Sharumathy, R R (2022) Analysis of Clinical and Diagnostic Methods of Identifying Metastatic Cervical Lymphadenopathy in Tertiary Care Centre. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
220400422sharumathi.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Cervical lymphadenopathy is the single presentation in the most of the head and neck neoplasms. Since Tuberculosis is prevalent infection in developing countries like India, our diagnostic modalities are directed towards it. So it is mandatory to include malignancy as a differential diagnosis as soon as the patient comes to outpatient department. Head and neck squamous cell carcinoma that presents as carcinomas of unknown primary (CUP) represents difficult challenge for practicing physician. CUP represents a heterogenous disease entity characterized by the presence of clinically or radiologically obvious primary tumour. In the head and neck the definition of true unknown or occult primary carcinoma is the presentation of metastatic neck lymphadenopathy without the development or manifestation of an index primary tumour within a subsequent 5 year perior Various diagnostic modalities available for diagnosis and ruling out malignant cervical lymphadenopathy which includes ultrasonogram (USG), computerized tomography (CT) NECK, Magnetic resonance imaging (MRI) and Positron emission tomography(PET). These investigations have high sensitivity and specificity. Eventhough the use of videolaryngoscopy and diagnostic nasal endoscopy play a vital role in the diagnosis of primary site of carcinoma of unknown primary with metastatic cervical lymphadenopathy. So in my study I am going to emphasize on the importance of using the endoscopy in the otorhinolaryngology department. AIMS OF THE STUDY: 1. To emphasize on the clinical evaluation of cervical lymphadenopathy in otorhinolaryngology department 2. The diagnosis of malignancy by noninvasive technique and also including endoscopy. 3. Proper evaluation of cervical lymphadenopathy for ruling out malignancy and initiating the treatment as soon as possible. OBJECTIVES: 1.Thorough Clinical evaluation and assessing the level of lymph nodes. 2. To do Videolaryngoscopy and diagnostic nasal endoscopy. If needed, endoscopic evaluation of upper gastrointestinal tract. Pan endoscopy as and when needed. 3. Radiological evaluation – USG neck including thyroid,USG abdomen including genital tract of both gender. 4. Histopathological evaluation followed by immunohistochemistry if needed. MATERIALS AND METHODS: ● The study was conducted on 50 selected patients with suspected metatstatic cervical lymphadenopathy who presented to the otorhinolaryngology Department .Patients informed written consent was taken. ● The patients were examined clinically after taking a detailed history. Nodes enlarged were classified according to Memorial Sloan- Kettering Cancer Centre leveling system of cervical lymph nodes. The number of nodes, their size, consistency noted at each level. ● Histories of any form of previous treatment to the nodes like radiotherapy, chemotherapy were excluded from the study. Terminally ill patients were also excluded. PROCEDURE: ● Videolaryngoscopic and diagnostic nasal endoscopic examination done looking for the primary. ● The patient sat facing the standing examiner. Each patient was sprayed with 10% lignocane spray and the videolaryngoscopy was done with Hopkin‟s 45 degree or 70 degree rigid laryngoscope. The oropharynx, hypopharynx and larynx was examined in detailed fashion and looked for any primary. ● The patient in supine position after decongetion of the nasal mucosa ,diagnostic nasal endoscopy done and looked for any primary in nasopharynx concentrating the fossa of rosenmuller. ● If primary is not identified, radiological investigations were done. Ultrasonography of the neck and CT scan were done. ● If primary identified biopsy is taken from the site. ● A FNAC of the cervical node is also done. ● If primary is not identified, blind biopsies taken from the most common site. If primary is proven, radiotherapy or chemotherapy started otherwise treated as carcinoma of unknown primary. CONCLUSION: ❖ Cervical lymphadenopathy is a confounding problem in general practice. The analysis of a cervical lymphadenopathy is never straight forward and the difficulty is compounded by the differential diagnosis that include several diseases that resemble each other. ❖ Many head and neck diseases manifest as neck masses with a wide range of pathologies from tuberculosis to malignancy. ❖ Cervical lymphadenopathy is one of the commonest presentations in otorhinolaryngology outpatient department. Thus, knowledge of prevalence of the different pathologies in this region is important for the management of patients with neck swelling. ❖ Most of the patients treated with over-the-counter drugs and with long term antibiotics in primary health care center. It is mandatory to evaluate the patient with cervical lymphadenopathy for malignancies at the primary health care itself. Most of the malignancies will be presented only with cervical lymphadenopathy. Further evaluation by fine needle aspiration and endoscopy can be done and further intervention either surgery or radio/chemotherapy can be initiated. ❖ Most of the malignancies are treated aa infection and when the patient presenting to ENT OPD will present in the advanced stage. Hence patient with cervical lymphadenopathy should be referred to ent department as soon as possible. The diagnosis of malignancy can be obtained by simple endoscopic techniques and treatment can be started earlier. Early identification and intervention in malignancy can result in good prognosis.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221914154 |
| Uncontrolled Keywords: | Clinical, Diagnostic Methods, Identifying Metastatic Cervical Lymphadenopathy, Tertiary Care Centre. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 10 May 2021 16:27 |
| Last Modified: | 17 Dec 2023 10:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/16389 |
Actions (login required)
 |
View Item |
