Head and Neck

Question 1

Approximately x% of cancers of the head and neck are SCCs, with the remainder largely consisting of x of salivary gland origin.

Answer 1

95
Adenocacrinomas

Question 2

Head and neck SCC

The pathogenesis is multifactorial:
* x now the primary cause of SCC of the oropharynx.
* Within North America and Europe, oral cavity SCC x
* In India and Asia, x is a major regional predisposing influence.
* x are known predisposing influences for cancer of the lower lip.

Answer 2

• Infection with high-risk human papillomavirus (HPV) is now the primary cause of SCC of the oropharynx.
• Within North America and Europe, oral cavity SCC has classically been a disease of middle-aged individuals who have been chronic users of smoked tobacco and alcohol.
• In India and Asia, the chewing of betel quid and paan is a major regional predisposing influence.
• Actinic radiation (sunlight) and pipe smoking are known predisposing influences for cancer of the lower lip.
• The incidence of oral cavity SCC (particularly involving the tongue) in individuals younger than 40 years of age, who have no known risk factors, has been on the rise. The pathogenesis in this group of patients, who are nonsmokers and are not infected with HPV, is unknown.

Question 3

In the oropharynx, as many as x% of SCCs, particularly those involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of x

Answer 3

In the oropharynx, as many as 80% of SCCs, particularly those involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of HPV, particularly HPV-16.

Question 4

SCC may arise anywhere in the head and neck region that is lined by x. For the “classic” HPVnegative keratinizing SCC, the favored locations are the x

Answer 4

SCC may arise anywhere in the head and neck region that is lined by stratified squamous epithelium. For the “classic” HPVnegative keratinizing SCC, the favored locations are the ventral surface of the tongue, floor of the mouth, lower lip, soft palate, and gingiva

Question 5

Differences Between HPV-Associated and Non-Associated SCC

Answer 5

Question 6

HPV-associated SCC is characterized by the proliferation of nests and lobules of x and basaloid cells growing within sheets of lymphocytes

Answer 6

nonkeratinizing

Question 7

Immunohistochemical detection of x protein expression can serve as a marker for HPV-associated SCC

Answer 7

p16 protein

Question 8

The dentigerous cyst originates …

Answer 8

The dentigerous cyst originates around the crown of an unerupted tooth as a result of fluid accumulation between the developing tooth and the dental follicle. Radiographically, these are unilocular lesions most often associated with impacted third molar (wisdom) teeth. Histologically, they are lined by a thin layer of stratified squamous epithelium, and there is frequently a dense chronic inflammatory cell infiltrate in surrounding connective tissue. Complete surgical excision is curative.

Question 9

The keratocystic odontogenic tumor must be differentiated from other odontogenic cysts because of its aggressive behavior.

Can be seen at any age but are most common between x and x years of age, in x(gender), and within the x.

Answer 9

The keratocystic odontogenic tumor, which was previously referred to as odontogenic keratocyst, must be differentiated from other odontogenic cysts because of its aggressive behavior. Keratocystic odontogenic tumors can be seen at any age but are most common between 10 and 40 years of age, in males, and within the posterior mandible. The lesions are well-defined unilocular or multilocular radiolucencies with a lining consisting of a thin layer of keratinized stratified squamous epithelium with a prominent basal cell layer and a corrugated epithelial surface. Treatment requires complete excision because of locally aggressive behavior. Recurrence rates for inadequately removed lesions can be as high as 60%. About 80% of the lesions are solitary, but patients with multiple cysts should be evaluated for nevoid basal cell carcinoma syndrome (Gorlin syndrome), which is associated with mutations in the tumor suppressor gene PTCH (Patched) on chromosome 9q22

Question 10

Nasopharyngeal angiofibroma is a x tumor that occurs almost exclusively in x who are often x and x.

Answer 10

Nasopharyngeal a fibroma is a benign, highly vascular tumor that occurs almost exclusively in adolescent males who are often fair-skinned and red headed.

