Sandbox: Gertrude: Difference between revisions

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* [[Benign]]
* [[Benign]]
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* More common in adults and [[children]] in [[endemic]] continent such as African
* More common in adults and [[children]] in [[endemic]] continent such as Africa
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* Recent travel to [[endemic]] regions
* Recent travel to [[endemic]] regions
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* PPD: +
* [[PPD-tuberculin skin test|PPD]]: +
Sputum smear:  
[[Sputum]] [[Smear test|smear]]:  
* Presence of acid fast bacilli
* Presence of [[Acid fast|acid fast bacilli]]
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* Chronic necrotizing caseating calcified granuloma
* Chronic [[necrotizing]] [[caseating]] [[Calcification|calcified]] [[granuloma]]
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* Neck Ultrasound: Multiple lymph nodes
* [[Ultrasound|Neck Ultrasound]]: Multiple [[lymph nodes]]


* Fusion tendency
* Fusion tendency
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* Culture for mycobacteria
* [[Mycobacteria|Culture for mycobacteria]]
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
|-
|-
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| align="center" style="background:#F5F5F5;" | -
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* Throat culture
* [[Throat culture]]
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* Acute rheumatic fever
* [[Acute rheumatic fever]]


* Post-streptoccocal glomerulonephritis
* [[Glomerulonephritis|Post-streptoccocal glomerulonephritis]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Parasitic|Parasitic lymphadenopathy]]
! align="center" style="background:#DCDCDC;" |[[Parasitic|Parasitic lymphadenopathy]]
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* Seen in Hot climates
* Seen in Hot climates
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* Cats or birds feces exposure
* [[Cat-scratch|Cats]] or birds [[feces]] exposure


* Drinking unpasteurized milk
* Drinking [[unpasteurized milk]]


* Undercooked food
* Undercooked food


* Organ transplant recipients
* [[Organ (anatomy)|Organ]] [[Organ transplant|transplant]] recipients
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
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* Serology :  
* [[Serology]] :  
+ IgG and IgM
+ IgG and IgM
antibodies
antibodies
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* Follicular hyperplasia
* Follicular hyperplasia
| align="center" style="background:#F5F5F5;" |MRI:
| align="center" style="background:#F5F5F5;" |[[MRI]]:
* Multiple rings enhanced lesions  
* Multiple rings enhanced lesions  
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* Serology
* [[Serology]]


* Immunofluorescence
* [[Immunofluorescence]]
MRI
[[MRI]]
* CT scan
* [[CT scan]]
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
|-
|-
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* More common in African American women aged 20 - 40 years.
* More common in African American women aged 20 - 40 years.
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* Family history of sarcodosis,
* [[Family]] history of [[sarcoidosis]]
* [[Fatigue]]


* Fatigue
* [[Swelling]] and [[pain]] in the [[joints]]
 
* Swelling and pain in the joints,
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| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
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* Bilateral
* Bilateral
tender LAD
tender [[lymph nodes]]
* Swollen
* [[Swelling|Swollen]]


* Non-tender parotid glands
* Non-tender [[parotid glands]]
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* Erythema nodosum,
* [[Erythema nodosum]]


* Lupus pernios
* [[Lupus]] pernios
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
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* ↑ ESR
* ↑ [[ESR]]


* ↑ ACE
* ↑ [[Angiotensin-converting enzyme|ACE]]
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| align="center" style="background:#F5F5F5;" |
* Non-necrotizing epithelioid granuloma
* [[Necrotizing|Non-necrotizing]] [[epithelioid]] [[granuloma]]
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* CXR: B/L hilar adenopathy
* CXR: B/L hilar adenopathy
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* MRI: B/L multiples enlarged cervical lymph nodes
* MRI: B/L multiples enlarged cervical lymph nodes
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| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]


| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" | -
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Castleman's disease|Castleman disease]] ([[Angiofollicular lymph node hyperplasia|angiofollicular lymphoproliferative disease]])<ref name="pmid22791417">{{cite journal |vauthors=Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM |title=The clinical spectrum of Castleman's disease |journal=Am. J. Hematol. |volume=87 |issue=11 |pages=997–1002 |date=November 2012 |pmid=22791417 |pmc=3900496 |doi=10.1002/ajh.23291 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Castleman's disease|Castleman disease]] ([[Angiofollicular lymph node hyperplasia|angiofollicular lymphoproliferative disease]])<ref name="pmid22791417">{{cite journal |vauthors=Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM |title=The clinical spectrum of Castleman's disease |journal=Am. J. Hematol. |volume=87 |issue=11 |pages=997–1002 |date=November 2012 |pmid=22791417 |pmc=3900496 |doi=10.1002/ajh.23291 |url=}}</ref>
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| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
|-
|-
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| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Hashimoto thyroiditis
* Hashimoto thyroiditis
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| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biospsy
* [[Biopsy]]
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| align="center" style="background:#F5F5F5;" |
* Nephrotic syndrom
* Nephrotic syndrom
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| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Clinical findings
* [[Clinical|Clinical findings]]
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
|-
|-
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* Tumors are hypointense on T1 and hyperintense on T2
* Tumors are hypointense on T1 and hyperintense on T2
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
|-
|-
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* Abundant myxochondroid stroma on T2
* Abundant myxochondroid stroma on T2
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
|-
|-
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Heterogeneous
Heterogeneous
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| align="center" style="background:#F5F5F5;" |
* Biopsy
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" |  
| align="center" style="background:#F5F5F5;" |  
|-
|-

Revision as of 19:17, 8 February 2019

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

Differential diagnosis of neck masses==

Differential diagnosis of neck masses include:

Category Diseases Benign or Malignant Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Skin changes LAP Others
Congenital Branchial cleft cyst Benign
Thyroglossal duct cyst
Hemangioma
Vascular malformations
Lymphatic malformations
Laryngocele
Ranula
Teratoma
Dermoid cyst
Thymic cyst
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis
Chronic sialadenitis
Reactive viral lymphadenopathy CMV
EBV
HIV
Viral URI
Bacterial lymphadenopathy Tularemia
Brucellosis
Cat-scratch disease[1][2]
  • More common in the Southern of U.S among children and young adults.
  • Cat exposure
+ - +

Serology:

- -
Actinomycosis[3][4] - -
  • Tender at the beginning
  • Painless
  • Fluctuant
  • Non-tender at late stage
  • Red
  • Blue
-

Gram stains:

-
Mycobacterial infections[5][6][7] - -
  • Firm
  • Non-tender
+

Sputum smear:

  • Fusion tendency
  • Internal echoes
-
Streptococcal infection[8][9] + + - +
  • Rapid antigen detection tests: +/-
  • Follicular hyperplasia
  • Infiltration of polymorphonuclear cells
-
Parasitic lymphadenopathy Toxoplasma gondii[10][11]
  • 6 years old and older adults are more affected in U.S.
  • Seen in Hot climates
  • Undercooked food
+ -
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
- +

+ IgG and IgM antibodies

  • Follicular hyperplasia
MRI:
  • Multiple rings enhanced lesions

MRI

-
Sarcoidosis[12][13]
  • More common in African American women aged 20 - 40 years.
- -
  • Bilateral

