颈部肿块的评价及处理（英文）

小米 · 发表于 2008-3-16 20:26

are compressible.  CT or MRI again help the diagnosis and define the extent of disease.  Surgical treatment is reserved for lesions with rapid growth, associated thrombocytopenia or involvement of vital structures that fail medical therapy (steroids, interferon).

Inflammatory Disorders

Lymphadenitis

Acute lymphadenitis is very common at some point in almost everyone’s life, especially during the first decade.  The presentation with marked tenderness, torticollis, trismus and dysphagia with systemic signs of infection is seldom a diagnostic challenge to the clinician and the source of the reactive lymphadenopathy is usually easily identified.  Initial treatment with directed antibiotic therapy and follow up is the rule.

Inflammatory nodes generally regress in size.  If the lesion does not respond to conventional antibiotics a biopsy is indicated after complete head and neck work-up.  Other indications for FNAB of lymphadenopathy include progressively enlarging nodes, a solitary and asymmetric nodal mass, supraclavicular mass or persistent nodal masses without active infectious signs.  Equivocal or suspicious FNAB in the pediatric nodal mass requires an open excisional  biopsy to rule out lymphoma or granulomatous disease.

Granulomatous lymphadenitis

These infections usually develop over weeks and months, often with minimal systemic complaints of findings.  They may be the result of typical or atypical mycobacteria, actinomycosis, sarcoidosis, or cat-scratch fever (Bartonella).  The glands tend to be firm, with some degree of fixation and injection of the overlying skin.  They may suppurate and drain only to reform.  Tuberculosis is now rarely seen in our population and is more common in adults within the posterior triangle.  Atypical mycobacteria and cat-scratch fever are more common and more prevalent in the pediatric age group.  Atypical mycobacterial infection usually involves anterior triangle lymph nodes often with brawny skin, induration and pain, while cat-scratch commonly involves the preauricular or submandibular nodes.  Typical TB lymphadenitis often responds to anti-tuberculosis medications.  Cat-scratch often undergoes spontaneous resolution with or without antibiotic treatment.  Atypical mycobacterial infection usually responds to complete surgical excision.

小米 · 发表于 2008-3-16 20:26

Summary

The differential diagnosis of neck masses is extensive and varies with the age of the patient at presentation. A thorough work-up including an accurate history and complete head and neck examination often narrows the diagnostic possibilities, thus obviating the need for excessive testing and invasive procedures. The fine needle aspiration biopsy has become an invaluable tool to aid clinicians in the evaluation of the neck mass and is safe, accurate, and cost-effective with minimal complications. The possibility of malignancy in any age group, especially in the late adult group, should never be overlooked. Close follow-up and aggressive pursuit of a diagnosis with appropriate work-up facilitates a timely and accurate treatment plan, which is essential to a favorable outcome.