parotid gland mass differential diagnosis

There is one parotid gland on each side of the face. However, they do recur or present with distant metastases many years after apparent disease-free survival. Malignant salivary gland tumors usually present after the 6th decade of life, whereas benign lesions present in the 4-5th decade of life. Tumors low in the tail of the parotid gland can easily be confused with an upper cervical lymph node. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The differential diagnosis of a neck mass includes: Infectious lymphadenitis - most common cause of a neck mass. government site. Patients may have blood tests or imaging tests as part of regular follow-up care. Howlett DC, Kesse KW, Hughes DV et-al. Just as a benign tumor does, they often present as a painless enlarging mass that may or may not be associated with neck lymph node metastases. The tumors are slow-growing and cause no symptoms. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Some cases of a link between occupational exposure to silica dust and nitrosamines have been reported.[3]. 2021 Apr 28;11:644150. doi: 10.3389/fonc.2021.644150. A CT scan is the best investigation to distinguish between these two differential diagnoses. The majority of patients first present to the primary care clinician or nurse practitioner with complaints of a painless lump. A doctor who uses blood and body tissue to diagnose diseases, who is called a pathologist, looks at the sample right away. These are called malignant parotid tumors or parotid gland cancers. In this situation, experts in facial plastic and reconstructive surgery will perform anerve transfer or other facial reanimation procedure. See this image and copyright information in PMC. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437. 2022 Aug 28;14(8):256-271. doi: 10.4329/wjr.v14.i8.256. Typical findings of pleomorphic adenoma included hyperintensity on T2w images (p = 0.02), strong contrast enhancement (p < 0.001) and lobulated shape (p = 0.04). This is the third most common cancer of the parotid gland. Preoperative tumor localization, differential diagnosis, and subsequentselection of appropriate treatment for parotid gland tumors is critical.However, the relative rarity of these tumors and the highly dispersed tissuetypes have left an unmet need for a subtle differential diagnosis of suchneoplastic lesions . A broad differential diagnosis must always be considered. Check for errors and try again. Operations used to remove parotid tumors include: To get to the parotid gland, surgeons make a cut in the skin near the ear. Superficial parotidectomy with identification and exposure of was traditionally the preferred procedure. Salivary gland neoplasms respond poorly to chemotherapy, with adjuvant chemotherapy used only for palliation. Usefulness of heavily T(2) weighted magnetic resonance images for the differential diagnosis of parotid tumours. ISBN: 9780702029714 -, elevators, retractors and evertors of the upper lip, depressors, retractors and evertors of the lower lip, embryological development of the head and neck. Careers. Surgeons can repair the facial nerve using nerves from other areas of the body or from artificial nerves. Epub 2020 Sep 14. Learn more about parotid tumor research being done in the Mayo Clinic Department of Otolaryngology Head and Neck Surgery. Keywords: Check for errors and try again. The distinction between tumor types can be difficult, particularly based on material from fine-needle aspiration (FNA). Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour The role of imaging in the evaluation of parotid disease. Salivary gland tumors represent 5%to 10%of tumors within the head and neck.1 Of these, 80% arise from the parotid gland.1 The ability of otolaryngologists to appropriately eval-uate and treat parotid masses is vitally important. Bron L, Traynor S, McNeil E, O?? Treasure Island (FL): StatPearls Publishing; 2022 Jan-. The accessory parotid gland and facial process of the parotid gland on computed tomography. Would you like email updates of new search results? yem karagz, hasan bulut, zde mahmutolu, dren zlem aksoy, abdullah soydan mahmutolu. Five-year survival averages about 70%. Wang K, Pearlstein KA, Moon DH, Mahbooba ZM, Deal AM, Wang Y, Sutton SR, Motley BB, Judy GD, Holmes JA, Sheets NC, Kasibhatla MS, Pacholke HD, Shen CJ, Zagar TM, Marks LB, Chera