|
Head/Neck/Endocrine Pathology
Monday, February 28, 2011, 7:30 PM
CC 006 A/B
Diagnostic Delights in Head and Neck/Endocrine Pathology
|
Moderator:
|
MARY RICHARDSON
Medical University of South Carolina, Charleston, SC
|
|
Disclosure:
|
In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. |
|
Panelists:
|
Diane P. Kowalski, Yale University School of Medicine, New Haven, CT
Peter M. Sadow, Massachusetts General Hospital, Boston, MA
Raja R. Seethala, University of Pittsburgh Medical center, Pittsburgh, PA
Bruce M. Wenig, Beth Israel Medical Center, New York, NY
|
Clinical Histories and Still Images are displayed below.
Click on slide thumbnail images for an enlarged view.
If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137.
Submitted by: Diane P. Kowalski -
This is a 62-year-old woman with a history of significant life long developmental delay. She presented to her primary care physician complaining of a 2-month history of nasal congestion and posterior nasal pain. Family denied complaints of fever, chills, night sweats, weight loss or weakness. Cranial nerves were intact. She was tried on multiple treatments, including systemic steroids, antibiotics, decongestants and nasal steroids, without improvement of her symptoms. She was then referred to an ENT specialist. Nasal endoscopy revealed a submucosal polypoid mass in the nasopharynx. CT scan of the sinuses revealed a soft tissue density centered within the posterior ethmoid sinus, extending into the sphenoid sinus, eroding surrounding bone, with extension to the base of skull. Subsequent MRI revealed a 7 cm mass centered roughly in the sphenoid sinus region with involvement of the entire clivus. There was no evidence of intracranial extension. The tumor was felt to be unresectable.
Submitted by: Peter M. Sadow -
From the surgeon's note (abridged): 65 year old tax accountant with a history of recent hypothyroidism. Exam in December 2009 for a right neck tenderness revealed a hard right thyroid nodule. Ultrasound showed a 3 cm right upper pole nodule. FNA came back positive for papillary carcinoma. She notes no further recent enlargement and denies related symptoms. ?On review of systems, the patient has no neck pain, dysphagia, choking sensation, change in voice or energy. No intolerance of heat or cold, palpitations, skin changes, or shortness of breath. Complete review is otherwise negative in detail. No family history of thyroid cancer or other endocrine tumors, but a brother with Graves disease. No history of head/neck irradiation. Her past medical history includes uncomplicated ovarian cystectomy. ?Her medications are levothyroxine 75 mcg daily and MVI. ? On examination, she is a well-appearing woman, in no distress, 5'3", 153#, 148/90, HR70, RR14. She has a normal affect and judgment and ability to communicate. Her eyes are anicteric. She has no lid lag or stare. Her oropharynx is clear. Her neck is supple. Her trachea is midline. Her carotid upstrokes are normal bilaterally. Her thyroid has a rock hard, 3cm right thyroid mass which is mobile, nontender. There is no cervical lymphadenopathy. Her chest is clear to auscultation and percussion. Her heart is regular rate and rhythm with no murmurs. Her extremities are without clubbing, cyanosis, edema or tremor. Her skin is warm and dry. The patient has a 3 cm papillary thyroid cancer which has a generally excellent prognosis. I detect no signs of metastasis or local invasion. I therefore recommended total thyroidectomy which would then be followed by radioiodine ablation for her best chance of cure. I reviewed the technique of surgery as well as the risks which are low but include life-threatening bleeding, infection, parathyroid damage, and voice damage. I reviewed my strategies for minimizing these and she would like to proceed this week. We will plan the surgery accordingly. I will also obtain a neck ultrasound to assess her lymph nodes prior to surgery.
Case 2 - Slide 1
|
Submitted by: Raja R. Seethala -
This is a 55 year old male with an 'indolent' right level II neck mass, found incidentally on clinical inspection. The patient has no known history of tobacco use. A prior fine-needle aspiration was performed and demonstrated a lymphocytic population. Flow cytometric analysis was reportedly limited due to low cell viability. The patient subsequently underwent excision of this neck mass.
Grossly, the excision contained a 3.0 x 2.0 x 0.6 cm tan- white ovoid mass with focal cystic change.
Case 3 - Slide 1
|
Submitted by: Bruce M. Wenig -
22 year old female presented with asymmetric enlargement of the left lobe of the thyroid gland. No information available relative to a prior fine needle aspiration biopsy. A left lobectomy was performed. Intraoperative consultation diagnosis was "Folliuclar pattern lesion, defer to permanent section."
Gross description: Left thyroid lobe measuring 6.5 x 3.5 x 3.5cm showing multiple circumscribed but not grossly encapsulated lesions, including a dominant nodule measuring 3.5cm in greatest dimension with a tan-yellow appearance and central hemorrhagic appearing area.
|
Handouts for all Specialty Conferences will be accessible via the
"Educational Materials" section on the homepage the morning after each respective conference. Printed
copies of the handout will not be available at the meeting.
|
|
|
Click to view with ImageScope
Click to view with a Web-Based Viewer
