Chapter 23: Malignant Tumors of the Head and Neck

Question 1

1. Comprises 90% of head and neck cancer

2. More common in men

Answer 1

Squamous cell carcinoma

Question 2

Has been associated with nasopharyngeal carcinoma

Answer 2

Epstein-Barr virus

Question 3

1. Develops in a major or minor salivary gland, is the next most common type
2. Occurs equally in men and women

Answer 3

Adenocarcinoma

Question 4

1. Develops as an ulcerative lesion with necrotic edges, usually surrounded by some inflammatory response
2. Initially spreads along the mucosal surface, eventually extending into the underlying soft tissue

Answer 4

Squamous cell carcinoma

Question 5

Occurs in the major or minor salivary glands located in the mucosal lining or in the immediately submucosal area

Answer 5

Adenocarcinoma

Question 6

Classification of common tumors of salivary glands

Answer 6

1. Acinic cell carcinoma
2. Adenoid cystic carcinoma (cylindroma)
3. Adenocarcinoma
4. Mucoepidermoid carcinoma
5. Carcinoma arising in pleomorphic adenoma
6. Malignant mixed tumor

Question 7

1. May metastasize by both lymphogenous and hematogenous

2. May occur at any age

Answer 7

Adenocarcinoma

Question 8

1. Has a high propensity to spread along the neural sheaths

2. Known to recur after a disease free interval of 5-10 years

Answer 8

Adenoid cystic carcinoma

Question 9

Generally submucosal, presenting as a smooth, firm, rounded mass that becomes ulcerated only late in the course of the disease or after biopsy

Answer 9

Adenocarcinoma

Question 10

May present as a primary malignancy in the head and neck

Answer 10

Malignant lymphoma

Question 11

Classification of Hodgkin’s lymphoma

Answer 11

1. Lymphocyte predominance
2. Nodular sclerosis
3. Mixed cellularity
4. Lymphocyte depletion

Question 12

Reported to have the most favorable 5-year survival rates

Answer 12

1. Lymphocyte predominance

2. Nodular sclerosis

Question 13

Commonly localized to the cervical lymph nodes and upper mediastinum

Answer 13

Nodular sclerosing type

Question 14

Systems used in the diagnosis of non-Hodgkin’s lymphoma

Answer 14

1. Rappaport
2. Lukes-Collin
3. Lennert

Question 15

Divides the tumors into well-differentiated lymphocytic, poorly differentiated lymphocytic, mixed histiocytic-lymphocytic and diffuse poorly differentiated

Answer 15

Rappaport

Question 16

Dependent on immunologic identification

Answer 16

Lukes-Collin system

Question 17

1. Most common sarcoma in children

2. Occurs in the posterior nares, ethmoid, orbital and nasopharyngeal regions

Answer 17

Rhabdomyosarcoma

Question 18

Most common sarcoma of the head and neck in adult

Answer 18

Malignant fibrous histocytoma

Question 19

Most common tumor to metastasize to the paranasal sinuses

Answer 19

Hypernephroma

Question 20

1. Most common skin malignancy and arises in areas with a high exposure to sunlight
2. Common sites: cheek, nose, forehead, ear
3. Excellent prognosis
4. Tx: excision

Answer 20

Basal cell carcinoma

Question 21

1. Arises in areas associated with high sunlight exposure
2. Most common sites: pinna and lower lip
3. Can metastasize regionally and distally

Answer 21

Squamous cell carcinoma

Question 22

1. Lesions involving only the epidermis
2. Considered to be “atypical melanocytic hyperplasia” and not included in the staging of malignant melanoma, for they do not represent a malignant lesion

Answer 22

Clark's classification
Level I (epidermis to epidermal-dermal interface)

Question 23

1. Invasion of the papillary dermis

2. Does not reach the papillary-reticular dermal interface

Answer 23

Clark's classification
Level II (papillary dermis)

Question 24

1. Invasion involves the full thickness of, fills and expands the papillary dermis
2. Abuts upon but does not penetrate the reticular dermis

Answer 24

Clark's classification
Level III (papillary-reticular dermis interface)

Question 25

Invasion occurs into the reticular dermis but not into the subcutaneous tissue

Answer 25

Clark's classification
Level IV (reticular dermis)

Question 26

Invasion occurs through the reticular dermis into the subcutaneous tissue

Answer 26

Clark's classification
Level V (subcutaneous tissue)

Question 27

Breslow’s classification by depth

Answer 27

1. 0.75 mm or less
2. 0.76 mm to 1.50 mm
3. 1.51 mm to 4.0 mm
4. More than 4.0 mm

Question 28

1. Arise on mucous membranes of the nose or throat

2. Most common sites: intranasal/hard palate/buccal mucosa

Answer 28

Malignant melanoma

Question 29

Modalities of treatment of head and neck malignancies

Answer 29

1. Radiation therapy
2. En bloc surgical excision
3. Laser excision
4. Chemotherapy
5. Combination of modalities