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Otorhinolaryngology Otorhinolaryngology |
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Case - Head and Neck
Each section will have a case for you to work through.
Their purpose is to broaden your knowledge of Otolaryngology Head and Neck Surgery and understand how the specialty works in real practice.
You are a GP and a 68 year old man presents to your clinic complaining of a right sided neck lump.
MCQ 1
MCQ 2
Your brilliant history and examination reveal that this 68 year old man is an ex-smoker of 20 pack years who has had this lump for 4 weeks. He hasn’t noticed a change in size. He hasn’t noticed any associated symptoms nor has he had a recent URTI.
He is otherwise healthy.
The mass is solitary and located in right level III. It feels firm and you measure it to be approximately 2cm in size. The rest of the examination is unremarkable.
MCQ 3
Quickly outline a possible differential diagnosis list for this mass – use any of the the VITAMIN CD acronym elements to help you.
Put an asterisk next to the most likely cause.
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Some of the differential diagnoses you might have considered are:
Inflammatory: Reactive lymphadenopathy
Neoplastic
- Benign: Carotid body tumour
- Malignant: Primary e.g. lymphoma; Secondary e.g. metastatic SCC*
Congenital: Branchial cyst
You are now the ENT surgeon who is seeing this man. When you examine him with the flexible nasendoscope in clinic you find a lesion on the base of tongue.
The FNA you requested confirms that the metastatic node contains p16 positive (marker for HPV) squamous cell carcinoma.
Jot down anything you know about HPV and cancer.
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- It has a better prognosis than smoking-related oropharyngeal carcinoma (both are SCC)
- Oncogenic HPV types include 16, 18, 31 and 33
- It is the same virus that causes cervical cancer in women
- The HPV vaccine in NZ (Trade name Gardasil) will, hopefully, reduce the incidence
- HPV-related oropharyngeal cancer occurs in younger patients when compared to smoking-related cancer
The patient is now referred to the regional head and neck cancer MDM for further assessment and management.
