Head and Neck PATH Flashcards
Inverted papilloma location ? RF ?
Location
- Lateral nasal wall can extend into maxillary antrum
RF
- HPV 6 and 11
Inverted papilloma complication ?
- 10% harbors SCC**
- Can also get other cancers like: mucoepidermoid carcinoma, verrucous carcinoma, and adenocarcinoma
- Hence need resection
Esthesioneuroblastoma location and age ? What scan to use ?
- This is a neuroblastoma of olfactory cells so it’s gorma start at the cribiform plate (Octreotide scan +)
- Dumbbell shape growth up into the skull and growth down into the sinuses, with a waist at the
plate (classic) - Often cysts in the mass (intracral posterior cyst is “diagnostic” look)
- Bi-modal age distribution
Ludwig angina imaging
- Gas filled abscess involving Submandibular AND sublingual space* (separated by Mylohyoid)
Ranula arise from what location ?
- Sublingual space (typically lateral)
- Plunging ranula: extends into submandibular space
OKC (Keratogenic Odontogenic Tumor)
- How is it different to periapical(radicular) and dentigerous cyst
- imaging ?
- location ?
- associated syndrome ?
Unlike the prior two lesions (which were basically fluid collections) this is an actual tumor.
Imaging
- Solitary, unilocular, expansile lesion with smooth, corticated borders* (can have septations, will look like ameloblastoma)
- Ramus or posterior body of mandible*
- When multiple think Gorlin Syndrome (Basal cell naevus syndrome)*
OKC (Keratogenic Odontogenic Tumor)
- Epidemiology
- Prognosis ?
- Younger people 10 – 40 years old and more common in males
- Locally aggressive and highly likely to recur (60%) without adequate resection
Gorlin Syndrome (Basal cell naevus syndrome) findings ?
- BCCs, calcified falx, medulloblastoma, short 4th metacarpal, PTCH gene**
Ameloblastoma
- Imaging ?
- Associated with ?
Also a tumor (Adamantinoma of the jaw)
Imaging
- Multilocular “Soap bubble”
- Extensive tooth root absoprtion* (hallmark)
- Solid component
- Angle of mandible
Associated with
- 20% of ameloblastomas may arise from dentigerous cysts**
Odontoma
- Imaging ?
- “Tooth Hamartoma”
- Start lucent, become radio-dense
- eventually Radiodense with a lucent rim
- can be LARGE with “fluffy” calcification
PLEOMORPHIC ADENOMA
- complication ?
- Benign
- Degenerate into Carcinoma ex Pleomorphic Adenoma (Malignant Mixed Tumour) – increases with time,
about 10% at 15 years - Most aggressive tumor
- High chance of seeding if large G core biopsy.
Warthin tumor
- Epi
- Site
- Recurrence ?
Epi
- Benign
- M > F
- Smokers
Site
- Parotid gland (ONLY, c.f. Pleomorphic can occur in all major glands)
- 10% Bilateral and multifocal
Recurrence
- 2% (c.f. Pleomorphic adenoma Likely to recur if only enucleated (25%))
Mucoepidermoid Carcinoma
- benign or malignant
- location ?
- Malignant (most common malignant tumor of minor gland)
- Mainly in the parotid glands and minor salivary glands
- Associated with radiation
ADENOID CYSTIC
- benign or malignant
- location
- Complication
- Malignant
- Minor gland (most common)
- Perineural spread and can disseminate to distant site decades after removal (Melanoma is the other that perineural spreads)
Lymphoma of salivary gland
- Location ?
- Association ?
Location
- Parotid gland (the only salivary gland with lymph nodes)
Association
- Sjogrens
- If you see it and it’s bilateral, you should think
Sjogrens. Sjogrens patients have a big risk (like lOOOx) of parotid lymphoma
Sjogrens in salivary gland
- Epi
- Associations
Epi
- Women in 60s
Association
- non-hodgkin MALToma (1000x)
Bilateral mixed solid and cystic lesions in parotid with diffusely enlarged parotid glands
Benign Lymphoepithelial Disease
- Seen in HIV
- Painless (unlike parotitis which also enlarges gland)
Schwannoma or Neurofibroma more common ?
Schwannoma
Neurofibroma vs Schwannoma imaging feature ?
