Differentials
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Kanker van de mondholte: diagnose, behandeling en follow-upPublished by: KCELast published: 2015Cancers de la cavité buccale : diagnostic, traitement et suiviPublished by: KCELast published: 2015Tonsillitis
SIGNS / SYMPTOMS
Typical features include sore throat, painful swallowing, headache, fever, chills, red swollen tonsils with white patches, and enlarged tender cervical lymphadenopathy.
Signs and symptoms resolve with conservative treatment or, if indicated, antibiotics. Tonsillitis is typically bilateral. Any patient with unilateral symptoms rather than bilateral should raise concern for malignancy.
INVESTIGATIONS
Throat culture for group A beta haemolytic streptococcus may be positive.
Aphthous ulcer
SIGNS / SYMPTOMS
Round, yellowish, elevated spot surrounded by a halo, followed by ulcer covered by white or greyish membrane surrounded by normal tissue.
Absence of induration noted, and ulcer is self-limiting.
INVESTIGATIONS
Clinical diagnosis.
Oral syphilis
SIGNS / SYMPTOMS
Solitary deep-base ulceration with irregular-based border associated with cervical adenopathy; history of oral sex.
Resolves with antibiotics.
INVESTIGATIONS
Positive VDRL test.
Oral tuberculosis
SIGNS / SYMPTOMS
Single or multiple ulceration, with or without cervical adenopathy in HIV-positive patient.
Resolves with anti-tuberculous and antiviral therapy.
INVESTIGATIONS
Granulomatous lesions and acid-fast bacilli on biopsy.
Oral herpes simplex virus
SIGNS / SYMPTOMS
Multiple blisters on an erythaematous base followed by painful ulceration; history of oral sex.
Resolves with aciclovir.
INVESTIGATIONS
Tzanck smear for intranuclear inclusions (virus colonies).
Culture of the blister positive for herpes simplex.
Oral cytomegalovirus infection
SIGNS / SYMPTOMS
Painful, punched-out ulcerations with non-indurated border in HIV-positive patients.
Resolves with ganciclovir.
INVESTIGATIONS
Viral nuclear inclusion by histology, viral culture of tissue.
Non-Hodgkin's lymphoma
SIGNS / SYMPTOMS
Mass involving Waldeyer's ring.
INVESTIGATIONS
Excision biopsy of nodal tissue showing abnormal lymphocytes.
Immunophenotype analysis and flow cytometric analysis of surface markers.
Sarcoma
SIGNS / SYMPTOMS
Painless mass that has been enlarging.
Kaposi's sarcomas appear as purplish macular-papular lesions, and there is often a history of HIV infection.
INVESTIGATIONS
Biopsy is performed in all patients to establish the histological subtype and grade of a sarcoma.
In patients presenting with Kaposi's sarcoma and unknown HIV status, HIV antibody, viral load, and CD4 count should be tested.
Paraganglioma
SIGNS / SYMPTOMS
Tumours arising from neural crest cells of the sympathetic and parasympathetic paraganglia. Functional paraganglioma presents with symptoms of catecholamine excess including hypertension, flushing, and diaphoresis. Non-functional paraganglioma are usually found incidentally during imaging studies.
INVESTIGATIONS
Initial evaluation involves 24-hour urine catecholamines and serum metanephrines.
CT scan will show a homogeneous mass with intense enhancement following administration of contrast. MRI gives better information about the adjacent vascular structures. I-123 metaiodobenzylguanidine (MIBG) scintigraphy may also be used.
Pleomorphic adenoma
SIGNS / SYMPTOMS
The most common benign tumour of the major salivary glands. They are seen rarely in the minor salivary glands, usually in hard palate, soft palate, and nasopharynx.
The tumours are smooth, painless, and do not produce any symptoms until they attain huge size, when they can show pressure symptoms.
INVESTIGATIONS
CT and MRI are the gold standard imaging modalities. The tumour is usually well demarcated from the surrounding tissue by a pseudocapsule due to compression of the surrounding parenchyma and fibrosis.
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