32 Head and neck pathology Flashcards
Oral candidiasis
Most common infection of oral cavity
-Dentures, DM, steroid/antibiotic use, cancer, AIDS/Immunosuppression
Silver stain shows hyphae
Herpes stomatitis
HSV1 Person to person transmission *Cold sores- vesicles *Multinucleated cells with intranuclear inclusions Multinucleation Molding- nuclei molded together Margination
Squamous papilloma
benign paillary grrowth.
age 30-60
assocaited with HPV6 and 11
Fibrovvacular cores of papillary squamous mucosal hyperplasia
Vocal cord nodules
Polyps- inflammation and damage under squamous epithelium of true vocal cord.
Lots of edema.
Go away with rest
Leukoplakia
White patches
not scraped off
occasionally associated with epithelial dysplasia
5-25% risk of malignancy
Eruthroplakyia
Red granular area with poorly ddefined boundries
50% risk of malignancy
Usually associated with epithelial dysplasia
Squamous cell carcinoma of mouth and larynx
95% of all oral/laryngeal cancers Age 50-70 M>F Associations: Tobbacco, alcohol, FHx, HPV 16,18, Leukoplakia and Erythroplakia
Aypia
Squamous pearls in stroma
Can get growth into skeletal muscles (tongue)
Perineural invasion- Recurrance along nerves.
Sq. cell carcinoma location and prognosis
Tongue, floor of mouth
also palates, gingiva, and dorsal tongue
Early:80% 5 year
Late 19%5 year
Submental nodes —> Cervical—>Mets of liver, lung, bone, mediatinal nodes
Laryngeal squamous cellcarcinoma
- Glottis/vocal cord (most common) -horaseness and early diagnosis
- infra or supraglottic - late diagnosis as usually assymptomatic
- adjacent spread -hemooptysis or dysphagia
Laryngeal SCC treatment
Previously Laryngectomy
now mainly radiation
Early:70% survival
Late 30% survival
HPV associated SCC
HPV 16, 18
Proteins E6 and E7 inactivate p53 RB pathway
Affects waldeyers ring
Often metastasize to neck mass
NON KERATINIZING- sheets of basal cells
Nasal cavity histo
ciliated pseudostratified submucosa with -seromucous glands -Thick walled vessels -Mixed inflammatory cells
Rhinossinusitis Histo
Edema, not a lot of glands near surface
associated with polyps
Schneiderian Papilloma
Benign growths associated with HPV 6, 11
Covered with pseudocolumnar epithelium
Olfactory neuroblastoma
Neuroendocrine cell malignancy 50 yo Salt and pepperchromatinEpistaxis, obstruction, headache NEUROSECRETORY GRANULES ON EM- synaptophysin chomogranin Immunostain
Lots of small round cells with rosettes or pseudorosettes- can have lumen
Olfactory neuroblastoma prognosis
5 year survival 50-70%
Nasopharyngeal carcnoma
Rare in americca
- Africa, China
Risk changes with movving
Associated with Diet, EBV, Smoking
Keritinizing, non keritinizing, and lymphoepithelial(lympphocytes between tumor cells)
Stained for cytokeratin-epithelial -showsepithelial in lymphocytes EB stain(EBER)
Nasopharyngeal carcinoma presentation prognosis
Silent growing until unresectable.
Local and regional mets
Radiotherapy is treatment of choice
50-70% 3 year surival.
Salivaary glands
Parotid- serous only
Sublingual- Mixed, mainly mucinous
Submental- mixed mainly serous
Acinar-dductal units
serous and or mucinous cells with intercalated myoepithelials
Parotid histo
Serous cells-zyogen granules
ducts
lots of adipose tissue
lympph nodes
Submandibular histo
Serous cells mainly
some clearer pinkish mucinous cells
Whartons duct- shor turning duct succeptable to stone and sludge formation
no lympph
Sublingual
Mucinous with scant serous
many ducts
Sjogren Syndrome
*Autoimmune with anti SS B and A (glands)
*Sicca syndrome- dry mouth and eyes
*Often associated with other autoimmune
Lymphocytic infiltration of salivary and lacrimal glands
Diag- lip biopsy
ee lymphocytes with no acini
Salivary neoplasms
- most parotid, some submandibular, less in minor glands
- F>M
- benign in the 5th to 6th decade
- Malignant later in life
MALIGNANCY MORE LIKELY IN TUMOR WITHIN GLAND OF SMALL SIZE ( i.e. tumor in sublingual 70-90% malignant, but parotid only 15% although parotid tumors more common)
Pleomorphic Adenoma
Benign mixed tumor
50-60% salivary tumors
Most parotid
Epithelials, myoepithelials, mesenchymal(stromal)
Usually firm, rubbery, and encapsulated
Pleiomorphic adenoma course
Slow growing painlesss lesions with 4% recurrence
2-10% malignant transformation over time (infiltration of tissues)
Warthin tumor
Parotid
Associated with smoking
Bilateral common
Papillary cystic changes- see bilayered bright pink epithelials and lymphocytes with spaces inside.
Mucoepidermoid carcinoma
50% parotid 40% minor salivatory glands
*Mixed squamoid, mucous, and intermediate cells (see squamous nests with mucin vacuoles)
Low grade: 90% 5 year survival- slow growing rare mets
High/intermediate have 30% mets, 50% 5 yr. survival - infiltrative growth
Tx: Resection and radiation
Adenoid cytic carcinoma
Minor and major salv glands Perineural invasion CRIBIFORM GROWTH local recurrence 50-70 YO
Wide/radical surgical resection.
Thyroglossal duct cyst
Atached to hyoid
lined with resp or squamous epithelium
Odd- swiss cheesy like thyroid tissue
Branchial cleft cyst
20-40 y.o. Laterally on the SCM muscle May be infected THin walled filled with caseous mucoid material Squamous lining and lymphoid tissue
Can look like metastatic squamous cell carcinoma
