Diagnosis of Salivary gland cancer
Salivary gland cancer Diagnosis: Book Excerpts
Diagnostic Tests for Salivary gland cancer: Online Medical Books
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Oral Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Aphthous stomatitis
–Idiopathic
–Recurrent, shallow, painful, spontaneously
resolving oral ulcers -
Herpes stomatitis
–Due to a primary outbreak of HSV-1
–Severe gingivostomatitis with pain, redness,
and erosions around the gum line
–Recurrent oral HSV (“cold sores”) often occur at the lip border
–Stress, sun exposure, and many other factors contribute to flare-ups
-
Self-limited viral disease (e.g., herpangina,
hand-foot-mouth disease)
–Most often seen in children
–Prodrome of malaise and fever followed by
a 5–10 day outbreak of oropharyngeal erosions or vesicles is common
-
Chemotherapy drugs (especially 5-FU and methotrexate)
-
Squamous cell carcinoma should always be considered if a nonhealing ulcer or oral erosion is noted
-
Bullous diseases (e.g., pemphigoid,
pemphigus, lichen planus)
–Recurrent painful oral ulcers and erosions
–Evaluate for other skin rashes suggestive of
these disorders
-
Behçet syndrome
–Uncommon but well-known cause of oral ulcers
–Patients must exhibit other symptoms (e.g., uveitis, CNS problems, GI complaints, genital ulcers) before this diagnosis can be made
-
Allergic contact dermatitis to amalgams in dental work may result in buccal tenderness
-
Erythema multiforme (Stevens-Johnson syndrome)
–Characterized by oral ulcers, ocular involvement, and simultaneous targetoid, erythematous, or bullous skin lesions
–May be triggered by HSV infection, Mycoplasma infection, or drugs (e.g., phenytoin, sulfonamides)
-
Primary syphilis
–Painless chancre
-
Agranulocytosis or leukopenia
-
Histoplasmosis (especially in immunosuppressed patients)
Workup and Diagnosis
-
Detailed history and physical examination
–Associated symptoms (e.g., fever, prodrome)
–Review the patient's past medical history and medication
list
–If ulcers occur in the same location with every episode, oral HSV is likely
–Is the patient sexually active (consider HIV, immunosuppression, or syphilis)
–Perform a thorough skin exam to evaluate for rashes or other mucosal lesions (ocular, urethral, or perianal)
–Lacy white plaques on the tongue or buccal mucosa may suggest lichen planus
–Ocular or anogenital complaints can be suggestive of Behçet syndrome, pemphigus, or pemphigoid
-
Initial evaluation includes a viral swab for culture and/or serum for HSV-1 IgG detection to diagnose HSV, and consider an RPR and CBC to rule out syphilis and leukopenia, respectively
-
Consider a punch biopsy of the edge of an ulcer/erosion to determine if there are viral changes or cytologic atypia; or evidence of an autoimmune bullous disease
-
Recurrent aphthous stomatitis is a diagnosis of exclusion, but is also the most common diagnosis of recurrent painful oral ulcers after HSV
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Salivary Gland Enlargement:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Congenital
–First branchial cleft cyst
–Retention cyst
–Ectopic rests of salivary tissue
-
Infectious/inflammatory
–Mumps (before immunization) was the most
common salivary gland inflammatory disease
–HIV
–Coxsackie A
–Echovirus
–Viral sialoadenitis
–Acute bacterial sialoadenitis: Typically
Staphylococcus aureus or Streptococcus viridans
–Sialolithiasis
-
Vascular lesions
–Hemangiomas: Most common salivary gland
mass in children
–Lymphangioma
-
Benign tumors
–Pleomorphic adenomas: Most common solid
benign tumor
–Warthin tumors
–Oncocytoma
–Adenomas
-
Malignant tumors
–Mucoepidermoid carcinoma: Most common
–Acinic cell carcinoma
–Adenoid cystic carcinoma
–Undifferentiated carcinoma
–Lymphoma
–Rhabdomyosarcoma
–Squamous cell carcinoma
-
Trauma (may often be associated with facial nerve injury)
-
Systemic diseases
–Diffuse bilateral salivary gland enlargement: often associated with diabetes mellitus, cystic fibrosis, thyroid disease, malnutrition, obesity, autoimmune disorders (Sjögren)
–Granulomatous disease: tuberculosis, atypical Mycobacterium, sarcoidosis, cat-scratch disease
- Drugs such as methimazole, thiourea, phenothiazine, thiocyanate
Workup and Diagnosis
-
History
–Duration, onset, pain, change in size with meals, prior history of recent weight loss or gain, joint tenderness
–Past medical history of systemic disease: CF, diabetes, autoimmune disorders
–Exposure: Immunization, radiation, cat-scratch disease
-
Physical exam
–Size, character: Firm, soft, cystic, tenderness, warmth, redness, bilaterality, oral cavity exam, pus from Stenson or Wharton duct, palpable stone, neck mass, facial nerve function (paresis or paralysis is highly suggestive of malignancy)
-
Culture of drainage may guide antibiotic therapy
-
Plain film X-rays: Limited utility but may identify salivary duct stone; 80–90% of submandibular stones are radio-opaque
-
Ultrasound: May differentiate between cystic and solid lesions, ductal dilations, and intra- and extraparenchymal lesions
-
CT or MRI: Provides better resolution of salivary gland lesions and surrounding tissues; MRI gives superior details for salivary gland neoplasms
-
Fine-needle aspiration: 90% sensitivity and 95–100% specificity for identifying malignancy with experienced pathologist
-
Sialography: Limited in children, contraindicated in acute infections
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Introduction: Malignant Neoplasms:
Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Oral Lesions:
Differential Overview
(Field Guide to Bedside Diagnosis)
Ulceration
❑ Aphthous ulcers
❑ Angular cheilitis
❑ Herpes simplex
❑ Traumatic ulcers
❑ Impetigo
❑ Erythema multiforme
❑ Mucositis
❑ Lichen planus
❑ Squamous cell cancer
❑ Syphilis
❑ Coxsackievirus A
❑ Herpes zoster
❑ Primary HIV
❑ Crohn disease
❑ Behçet syndrome
❑ Acute leukemia
❑ Pemphigoid
Glossitis
❑ Vitamin B12 deficiency
❑ Folate deficiency
❑ Niacin deficiency
❑ Riboflavin deficiency
❑ Leukoplakia
❑ Candida
❑ Geographic tongue
❑ Black hairy tongue
❑ Scarlet fever
❑ Kwashiorkor
❑ Polyarteritis nodosa
Macroglossia
❑ Myxedema
❑ Angioedema
❑ Acromegaly
❑ Amyloidosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
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