tender lymph nodes

+
  • CXR: B/L hilar adenopathy
  • MRI: B/L multiples enlarged cervical lymph nodes
  • Heerfordt's syndrome: uveitis, facial nerve paralysis, parotitis
Sjögren syndrome[14]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
  • History of RA, SLE, and non-hodgkin B-cell lymphoma.
  • Dry mouth, dry eyes.
- +
  • Firm,
  • B/L enlarged parotid glands
  • Itchy
  • Rashes
  • Dry
+
  • ↑ ESR
  • Anti-SSA/Ro: +
  • Anti-SSB/La: +
  • Cytopenia
  • Hyperactivity of B cells and lymphocytes which lead to infiltration of the exocrine glands.
-
Castleman disease (angiofollicular lymphoproliferative disease)[15] Mean age: 30-40 years
Kikuchi disease (histiocytic necrotizing lymphadenitis)[16]
  • High prevalence in Japan
  • More common in young adults <30 years old
  • Fever
  • Flu-like prodrome
+ -
  • Tender cervical node
  • rashes
+
  • ↑ ESR
  • Abnormal liver enzymes
  • leucopenia
  • Irregular paracortical areas of coagulative necrosis with abundant karyorrhectic debris
-
  • Hashimoto thyroiditis
Kimura disease[17]
  • More common in Asian males.
  • History of painless cervical lump
- -
  • Large
  • Non-tender cervical node
  • Itching
+ ↑ eosinophils
  • Conserved lymph node structure
  • Eosinophilic infiltration
  • High postcapillary venules
-
  • Nephrotic syndrom
  • Hypercoaguble state
Rosai-Dorfman disease[18][19]
  • More common in children
  • Fever
- -
  • Non-tender enlarged cervical lymph nodes
  • Erythema
+
  • ↑ ESR
  • Polyclonal hypergammaglobulinemia
- - - -
Kawasaki disease[20][21]
  • More common in children younger than 5 years old.
  • Highest incidence in Japan.
  • Most leading cause of acquired heart disease in U.S.
  • High fever
  • B/L conjunctivitis
  • Rash
  • Swelling of hands and feet
  • Inflammation of lips
  • Strawberry tongue
- -
  • Large, single palpable cervical node
  • Rashes
  • Desquamation of skin
+
  • ↑ ESR
  • ↑ CRP
  • Inflammation of medium sized arteries and organs.
Echocardiography:
  • Coronary artery

dilation

  • Coronary artery aneurysm
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[22][23][24]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common: Japan, India, Iran
  • Tobacco use
  • Abuse alcohol consumption
  • HPV infection
  • Lump in the neck
  • Odynophagia
  • Hoarseness
- +
  • Non tender cervical node
- + -
  • Spindle cells
  • Nuclear atypia
  • Basaloid cells
  • Abundant chromatin
Neck CT scan:
  • Soft tissue mass
  • Irregular thickening of mucosa
  • Necrotic region

MRI:

  • Tumors are hypointense on T1 and hyperintense on T2
-
Salivary gland neoplasm Pleomorphic adenoma[25]
  • More common in Females
  • Incidence increase with age.
  • Incidence : 2-3.5 cases per 100,000 population
  • History of swelling
  • Dysphagia
  • Hoarseness
- +
  • Palpable mass of deep lobe of parotid gland
  • Firm
  • Mobile
- - -
  • Proliferation of epithelial cells and stromal matrix in the ducts.
  • MRI:[26] Homogenous on T1
  • Abundant myxochondroid stroma on T2
-
Warthin's tumor[27][28]
  • Male to Female ratio : 4:1
  • More common in people aged 60 to 70 years old.
  • History of swollen salivary gland
  • Jaw pain
  • Tinnitus
- +
  • Non tender
  • Mobile
  • Firm
  • Solitary
- - -
  • Papillae
  • Fibrous capsule
  • Cystic spaces
Neck CT:
  • Cystic lesion posteriorly within the parotid gland.

MRI:

  • B/L lesions

Heterogeneous

Oncocytoma
Monomorphic adenoma
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Adenocarcinoma
Salivary duct carcinoma
Squamous cell carcinoma
Parathyroid tumors
Carotid body tumors
Paraganglioma
Schwannoma
Lymphoma
Liposarcoma
Lipoma
Glomus vagale, glomus jugulare tumors
Nasopharyngeal cancer
Other Hematoma
Arteriovenous fistula
Goiter
Category Diseases Benign Demography History Pain Dysphagia Mass exam Skin changes LAP Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