Because nasopharyngeal angiofibroma is often locally aggressive, with intracranial extension, recurrence rates can approach 20%, and 9% of cases can be fatal

Question 11

Fungi may cause severe chronic sinusitis (e.g., in x), especially in x patients.

Answer 11

Fungi may cause severe chronic sinusitis (e.g., in mucormycosis), especially in diabetic patients.

Question 12

Sinonasal papilloma is a x neoplasm arising from the respiratory or Schneiderian mucosa lining the nasal cavity and paranasal sinuses.

These lesions occur in three forms: exophytic (most common), endophytic (or inverted), and oncocytic (formerly known as cylindrical cell).

Sinonasal papillomas are most common in males between x and x years of age.

Answer 12

benign
30 and 60 years of age

The endophytic form may invaginate into the underlying stroma. Although this is a benign neoplasm, it can display locally aggressive behavior within both the nose and the paranasal sinuses, including invasion into the orbit or cranial vault, and has a high rate of recurrence if not adequately excised. Malignant transformation occurs in approximately 10% of cases. Most endophytic sinonasal papillomas have EGFR gene mutations. The remaining cases generally harbor HPV DNA, often low-risk types 6 and 11.

Question 13

Olfactory neuroblastomas arise from neuroectodermal olfactory cells within the mucosa, particularly in the x(sup/inf/post/ant) of the nasal cavity.

Answer 13

Olfactory neuroblastomas arise from neuroectodermal olfactory cells within the mucosa, particularly in the superior aspect of the nasal cavity.

The age distribution is bimodal, with peaks at 15 and 50 years.

Histologically, olfactory n blastomas are small, blue, round cell neoplasms, a category that includes lymphoma, small cell carcinoma, Ewing sarcoma/ peripheral neuroectodermal tumor, rhabdomyosarcoma, melanoma, and sinonasal undifferentiated carcinoma.

Question 14

Nasopharyngeal carcinoma is characterized by a distinctive geographic distribution, a close anatomic relationship to x tissue, and an association with x infection.

The nomenclature for nasopharyngeal carcinomas continues to evolve, but, at present, is described as one of three patterns:

Answer 14

close anatomic relationship to lymphoid tissue, and an association with EBV infection.

(1) keratinizing SCCs
(2) nonkeratinizing SCCs
(3) basaloid SCCs

The three principal factors that influence development of nasopharyngeal carcinomas are heredity, age, and EBV infection.

Question 15

Antrochoanal polyps (ACP) are x sinonasal polyps that arise within the x sinus.

Answer 15

Antrochoanal polyps (ACP) are solitary sinonasal polyps that arise within the maxillary sinus (antrum). They pass through and enlarge the sinus ostium and posterior nasal cavity at the level of the choana.

ntrochoanal polyps represent only ~5% of sinonasal polyps 3. They are most commonly seen in young adults in their 3rd to 5th decades.

Question 16

Laryngitis may occur as the sole manifestation of allergic, viral, bacterial, or chemical insult, but it is more commonly associated with generalized upper respiratory tract infection, heavy environmental toxin exposure (e.g., x), or x

Answer 16

(e.g., tobacco smoke), or gastroesophageal reflux due to irritating effects of gastric contents.

Question 17

The vast majority of branchial cysts are thought to arise from remnants of the x branchial arch and are most commonly observed in x between x and x years of age.

Answer 17

The vast majority of branchial cysts are thought to arise from remnants of the second branchial arch and are most commonly observed in young adults between 20 and 40 years of age.

Question 18

Paragangliomas arise from neuroendocrine cells associated with the x and x x systems and occur at many sites

x are the most common paraganglioma

Answer 18

Paragangliomas arise from neuroendocrine cells associated with the sympathetic and parasympathetic nervous systems and occur at many sites.

Adrenal medullary phaeochromocytomas are the most common paraganglioma.

Approximately 70% of extra-adrenal paragangliomas occur in the head and neck.

Question 19

The carotid body tumor is a typical parasympathetic x. It rarely exceeds 6 cm in diameter and arises close to or envelops the bifurcation of the common carotid artery.The tumor tissue is red-pink to brown, and the microscopic features are characteristic of paragangliomas at all sites.

