Head and Neck Pathology Flashcards
What are Aphthous ulcers (canker sore)?
Prognosis?
Noninfectious ulcers of oral mucosa with unkown etiology. (erosion of the squamous epithelium)
Resolves in 7-10 days or persistent for weeks
What is Herpes Stomatitis caused by?
Transmission?
What happens in the two stages?
How to dx?
HSV Type I
Person to person transmission
Virus persists in dormant state and will reactivate (vesicles (cold sore) with intraepithelial edema–>clear fluid–> rupture–> ulcer)
Tzank test (swab ulcer and smear on slide and stain) looking for the 3 M’s: Multinucleation, molding, margination
How does Candidiasis of the oral cavity present?
Causes?
Thrush
Most common fungal infection of the oral cavity.
Causes:
Dentures,
diabetes mellitus,
steroids,
prolonged antibiotic therapy,
widespread cancer,
immunosuppression (transplant, AIDS)
What is the clinical appearance of Candidiasis?
Microscopic apperance?
White plaque-like pseudomembrane, scraping it off shows erythematous base.
Microscopic apperance: fungal hyphae superficially attached to underlying mucosa. Use special stain=GMS (silver
What is Squamous papilloma?
Sites?
Gross appearance?
Microscopic appearance?
Benign epithelial hyperplasia associated with HPV (the low risk subtypes, HPV-6 and HPV-11)
Lingual, labial, buccal, larynx
Soft, finger like projections
Papillary hyperplasia of squamous mucosa with fibrovascular cores.
What are Vocal Cord nodules and Polyps?
Cause?
How to treat?
Cancer Risk?
Nodules which are..
Bilateral on opposing surface of the middle third of vocal cord
Single in the ventricle or Reinke’s space
Causes: Smoking and vocal abuse
Treat: Rest
No Cancer Risk
What are precancerous lesions of the oral cavity and how do they appear?
What are they associated with/what are their risks for malignancy?
Leukoplakia (WHITE patch caused by epidermal thickening or hyperkeratosis that cannot be scrapped off (unlike trush). Occasionally associated with epithelial dysplasia with risk of malignancy 5-25%)
and
Erythroplakia (RED granular area that maybe is elevated with poorly defined boundaries. USUALLY ASSOCIATED WITH epithelial dysplasia. Risk of malignancy ~50%)
What is the most common malignancy in the oral cavity and larynx?
What are the different stages?
What age and gender are more common?
Advancements in early dx?
Squamous Cell Carcinoma (95%)
I. Hyperplasia- increased number of cells
II. Dysplasia- Progressively increasing degrees of pleomorphism, hyperchromasia, increased nuclear size and nuclear/cytoplasmic ratio)
Mild dysplasia has risk of carcinoma 1-2% over 5-10 years
Severe dysplasia has risk of carcinoma 5-10% over 5-10 years
III. Carcinoma
Age 50-70 years. M>F
No significant improvements in early dx of oral/laryngeal cancers over the past 25 years.
How does epithelial dysplasia look?
Mild vs. Moderate vs. Carcinoma In Situ?
- Proliferation of immature (Basal) cells
- Loss of cell polarity
- Increased # of mitotic figures
- Variation in nuclear size and shape
- Hyperchromasia
Mild-lower 1/3, Moderate-2/3 CIS-full thickness. Invasive after breaks through underlying stroma.
What are squamous cell carcinomas of the oral cavity and larynx associated with?
Tobacco
Alcohol
Family Hx
HPV (high risk serotypes, HPV-16, HPV-18)
Leukoplakia
Erythroplakia
Where do squamous cell carcinomas of the oral cavity appear?
Most occur on the tongue and floor of mouth
Also underside of tongue, gingiva, hard/soft palates, dorsal tongue, mucosa
Why is it important to catch oral squamous cell carcinoma early?
Where do they metastasize to?
5 year survival rate for Early stage 80% versus Late stage 19%
Sites of metastasis: Regional lymph nodes (submental, cervical). Distant: lung, liver, bone, mediastinal lymph nodes.
What carcinoma is most common in larynx?
Where does it occur most commonly?
Where else?
Also Squamous cell carcinomas are the most common
Most commonly on the Glottis (true vocal cords): Patient presents with hoarseness.
