Head and Neck Flashcards
Oral cancers are not associated with: (March 2014)
a. Syphilis
b. Alcohol
c. HPV
ANSWER: Oral cancer is not associated with syphilis. Alcohol has a synchronous effect with smoking
Regarding ameloblastoma, which is false? (March 2015)
a. When occurring in the sella region, is referred to as a craniopharyngioma
b. Mostly solid, rather than cystic
c. Occurs in association with an impacted wisdom tooth
d. More common in males
e. More common in the mandible
Ameloblastoma:
- Locally aggressive but benign tumours
- Usually present as a slow growing, painless mass
- Variable components of solid and cystic material
May be multi-locular (80%) or unilocular (20%)
Soap bubble pattern is typical (but not pathognomonic)
Unicystic type more commonly associated with an impacted or displaced molar tooth
- Expansile – can be disfiguring if large. Usually >2cm at diagnosis
- Tumour recurrence rate high (15%) post resection
Local recurrence more common with multiloculated lesions
90% recurrence with curettage
Late recurrence (>5 years) has been reported
Usually arise in the mandible, rarely in the maxilla
Epidemiology:
- Second most common odontogenic tumour (but most common lucent lesion as odontomas are solid)
- Typically present in the 3rd to 5th decade
Unicystic variant presents at a younger age
No significant gender predilection
Women are on average slightly younger at presentation (4 years younger)
ANSWER: Ameloblastoma does not occur more commonly in males (equal gender predilection); although the lesions are considered multi or unilocular they have enhancing solid nodules
Radiograph of the mandible shows a lucent lesion near the root of a tooth with dental particles. Which is the most likely diagnosis? (March 2014)
a. Odontoma
b. Keratogenic odontoid tumour
c. Dentigerous cyst
d. Ameloblastoma
e. Cementoma
Odontoma: radiodense with a lucent rim; may have tooth like particles (tooth hamartoma)
o Most common mandibular lesion
o May contain dentin, cementin, pulpal tissue and enamel
Keratocystic odontogenic tumour: benign cystic neoplasm with locally aggressive features; well corticated
o High rate of local recurrence
Dentigerous cyst: lucent lesion near the crown of the tooth
Ameloblastoma: soap bubble lesion, locally destructive
Cementoma: hyperdense, attached to the tooth root
ANSWER: Odontoma
Which is most likely to recur post surgery? (August 2014)
a. Dentigerous cyst
b. Ameloblastoma
c. Odontoma
d. Periapical cyst
e. Keratocytic odontogenic tumour
Ameloblastoma
- High recurrence rate with curettage (45-90%)
- Typically resected en-bloc which reduces the recurrence rate (15-25%)
Keratocytic odontogenic tumour
- Treated with enucleation and excision, with aggressive curettage
- Recurrence rate 30-60% for locally aggressive tumour
- Recurrence rate approaching 0% for en bloc resection
ANSWER: Ameloblastoma is most likely to recur post-surgery. It is more effectively treated with en-bloc resection.
What lesion occurs most commonly in the mandible in a patient with Gorlin-Goltz syndrome? (March 2016)
a. Ondontogenic keratocyst
b. Dentigerous cyst
c. Periapical cyst
d. Odontoma
ANSWER: Odontogenic keratocyst
Regarding juvenile nasopharyngeal angiofibroma: (March 2014)
a. Location is the posterolateral wall of the nose
b. Complicated by sarcomatous transformation
Juvenile nasopharyngeal angiofibroma
- Rare benign, but locally aggressive tumour
Epidemiology:
- Almost exclusively in males, Adolescents
- Most common benign nasopharyngeal neoplasm, but only accounts for 0.5% of head and neck neoplasms
Presentation:
- Obstruction
- Bleeding (epistaxis – may be life threatening)
- Chronic otomastoiditis from obstruction of the Eustachian tube
Pathology:
- Highly vascular tumours
- Arise from the posterior choanals in the region of the sphenopalatine foramen
- Often very large at presentation
- Mostly supplied by the ECA branches, less commonly supply from ICA branches
Larger lesions more likely to have internal carotid tributaries
Complications:
- Haemorrhage, Obstruction
- No risk of sarcomatous transformation
ANSWER: JNAs are thought to arise at the sphenopalatine foramen at the posterolateral aspect of the nasal cavity, although they are often very large at diagnosis
Which of the following associations is true? (March 2014)