BS. Access free multiple choice questions on this topic. Martins S, Fernandes BM, Bernardes M, Melo D, Neto T. Head Neck Pathol. Because of the possibilityof recurrence and distant metastasis,patients with a history of salivary gland, cancermustbe monitored throughout their lifetime. If your doctor suspects a tumor in this area, he or she is likely to recommend several steps to diagnose and evaluate it. How likely is it that the facial nerve will be hurt? In experienced hands, this can distinguish malignant from benign disease in 80% to 90% of cases. . La finalit del nostro lavoro di valutare le caratteristiche di risonanza magnetica (RM) tipiche dei tumori parotidei maligni e benigni. Epub 2016 Jun 14. The usual presentation is a slow-growing painless mass. Frozen section pathology for decision making in parotid surgery. HHS Vulnerability Disclosure, Help Typical findings of Warthin's tumour included hyperintense components on T1w images (p < 0.001), location in the parotid inferior process (p < 0.001) and mild or incomplete contrast enhancement (p = 0.01). Ultrasound scan (USS) provides invaluable information about the site, size, and nature of salivary gland tumors and the presence of any significant cervical lymphadenopathy. Tumors arising in minor salivary glands are not included in this classification. Salivary gland tumorsare variable in location, origin, and malignant potential. HHS Vulnerability Disclosure, Help Elsevier Australia. Maahs GS, Oppermann Pde O, Maahs LG, Machado Filho G, Ronchi AD. Accessibility 2004;13:716. Accessibility Narrative review of multiparametric ultrasound in parotid gland evaluation. Braz J Otorhinolaryngol. If your doctor suspects a tumor in this area, he or she is likely to recommend several steps to diagnose and evaluate it. It is usually combined with FNA (USSgFNAB), which improves the adequacy rate. Eur J Radiol. Benign lesions tend to be more common in women, but malignant lesions tend to occur with equal frequency in both genders. Neoplasms (benign and malignant) are more likely to be present in. 4. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-10448, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10448,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/parotid-gland/questions/1919?lang=us"}. An official website of the United States government. It is located in the parotid space. Olsen KD, et al. A "lumpectomy" is not considered an appropriate procedure due to high recurrence rates. 2009 Apr;123(4):449-52. doi: 10.1017/S0022215108003563. Muscle movement often gets better over time. They are of 2 types: Benign or non-cancerous Malignant or cancerous In certain cases, the growth inside the parotid gland may not originate from parotid tissues but originate from enlarged lymph nodes which invade the glands. Inflammation, infection, and/or blockage of the parotid or submandibular glands or their ducts can produce neck masses. Multiparametric magnetic resonance imaging of parotid tumors: A systematic review. The role of imaging in the evaluation of parotid disease. Multiphasic CT-Based Radiomics Analysis for the Differentiation of Benign and Malignant Parotid Tumors. 2009;3:271275. Sometimes the tumors are cancers. It has been linked to smoking and presents after the 4th decade of life. Malignant parotid gland neoplasms; Monomorphic adenoma; Parotid gland tumor; Pleomorphic adenoma; Ultrasound. Unable to process the form. The Diagnostic Value of Ultrasound-Based Deep Learning in Differentiating Parotid Gland Tumors. The most common type of biopsy used for parotid masses is afine needle aspiration biopsy. Coudert H, Mirafzal S, Dissard A, Boyer L, Montoriol PF. Bookshelf Sometimes the results say a tumor isn't cancerous when it is. The differential diagnosis includes mucous retention cyst, unilateral blockage of the parotid duct, benign mesenchymal tumors like lipoma, fibroma, hemangioma or neurofibroma, branchial cleft cyst, benign salivary gland tumors like pleomorphic adenoma, Warthin's tumor and malignant salivary gland tumor like muco-epidermoid tumor [3, 6]. Robert Hermans. eCollection 2022 Feb. Vernuccio F, Arnone F, Cannella R, Verro B, Comelli A, Agnello F, Stefano A, Gargano R, Rodolico V, Salvaggio G, Lagalla R, Midiri M, Lo Casto A. Br J Radiol. (2011) Page 22-24. About 20% of parotid tumors are malignant, with higher percentages for children, for the submandibular gland, and for intraoral minor salivary glands. The gender incidence is equal, and they are seen most often in patients in their sixth decade. Tian Z, Li L, Wang L, et al. Parotid tumors often cause swelling in the face or jaw. Cigarette smoking and alcohol is associated with head and neck squamous cell carcinoma, skin malignancies in the head and neck have been known to metastases to the parotid glands. Front Oncol. Radiation therapy is used to treat parotid gland cancers. 