Acinic cell carcinoma physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination findings of salivary gland  cancer include painless, firm swelling in one of the salivary gland, [[cervical]] [[lymphadenopathy]], [[difficulty swallowing]], trouble opening the mouth widely, difficulty moving one side of the face and muscle [[weakness]] on one side of the face suggestive of [[cranial nerve VII]] deficit, loss of [[corneal reflex]], localized or regional pain, [[numbness]], paresthesia, [[causalgia]], or a loss of motor function suggestive of [[cranial nerve]] V deficit.<ref name="CCS">  Salivary gland cancer. Canadian cancer society(2015)http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/signs-and-symptoms/?region=sk Accessed on November 8, 2015</ref>
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
Physical examination should document size of the mass, mobility of the mass, fixation of the mass to the overlying skin or to the deep structures, pain with palpation, any limitation in jaw opening, buccal involvement or pharyngeal asymmetry, skin or scalp lesions indicative of primary malignancy.
===HEENT===
Fluid draining from the ear
===Neck===
*Painless, firm swelling or a [[lump]] in one of the salivary glands
*[[Cervical]] [[lymphadenopathy]]
*[[Difficulty swallowing]]
*Trouble opening the mouth widely<ref name="CCS">  Salivary gland cancer. Canadian cancer society(2015)http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/signs-and-symptoms/?region=sk Accessed on November 8, 2015</ref>


OR
===Neuromuscular===
*Difficulty moving one side of the face and muscle weakness on one side of the face suggestive of [[cranial nerve VII]] deficit
*Loss of [[corneal reflex]], localized or regional pain, [[numbness]], [[paresthesia]], [[causalgia]], or a loss of motor function suggestive of loss of [[cranial nerve]] V deficit
*[[Facial nerve]] [[weakness]]
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
===Neck===
<div align="left">
<gallery heights="175" widths="175">
Image:Salivary gland enlargement 1.jpg|SALIVARY GLANDS: MIXED TUMOR OF PAROTID. The pre-auricular mass had enlarged to this size over a period of 5 years.(Courtesy of Dr. Charles E. Tomich, Indianapolis, IN.)
Image:Salivary gland enlargement 2.jpg|SALIVARY GLANDS: RECURRENT MIXED TUMOR. The characteristic multinodular growth of recurrent mixed tumor is obvious inthis parotid mass. (Courtesy of Dr. Lewis R. Eversole, Los Angeles, CA.)
</gallery>
</div>


OR


The presence of [finding(s)] on physical examination is diagnostic of [disease name].


OR
<div align="left">
<gallery heights="175" widths="175">
Image:Salivary gland enlargement 3.jpg|SALIVARY GLANDS: MIXED TUMOR OF PALATE. Most mixed tumors involve only one side of the palate because there are few minor glands in the midline. In this case the tumor appears symmetrical on either side of the midline. Large intraoral tumors are susceptible to trauma-related ulceration, as illustrated here. (Courtesy of F. J.Kratochvil, Bethesda, MD.)
Image:Salivary gland enlargement 4.jpg|SALIVARY GLANDS: CANALICULAR ADENOMA. The upper lip is the site for over 70% of canalicular adenomas.
</gallery>
</div>


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
<div align="left">
 
<gallery heights="175" widths="175">
*High-grade / low-grade fever
Image:Salivary gland enlargement 5.jpg|SALIVARY GLANDS: MUCOEPIDERMOID CARCINOMA OF PALATE. These tumors frequently are slightly raised, fluctuant, bluish discolorations of the palatal mucosa that are clinically thought to represent mucous escapereactions.
*[[Hypothermia]] / hyperthermia may be present
Image:Salivary gland enlargement 6.jpg|SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION: A 2.0-cm raised subcutaneous nodule just anterior to the lower portion of the ear is a common clinical presentation for acinic cell adenocarcinoma. The tumor is in the superficial lobe of the left parotid gland of this 24-year-old man.
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
</gallery>
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
</div>
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">


UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}


<div align="left">
<gallery heights="175" widths="175">
Image:Salivary gland enlargement 7.jpg|SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION. The upper lip, or any other intra oral site, is an uncommon location for acinic cell adenocarcinoma.
Image:Salivary gland enlargement 8.jpg|SALIVARY GLANDS: ADENOID CYSTIC CARCINOMA. This sublingual gland tumor slowly enlarged to produce a large, lobulated mass in the anterior floor of the mouth. The oral mucosa is intact.
</gallery>
</gallery>
</div>


===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
<div align="left">
* Pulmonary examination of patients with [disease name] is usually normal.
<gallery heights="175" widths="175">
OR
Image:Salivary gland enlargement 9.jpg|SALIVARY GLANDS: POLYMORPHOUS LOW-GRADE ADENOCARCINOMA. This tumor presented as a well-circumscribed, slow growing mass at the junction of the hard and soft palates. Pronounced telangiectasia of the overlying mucosa is evident. (Courtesy of Dr. Richard Canaan, Ocean Springs,MS.)
* Asymmetric chest expansion OR decreased chest expansion
Image:Salivary gland enlargement 12.jpg|SALIVARY GLANDS: NECROTIZING SIALOMETAPLASIA. Swelling, as shown in this photograph of a palatal lesion, is a frequent initial clinical presentation. Many of the swellings subsequently ulcerate. (Courtesy of Dr. Ralph Correll, LosAngeles, CA.)
*Lungs are hyporesonant OR hyperresonant
</gallery>
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
</div>
*Rhonchi
=====Parotid carcinoma=====
*Vesicular breath sounds OR distant breath sounds
<gallery>
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
Image:Parotid carcinoma01.jpg|Parotid carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
* Cardiovascular examination of patients with [disease name] is usually normal.
Image:Parotid carcinoma02.jpg|Parotid carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
Image:Parotid carcinoma03.jpg|Parotid carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
Image:Parotid carcinoma04.jpg|Parotid carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
</gallery>
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{reflist|2}}
 
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Latest revision as of 13:34, 15 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

Common physical examination findings of salivary gland cancer include painless, firm swelling in one of the salivary gland, cervical lymphadenopathy, difficulty swallowing, trouble opening the mouth widely, difficulty moving one side of the face and muscle weakness on one side of the face suggestive of cranial nerve VII deficit, loss of corneal reflex, localized or regional pain, numbness, paresthesia, causalgia, or a loss of motor function suggestive of cranial nerve V deficit.[1]

Physical Examination

Physical examination should document size of the mass, mobility of the mass, fixation of the mass to the overlying skin or to the deep structures, pain with palpation, any limitation in jaw opening, buccal involvement or pharyngeal asymmetry, skin or scalp lesions indicative of primary malignancy.

HEENT

Fluid draining from the ear

Neck

Neuromuscular

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Neck

  • SALIVARY GLANDS: MIXED TUMOR OF PAROTID. The pre-auricular mass had enlarged to this size over a period of 5 years.(Courtesy of Dr. Charles E. Tomich, Indianapolis, IN.)

    SALIVARY GLANDS: MIXED TUMOR OF PAROTID. The pre-auricular mass had enlarged to this size over a period of 5 years.(Courtesy of Dr. Charles E. Tomich, Indianapolis, IN.)

  • SALIVARY GLANDS: RECURRENT MIXED TUMOR. The characteristic multinodular growth of recurrent mixed tumor is obvious inthis parotid mass. (Courtesy of Dr. Lewis R. Eversole, Los Angeles, CA.)

    SALIVARY GLANDS: RECURRENT MIXED TUMOR. The characteristic multinodular growth of recurrent mixed tumor is obvious inthis parotid mass. (Courtesy of Dr. Lewis R. Eversole, Los Angeles, CA.)


  • SALIVARY GLANDS: MIXED TUMOR OF PALATE. Most mixed tumors involve only one side of the palate because there are few minor glands in the midline. In this case the tumor appears symmetrical on either side of the midline. Large intraoral tumors are susceptible to trauma-related ulceration, as illustrated here. (Courtesy of F. J.Kratochvil, Bethesda, MD.)

