Chapter 10: Epithelial pathology Flashcards

Question

Nicotine stomatitis

Answer 1

-‐ Dry mud appearance -‐ Reverse smoker’s palate: significant potential for dysplasia and carcinoma -‐ Should resolve upon discontinuation of habit within 1 month

Answer 2

-‐ Due to sun damage in fair-‐skinned individuals -‐ Risk factors: immunosuprresion, albinism, xeroderma pigmentosum, Cockayne syndrome, Bloom syndrome and Rothmund-‐Thompson syndrome -‐ Bowenoid actinic keratosis: when full thickness dysplasia is present -‐ 10% progress to SCC

Answer 3

-‐ Similar to actinic keratosis of the skin in behavior and pathophysiology -‐ Sun damage to lip of fair-‐skinned people and outdoor occupation (farmer’s lip, sailor’s lip) -‐ Estimated 6-‐10% SCC progression -‐ Vermiolionectomy may be employed

Answer 4

-‐ Causes: UV (95% on sun-‐exposed skin), HPV (26 or 37), tar exposure, immunosupp and trauma -‐ Seen in Muir-‐Torre syndrome -‐ Phases: growth (6 wks), stationary (6 wks) and involution (6-‐12 mths) -‐ Fergunson Smith: multiple non-‐involuting KAs, early life, hereditary (AD 9q22-‐31) -‐ Eruptive Grzybowski: 100’s of small KAs in skin and upper digestive tract; sign of internal malignancy -‐ Histo: center of lesion is crater-‐like and keratin-‐filled. Surrounding epithelium constricts neck of lesion. Downward proliferation pushes adjacent tissues and its extent is regular (inverted cup)

Answer 5

-‐ US: 3% of all cancers; 35,000 new cases (2011), 5300 deaths per year; 8th M/15th F -‐ Plummer-‐Vinson (Paterson-‐Kelly):  risk of SCC of esophagus, oropharynx and posterior mouth -‐ Esophageal webs: intertwining fibrous bands of scar in esophagus, higher malignancy rate -‐ Tertiary syphilis: increased risk dorsal tongue SCC -‐ HPV: SCC of the oropharynx (16, 18, 31 and 33) -‐ Locations: tongue, FOM, soft palate, gingiva, cheek, labial mucosa and hard palate -‐ Gingiva: in post MD, similar to PG or IFH. Least associated with tobacco and most common in F -‐ Distant mets: lung, liver and bones -‐ Desmoplasia (scirrhous change): dense fibrosis in CT induced by SCC cells -‐ Pts with SCC at risk for develop add synchronous (33%) or metachronous (66%; w/in 3y) cancers of the upper aerodig tract, esophagus, stomach and lung

Answer 6

-‐ Also seen in larynx, vagina, penis, anus, sinonasal, esophagus, breast, axilla, ear and soles of feet -‐ Associated with smokeless tobacco. May also arise from PVL -‐ Oral florid papillomatosis: old name for PLV and VC -‐ 20% may show concurrent SCC (if so, tx as SCC) -‐ 90% survival with sx w/ou neck dissection

Answer 7

-‐ Seen posteriorly (oropharynx, hypopharynx, larynx and sinonasal tract-‐worst prognosis) -‐ Exophytic and looks like papilloma with fibrovascular cores -‐ Cytologically looks like CIS and is not hyperkeratotic and not highly invasive -‐ HPV 6,11,16,18+

Answer 8

-‐ SCC (in situ or invasive) + invasive spindle cell component. Oral cavity and larynx. -‐ Due to dysfunctional cadherin-‐catenin complex -‐ 1/3 develop as recurrence after RT for WD-‐SCC (dedifferentiation) -‐ IHC: + for CK (AE1/AE3, CAM 5.2) -‐ Depth of invasion related to prognosis; tumor size unrelated

Answer 9

-‐ Combination of adenocarcinoma and SCC (maybe it’s a mucoep). Located posteriorly.

Answer 10

-‐ Due to acantholysis (not true glandular structures) -‐ Mostly on lip

Answer 11

-‐ Most in larynx, pyriform sinus and base of tongue -‐ Superficial SCC (WD or in situ) + basaloid epithelium. Comedonecrosis common.

Answer 12

-‐ Weak association with tobacco

Answer 13

-‐ Strong assocation with wood dusts exposure (more in men); sporadic more in women -‐ Second most common glandular sinonasal malignancy, after adenoid cystic carcinoma -‐ Most on ethmoid sinus (men), followed by nasal cavity and MX sinus (women) -‐ Mimics colonic adenoca (glands lined with plemorphic columnar cells in back-‐to-‐back pattern) -‐ Types: papillary, colonic, solid, mucinous and mixed -‐ CK20+, CDX2+, CK variable

Answer 14

-‐ Divided into low-‐grade and high-‐grade -‐ HG: males, MX sinus, markedly atypical and pleomorphic. LG: no sex predilection, nasal cavity -‐ Histo: small glands lined with a single layer of uniform cells (seromucinous carcinoma), B2B