Also appears on supraglottic or infraglottic (usually asymptomatic early in course and diagnosed at later stages).
Also can spread into adjacent structures (you get hemoptysis or dysphagia)
How is carcinoma of the larynx treated?
Radiation. IF reoccur, surgery. (Laryngectomy)
How can the microscopic appearance of squamous cell carcinoma be problematic?
They appear the same no matter the origin, whether it is oral cavity, larynx, lungs etc. Ergo it makes it more difficult to know if it is primary or secondary.
What is Nonkeratinizing Squamous Cell Carcinoma caused by?
Where?
Clinical presentation?
HPV associated, HPV-16 and HPV18. HPV proteins E6 and E7 inactivate P53 and Rb (respectively)
Occur in Waldeyer’s Ring (base of tongue and tonsils)
Presents clinically as neck mass (because will metastasize early to neck lymph nodes)
What is Rhinosinusitis
Gross examination?
Microscopy?
Complication?
Inflammation which can be caused by: Viral (common cold), allergic, obstructive process (eg deviated septum)
Gross examination is similar: Edematous nasal mucosa/Turbinates enlarged
Microscopy: Mixed inflammatory infiltrate, edema, thickened basement membrane
Complication: Nasal polyps
What are the nasal cavity and paranasal sinus tumors that we covered? and are they benign or malignant?
Benign-
Schneiderian papilloma
Malignant-
Olfactory neuroblastoma
Nasopharyngeal carcinoma
What are Schneiderian Papillomas?
Clinical symptoms?
Types?
Associations?
Recurrence rate/Prognosis?
Benign neoplastic papillomatous proliferations arising from Schneiderian membrane: nasal mucosa consisting of ciliated columnar epithelium
Non-specific clinical symptoms: Nasal obstruction, headaches, epistaxis, rinhorrhea, facial pressure.
3 Types: Exophytic, endophytic (inverted) and cylindrical cell type
Associated with HPV (mostly 6 and 11) [low risk serotypes]
High recurrence rate 60% and most commonly in inverted type. Excellent prognosis if no malignant transformation
What is an Olfactory Neuroblastoma?
Where does it occur?
Symptoms?
Appearance?
How would you diagnose?
Origin from neuroendocrine cells, arise in superior and lateral mucosa of the nose.
Symptoms: epistaxis, nasal obstruction, headache
Composed of uniform cells w/ round nuclei, scant cytoplasm, “salt and pepper” chromatin.
EM: neurosecretory granules
Immunohistochemistry: neuroendocrine markers (synaptophysin, chromogranin)
What is the prognosis of Olfactory Neuroblastomas?
Locally invasive, metastasizing widely (local lymph nodes and lungs).
5 yr survival 50-70%
What are Nasopharyngeal carcinomas?
Where do Nasopharyngeal carcinomas occur in the world?
Etiologic factors?
How does it look?
Nasopharyngeal carcinomas are a specific squamous cell carcinoma that occur in the nasopharynx.
Geographic distrubiton, Africa, China/Asia. But their risk goes down when migrating from high incidence local to low incidence locale. suggesting environmental factors as key.
Etiologic factors
EBV infection
Diet (salted fish), smoking
Looks undifferentiated, with sheets of lympocytes (Why it’s also called lymphoepithelial carcinoma).
How to Dx for nasopharyngeal carcinomas?
Prognosis?
Treatment?
Cytokeratin IHC stain or stain for EBV (epstein barr virus).
Prognosis: grow silently until unresectable. Local regional lymph node and distant metastasis. 50-70% 3 year survival rate
Treatment: Radiotherapy
What salivary glands are there?
Major Salivary Glands:
Parotid gland (serous)
Submandibular gland (mixd, mainly serous)
Sublingual gland (mixed, mainly mucinous)
Minor Salivary Glands:
Innumerable minor salivary glands distributed throughout the mucosa of the oral cavity.
What are salivary gland fxns?
Production and Secretion of saliva for:
Mastication
Digestion
Protection of teeth
Why can you get stones in the duct for the submandibular glands?
There is a right angle in the submandibular gland duct (Wharton’s duct) so it can easily become blocked.