Nests (zellballen) of round to oval chief cells with abundant, clear or granular, eosinophilic cytoplasm and uniform, round to ovoid, sometimes vesicular, nuclei are surrounded by delicate vascular septae

Answer 19

paraganglioma

Question 20

Carotid body tumors, and paragangliomas in general, are rare, slow-growing, painless masses that usually arise in the x decades of life.

Tumors associated with multiple endocrine neoplasia type x most often occur within the adrenal pheochromocytomas.

Carotid body tumors frequently x after incomplete resection and, despite their benign appearance, may metastasize to regional lymph nodes and distant sites.

Answer 20

Carotid body tumors, and paragangliomas in general, are rare, slow-growing, painless masses that usually arise in the fifth and sixth decades of life. They commonly occur singly and sporadically but also may be familial.

Tumors associated with multiple endocrine neoplasia type 2 most often occur within the adrenal (pheochromocytomas)

Carotid body tumors frequently recur after incomplete resection and, despite their benign appearance, may metastasize to regional lymph nodes and distant sites.

About 50% ultimately prove fatal, largely because of infiltrative growth. Unfortunately, histologic features do not predict the clinical course of a carotid body tumor—mitoses, pleomorphism, and even vascular invasion are not reliable indicators.

Question 21

Sialadenitis may be induced by x, x or x infection, or x disease. The most prevalent form of sialadenitis is the mucocele.

The most common viral cause of sialadenitis is x, which affects the major salivary glands, particularly the parotids, and frequently involves other glandular organs such as the pancreas and testes

Answer 21

Sialadenitis may be induced by trauma, viral or bacterial infection, or autoimmune disease. The most prevalent form of sialadenitis is the mucocele. The most common viral cause of sialadenitis is mumps, which affects the major salivary glands, particularly the parotids, and frequently involves other glandular organs such as the pancreas and testes

Question 22

Nonspecific bacterial sialadenitis, involving the submandibular and other major salivary glands, is common and most often caused by infection with x and x following ductal obstruction by stones (sialolithiasis).

Answer 22

Nonspecific bacterial sialadenitis, involving the submandibular and other major salivary glands, is common and most often caused by infection with S. aureus and Streptococcus viridans following ductal obstruction by stones (sialolithiasis).

Question 23

Histologic Classification and Incidence of the Most Common Benign and Malignant Tumors of the Salivary Glands

Answer 23

Question 24

Little is known about the origin of pleomorphic adenomas, but x exposure increases risk.

Answer 24

radiation exposure

Question 25

The Warthin tumor is the x most common salivary gland neoplasm. It is unique in that it arises almost exclusively in the x gland.

x (or swollen cell in Greek) refers to large cells containing numerous mitochondria that impart a granular, eosinophilic appearance to the cytoplasm and have large nuclei with prominent nucleoli.

Warthin tumors are x (benign/malignant) and occur more commonly in x than in x (genders), the x to x decades of life. The risk is increased x (how many fold) in smokers.

Most Warthin tumors are unifocal, but about x% are multifocal and x% bilateral

Answer 25

The Warthin tumor is the second most common salivary gland neoplasm. It is unique in that it arises almost exclusively in the parotid gland.

oncocyte (or swollen cell in Greek) refers to large cells containing numerous mitochondria that impart a granular, eosinophilic appearance to the cytoplasm and have large nuclei with prominent nucleoli.

Warthin tumors are benign and occur more commonly in males than in females, the fifth to seventh decades of life. The risk is increased eightfold in smokers.

Most Warthin tumors are unifocal, but about 10% are multifocal and 10% bilateral

Question 26

x carcinoma is the most common primary malignant tumor of salivary glands, representing about 15% of all salivary gland tumors.

Most (x%) occur in the parotids, but mucoepidermoid carcinomas account for a large fraction of salivary gland neoplasms in the other glands, particularly the minor salivary glands.

