOBRANCHIAL BODY–BECOMES INFILTRATED WITH NEURAL CREST CELLS(APUD)—BECOME PARA OR INTERFOLLICULAR (C-CELLS) OF THE THYROID (AMYLOID STROMA) AND SECRETE TCT (MEDULLARY CA)
1ST POUCH—MIDDLE EAR CAVITY
2ND POUCH—-OPENS TO TONSILLAR FOSSA
3RD POUCH—-OPENS TO PIRIFORM SINUS
FORMS 3 STRUCTURES:THYMUS(VENTRAL), L AND R INF PTG(DORSAL)
4TH POUCH—-SUP PTGS AND ULTIMOBRANCHIAL BODY
FIRST BRANCHIAL APPARATUS ANOMALIES(1-3%)
EAC
SUPERFICIAL TO ICA, ECA, CN IX, CN XII
TYPE I—LIKE AN ACCESSORY EAC(RUNS PARALLEL TO THE EAC)
SUPERFICIAL TO THE FACIAL NERVE
TYPE II—MUCH MORE COMMON
RUNS PERP TO THE EAC
INVOLVES THE FACIAL NERVE—-BEWARE!!!!
EXT. OPENING NEAR THE BC JUNCTION IN THE EAC
OFTEN PRESENTS AS A DRAINING EAR WITH AN INTACT TM
SECOND BRANCHIAL APPARATUS ANOMALIES(95%)
4 TYPES
SUPERIOR TONSILLAR FOSSA
BETWEEN ICA(POST) AND ECA(ANT), SUPERFICIAL TO 9 AND 12, ANT TO SCM
MEAN AGE 13, MALE=FEMALE, 2% BILAT
THIRD BRANCHIAL APPARATUS ANOMALIES(RARE)
PIRIFORM SINUS
POST TO ICA AND ECA
DEEP TO CN 9
SUPERFICIAL TO 12
OTHERS ARE REALLY THEORETICAL
NEOPLASTIC:
THYROID TUMORS ARE ALL ENDODERMAL (POUCH) DERIVATIVES EXCEPT MEDULLARY (NEURAL CREST DERIVATIVES/ECTODERMAL) PARAFOLLICULAR C-CELLS FROM THE ULTIMOBRANCHIAL BODY
MESENCHYMAL—MESODERM +VIMENTIN
LYMPHOMAS—MESENCYMALLY DERIVED LYMPHORETICULAR MALIGNANCIES
HODGKINS DISEASE
NHL
BURKITTS
EXTRANODAL ANGIOCENTRIC PERIPHERAL T-CELL LYMPHOMAS
HISTIOCYTOSIS X = RETICULOENDOTHELIOSIS = (LCH) LANGERHANS CELL HISTIOCYTOSIS
NEW NOMENCLATURE –UNIFOCAL LCH, MULTIFOCAL LCH CONFINED TO SKELETAL SYSTEM, MULTIFOCAL LCH WITH SOFT TISSUE INVOLVEMENT
MAY TREAT ALL LIKE LYMPHOMAS = RT, CYTOXAN, STEROIDS, CURETTAGE
LETTERER-SIWE (“BETTER SEND A LETTER”)–ERICH LETTERER 1924
HAND-SCHULLER-CHRISTIAN Dz–ALFRED HAND–PEDIATRICIAN 1893
EOSINOPHILIC GRANULOMA (EG) OF BONE
POLYMORPHIC RETICULOSIS
SYNONOMOUS WITH MIDLINE GRANULOMATOUS OR DESTRUCTIVE DISEASES—LEATHAL MIDLINE GRANULOMA
REALLY AND EXTRANODAL PERIPHERAL ANGIOCENTRIC T-CELL LYMPHOMA
ORBITAL PSEUDOTUMOR—-INFLAMMATORY PSEUDOTUMOR
OFTEN PRESENT AS AN ORBITAL MASS—PERIVASCULAR CUFFING
RHABDOMYOSARCOMA—THE MOST COMMON SOFT TISSUE MALIGNANCY IN PEDIATRICS (40% IN THE H&N)
TREAT WITH ALL POSSIBLE MODALITIES
SARCOMA (MESODERMAL IN ORIGIN)
RHABDOMYOSARCOMA
LEIOMYOMA/LEIOMYOSARCOMA
MFH(MALIGNANT FIBROUS HISTIOCYTOMA)
ANGIOSARCOMA
OSTEOSARCOMA
FIRBOSARCOMA
SYNOVIAL SARCOMA
ATYPICAL FIBROXANTHOMA