What is Sjogren Syndorme?
Symptoms?
Pathology?
how to diagnose?
An autoimmune disease affecting salivary glands. (anti-SS-B)
Sicca syndrome (xerostomia (Dry mouth) and Keratoconjunctivitis (dry eyes))
Often in assoc w other autoimmune disease
Pathology: lymphocytic infiltration of salivary and lacrimal glands with eventually gland destruction.
Lip biopsy of minor salivary glands to diagnose.
What are the characteristics of neoplasms in the salivary glands?
(what percent of all human tumors)
(which glands are affected)
(predominant demographics)
How is size of the gland related to likelihood of malignancy?
<2% of all human tumors
65-85% arise in parotid gland, 10% in submandibular gland. Rest in minor salivary glands
Adults mostly (5% in children), slight female predominance, Benign tumors from 5th to 7th decades with malignant tumors slightly older
INVERSE relationship for malignancy to size of gland.
What are the neoplasms of the salivary glands we covered?
Are they benign or malignant?
Benign-
Pleomorphic adenoma
Warthin tumor
Malignant-
Mucoepidermoid CA
Adenoid cystic carcinoma
What is the most common salivary gland tumor?
Where do they occur?
What type of tumor are they
Pleomorphic adenomas.
75-85% in parotid
Benign mixed tumor (epithelial cells/ductal, myoepithelial cells, mesenchyma components).
Pleomorphic (variability), adenoma (proliferation of cells epithelial and myoepithelial)
What are Warthin Tumors?
Associated with?
How does it appear?
Gross and Microscopic?
2nd most common salivary gland tumor, restricted to parotid gland.
Associated with Smoking
Most common: Bilateral salivary gland tumor
Gross pathology: often undergoes papillary cystic change
Microscopy: Characteristic oncocytic (pink) epithelial cells and lymphocytes
What is the most common malignant tumor of the salivary glands? What is it?
Where do they occur? what age do they appear?
Prognosis and treatment?
Mucoepidermoid carcinoma, Mixture of squamoid, mucous, and intermediate cells
Occur 50% in parotid gland and 40% in minor salivary glands. Both adults and children.
Surgical resection followed by radiation.
Low grade invade locally , rarely metastasize; 5 yr survival >90%.
High grade recur more frequently and metastasize in 30%. 5 yr survival 50%
What is Adenoid cystic carcinomas
Microscopy characteristics?
Treatment?
2nd most common malignant tumor of the salivary glands.
Microscopy- perineural invasion and cribiform architecture
Wide to radical surgical resection
What are Thyroglossal duct cysts?
When do they occur?
Characteristics?
Midline developmental cyst
Presents prior to 4th decade
Always connected to the hyoid bone, move with swallowing. Lined by respiratory or squamous epithelium
Has thyroid tissue in wall of cyst.
Rarely can result in papillary thyroid carcinoma.
What are branchial cleft cysts/Cervical lymphoepithelial cysts?
What age of patients?
Where is it located?
Complication?
Gross?
Micro?
Differential?
Arises from 2nd branchial pouch
75% patients between 20-40 yrs
Laterally placed in neck along anterior border of the SCM
May become infected.
Gross: thin walled filled with cheesy mucoud material
Micro: squamous lining, lymphoid tissue
Differential: metastatic squamous cell carcinoma.
What are the different pathologies discussed in..
Oral Cavity and Larynx?
– Aphthous ulcers
– Herpetic stomatitis
– Thrush
– Squamous papilloma
– Vocal cord nodules / polyps
– Precancerous lesions
• Leukoplakia
• Erythroplakia
– Squamous cell carcinoma
What are the different pathologies discussed in
Nasal Cavity/Paranasal sinuses?
Salivary glands?
Neck Cysts?
• Nasal Cavity / Paranasal Sinuses
– Sinusitis
• Inflammatory polyps
– Schneiderian papillomas
– Olfactory neuroblastoma
– Nasopharyngeal carcinoma
• Salivary glands
– Sjogren’s syndrome
– Pleomorphic adenoma
– Warthin tumor
– Mucoepidermoid carcinoma
– Adenoid cystic carcinoma
• Neck cysts
– Thyroglossal duct cyst
– Branchial cleft cyst
