Pattern of non thyroidal neck swellings in Tirunelveli Medical College Hospital

Jeyakumar, Sagayam (2009) Pattern of non thyroidal neck swellings in Tirunelveli Medical College Hospital. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: The head and neck is an intricate anatomical region and many of its structures have highly complex and important physiological function. Of the numerous afflictions of this area, those of particular interest to the General surgeon are congenital, developmental, inflammatory and neoplastic lesions. This study is focussed on regional swellings of the neck and the thyroid swellings are excluded. Several classifications have been proposed to enable a comprehensive differential diagnosis of neck swellings. The age group of the patient is a crucial factor that should be taken into consideration. Younger patients tend to present with inflammatory or congenital swelling. In case of swellings present in individuals above the age of forty, on the other hand, malignancy of the head and neck, either a primary or secondary should be ruled out. Approximately 30% of body’s lymph nodes are located in the cervical region. As the lymphatic drainage of this zone is highly predictable, a cervical lymphnode can be helpful in the search for a primary malignancy. AIM OF THE STUDY: The study was carried out in Tirunelveli Medical College Hospital on inpatients as well as patients attending the outpatient department. The following points were set out to be considered. 1. To study the epidemiology of nonthyroidal neck swellings. 2. To present a histopathological study of nonthyroidal neck swellings. 3. To show the frequency of cervical node involvement in Malignancy. 4. To show the incidence of secondaries neck with unknown primary. 5. To study the accuracy of FNAC. MATERIALS AND METHODS: The analysis is a prospective study of Nonthyroidal neck swellings diagnosed and treated at Tirunelveli Medical College Hospital during the period from July 2006 to October 2008. All histologically proven benign, malignant, congenital and inflammatory non thyroidal neck swellings are included in the study. The age group of patients is above twelve years. The study includes 125 cases of nonthyroidal neck swellings. A thorough clinical examination was carried out and physical findings were recorded in detail. Patients with thyroid swellings and infective neck masses are excluded in this study. The following investigations were carried out. Blood : Haemoglobin, Total count, Differential count, ESR Blood : Sugar, Urea, Creatinine. Urine : Albumin, Sugar, deposits, Chest X – ray. X ray of adjacent bone involved. Ultrasonogram of the abdomen and pelvis. CT Scan neck, CT scan Thorax, FNAC of the neck lump. Biopsy if FNAC is inconclusive. TRIPLE ENDOSCOPY (PANENDOSCOPY): Indirect and Direct laryngoscopy, Upper GI Endoscopy, Bronchoscopy. Mantoux test (PPD test), Serum IgM titre for tuberculosis. In many instances, even a through clinical examination is insufficient to provide the clinician with enough information to establish a diagnosis and additional tests are required. Immunological and serological tests like Kviem’s test ,EBV titres. Anti capsid antibody, S.Immunoglobulin.A are not available at our Institution. Immunohistochemistry and tumour marker assay for secondaries with unknown primary are also unavailable. A proforma was prepared to record the details of Non thyroidal neck swellings. (enclosed). CONCLUSIONS: 1. Any patient above the age of forty presenting with a swelling in the neck should be thoroughly investigated. 2. 80.8% of non thyroidal neck swellings are of lymph nodal origin. 3. Neck swellings especially Tuberculous lymphadenitis and Secondaries are more common among the lower social economic status. 4. Tuberculous adenitis is the most common non thyroidal swellings found in the neck (26.4%) 5. Commonest age group affected by Tuberculous Lymphadenitis is 15 – 30 age group (79%). 6. Secondary mestastatic lymphnodes are the next common non thyroidal neck swelling (23.2%). 7. Secondaries neck with Unknown Primary forms 34.5% of all secondary lymph nodes of the neck. 8. For secondaries in the cervical lymphnodes, thyroid is the most common primary. 9. Secondaries neck is more common in males (72%) and 83% of patients are above 40 yrs of age. 10. The incidence of Thyroglossal cyst is equal in both sexes Cuscheiri [] But in this study Thyroglossal cyst has a female preponderance. 11. Non hodgkin’s lymphoma constitutes 76% of all Lymphomas. 12. Hodgkin’s lymphoma is more common in 3 rd decade and NHL in the 4thand 6th decade. 13. Inflammatory lesions of submandibular salivary gland constitute about 46% of submandibular gland swellings. 14. Reactive hyperplasia of cervical nodes are due to periodontitis and dental caries. 15. FNAC is a simple, easy to perform diagnostic method with an accuracy rate of 90% in our study. 16. Biopsy is to be avoided until full investigation of the mass is complete.

Item Type: Thesis (Masters)
Uncontrolled Keywords: non thyroidal neck swellings, Pattern, Tirunelveli Medical College Hospital.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:12
Last Modified: 13 Jan 2020 13:54

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