Answer 15

-‐ Origin: schneiderian membrane or olfactory epithelium -‐ Some cases assoc w/ smoking, EBV and RT (weak) -‐ Histo: nests, trabeculae, ribbons of medium-‐sized polygonal cells with organoid apperance -‐ Comedonecrosis common -‐ IHC: CK (7,8,19); negative for chromogranin and synaptophysin

Answer 16

-‐ Arises from olfactory epithelium, high in the nasal cavity close to cribiform plate -‐ Rare <10y (unlike usual neuroblastoma). Bimodal peaks (15y and 50y). Most in adults -‐ Histo: nests of round cells separated by fibrovascular septa. May have neurofibrillary stroma -‐ True rosettes (Flexner-‐Wintersteiner) and pseudorosettes (Homer Wright) -‐ Type: A (in nasal cavity), B (ext to paranasal sinus) and C (beyond nose and paranasal sinuses) -‐ IHC: CD56, NSE, synaptophysin and chromogranin

Answer 17

- Oat cell ca in lung; Carcinoid tumor in GI - Mills scheme: WDNEC (carcinoid tumor), MDNEC (atypical carcinoid tumor), PDNEC small cell (small cell undiff) and PDNEC large cell (large cell undiff) - MDNEC: most common non-‐squamous tumor of the larynx, tobacco related - Histo: “Salt and pepper” nuclei, nuclear molding, crush artifact - NSE+, chromogranin+, synaptophysin+

Answer 18

-‐ Group of malignancies that arise from lining epithelium of lymphoid-‐rich nasopharynx -‐ High incidence in China; intermediate in SE Asia; low in US -‐ Assoc factors: EBV, vitamin C def, salt fish diet (nitrosamines) -‐ Rule out whenever recurrent persistent otitis media occurs in a middle aged person -‐ Most common site or origin: lateral wall at Rosenmuller’s fossa -‐ In 60% of pts, first sign is an enlarged metastatic lymph node -‐ Types: keratinizing (type 1, SCC); nonkeratizining, differentiated (type 2); nonkeratinizing, undifferentiated (type 3, lymphoepitelioma, lymphoepithelial carcinoma) -‐ Type 1 has worse prognosis, probably because due to response to radiation -‐ Lymphoepithelioma: Regaud type (clusters, nests or aggregates of neoplastic epithelial cells with lymphocytes) and Schminke type (dispersed tumor cells forming a syncitial net)

Answer 19

-‐ Most common of all cancers -‐ Mainly due to UV. Also arsenic ingestion, immunosuppresion, PUVA (for psoriasis) -‐ Seen in Gorlin syndrome, xeroderma pigmentosum, albinism, Rasmussen, Rombo and Bazex-‐ Christol-‐Dupre syndromes -‐ PTCH (9q22) mutation +p53 mutation+ SMO -‐ Clinical patterns: noduloulcerative (most common-‐telangiectatic vessels, aka rodent ulcer), pigmented (nodular with melanocytes), sclerosing (morpheaform-‐ mimics scar), superficial (multifocal-‐ mimics psoriasis), and syndromic (sun exposed and not exposed areas) -‐ Basosquamous carcinoma: “collision” tumor of BCC and SCC -‐ Mohs micrographic surgery: frozen sections to determine if BCC/SCC was entirely removed

Answer 20

-‐ Merkel cells of the epidermis are primarily associated with nerve endings -‐ Risk factors: UV light and immunosuppresion (transplant, HIV and lymphocytic leukemia). -‐ May be caused by the Merkell cell polyoma virus (MCPyV) -‐ 75% facial skin. Dome shaped nodule with smooth surface and telangiectasias (rarely ulcerates). -‐ AEIOU: Asymptomatic; Expands rapidly; Immunosuppressed; Older people; UV exposed areas -‐ IHC: CK20+ (perinuclear dot-‐like); also synapt, chromogr A and NSE; TTF-‐1 to exclude lung met -‐ Grimelius stain shows granules -‐ 25% of pts develop additional malignancies (SCC skin, hem malig or breast/ovary adenoca.)

Answer 21

-‐ Cytologically bland but locally aggressive -‐ Plaque-‐like indurated lesion of the upper lip -‐ Histo: squamous/basaloid cells; horn cysts in superficial portion; ductal structures in deeper portions; neural/vascular invasion; and desmoplastic stroma

Answer 22

-‐ 50-‐70% BRAF mutation (Ras-‐Raf-‐Erk pathyway). -‐ Types: superficial spreading (most common), nodular (sometimes amelanotic), lentigo maligna melanoma (melanoma in situ, arises from lentigo maligna-‐Hutchinson’s freckle), and acral/mucosal lentiginous melanoma (most common in oral cavity and blacks) -‐ Superficial spreading: interscapular area in males, back of leg in female -‐ IHC: HMB-‐45, Melan-‐A, Mart-‐1, Fontana-‐Masson, S-‐100 -‐ Prognosis: Breslow classification (depth of invasion assoc w/ poor prognosis for skin lesions) -‐ Elevated serum lactic dehydrogenase (LDH) and ulceration: poor prognosis (skin) -‐ BNAS: worse prognosis (interscapular back, post and lat neck, posterior upper arm, and scalp) -‐ Better prognosis for women and pts < 50y -‐ Oral: 13-‐22% survival (better for younger, worse for amelanotic)