Occipital lymph nodes4/10/2023 ![]() ![]() b Immunohistochemical analysis and in situ hybridization of the occipital lymph node shows the expression of Epstein-Barr virus-encoded RNAs (EBERs) in tumor cells a Hematoxylin and eosin (H and E) stained section shows diffused tumor cells displaying characteristics of nasopharyngeal carcinoma (NPC) cells. Representative images of pathologic slices from fine-needle aspiration of the occipital lymph node (original magnification, ×40). Immunohistochemical analysis and in situ hybridization of the occipital lymph node further confirmed the presence of EBV-encoded RNAs (EBERs), indicating EBERs expression in tumor cells (Fig. The pathologic report after hematoxylin and eosin (H and E) staining identified poorly differentiated carcinoma, which suggested metastasis from NPC (Fig. Because of the possibility, though rare, of NPC-caused metastasis in the occipital region, a fine-needle aspiration of the occipital lymph node was also performed. EBV levels were abnormally elevated: EBV viral capsid antigen (VCA)-IgA, 1:640 EBV early antigen (EA)-IgA, 1:40 and EBV-DNA, 8.82 × 10 5 copies/mL.īiopsy of the nasopharyngeal neoplasm confirmed undifferentiated non-keratinizing carcinoma. The laboratory results were normal except for the results of Epstein-Barr virus (EBV). In addition, an occipital lymph node of 2 cm × 2 cm was palpable, with medium firmness and clear edge. Physical examination showed a neoplasm in the nasopharynx and several enlarged cervical lymph nodes of bilateral levels II–V the largest one was 10 cm × 8 cm. He had no history of trauma, surgery, smoking, or drinking. The patient did not complain any of the following symptoms: fever, nose bleeding, obstruction, tinnitus, diplopia, or headache. Trachea, esophagus, and prevertebral fasciaĪ 19-year-old man from Jiangxi Province, China, was admitted with the chief complaint of bilateral cervical masses for 3 months. Posterior border of the sternocleidomastoid muscle Horizontal plane defined by the lower border of the cricoids cartilage Posterior border of the sternocleidomastoid muscle or sensory branches of cervical plexus Horizontal plane defined by the lower border of the cricoid cartilage ![]() Lateral border of the sternocleidomastoid or sensory branches of cervical plexusĪpex of the convergence of the sternocleidomastoid and trapezius muscles Horizontal plane defined by the inferior border of the cricoid cartilage Horizontal plane defined by the inferior body of hyoid Lateral border of the sternocleidomastoid muscle Horizontal plane defined by the inferior body of the hyoid bone Vertical plane defined by the spinal accessory nerve Horizontal plane defined by the inferior border of the hyoid bone Occipital nodes (Figure 11) – Palpate the occipital nodes about one inch above and below the hairline.Anterior belly of contralateral digastric muscleĪnterior belly of ipsilateral digastric muscle Figures 11 through 18 depict the examination techniques for the following lymph nodes. If suspicious nodes are discovered, the patient should be referred to a physician for immediate evaluation. For example, a previous history of cancer should cause the clinician to be more suspicious of newly appearing palpable nodes than if there is no history of cancer. Remember to correlate findings from the medical history and general appraisal of the patient to the observations made during the head and neck examination. When examined, these nodes should be small (less than 1 cm), non-tender and mobile. This is a relatively common occurrence especially within the submandibular group of lymph nodes. Occasionally nodes will remain enlarged and palpable after an infection. Groups of tender nodes usually occur in conjunction with some type of acute infection. Single or multiple non-tender, and fixed nodes are very suspicious for malignancy. Findings which should be noted in the patient record include enlarged palpable nodes, fixed nodes, tender nodes and whether the palpable nodes are single or present in groups. The major lymph nodes of the head and neck area should be palpated with the patient in an upright position. ![]()
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