2005 Oct;31(10):1287-96. doi: 10.1016/j.ultrasmedbio.2005.06.011. Those with chronic parotitis usually don't have much pain or discomfort. Diagnostic grading of parotid lesions by conventional ultrasound: a pilot study. Imaging of salivary gland tumors. Those that are deep in the parapharyngeal space can require a special approach.. You should avoid heavy lifting and straining, and follow your doctors instructions, including keeping the wound clean and dry. Chemotherapy may help relieve pain and other symptoms caused by the cancer. Head and neck cancers. -, Aparecida de Oliveira F, Barroso Duarte EC, Teixeira Taveira C, et al. Due to theepithelial and the non-epithelial histology of the affected organ,many histological types of parotid tumors are possible, although some arerare. Outline the types of salivary gland tumors. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, nerve transfer or other facial reanimation procedure, Learn more about the Salivary Gland Center. Salivary gland tumors are uncommon in children, but a greater proportion of them (30%) are malignant and are usually low-grade mucoepidermoid carcinoma. ), which permits others to distribute the work, provided that the article is not altered or used commercially. to create a predictive score for the discrimination between benign and malignant parotid tumors using elastographic parameters and to compare its sensitivity and specificity with standard ultrasound.a total of 124 patients with parotid gland lesions for whom surgery was planned were examined using conventional ultrasound, doppler examination, and official website and that any information you provide is encrypted [Cyto-histological correlation in the management of parotid gland tumors: A retrospective study of 160cases]. 2001;21 (5): 1211-27. MATERIALS AND METHODS. and transmitted securely. sympathetic: via plexus surrounding external carotid artery from the superior cervical ganglion, parasympathetic: otic ganglion via the auriculotemporal nerve, sensory:auriculotemporal nerve, greater auricular nerve, facial process: anterior extension of glandular tissue along the parotid duct continuous with the main gland, congenital agenesis: either unilateral and bilateral 10. Berlin Heidelberg: Springer-Verlag; 2007. pp. The glands will be enlarged and heterogeneous with increased vascularity as shown below. You might consider asking: Radiation therapy uses powerful energy beams to kill cancer cells. Differential diagnosis: IA (Submental) Lymph node, Thyroglossal cyst, Dermoid cyst, Plunging ranula. Preoperative tumor localization, differential diagnosis, and subsequent selection of appropriate treatment for parotid gland tumors is critical. 2002;57 (8): 692-701. Differential diagnosis includes chronic sialoadenitis, necrotizing sialometaplasia, and other carcinomas. 2000;216(1):19-29. A good rule of thumbto remember is the rule of 80s; that 80% of all salivary tumors are in the parotid, 80% of parotid tumors are benign, and 80% of the benign tumors that arise in the parotid are pleomorphic adenomas. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Most parotid tumors are benign with malignancy only comprising approximately 15% to 32%. Dentomaxillofac Radiol. Mayo Clinic does not endorse companies or products. Front Oncol. Laryngoscope. Accessibility 50 (7): 806-11. Rapid growth, pain, tethering of the skin, ulceration of the skin, cervical lymphadenopathy, and facial nerve paralysis are all suggestive of malignancy. This is usually temporary: Permanent facial paralysis is rare.. Rarely, the facial nerve must be cut in order to get all of the tumor. Methods: A total of 124 patients with parotid gland lesions for whom surgery was planned were examined using conventional ultrasound, Doppler examination, and shear wave elastography. 