Answer 26

Mucoepidermoid carcinoma is the most common primary malignant tumor of salivary glands, representing about 15% of all salivary gland tumors.

Most (60% to 70%) occur in the parotids, but it accounts for a large fraction of salivary gland neoplasms in the other glands, particularly the minor salivary glands.

Question 27

Adenoid cystic carcinomas. 50% of these relatively uncommon tumors occur in the x salivary glands (particularly the x glands).

Among major salivary glands, x and x glands are most commonly affected.

Adenoid cystic carcinomas also occur in the nose, sinuses, upper airways, lung, breast, and other sites.

Adenoid cystic carcinomas are unpredictable, slowgrowing tumors that tend to invade perineural spaces. They regularly recur, and 50% or more eventually disseminate to distant sites including bone, liver, and brain, sometimes decades after attempted removal.

Answer 27

Adenoid cystic carcinomas. 50% of these relatively uncommon tumors occur in the minor salivary glands (particularly the palatine glands).

Among major salivary glands, parotid and submandibular glands are most commonly affected.

Adenoid cystic carcinomas also occur in the nose, sinuses, upper airways, lung, breast, and other sites.

Adenoid cystic carcinomas are unpredictable, slowgrowing tumors that tend to invade perineural spaces. They regularly recur, and 50% or more eventually disseminate to distant sites including bone, liver, and brain, sometimes decades after attempted removal.

Question 28

The x cyst is a common inflammatory lesion found at the tooth apex. The cysts develop as a result of longstanding inflammation of the tooth (pulpitis), often secondary to advanced carious lesions or local trauma.

Answer 28

The radicular cyst is a common inflammatory lesion found at the tooth apex. The cysts develop as a result of longstanding inflammation of the tooth (pulpitis), often secondary to advanced carious lesions or local trauma.

Question 29

Occipital encephaloceles may be associated with a number of additional abnormalities:

Answer 29

Chiari malformations
Dandy-Walker malformations
Meckel-Gruber syndrome

Question 30

Lemierre syndrome (also known as postanginal septicaemia) refers to:

An anaerobic Gram-negative bacillus, x, is responsible for a majority (80%) of cases and gives rise to the term x

Answer 30

Lemierre syndrome (also known as postanginal septicaemia) refers to thrombophlebitis of the internal jugular vein(s) with distant metastatic sepsis in the setting of initial oropharyngeal infection such as pharyngitis/tonsillitis with or without peritonsillar or retropharyngeal abscess.

An anaerobic Gram-negative bacillus, Fusobacterium necrophorum, is responsible for a majority (80%) of cases and gives rise to the term necrobacillosis

Question 31

Disorders Associated With Thyrotoxicosis

Answer 31

Question 32

The most common causes of thyrotoxicosis are associated with hyperfunction of the gland and include the following:

Answer 32

• Diffuse hyperplasia of the thyroid associated with Graves disease (approximately 85% of cases)
• Hyperfunctional multinodular goiter
• Hyperfunctional thyroid adenoma