    SALIVARY GLANDS: MIXED TUMOR OF PALATE. Most mixed tumors involve only one side of the palate because there are few minor glands in the midline. In this case the tumor appears symmetrical on either side of the midline. Large intraoral tumors are susceptible to trauma-related ulceration, as illustrated here. (Courtesy of F. J.Kratochvil, Bethesda, MD.)

  • SALIVARY GLANDS: CANALICULAR ADENOMA. The upper lip is the site for over 70% of canalicular adenomas.

    SALIVARY GLANDS: CANALICULAR ADENOMA. The upper lip is the site for over 70% of canalicular adenomas.


  • SALIVARY GLANDS: MUCOEPIDERMOID CARCINOMA OF PALATE. These tumors frequently are slightly raised, fluctuant, bluish discolorations of the palatal mucosa that are clinically thought to represent mucous escapereactions.

    SALIVARY GLANDS: MUCOEPIDERMOID CARCINOMA OF PALATE. These tumors frequently are slightly raised, fluctuant, bluish discolorations of the palatal mucosa that are clinically thought to represent mucous escapereactions.

  • SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION: A 2.0-cm raised subcutaneous nodule just anterior to the lower portion of the ear is a common clinical presentation for acinic cell adenocarcinoma. The tumor is in the superficial lobe of the left parotid gland of this 24-year-old man.

    SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION: A 2.0-cm raised subcutaneous nodule just anterior to the lower portion of the ear is a common clinical presentation for acinic cell adenocarcinoma. The tumor is in the superficial lobe of the left parotid gland of this 24-year-old man.


  • SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION. The upper lip, or any other intra oral site, is an uncommon location for acinic cell adenocarcinoma.

    SALIVARY GLANDS: ACINIC CELL ADENOCARCINOMA: CLINICAL PRESENTATION. The upper lip, or any other intra oral site, is an uncommon location for acinic cell adenocarcinoma.

  • SALIVARY GLANDS: ADENOID CYSTIC CARCINOMA. This sublingual gland tumor slowly enlarged to produce a large, lobulated mass in the anterior floor of the mouth. The oral mucosa is intact.

    SALIVARY GLANDS: ADENOID CYSTIC CARCINOMA. This sublingual gland tumor slowly enlarged to produce a large, lobulated mass in the anterior floor of the mouth. The oral mucosa is intact.


  • SALIVARY GLANDS: POLYMORPHOUS LOW-GRADE ADENOCARCINOMA. This tumor presented as a well-circumscribed, slow growing mass at the junction of the hard and soft palates. Pronounced telangiectasia of the overlying mucosa is evident. (Courtesy of Dr. Richard Canaan, Ocean Springs,MS.)

    SALIVARY GLANDS: POLYMORPHOUS LOW-GRADE ADENOCARCINOMA. This tumor presented as a well-circumscribed, slow growing mass at the junction of the hard and soft palates. Pronounced telangiectasia of the overlying mucosa is evident. (Courtesy of Dr. Richard Canaan, Ocean Springs,MS.)

  • SALIVARY GLANDS: NECROTIZING SIALOMETAPLASIA. Swelling, as shown in this photograph of a palatal lesion, is a frequent initial clinical presentation. Many of the swellings subsequently ulcerate. (Courtesy of Dr. Ralph Correll, LosAngeles, CA.)

    SALIVARY GLANDS: NECROTIZING SIALOMETAPLASIA. Swelling, as shown in this photograph of a palatal lesion, is a frequent initial clinical presentation. Many of the swellings subsequently ulcerate. (Courtesy of Dr. Ralph Correll, LosAngeles, CA.)

Parotid carcinoma

References

  1. ↑ 1.0 1.1 Salivary gland cancer. Canadian cancer society(2015)http://www.cancer.ca/en/cancer-information/cancer-type/salivary-gland/signs-and-symptoms/?region=sk Accessed on November 8, 2015
  2. ↑ 2.0 2.1 2.2 2.3 "Dermatology Atlas".

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