2005;27(10):923-926. Hamilton BE, Salzman KL, Wiggins RH, Harnsberger HR. Epub 2012 Apr 13. An extracapsular dissection for benign pathology, away from the main branches of the facial nerve is an option, and even endoscopically-assisted parotidectomy can be effective in selected patients. 179.1 and 179.2). The survival rates of patients with salivary gland cancer depend on the histological type and the stage of cancer. You have hundreds of salivary glands in and around your mouth that create saliva, which helps to keep your mouth moist and aids in swallowing, speaking and eating. Facial nerve injury. Bilateral parotid tumors are most common in Warthin tumors and HIV related lymphoepithelial cysts. Squamous carcinoma of the left parotid gland. It is an Open Access platform to support scientific innovation and advancement in the research community by increasing access to peer-reviewed quality research articles. 2017 Aug;274 (8):3231-3240. doi: 10.1007/s00405-017-4636-2. The .gov means its official. Lymphomas may develop in intra-parotid lymph nodes. Warthin tumor is the 2nd most common benign lesion. National trends in inpatient parotidectomy: A fourteen-year retrospective analysis. Patients with stage III and IV diseases have a poorer prognosis with low survival rates (as low as 15% to 50%) at 10 years. 2003;76 (904): 271-7. . Microscopic evidence alone does not constitute extra-parenchymal extension for classification purposes. Most superficial lesions can be removed with simple enucleation. It requires well-trained surgeons and specialists for the best outcome. Dry mouth or dry eyes (usually associated with Sjogren's syndrome ). Instead, they may take a sample of tissue for testing during surgery. The gland usually contains several intraparotid lymph nodes. Acta Otorhinolaryngol Ital. It is important to seek out an experienced head and neck surgeon to perform this procedure. Radiol Case Rep. 2021 Nov 27;17(2):344-349. doi: 10.1016/j.radcr.2021.10.043. Sore throat. Front Oncol. differential diagnosis of Warthin tumor from mucoepidermoid car- . Radiation exposure has been linked to parotid gland carcinomas 15 years afterthe event. [1]Salivary gland tumors are characterized by diverse histological appearances and variable biological behavior. 10. Lesions that have pseudopodia are most likely to recur after surgery. [Updated 2022 Aug 8]. It is rare in the parotid. The approach is based on the characteristics of the tumor whether it is benign or malignant. A comprehensive history and physical examination, in conjunction with judicious use of radiographic imaging (MRI, compute Evaluation of Parotid Lesions However, the behavior is not always accurately predicted by the histological appearance. [5][6]The overall 5-year survival of malignant salivary disease depends on the stage of the disease but has been reported around 70%. 2022; doi:10.1002/wjo.2.50. Figure 3: submandibular gland pleomorphic adenoma, Case 4: oncocytoma of submandibular gland, Case 7: submandibular gland pleomorphic adenoma, Case 8: lymphoepithelial carcinoma - submandibular gland, squamous cell carcinoma of salivary glands, malignant mixed tumors of the salivary glands, staging of malignant salivary gland tumors, metastases (mostly to intraparotid lymph nodes), primary:arising from the parotid gland as a, secondary: involving the intraparotid lymph nodes. (2012) ISBN: 9783642178689. However, diffuse cervical lymphadenopathy is common in HIV disease and uncommon in Sjgren's syndrome. 6Hepatomycosis: The patient has progressive enlargement of the liver, hard texture and nodularity, most of the liver is destroyed in the advanced stage, and the clinical manifestation is very similar to primary liver cancer. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. government site. Results of the examinations were compared with those ones of histology. Grazioli L, Olivetti L, Matricardi L et-al. There are many salivary glands in the lips, cheeks, mouth and throat. Flint PW, et al., eds. 8. 2021 Aug 3;13(15):3910. doi: 10.3390/cancers13153910. ( a ) Axial T2w, MeSH Parotid tumor treatment often involves surgery to remove the tumor. Moore EJ (expert opinion). The needle may be inserted through the skin on the face and into the parotid gland. 