Question 33

Manifestations of hyperthyroidism

Answer 33

1. an increase in the basal metabolic rate. The skin of thyrotoxic patients tends to be soft, warm, and flushed because of increased blood flow and peripheral vasodilation, adaptations that serve to increase heat loss. Heat intolerance is common. Sweating is increased because of higher levels of calorigenesis. Heightened catabolic metabolism results in weight loss despite increased appetite.
2. Cardiac manifestations are among the earliest and most consistent features. Individuals with hyperthyroidism can have elevated cardiac contractility and output, a response to increased peripheral oxygen requirements. Tachycardia, palpitations, and cardiomegaly are common. Arrhythmias such as atrial fibrillation occur frequently, particularly in older patients. Congestive heart failure in older
3. Overactivity of the sympathetic nervous system produces tremor, hyperactivity, emotional lability, anxiety, inability to concentrate, and insomnia. Proximal muscle weakness and decreased muscle mass are common (thyroid myopathy). In the gastrointestinal system, hypermotility and reduced transit times lead to hyperdefecation
4. Ocular changes often call attention to hyperthyroidism. A wide, staring gaze and lid lag are present because of sympathetic overstimulation of the superior tarsal muscle (also known as Müller’s muscle), which functions alongside the levator palpebrae superioris muscle to raise the upper eyelid (Fig. 24.9). However, true thyroid ophthalmopathy associated with proptosis occurs only in Graves disease (see later).
5. The skeletal system is also affected. Thyroid hormone stimulates bone resorption, increasing cortical bone porosity and reducing trabecular bone volume. The net effect is osteoporosis and an increased risk of fractures. Other findings include atrophy of skeletal muscle, with fatty infiltration and focal interstitial lymphocytic infiltrates; hepatic fatty change (steatosis) leading to mild hepatomegaly; and generalized lymphoid hyperplasia and lymphadenopathy in patients with Graves disease.
6. Thyroid storm refers to the abrupt onset of severe hyperthyroidism. This condition occurs most commonly in patients with Graves disease and probably results from an acute elevation in catecholamine levels, as might be encountered during infection, surgery, cessation of antithyroid medication, or any form of stress. Patients are often febrile and present with tachycardia out of proportion to the fever. Thyroid storm is a medical emergency. A significant number of untreated patients die of cardiac arrhythmias. * Apathetic hyperthyroidism refers to thyrotoxicosis occurring in older adults, in whom advanced age and various comorbidities blunt the typical features of thyroid hormone excess. The diagnosis in these individuals is often made during laboratory workup for unexplained weight loss or worsening cardiovascular disease.

Question 34

Causes of Hypothyroidism

Answer 34

Question 35

Primary hypothyroidism can be congenital, autoimmune, or iatrogenic.

Answer 35

Congenital hypothyroidism. Worldwide, congenital h thyroidism is most often the result of endemic iodine deficiency in the diet (see later). Other rare forms of congenital hypothyroidism include inborn errors of thyroid metabolism (dyshormonogenetic goiter), wherein one of the several steps leading to thyroid hormone synthesis is defective, such as (1) iodide transport into thyrocytes, (2) “organification” of iodine (covalent binding of iodine to tyrosine residues in thyroglobulin), and (3) further processing to form hormonally active T 3 and T4 . In rare instances, there may be complete absence of thyroid parenchyma (thyroid agenesis), or the gland may be greatly reduced in size (thyroid hypoplasia) due to germline mutations in genes responsible for thyroid development (see Table 24.4).

• Autoimmune hypothyroidism. Autoimmune hypothyroidism is the most common cause of hypothyroidism in iodinesufficient areas of the world. The vast majority of cases of autoimmune hypothyroidism are due to Hashimoto thyroiditis. Circulating autoantibodies, including antimicrosomal, antithyroid peroxidase, and antithyroglobulin antibodies, are found in this disorder, and the thyroid is typically enlarged (goitrous). Autoimmune hypothyroidism can occur in isolation or in conjunction with autoimmune polyendocrine syndrome types 1 and 2 (APS-1 and APS-2; see discussion in the Adrenal Glands section later in this chapter).
• Iatrogenic hypothyroidism. This can be caused by either surgical or radiation-induced ablation. Resection of a large portion of the gland for the treatment of hyperthyroidism or a primary neoplasm can lead to hypothyroidism. The gland may also be ablated by radiation, whether in the form of radioiodine administered for the treatment of hyperthyroidism, or exogenous irradiation, such as external radiation therapy to the neck. Drugs given to decrease thyroid secretion (e.g., thionamides like methimazole and

Question 36

x refers to hypothyroidism that develops in infancy or early childhood.

Clinical features include x

Answer 36

Cretinism refers to hypothyroidism that develops in infancy or early childhood.

Clinical features include severe intellectual disability, short stature, coarse facial features, a protruding tongue, and umbilical hernia

Question 37

The term myxedema is applied to hypothyroidism developing in the older child or adult.