a. Mucomycosis is associated with diabetic ketoacidosis
b. Rhinosporidiosis and …
c. Leprosy involves the nasal septum
d. Immunocompetent male with allergic rhinitis and aspergillus infection
ANSWER: Leprosy is associated with nasal septum erosion; mucomycosis is associated with diabetes, so technically could be associated with DKA in this context
What is caused by HPV in the nasal cavity? (August 2014)
a. NK/T cell lymphoma
b. Papilloma
c. Nasopharyngeal carcinoma
d. Juvenile angiofibroma
• NK/T cell lymphoma: associated with EBV
• Papilloma: no infectious risk factors for inverted papilloma
- More common in middle aged males
- Nasopharyngeal carcinoma: associated with EBV and HPV
- Juvenile angiofibroma: no associated infectious risk factors
ANSWER: Nasopharyngeal carcinoma is associated with HPV in the nasal cavity
Which is most likely to be associated with HPV? (March 2016)
a. Juvenile laryngeal papillomatosis
b. Vocal cord nodules
c. Epiglottitis
Juvenile laryngeal papillomatosis:
- Benign tumours of the aerodigestive tract caused by HPV (6 and 11)
- Transmission occurs at the time of delivery
Epidemiology:
- Children ~4 years old
- Increased risk with mothers <20 years, firstborn child and delivery time longer than 10 hours
- Vaccination is protective
Location:
- Larynx most common
- Extralaryngeal spread in 30%: Endobronchial spread; Pulmonary nodules in 3%
Imaging:
- Soft tissue nodules protrude into the airway lumen
- Multiple solid or cavitated nodules
- May give post-obstructive atelectasis or pneumonia
Pathology:
- HPV 6 & 11
- Malignant degeneration to SCC in 0.5%
- May spontaneously regress, however some children have lifelong morbidity
ANSWER: Juvenile laryngeal papillomatosis is associated with HPV 6 & 11
There is a lesion at the angle of the mandible. The tail extends between the ICA and ECA. What is the most likely lesion? (March 2017)
a. 1st branchial cleft cyst
b. 2nd branchial cleft cyst
c. 3rd branchial cleft cyst
d. 4th branchial cleft cyst
ANSWER: This is most in keeping with a second branchial cleft cyst
Which is true? (March 2016):
a. A thyroglossal duct cyst, if not excised, has a small chance of developing cancer
Thyroglossal duct cyst:
o Lined by squamous or bronchial epithelium
o 1% risk of developing thyroid carcinoma:
- Nodularity or coarse calcification suggests development of thyroid carcinoma
- 85% papillary
ANSWER: A thyroglossal duct cyst has a small chance of developing carcinoma (1%, most commonly papillary)
Adenoid cystic carcinoma (March 2015)
a. Arises from pleomorphic adenoma
b. Favours perineural spread
c. Majority in parotid
- Rare histological subtype of adenocarcinoma
- Generally low grade
- Tendency to perineural spread, locally aggressive
- Adenoid cystic carcinoma of the salivary glands:
One of the most common malignancies of the submandibular and sublingual
Most common malignancy in the minor salivary glands and second most common in the parotid
55% arise in the minor salivary glands
ANSWER: Favours perineural spread
Which parotid lesion has a predilection for perineural spread? (March 2017)
a. Adenoid cystic carcinoma
ANSWER: Adenoid cystic carcinoma has a predilection for perineural spread
What is the least likely cause of parotid malignancy? (March 2014)
a. Acinar cell carcinoma
b. Mucoepidermoid carcinoma
c. Carcinoma ex pleomorphic adenoma
d. Squamous cell carcinoma
Malignant Tumours of Salivary Glands:
- Mucoepidermoid carcinoma 15%
- AdenoCa NOS 10%
- Acinic cell Ca 5%
- Adenoid cystic Ca 5%
- Malignant mixed tumour 3-5%
- SCC 1%
- Other Ca 2%
ANSWER: SCC is the least likely cause of neoplasm of the provided options
Concerning Sjogren’s Syndrome, which of the following is LEAST correct?
- Enlargement of the salivary glands may be seen in Sjogren’s Syndrome without additional complication
- Reduction in size of the salivary glands may be seen in Sjogren’s Syndrome without additional complication
- Duct/ductule obstruction occurs due to associated calculi formation and sludge
- Flow cytometry should be considered on any salivary mass in this condition: There is an increased risk of salivary B cell lymphoma.
- Systemic associations include pulmonary fibrosis, synovitis, peripheral neuropathy
- *Duct/ductule obstruction occurs due to associated calculi formation and sludge