CUTANEOUS TUMORS OF VESSELS
MALIGNANT ANGIOENDOTHELIOMA
KAPOSIS SARCOMA(SHOULD BE CALLED KAPOSIS ANGIOSARCOMA)
HEMANGIOPERICYTOMA ——FROM THE CAPILLARY PERICYTE(EPITHELIAL ORIGIN) OF ZIMMERMAN
DFSP (DERMATO FIBRO SARCOMA PROTUBERANS) (DARIER AND FERRAND–1924)
NEUROFIBROSARCOMA—-PROBABLY BETTER CLASSIFIED UNDER NEUROECTODERM
ECTODERMAL
SALIVARY GLAND TUMORS ARE ALL ECTODERMAL
ADNEXAL TUMORS
SEBACEOUS GLAND=MOST COMMON
—-OF THE MEIBOMIAN GLAND—USUALLY PRESENT AS ULCERATED NODULAR LESOIN OF THE PALPEBRAE
SWEAT GLAND
APOCRINE OR ECCRINE GLAND CA
HAIR FOLLICLES
TRICHOLEMMAL CA OR MALIGNANT TRICHOLFOLLICULOMA
PILOMATRIXOMA—”OF MALHERBE”
NEUROECTODERMAL—NEURAL CREST CELL TUMORS
NOTOCHORD= STRUCTURAL VESTIGE FORMED FROM MESODERM–CLIVAL OR SACRAL CHORDOMA
EVENTUALLY BECOMES THE NUCLEUS PALPOSUS—VERTEBLRAL COLUM FORMS AROUND IT
STIMULATES NEURULATION PROCESS IN THE OVERLYING NEUROECTODERM
NEURULATION—-SOME OF THE NEUROECTODERM SEPERATES AN MIGRATES OUT TO FORM PERIPHERAL NEURAL STRUCTURES:
AFFERENT–DORSAL ROOT GANGLION
AUTONOMIC GANGLION—-SYMPATHETIC TRUNK, CN 3, 7, 9, AND 10 (GLOMUS CELL TUMORS—PARAGANGLIOMAS)
ADRENAL MEDULLA (CHROMAFFIN CELLS)—PHEOCHROMOCYTOMA, CHROMAFFINOMA
CELIAC,RENAL, INTESTINAL PLEXUS
SCHWANN CELLS(MYELINATE THE PNS)—-SCHWANNOMA
MENINGES—PIA AND ARACHNOID (MENINGIOMA)
PIGMENT CELLS—-MELANOMA
IRIS CHROMATOPHORES
MERKEL CELL CA
ULTIMOBRANCHIAL BODY—-PARAFOLLICULAR C-CELLS OF THE THYROID—-MEDULLARY CA OF THE THYROID
GRANULAR CELL TUMOR (DORSAL TONGUE)
NEUROBLASTOMA
ESTHESIONEUROBLASTOMA (OLFACTORY NEUROBLASTOMA)
NEUROECTODERMAL TUMOR OF INFANCY
CUTANEOUS TUMORS OF NERVES AND NEUROENDOCRINE CELLS
NEUROFIBROSARCOMA
GLOMUS CELL TUMOR——SYMPATHETIC INNERVATION—-REGULATES THE SUEQUET HOYER CANAL
TRAUMATIC:
IDIOPATHIC:
INFLAMMATORY:
INFXN (STAPH OR GABHS)
ATYPICAL MTB
CAT SCRATCH
TULAREMIA
TOXO
LYME Dz
INFECTED BRANCHIAL CLEFT CYST
AGE:
NEONATE:  S.a, GBS
INFANT: Sa, GBS, KAWASAKI
1-4: Sa, GABHS, ATYPICAL MYCOBACTERIUM
5-15: ANAEROBIC BACTERIA, TOXO, CAT SCRATCH, MBT
Hx
PE
LAB
CBC WITH PBS
THROAT CULTURE
THYROID PROFILE, TN99 SCAN
ASO TITERS
MONO SPOT
ANTI- DNAse B TITER
FEBRILE AGGLUTININS : (BRUCCELOSIS ABORTUS, FRANCESCELLA TULARENSIS)
CAT SCRATCH Ab (OKLAHOMA CHILDRENS)
PPD
TOXO TITER
FNA—EMLA–20 GUAGE NEEDLE—GS,-AFB STAINS,  AND ANAEROBIC, AEROBIC, FUNGAL, AND MYCOBACTERIAL CULTURES
CXR
CT OF NECK
MRI
DUPLEX–LEMIER’S