Neurofibroma
- less common than schwannoma
- 10% relates to NF-1, will be bilateral
- more homogeneous with target sign on T2 (c.f. Schwannoma heterogeneous)
Laryngeal cancer most common location to least
Glottic (most common)
- best outcome
- slow growing
- rarely mets / mets late
- hoarseness
Supraglottic (next common)
- worst outcome
- early nodal mets
- don’t get hoarseness
Subglottic (least common)
- late presentation due to minimal symptoms
- early nodal mets hence poor prognosis
Laryngeal SCC most common location and aetiology
- True vocal cords
- Arises from epithelial changes in the larynx, which occur in response to insult. known as the hyperplasia –
dysplasia – carcinoma sequence - Smoking most common cause*
Contraindication for laryngeal SCC surgery
- Invasion of Cricoid cartilage (Cricoid cartilage necessary for postoperative stability of vocal cords)
Direct vs Indirect CCF
Direct
- ICA communication with Cavernous sinus
- Occurs from Trauma
Indirect
- Dural shunt between ECA meningeal branches and Cavernous sinus
- Occurs randomly in post menopausal woman
Varix (orbital vein dilatation) vs Lymphangioma (Venous lymphatic malformation)
Varix (Orbital vein dilatation)
- Distends with valsalva
- Bleeds (most common cause of orbital bleed)
Venous lymphatic malformation
- Does not distend with valsalva
- Fluid-Fluid level
- Bleeds
Pre-Septal vs Post-Septal Orbital infection
Pre-septal
- anterior to orbital septum (originates from the periosteum of the orbit and inserts in the palpebral tissue along the tarsal plate)
- infection starts from adjacent structures like teeth and face
- Medical treatment
Post-septal
- Infection starts from paranasal sinusitis
- Surgical treatment
Well-circumscribed, round rim enhancing lesion in the lacrimal fossa
Dacryocystitis (Aunt minnie)
Spinal cord infarct
- most common cause
- most common involved
- imaging ?
Cause
- Idiopathic (most common cause)
- Atherosclerosis (aortic aneurysm, dissection etc)
Imaging:
- Anterior spinal artery (most common)
- Central cord / anterior horn cell high signal on T2 (because gray matter is more vulnerable to ischemia).
- The “owl’s eye” sign of anterior spinal cord infarct is a buzzword
- Usually long segment*
- However, can be more extensive and look like NMO, TM, MS*
DDx
- POLIO**
ADEM vs MS
ADEM
- male (c.f. MS female)
- Monophasic, ANTI-MOG
- affects basal ganglia and basal ganglia (c.f. MS)
- affects grey matter more often
- involvement of callososeptal interface is unusual
- Gets acute haemorrhagic leukoencephalitis (Hurst disease)
Inverted V sign in the dorsal column
Subacute Combined Degeneration
- B12 deficiency (Cobalamin)
DDx
*HIV Vacuolar Myelopathy:
- It can only be shown 2 ways
(a) by telling you the patient has AIDS or risk factors
(b) not including B12 as an answer choice
Arachnoiditis
- cause
- imaging
Cause
- Post spinal surgery
- Post infectious
Imaging
- Empty sac sign: Nerve roots adherent peripherally
- Central nerve root clumping
GBS (Guillain Barre Syndrome)
- Cause
- Imaging
Cause
- Campylobacter
- Others: lymphoma, post surgery, SLE
Imaging
- Enhancement of the nerve roots of the cauda equina*
- Anterior nerve roots involved more
- Facial nerve most common CN involved
DDx
- Chronic inflammatory Demylinating Polyneuropathy (CIDP) if does not improve in 8 weeks: Diffuse “Onion bulb” thickening of nerve roots
Astrocytoma vs Ependymoma
Astrocytoma
- most common in Peds
- Upper thoracic
- Eccentric
- May have caudal / rostral syrinx associated
- Heterogeneous enhancement
Ependymoma
- most common in Adults
- Cervical
- Central
- Hemorrhagic (dark T2 cap)
- May have tumoral cysts
- Homogeneous enhancement
Locations of Brachial cleft cysts
1st BAC
- Periauricular adjacent to Parotid, Communicates with EAC
2nd BAC
- anterior to SCM
- posterolateral to submandibular gland
- lateral to carotid space
3rd BAC
- Posterior triangle in upper neck
- Anterior triangle in lower neck
4th BAC
- in or adjacent to left thyroid lobe
Medullary thyroid cancer arises from what cell ?
- Parafollicular C-cell (the rest arises from Follicular cell)
Medullary thyroid cancer secrets what ?
- high calcitonin (however calcium is LOW!)
Papillary thyroid cancer
- Microscopic finding ?
- Multifocal or Solitary
Micro
- Orphan Annie eye. Psamomma bodies
- Can be solitary or mutlifocal (c.f. Follicular Solitary)
- Calcifications, Fibrosis, cysts
Follicular thyroid cancer
- Can differentiate adenoma to carcinoma on FNA ?
- Solitary or Multifocal
- What’s a variant ?
- Can’t differentiate adenoma from carcinoma on FNA (need hemithyroidectomy)
- Solitary
- Hurthell cell (variant - associated with Hashimotors - like an oncocytoma)
Medullary thyroid cancer
- Microscopic
- Amyloid deposits**
- Parafollicular C-cells
- High calcitonin but low calcium
