head and neck Flashcards
Oral cavity- herpes
HSV type 1, transmission (person to person), virus persists in dormant state, asymptomatic
Reactivation: vesicles (cold sore, intraepithelial edema–> clear fluid—> rupture–> ulcer. multinucleated cells with intranuclear viral inclusions
Tzanck smear, 3 Ms Multinucleation, molding and margination
oral cavity- candidiasis
Thrush, most common fungal infection, dentures, diabetes, steroids, AIDS, transplant and chemo
Fungal hyphae superficially attached to underlying mucosa
GMS silver stain
malignant cancers of oral cavity and larynx
95% are squamous cell carcinoma
50-70
M>F
Tobacco, alcohol famhistory HPV (16 and 18 leukoplakia and erythroplakia (common)
oral cavity precancerous lesions
Leukoplakia: Clinical non pathologic diagnosis
WHITE patch caused by epidermal thickening or hyperkeratosis
can NOT be scraped off unlike thrusk
Occasionally associated with epithelial dysplasia, risk of malignancy: 5-25%
Erythroplakia: clinical non pathologic diagnosis, RED granular area that can be eleveated or not, Usually associated with epithelial dysplasia, risk of malignancy 50%
Epithelial dysplasia
proliferation of immature (basal) cells, loss of cell polarity, increased number of mitotic figures above base, variation in nuclear size and shape, hyperchromasia
Progression of squamous cell carcinoma: dysplasia progressing to carcinoma in situ, followed by invasion/infiltration of submucosa (normal-> hyperplasia-> mild/mod dysplasia-> severe dysplasia CIS-> invasive CA)
Most occur on the tongue and floor also on gingiva, hard soft palates, dorsal tongeu, mucosa (early stage 80%, late stage 19% survival), sites of mets (lymph nodes , lung liver, bone, mediastinal lymph nodes)
Squamous cell carcinoma of larynx clinical presentation
Glottis (true vocal cords)- patient presents with hoarseness, most common location of laryngeal carcinoma, diagnosed at earlier stage because of symptoms
Supraglottic or infraglottic: usually asymptomatic early in course, diagnosed at later stages (symptoms secondary to mass)
With spread into adjacent structures (hemoptysis or dysphagia)
Surgery laryngectomy, radiation , 5 year 70% stage 1, 30% stage
Variants : classic keratinizing, HPV association non keratinizing
HPV associated squamous cell carcinoma
Affects oropharynx, waldeyer/s ring (tonsillar type llymphoid tissue, palatine tonsils, base of tongue, adenoids
HPV 16 and 18 associated, HP proteins E6 and E7 inactivate p53, Rb, frequently mets to neck lymph nodes
No keratinization, sheets and strips of cohesive cells with basaloid morphology, nuclear atypia, increaed mitoitc activity
Rhinosinusitis
Viral (common cold), allergic, obstructive process (deviated septum), gross examination is similar (edematous nasal mucosa, turbinatess enlarged)
Microscopy (mixed inflammatory inflitrate, edema, thickened basement membrane), complication (nasal polyps)
nasal cavity and paranasal sinus tumors (olfactory Neuroblastoma)
malignant: olfactory neuroblastoma, nasopharyngeal carcinoma
Olfactory neuroblastoma (esthesioneruoblastoma): Superior and lateral mucosa of the nose (olfactory mucosa) origin from neuroendocrine cells, Median age 50 years, Symptoms (epistaxis, nasal obstruction, headache, composed of uniform cells with round nuclei, scr=ant cytoplasm Salt pepper chromatin,
EM: neurosecretory granules
IHC: neuroendocrine markers, synaptophysin, chromogranin
Prognosis: locally invasive, mets widely lypmh nodes and lungs, 5 year survival 50-70%
nasal cavity and paranasal sinus tumors (nasopharyngeal carcinoma)
Northern africa and asia, EBV infection Salted fish and smoking, hereditary
Keratinizing squamous cell, non keratinizing squamous cell carcinoma (undifferentiated)
Prognosis: grows silently until resectable, local regional lymph nodes metastasis, radiotherapy, 50-70% 3 yr survival rate
Major and minor salivary glands
Major:
Parotid Gland: serous
Submandibular: mixed, mainly serous
Sublingual: Mixed mainly mucinous
Minor: throughout the oral mucosa, lips–> oropharynx
Sjorgren syndrome
Autoimmune disease: ANTI-SS-B and anti-SSa
Sicca syndrome: Xerostomia (drymouth), Keratoconjuctivitis (dry eyes)
In association with other AI diseases (rheumatoid, lupus)
Path: lymphocytic infiltrattion, lacrimal glands, eventual gland destruction (lymphoepithelial isands, biopsy)
Neoplasms of the salivary glands
parotid gland mainly
submandibular
Epidemiology (adults, females, 5th -7th dec, benign, malignancy in elderly)
Benign (pleomorphic adenoma, warthin)
Malignant (mucoepidermoid, adenoid cystic carcinoma)
Pleomorphic adenoma
Common salivary gland tumor
Wide age range, 75-85% occur in the parotids, Benign Mixed Tumor
Epithelial cells (ductal, myoepithelial cells, mesenchymal components (myxoid, haline, chondroid
Pleomorphic (variability)
Adenoma (proliferation of cells (epithlial and myoepithelial)
Painless slow growing, local recurrence rate About 4%, malignant transformation (2% for tumors less than 5 yrs and 10% for fumors more than 10 yrs)
warthin tumor
2nd most common salivary glands, restricted parotid gland, M>F, smoking, bilateral salivary gland tumor.
Papillary cystic change
Bilayered oncocytic pink epithelial cells and lymphocytes