  1. "Cat-Scratch Disease in the United States, 2005–2013 - Volume 22, Number 10—October 2016 - Emerging Infectious Diseases journal - CDC".
  2. Hansmann, Y.; DeMartino, S.; Piemont, Y.; Meyer, N.; Mariet, P.; Heller, R.; Christmann, D.; Jaulhac, B. (2005). "Diagnosis of Cat Scratch Disease with Detection of Bartonella henselae by PCR: a Study of Patients with Lymph Node Enlargement". Journal of Clinical Microbiology. 43 (8): 3800–3806. doi:10.1128/JCM.43.8.3800-3806.2005. ISSN 0095-1137.
  3. Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, Gleizal A, Boussel L, Laurent F, Braun E, Chidiac C, Ader F, Ferry T (2014). "Actinomycosis: etiology, clinical features, diagnosis, treatment, and management". Infect Drug Resist. 7: 183–97. doi:10.2147/IDR.S39601. PMC 4094581. PMID 25045274.
  4. Bonnefond S, Catroux M, Melenotte C, Karkowski L, Rolland L, Trouillier S, Raffray L (June 2016). "Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations". Medicine (Baltimore). 95 (24): e3923. doi:10.1097/MD.0000000000003923. PMC 4998488. PMID 27311002.
  5. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  6. Suskind DL, Handler SD, Tom LW, Potsic WP, Wetmore RF (July 1997). "Nontuberculous mycobacterial cervical adenitis". Clin Pediatr (Phila). 36 (7): 403–9. doi:10.1177/000992289703600705. PMID 9241478.
  7. Drobniewski FA, Caws M, Gibson A, Young D (March 2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
  8. Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
  9. Kenealy T (November 2007). "Sore throat". BMJ Clin Evid. 2007. PMC 2943825. PMID 19450346.
  10. Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK (June 2010). "Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature". J Magn Reson Imaging. 31 (6): 1469–72. doi:10.1002/jmri.22192. PMC 2908244. PMID 20512900.
  11. [+https://www.cdc.gov/parasites/toxoplasmosis/diagnosis.html "CDC - Toxoplasmosis - Diagnosis"] Check |url= value (help).
  12. "Sarcoidosis | National Heart, Lung, and Blood Institute (NHLBI)".
  13. Abdel Razek A, Mukherji S (June 2017). "Imaging of sialadenitis". Neuroradiol J. 30 (3): 205–215. doi:10.1177/1971400916682752. PMC 5480791. PMID 28059621. Vancouver style error: initials (help)
  14. Mavragani CP, Moutsopoulos HM (October 2014). "Sjögren syndrome". CMAJ. 186 (15): E579–86. doi:10.1503/cmaj.122037. PMC 4203623. PMID 24566651.
  15. Dispenzieri A, Armitage JO, Loe MJ, Geyer SM, Allred J, Camoriano JK, Menke DM, Weisenburger DD, Ristow K, Dogan A, Habermann TM (November 2012). "The clinical spectrum of Castleman's disease". Am. J. Hematol. 87 (11): 997–1002. doi:10.1002/ajh.23291. PMC 3900496. PMID 22791417.
  16. Bosch X, Guilabert A (May 2006). "Kikuchi-Fujimoto disease". Orphanet J Rare Dis. 1: 18. doi:10.1186/1750-1172-1-18. PMC 1481509. PMID 16722618.
  17. AlGhamdi FE, Al-Khatib TA, Marzouki HZ, AlGarni MA (March 2016). "Kimura disease: No age or ethnicity limit". Saudi Med J. 37 (3): 315–9. doi:10.15537/smj.2016.3.14448. PMC 4800898. PMID 26905356.
  18. "Rosai-Dorfman disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
  19. Foucar E, Rosai J, Dorfman R (February 1990). "Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): review of the entity". Semin Diagn Pathol. 7 (1): 19–73. PMID 2180012.
  20. "About Kawasaki Disease | Kawasaki Disease | CDC".
  21. "Kawasaki Disease | National Heart, Lung, and Blood Institute (NHLBI)".
  22. Helliwell TR (February 2003). "acp Best Practice No 169. Evidence based pathology: squamous carcinoma of the hypopharynx". J. Clin. Pathol. 56 (2): 81–5. PMC 1769882. PMID 12560383.
  23. International Journal of Recent Scientific Research. doi:10.24327/IJRSR. ISSN 0976-3031. Missing or empty |title= (help)
  24. Maasland, Denise HE; van den Brandt, Piet A; Kremer, Bernd; Goldbohm, R Alexandra; Schouten, Leo J (2014). "Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study". BMC Cancer. 14 (1). doi:10.1186/1471-2407-14-187. ISSN 1471-2407.
  25. Debnath SC, Adhyapok AK (June 2010). "Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip". J Maxillofac Oral Surg. 9 (2): 205–8. doi:10.1007/s12663-010-0052-5. PMC 3244097. PMID 22190789.
  26. Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M (August 2018). "Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features". Jpn J Radiol. 36 (8): 463–471. doi:10.1007/s11604-018-0747-y. PMID 29845358.
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