32 Head and neck pathology

Question 0

Oral candidiasis

Answer 0

Most common infection of oral cavity
-Dentures, DM, steroid/antibiotic use, cancer, AIDS/Immunosuppression

Silver stain shows hyphae

Question 1

Herpes stomatitis

Answer 1

HSV1 
Person to person transmission
*Cold sores- vesicles
*Multinucleated cells with intranuclear inclusions
Multinucleation
Molding- nuclei molded together
Margination

Question 2

Squamous papilloma

Answer 2

benign paillary grrowth.
age 30-60
assocaited with HPV6 and 11

Fibrovvacular cores of papillary squamous mucosal hyperplasia

Question 3

Vocal cord nodules

Answer 3

Polyps- inflammation and damage under squamous epithelium of true vocal cord.
Lots of edema.
Go away with rest

Question 4

Leukoplakia

Answer 4

White patches
not scraped off
occasionally associated with epithelial dysplasia
5-25% risk of malignancy

Question 5

Eruthroplakyia

Answer 5

Red granular area with poorly ddefined boundries
50% risk of malignancy
Usually associated with epithelial dysplasia

Question 6

Squamous cell carcinoma of mouth and larynx

Answer 6

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.

Question 7

Sq. cell carcinoma location and prognosis

Answer 7

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

Question 8

Laryngeal squamous cellcarcinoma

Answer 8

• Glottis/vocal cord (most common) -horaseness and early diagnosis
• infra or supraglottic - late diagnosis as usually assymptomatic
• adjacent spread -hemooptysis or dysphagia

Question 9

Laryngeal SCC treatment

Answer 9

Previously Laryngectomy
now mainly radiation

Early:70% survival
Late 30% survival

Question 10

HPV associated SCC

Answer 10

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

Question 11

Nasal cavity histo

Answer 11

ciliated pseudostratified
submucosa with 
-seromucous glands
-Thick walled vessels
-Mixed inflammatory cells

Question 12

Rhinossinusitis Histo

Answer 12

Edema, not a lot of glands near surface

associated with polyps

Question 13

Schneiderian Papilloma

Answer 13

Benign growths associated with HPV 6, 11

Covered with pseudocolumnar epithelium

Question 14

Olfactory neuroblastoma

Answer 14

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

Question 15

Olfactory neuroblastoma prognosis

Answer 15

5 year survival 50-70%

Question 16

Nasopharyngeal carcnoma

Answer 16

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)

Question 17

Nasopharyngeal carcinoma presentation prognosis

Answer 17

Silent growing until unresectable.
Local and regional mets
Radiotherapy is treatment of choice
50-70% 3 year surival.

Question 18

Salivaary glands

Answer 18

Parotid- serous only
Sublingual- Mixed, mainly mucinous
Submental- mixed mainly serous

Acinar-dductal units
serous and or mucinous cells with intercalated myoepithelials

Question 19

Parotid histo

Answer 19

Serous cells-zyogen granules
ducts
lots of adipose tissue
lympph nodes

Question 20

Submandibular histo

Answer 20

Serous cells mainly
some clearer pinkish mucinous cells
Whartons duct- shor turning duct succeptable to stone and sludge formation
no lympph

Question 21

Sublingual

Answer 21

Mucinous with scant serous

many ducts

Question 22

Sjogren Syndrome

Answer 22

*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

Question 23

Salivary neoplasms

Answer 23

• 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)

Question 24

Pleomorphic Adenoma

Answer 24

Benign mixed tumor
50-60% salivary tumors
Most parotid
Epithelials, myoepithelials, mesenchymal(stromal)

Usually firm, rubbery, and encapsulated

Question 25

Pleiomorphic adenoma course

Answer 25

Slow growing painlesss lesions with 4% recurrence

2-10% malignant transformation over time (infiltration of tissues)

Question 26

Warthin tumor

Answer 26

Parotid
Associated with smoking
Bilateral common
Papillary cystic changes- see bilayered bright pink epithelials and lymphocytes with spaces inside.

Question 27

Mucoepidermoid carcinoma

Answer 27

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

Question 28

Adenoid cytic carcinoma

Answer 28

Minor and major salv glands
Perineural invasion
CRIBIFORM GROWTH
local recurrence 
50-70 YO

Wide/radical surgical resection.

Question 29

Thyroglossal duct cyst

Answer 29

Atached to hyoid
lined with resp or squamous epithelium
Odd- swiss cheesy like thyroid tissue

Question 30

Branchial cleft cyst

Answer 30

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