1 The typical clinical presentation is a painless mass or swelling in the cheek about the mandibular rami. Imaging allows your surgeon to better visualize the extent of the tumor. I parametri significativamente predittivi di malignit sono risultati i margini mal-definiti (p < 0,001), le linfoadenopatie (p < 0,001) ed il pattern di crescita infiltrativo (p < 0,001). It is important to note that both alcohol and smoking are not linked to salivary gland tumors, except for Warthin tumors. Howlett DC, Kesse KW, Hughes DV, Sallomi DF. The differential diagnosis mainly relies on methemoglobin determination, B-type ultrasound and hepatic angiography. Unusual presentation of parotid gland adenoid cystic carcinoma : A case presentation and literature review. This could be with radiation therapy and chemotherapy. Tumors were divided into 5 histological subtypes, and different MRI features were compared between groups. How long will it take to heal? doi: 10.1016/j.suronc.2003.10.002. Mansour N, Stock KF, Chaker A, Bas M, Knopf A. Ultraschall Med. The greater auricular nerve as a donor is an option, but it may be involved, so the sural nerve from the leg may be preferred. J Clin Ultrasound. If the history and physical are suggestive of a tumor, these patients should be referred to the otolaryngologist for workup. Radiology. FOIA Since "parotid masses" are frequently of nonparotid origin (Table 175.1), the relationship of the mass to the gland markedly alters the management in as many as a third of patients presenting with a parotid-region mass (Figs. The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Chemotherapy is sometimes used to treat parotid gland cancers. After the treatment of salivary gland carcinomas, long-termfollow up is necessary to detect local and distant relapse. eCollection 2021. 2022 May 1;51(4):20210484. doi: 10.1259/dmfr.20210484. The facial nerve us found 1cm inferior and 1-cm deep to the tragal pointer and bisecting the angle of the insertion of the digastric muscle into the digastric ridge. The surgeon makes an incision (cut) in the skin to reach the parotid gland. ( 2020 Dec;9(6):2295-2311. doi: 10.21037/gs-20-530. Federal government websites often end in .gov or .mil. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. Epub 2016 Feb 20. the differential diagnosis of diseases that occur with increased volume in the head, lymphadenopathy, drooling, dysphagia, and progressive weight loss. [2]It is not surprising that with such a wealth of pathology, clinical features, investigation issues, and contentious treatment options that salivary gland neoplasms are regularly used in clinical examinations. Most skin cancer metastases that affect the parotid gland spread from cancerous lesions on the head and face. Once the imaging studies and biopsy are done, your surgeon will review your case, confer with colleagues and develop a personalized treatment plan. Loss of appetite. However, the relative rarity of these . Wiley-Blackwell, Iowa, pp 171198, Wong DS. Facial nerve involvement generally suggests a malignant tumor, which may present with pain or paralysis. Space occupying lesions of parotid gland. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. Sometimes patients notice a fullness or swelling of the cheek or an asymmetry in the mouth. The major salivary glands are the submandibular (below the jaw), the sublingual (under the tongue) and the parotid glands, which are located by the angle of your jaw in front of the ear. -, Eveson JW, Cawson RA. Eisele says that tumor surgery on one parotid gland is not likely to affect a persons saliva level since there are so many other salivary glands that can compensate. Izzo L, Casullo A, Caputo M et-al. 12. Howlett DC. The patients often complain of facial pain and may present with facial paresis. Earring lesions of the parotid tail. Surgeons take special care to avoid hurting it. Stage I and II cancers have good cure rates, although the prognostic survival curve never flattens even after 20 years. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The tail is not distinct from the rest of the gland, but it has been defined as the inferior 2 cm of the gland 11. parotid gland : 70% minor salivary glands (including sublingual): 22% with the palate being most frequent (see: minor salivary gland tumors) submandibular gland : 8% Overall ~80% of all parotid masses are benign and the majority of these are pleomorphic adenomas. In these situations, chemotherapy might be done at the same time as radiation therapy. Aktan ZA, Bilge O, Pinar YA, Ikiz AO. Explain the interprofessional team strategies to improve care for patients with salivary gland tumors. Chemotherapy is sometimes used on its own for advanced cancer, such as cancer that has spread to other parts of the body. The radiation can kill any cancer cells that remain. Facial nerve assessment is mandatory, as is neck node palpation. Perioral palpation can be useful to assess the extent of tumors, particularly with submandibular gland tumors. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review. The parotid glands are the most common place that salivary gland tumors happen. Will I have a scar? Salivary glands make saliva to help with chewing and digesting food. In either case, treatment begins with surgical removal of the tumor, called aparotidectomy. Parotid tumors are growths of cells that start in the parotid glands. This site needs JavaScript to work properly. Parotid tumors usually do not cause pain, Eisele notes. Stenner M, Klussmann JP. elebi and Mahmutoglu found that with the exception of low grade carcinomas the ES did not improve the sensitivity and specificity of standard ultrasound in differentiation of benign from malignant lesions [ 4 ]. Squamous cell carcinoma tends towards early extracapsular extension. -, Takahama Junior A, Almeida OP, Kowalski LP. Parotid tumor surgery can be complex. 2013 Oct;41(8):501-8. doi: 10.1002/jcu.22054. Sono state valutate le seguenti caratteristiche RM: morfologia, sede, dimensioni, margini, intensit di segnale nelle sequenze T2-pesate e T1-pesate, impregnazione dopo mezzo di contrasto (mdc), intensit di segnale della porzione cistica, presenza o assenza di una capsula, diffusione perineurale, pattern di crescita extraghiandolare e linfoadenopatie laterocervicali. Fernandes BM, Bernardes M, Knopf A. Ultraschall Med ducts can produce masses. Radiol case Rep. 2021 Nov 27 ; 17 ( 2 ):344-349. doi: 10.3390/cancers13153910, Kesse KW Hughes... Hasan bulut, zde mahmutolu, dren zlem aksoy, abdullah soydan mahmutolu histological... Generally suggests a malignant tumor, which permits others to distribute the work, provided the! Diffuse cervical lymphadenopathy is common in women, but malignant lesions tend to be present in: 10.1017/S0022215108003563 in. 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Uses blood and body tissue to diagnose and evaluate it lips, cheeks, mouth and throat,! ; 274 ( 8 ):3231-3240. doi: 10.1007/s00405-017-4636-2 nerve must be cut in order to get all the... Fna ( USSgFNAB ), which improves the adequacy rate make saliva to help with and!, hasan bulut, zde mahmutolu, dren zlem aksoy, abdullah soydan mahmutolu at... Be more common in Warthin tumors the tail of the parotid or submandibular glands or their ducts produce! With pain or discomfort uses blood and body tissue to diagnose and evaluate it reanimation procedure tumors and related. In.gov or.mil 15 ):3910. doi: 10.1002/jcu.22054 of a painless or! Doi: 10.1259/dmfr.20210484 reference to histological types of parotid tumours the sample right.... In these situations, chemotherapy might be done at the same time as therapy. Occur with equal frequency in both genders ; Monomorphic adenoma ; parotid gland benign disease in 80 to., Kesse KW, Hughes DV et-al, which improves the adequacy rate as part regular... Di risonanza magnetica ( RM ) tipiche dei tumori parotidei maligni E benigni a ) Axial,... 51 ( 4 ):20210484. doi: 10.1259/dmfr.20210484 between tumor types can be difficult, with. Have good cure rates, although the prognostic survival curve never flattens even after 20 years fullness or of. Into the parotid glands common in Warthin tumors and HIV related lymphoepithelial cysts gland on tomography! The treatment of salivary gland carcinomas 15 years afterthe event who is called a pathologist, looks at the parotid gland mass differential diagnosis. Done at the same time as radiation parotid gland mass differential diagnosis chewing and digesting food 2013 Oct ; 41 ( 8:3231-3240.... The best investigation to distinguish between these two differential diagnoses suggestive of a tumor in this area, or! Are characterized by diverse histological appearances and variable biological behavior in order to get all of the affected,... All of the tumor `` lumpectomy '' is not considered an appropriate due. As is neck node palpation are suggestive of a neck mass, Traynor S, McNeil E, O?! Not included in this area, he or she is likely to be present in are!

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