Is marked by x

Answer 37

Is marked by a slowing of physical and mental activity. Early symptoms include generalized fatigue, apathy, and mental sluggishness, which may mimic depression. Speech and intellectual functions are slowed, and patients are listless, cold intolerant, and frequently overweight. Decreased sympathetic activity results in constipation and decreased sweating. The skin is cool and pale because of decreased blood flow. Reduced cardiac output probably contributes to shortness of breath and decreased exercise capacity, two frequent complaints.

nonpitting edema, a broadening and coarsening of facial features, enlargement of the tongue, and deepening of the voice.

Question 38

Hashimoto thyroiditis is an x disease that results in:

It is the x cause of hypothyroidism in areas of the world where iodine levels are sufficient.

It is most prevalent between x years of age and is more common in x than in x, with a predominance of 10 : 1 to 20 : 1

Hashimoto thyroiditis is caused by a breakdown in x

Answer 38

Hashimoto thyroiditis is an autoimmune disease that results in destruction of the thyroid gland and gradual and progressive thyroid failure.

It is the most common cause of hypothyroidism in areas of the world where iodine levels are sufficient.

It is most prevalent between 45 and 65 years of age and is more common in women than in men, with a female predominance of 10 : 1 to 20 : 1

Hashimoto thyroiditis is caused by a breakdown in self-tolerance to thyroid autoantigens.

Question 39

Individuals with Hashimoto thyroiditis are at increased risk for developing other autoimmune diseases, both endocrine, x and non-endocrine x

They are also at increased risk for development of x

The relationship between Hashimoto disease and thyroid epithelial cancers remains controversial, with some morphologic and molecular studies suggesting a predisposition to x

Answer 39

Individuals with Hashimoto thyroiditis are at increased risk for developing other autoimmune diseases, both endocrine (type 1 diabetes, autoimmune adrenalitis) and non-endocrine (systemic lupus erythematosus, myasthenia gravis, and Sjögren syndrome

They are also at increased risk for development of extranodal marginal zone B-cell lymphoma within the thyroid gland

The relationship between Hashimoto disease and thyroid epithelial cancers remains controversial, with some morphologic and molecular studies suggesting a predisposition to papillary carcinoma.

Question 40

x, a rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures. The presence of a hard and fixed thyroid mass clinically simulates a thyroid carcinoma. It may be associated with fibrosis in other sites in the body, such as the retroperitoneum, and appears to be another manifestation of IgG4-related disease, which is associated with fibrosis and tissue infiltration by plasma cells producing IgG4

Answer 40

Riedel thyroiditis, a rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures. The presence of a hard and fixed thyroid mass clinically simulates a thyroid carcinoma. It may be associated with fibrosis in other sites in the body, such as the retroperitoneum, and appears to be another manifestation of IgG4-related disease, which is associated with fibrosis and tissue infiltration by plasma cells producing IgG4

Question 41

x disease is the most common cause of endogenous hyperthyroidism.

The disease is characterized by a triad of clinical findings:

x disease has a peak incidence between x and x years of age.

Women are affected as much as x times more frequently than men.

Answer 41

Graves disease is the most common cause of endogenous hyperthyroidism.

The disease is characterized by a triad of clinical findings:

• Hyperthyroidism associated with diffuse enlargement of the gland
• Infiltrative ophthalmopathy and resultant exophthalmos
• Localized, infiltrative dermopathy, sometimes called pretibial myxedema, which is present in a minority of patients

Graves disease has a peak incidence between 20 and 40 years of age. Women are affected as much as 10 times more frequently than men. This disorder is said to affect 1.5% to 2% of women in the United States.

Question 42

Graves disease is an autoimmune disorder characterized by the production of

Answer 42

Graves disease is an autoimmune disorder characterized by the production of autoantibodies against multiple thyroid proteins, most importantly the TSH receptor.

