Diseases of the head and neck

Question 1

Vocal cord nodules

Answer 1

• Nodules = bilateral, on opposing surfaces of vocal fold, usually on middle 1/3

Question 2

Vocal cord polyps

Answer 2

• Polyps = unilateral (>90%), usually in Reinke’s space/ventricular space, anterior 1/2

Question 3

Precursor lesions of laryngeal squamous cell carcinoma

Answer 3

• Squamous lesions with an increased risk of progression to squamous carcinoma - 10% progress
• Supraglottic and glottis regions most affected
• M>F; 60s, associated with tobacco and alcohol

Question 4

Squamous cell carcinoma of the larynx

Answer 4

• Malignant tumour characterised by squamous differentiation
• 90% of H&N cancers
• Supraglottic and glottic regions most affected
• M>F
• Associated with tobacco and alcohol
• T1 = 90% 5 year survival whereas T4 = at least 50%

Question 5

Alcohol and tobacco smoke =

Answer 5

• Carcinogens

- Activate oncogenes, inhibit apoptosis, increase chance of uncontrolled cell proliferation

Question 6

Sino-nasal polyps definition

Answer 6

• Polypoid lesions formed by expansion of the lamina propria by fluids, protein and fibrosis. In the nasal cavity and paranasal sinuses

Question 7

Sino-nasal polyps clinical features

Answer 7

• rhinorrhoea (> sinus mucus)
• Eosinophils show there is allergy
• Excellent prognosis, often recurrent; usually over 20s
• Looks like rhabdomyosarcoma

Question 8

Sino-nasal polyps aetiology

Answer 8

• Allergy, infection, diabetes, aspirin sensitivity, asthma, CF

Question 9

Allergic fungal sinusitis

Answer 9

• Allergic response to fungal allergens
• Warmer climates, 20-60s
• allergic symptoms, nasal discharge, rhinorrhoea
• Associated with peripheral eosinophilia and elevated antifungal IgG
• Histology = Charcot-Leyden crystals
• Treatment = evacuation and steroids

Question 10

Oral lichen planus

Answer 10

• Self-limited inflammatory mucocutaneous disorder of unknown aetiology
• 1-2% of population; F>M; peak in middle aged
• Increased risk of malignant disease
• Reticular variant - (Wickham’s striae)
• Erosive variant – atrophic oedematous mucosa with ulceration

Question 11

Squamous cell carcinoma of orophaynx

Answer 11

• Malignant neoplasm arising from squamous epithelium lining the oral cavity
• Most commonly arise from lip, tongue, floor of mouth, gingiva, palate, buccal mucosa
• Often preceded by leukoplakia or erythroplakia

Question 12

Squamous cell carcinoma of orophaynx prognosis

Answer 12

• Depends on stage - advanced = poor survival
• Associated with HPV 16/18, smoking and drinking
• Prognosis better in HPV associated cases without smoking/drinking

Question 13

Pleomorphic adenoma

Answer 13

• Benign neoplasm of the salivary gland composed of ductal epithelial cells and myoepithelial cells
• Peak in 30s-40s
• Clinical features = asymptomatic, slow growing mass, characterised by formation of cartilage
• 1% risk of malignant transformation per year

Question 14

Carcinoma ex pleomorphic adenoma

Answer 14

• Carcinoma arising in association with pleomorphic adenoma
• Non-invasive/minimally invasive carcinoma - has same prognosis as pleomorphic adenoma (good prognosis)
• Invasive = more than 1.5mm beyond capsule = poor prognosis; <50% live for 5 years

Question 15

Adenoid cystic carcinoma

Answer 15

• Malignant neoplasm of the salivary gland
• Basaloid tumour consisting of epithelial and myoepithelial cells
• Peak 40-60s
• Most patients die of or with tumour
• Metastasis to lung, bone, brain, liver – up to 60%