Head and Neck Flashcards
benign lesion of HPV origin, most commonly type 6/11 with exophytic, finger-like projectionsindic
papilloma
premalignant lesion that is white plaque like
leukoplakia
95% of head and neck malignancies
squamous cell carcinoma
80% of these harbor oncogenic variants of HPV
squamous cell carcinoma
most commonly on the hard palate or gingiva
mucosal melanoma
most SCC occur on these 2 locations
-floor of mouth
-lateral/ventral surfaces of tongue
for a shave/mucosal biopsy, what is it important to do
maintain orientation of the mucosa
if there is suspicion of bone invasion, what should be done
radiograph the specimen
if IHCs need to be performed for a specimen with bone, what must you make sure to do
make sure the appropriate decal is used
staging oral cavity or tongue is largely dependent on these two things
tumor size and depth of invasion
measurement from the horizon of basement membrane of the adjacent uninvolved mucosa perpendicularly to the deepest point of invasion
depth of invasion
measured from the surface of the invasive SCC for an endophytic/exophytic tumor, and from the ulcer base for an ulcerated tumor to the deepest point of invasion
tumor thickness
anterior thyroid is what shape
convex
posterior thyroid is what shape
concave
types of thyroid specimens you can receive (3)
-FNA
-hemi-thyroidectomy
-Thyroidectomy
gross appearance is diffusely enlarged, pale yellow-tan, with a firm nodular cut surface
Hashimoto’s thyroiditis
recurrent episodes of hyperplasia and involution
multinodular goiter
caused by insufficient iodine, with gradual thyroid failure due to autoimmune destruction of the gland
Hashimoto’s thyroiditis
thyroid enlargement with over 2000 g possible
multinodular goiter
normal weight of thyroid
18-25 g
gross cut section bulges from the cut surface, solitary spherical and encapsulated
follicular adenoma (of thyroid)
gross appearance of well circumscribed, encapsulated with a friable, papillary surface
papillary carcinoma
gross appearance of capsular invasion, multilobulated tan-yellow to pink, solid to cystic
follicular carcinoma
neuroendocrine origin, well circumscribed, may contain central coarse/microcalcifications ranging from gray-white to yellow-brown
medullary carcinoma
dark, maroon red “beefy” parenchyma is indicative of
normal thyroid
serially section thyroid lobes this way
superior to inferior
thyroid staging is largely dependent on these two characteristics
-tumor size
-confinement within thyroid
for papillary carcinoma, section this much
1 section per cm
if a papillary carcinoma is friable these should be used
bags/paper to wrap
for a goiter, a representative sections must be taken for
each nodule, up to 5
what are parathyroids usually removed for
hyperparathyroidism (adenoma)
most important feature of a parathyroid specimen
weight
parathyroid specimens are often received for this process
frozen section
extends from tip of epiglottis to apex of ventricle, contains false vocal cords and ventricle, folds etc.
supraglottis
extends from ventricle to about 1.0cm below the free level of true vocal cords, contains ant. and pos. commissures and true vocal cord
glottis
extends from free level of true vocal cord to inferior rim of cricoid cartilage
subglottis
laryngeal carcinomas are
squamous cell carcinoma
bengin lesion on larynx
squamous papilloma
most laryngeal carcinomas are typically on the
vocal cords
measure laryngeal specimens in this orientation
3D
open a laryngeal specimen this way
posteriorly
larynx staging is dependent on
Anatomic Subsite/Tumor Site
this often accompanies head and neck malignancies
radical lymph node dissection
cervical lymph nodes, sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve, submandibular gland (maybe tail of parotid)
standard radical lymph node dissection
does not include sternocleidomastoid muscle, spinal accessory nerve or internal jugular vein
modified radical lymph node dissection
also includes retropharyngeal, paratracheal, parotid, suboccipital, and/or upper mediastinal nodes
extended radical lymph node dissection
only the nodes of the first metastatic station
regional radical lymph node dissection
if you have low yield of lymph nodes, you may
submit surrounding soft tissue (oriented per level)
it is important to describe these types of lymph nodes that have gross tumor involvement, and submit the whole thing
matted
mucosal biopsy CPT code
88305
parathyroid gland CPT code
88305
lymph node CPT code
88305
thyroid total/lobe CPT code
88307
larynx partial/total resection
88307
lymph nodes regional resection
88307
tongue resection for tumor
88309
larynx, partial/ total resection with regional lymph nodes
88309