Question 43

The protrusion of the eyeball (exopthalmos) is caused by an increase in the volume of the retro-orbital connective tissues and extraocular muscles, which occurs for several reasons:

Answer 43

The protrusion of the eyeball (exopthalmos) is caused by an increase in the volume of the retro-orbital connective tissues and extraocular muscles, which occurs for several reasons: (1) marked infiltration of connective tissue by mononuclear cells, predominantly T cells; (2) inflammation, edema, and swelling of extraocular muscles; (3) accumulation of extracellular matrix components, specifically hydrophilic glycosaminoglycans such as hyaluronic acid and chondroitin sulfate; and (4) increased numbers of adipocytes (fatty infiltration). These changes not only displace the eyeball but also may interfere with the function of the extraocular muscles.

Question 44

Most thyroid carcinomas are derived from x epithelium (except medullary carcinoma, which is derived from x)

Answer 44

Most thyroid carcinomas are derived from thyroid follicle epithelium (except medullary carcinoma, which is derived from parafollicular C cells)

Question 45

The major subtypes of thyroid carcinoma and their relative frequencies are as follows:

Answer 45

The major subtypes of thyroid carcinoma and their relative frequencies are as follows:

• Papillary thyroid carcinoma (PTC), including “conventional” PTC and the “encapsulated follicular variant” (80% to 85%% of cases). This category includes the newly described lesion known as “noninvasive follicular thyroid neoplasm with papillary-like nuclear features,” a low-grade neoplasm with such a minimal risk of recurrence that “carcinoma” has been removed from its name.
• Follicular carcinoma (10% to 15% of cases)
• Poorly differentiated and anaplastic (undifferentiated) carcinoma (<5% of cases)
• Medullary carcinoma (5% of case

Question 46

Thyroid
The microscopic hallmarks of papillary neoplasms include the following

• Branching x having a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells. In most neoplasms, the epithelium covering the papillae consists of well-differentiated, uniform, orderly cuboidal cells, but at the other extreme are those with fairly anaplastic epithelium showing considerable variation in cell and nuclear morphology. When present, the papillae differ from those seen in areas of hyperplasia in being more complex and having dense fibrovascular cores.
• Nuclei with finely dispersed chromatin and an optically clear or empty appearance, giving rise to the designation x or x nuclei. In addition, invaginations of the nuclear membrane may give the appearance of nuclear inclusions (“pseudo-inclusions”) or grooves. The diagnosis of papillary carcinoma can be made based on these nuclear features, even in the absence of papillary architecture.
• Concentrically calcified structures termed psammoma bodies are often present, usually within the cores of papillae. Thesestructures are almost never found in follicular and medullary carcinomas, and they are a strong indication that the lesion is a papillary carcinoma when present in fine-needle aspiration material.

Answer 46

• Branching papillae having a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells. In most neoplasms, the epithelium covering the papillae consists of well-differentiated, uniform, orderly cuboidal cells, but at the other extreme are those with fairly anaplastic epithelium showing considerable variation in cell and nuclear morphology. When present, the papillae differ from those seen in areas of hyperplasia in being more complex and having dense fibrovascular cores.
• Nuclei with finely dispersed chromatin and an optically clear or empty appearance, giving rise to the designation ground-glass or Orphan Annie eye nuclei. In addition, invaginations of the nuclear membrane may give the appearance of nuclear inclusions (“pseudo-inclusions”) or grooves. The diagnosis of papillary carcinoma can be made based on these nuclear features, even in the absence of papillary architecture.
• Concentrically calcified structures termed psammoma bodies are often present, usually within the cores of papillae. Thesestructures are almost never found in follicular and medullary carcinomas, and they are a strong indication that the lesion is a papillary carcinoma when present in fine-needle aspiration material.

Question 47

Anaplastic thyroid carcinomas - x cells

Answer 47

spindle cells

most cases death occurs in less than 1 year

Question 48

Medullary carcinomas arising in the context of x are generally more aggressive and metastasize more frequently than those occurring in patients with x tumors or x.

Answer 48

Medullary carcinomas arising in the context of MEN-2B are generally more aggressive and metastasize more frequently than those occurring in patients with sporadic tumors or MEN-2A.

Question 49

The most common malignancy of the eyelid is x

Answer 49

The most common malignancy of the eyelid is basal cell carcinoma.