头颈部淋巴瘤.ppt

Lymphomas of the Head and Neck Tal Marom, MD Lymphoma Cancer of the lymphatic system Lymphoma is differentiated by the type of cell that multiplies and how the cancer presents itself Two main groups: Hodkgin’s disease and NHL US prevalence (HD) = 3 cases/100,000 (incidence ↓) US prevalence (NHL)=16 cases/100,000 (incidence↑) Hodgkin vs. Non-Hodgkin Ly. Hodgkin vs. Non-Hodgkin Ly. Hodgkin vs. Non-Hodgkin Ly. Reed Sternberg Cell HN Lymphoma Lymphoma is the second most common primary malignancy occurring in the head and neck, and incidence of aggressive non-Hodgkin lymphoma is rising in young and middle-aged patients. 25% of all extra-nodal lymphomas occur in the head and neck, and 8% of supraclavicular fine-needle aspirates are diagnosed as lymphoma. REAL classification (Revised European American Lymphoid neoplasm) : indolent, aggressive and Hodgkin disease Clinical presentation Neck- lymphadenopathy, ulcerated mass Oropharynx- enlarged tonsil, tongue base thickening Nasopharynx – mass, SOM Nose paranasal sinuses- ulcerated destructive lesion –susp. NK/T cell Lymphoma (“midline lethal granuloma”), associated with EBV Thyroid - neck swelling, hoarseness, dysphagia, or neck pressure/tenderness Salivary glands- masses Base skull – cranial neuropathy, facial pain, hearing loss, vertigo, proptosis, or visual symptoms Physical examination History – cough, fever, GI, abdominal masses, pruritus Full PE, look for peripheral adenopathy Differential diagnosis infectious etiologiesBacteriaViruses (eg, infectious mononucleosis, cytomegalovirus, HIV)Parasites (eg, toxoplasmosis) Nasal granulomatous diseaseWegener granulomatosisLymphomatoid granulomatosisInfections (eg, leishmaniasis, syphilis, TB) Mediastinal presentationInfections (eg, histoplasmosis, tuberculosis)SarcoidosisOther neoplasms Benign lymphoid hyperplasiasB-cell predominant - Cutaneous lymphoid hyperplasia (CLH), angiolymphoid hyperplasia with eosinophilia, Kimura disease, and Castleman dise