NECK MASSES: NECK MASSES: UNC MS III SURGERY UNC MS III SURGERY • Case discussions by students Case discussions by students • Discussion of thyroid Discussion of thyroid disorders disorders • Discussion of how to develop Discussion of how to develop a differential diagnosis a differential diagnosis • Management algorithm Management algorithm
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NECK MASSES: UNC MS III SURGERY Case discussions by studentsCase discussions by students Discussion of thyroid disordersDiscussion of thyroid disorders.
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NECK MASSES:NECK MASSES:UNC MS III SURGERYUNC MS III SURGERY
• Case discussions by studentsCase discussions by students
• Discussion of thyroid disordersDiscussion of thyroid disorders
• Discussion of how to develop a Discussion of how to develop a differential diagnosisdifferential diagnosis
• Management algorithmManagement algorithm
THYROIDTHYROID
COLIN G THOMAS, Jr. MDCOLIN G THOMAS, Jr. MD
Professor, Department of SurgeryProfessor, Department of Surgery
University of North CarolinaUniversity of North Carolina
Incidence of Thyroid Disorders in ConnecticutIncidence of Thyroid Disorders in Connecticut(Annual physical Examination, 1544 Patients – One Year)(Annual physical Examination, 1544 Patients – One Year)
University of North CarolinaUniversity of North Carolina
Some pearls:Some pearls:
• 90% of adult neck masses are malignant90% of adult neck masses are malignant
• 90% of pediatric neck masses are 90% of pediatric neck masses are infectious in natureinfectious in nature
• Know your anatomy then develop a Know your anatomy then develop a differential diagnosisdifferential diagnosis
• Close observationClose observation
• Generally, one course of a broad spectrum Generally, one course of a broad spectrum antibiotic is acceptable then …..antibiotic is acceptable then …..
• It is never wrong to refer to a specialist for It is never wrong to refer to a specialist for evaluation and probable biopsyevaluation and probable biopsy
• Imaging is important but tissue is Imaging is important but tissue is everythingeverything
• If you don’t get an answer with a FNA, If you don’t get an answer with a FNA, repeat it up to three times. Consider repeat it up to three times. Consider ultrasound guided or CT guided FNA.ultrasound guided or CT guided FNA.
• Never violate a neck or I will come after Never violate a neck or I will come after you.you.
HISTORYHISTORY• AgeAge
• Duration Duration
• Acute symptomsAcute symptoms
• Recent travelRecent travel
• TraumaTrauma
• Insect bites, petsInsect bites, pets
• Tobacco, alcohol, XRTTobacco, alcohol, XRT
CONGENITALCONGENITAL
• Central neck:Central neck:– Thyroglossal duct cystsThyroglossal duct cysts
• Pyramidal lobe of thyroidPyramidal lobe of thyroid
• Use CT but consider MRI for Use CT but consider MRI for salivary gland problemssalivary gland problems
• Role of nonionizing ultrasoundRole of nonionizing ultrasound
–Like a stethoscope?Like a stethoscope?
National Comprehensive Cancer National Comprehensive Cancer NetworkNetwork
• Use Use www.nccn.orgwww.nccn.org for evidence-based, for evidence-based, consensus guidelines for:consensus guidelines for:– StagingStaging– EvaluationEvaluation– ReferencesReferences– TreatmentTreatment– All sitesAll sites– Updated annually.Updated annually.