By Vijay P. Khatri MD FACS
This detailed case-based assessment of surgical oncology deals very good training for oral board examinations, which emphasize either common wisdom and case administration. The ebook offers ninety one circumstances dependent to mirror the surgeon's decision-making approach. each one case starts with a sufferer presentation and imaging stories or pathology effects and proceeds via a sequence of selection points—differential analysis, requests for added checks, prognosis, surgical method, dialogue of strength pitfalls, and follow-up. situations are grouped via organ approach and every part ends with a remedy set of rules summarizing the choice issues. approximately four hundred radiologic photographs and different correct illustrations accompany the text.
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Sample text
Physical examination reveals a mass at least 3 cm in diameter, deep to the anterior border of the sternomastoid muscle with no additional evidence of adenopathy. Inspection of the oral cavity and oropharynx and flexible nasopharyngoscopy reveal no obvious abnormality. Differential Diagnosis A lateral neck mass presenting in an older patient, particularly one who smokes, should be considered metastatic carcinoma in a cervical lymph node until proven otherwise. The most likely diagnosis is metastatic squamous cell carcinoma (SCC), either from a mucosal or cutaneous site.
There is a firm, nontender mass overlying the right angle of the mandible, somewhat mobile but with a suggestion of fixity to the overlying skin. No adenopathy is palpable elsewhere in the neck. No mucosal lesions or cutaneous tumors are present. ■ Clinical Photograph A right parotid mass is clearly visible. Differential Diagnosis This man has significant risk factors for mucosal carcinoma of the upper aerodigestive tract, and careful assessment is needed to exclude a mucosal tumor. However, the presence of a mass partially overlying the angle of the mandible, in association with facial nerve weakness, strongly suggests a malignancy arising in, or metastatic to, the parotid salivary gland.
There is inferior extension of the tumor into the oropharynx along the left lateral wall. The anterior nasal space is not involved. There is no involvement of the skull base. Enlargement of the left deep cervical chain is noted (5 ϫ 4 cm maximum diameter). Retropharyngeal and supraclavicular nodes are not enlarged. Black arrows indicate the location of the primary tumor. Case Continued Case Continued As part of the disease staging, MRI and CT scans of the nasopharynx and neck are obtained. A bone scan, abdominal ultrasound, and CT scan of the chest are normal, with no evidence of metastases.