Head, Neck & Endocrine Flashcards

1
Q

Weight of normal parathyroid gland

A

Most weigh between 20 - 40 mg
Over 60 mg usually considered abnormal

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2
Q

Syndromes Associated with Phaeochromocytoma

A

SDH deficiency syndromes

NF1

MEN2A

MEN2B

Von Hippel Lindau

MAXX (MEN5)

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3
Q

Prognostic Features in Phaeo / Paraganglioma

A

GAPP Score

Histologic Pattern (Zellballen, large irregular nests, pseudorosettes)

Cellularity low, moderate, high

Confluent tumour necrosis

Vascular or capsular invasion

Ki67 <1, 1-3, >3%

Catecholamine type

NB: SDH deficient tumour higher risk of malignancy independent of other criteria

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4
Q

Prognostic Features in Adrenal Cortical Neoplasms

A

Modified Weiss Criteria

Mitotic Rate (>6 per 50 HPF) = 2 points

Clear cytoplasm <25% of cells = 2 points

Abnormal mitoses = 1 point

Tumour necrosis = 1 point

Capsular invasion = 1 point

Total Score 3 or More = Malignant

NB

Oncocytic adrenal cortical neoplasms use Lin-Weiss-Bisceglia criteria

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5
Q

Staging of Primary Salivary Gland Carcinoma

A

pTis = CIS

pT1 = confined to salivary gland, <2cm

pT2 = confined to salivary gland, 2 4 cm

pT3 = >4cm or extraparenchymal extension

(extraparenchymal extension = clinical or macroscopic evidence of soft tissue invasion, microscopic invasion alone insufficient)

pT4a = moderately advance local disease (skin, mandible, ear canal, facial nerve)

pT4b = very advanced local disease skull base, pterygoid plates, carotid artery)

pN - number of nodes involved

ipsi / contra / bilateral

size of metastatic deposit

presence or absence of ENE

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6
Q

Molecular Alterations in Salivary Gland Tumours

A

Acinic Cell Carcinoma: NR4A3 rearrangements

Adenoid Cystic Carcinoma: MYB, MYBL1 rearrangements

Clear cell Carcinoma: EWSR1-ATF1 translocation

Mucoepidermoid Carcinoma: MAML2 rearrangements

Myoepithelial Carcinoma: EWSR1 rearrangements

Pleomorphic Adenoma: PLAG1, HMGA2 rearrangements

Secretory Carcinoma: ETV6-NTRK3 / RET / MET translocation

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7
Q

WHO 2022 Thyroid Neoplasms

A

Developmental Abnormalities:

Thyroglossal Duct Cyst

Follicular Cell-Derived Neoplasms:

Thyroid follicular nodular disease

Follicular thyroid adenoma (+/- papillary architecture)

Oncocytic adenoma of the thyroid

Low Risk Neoplasms

NIFTP

Thyroid tumour of UMP

Hyalinising trabecular tumour

Malignant Neoplasms

Follicular thyroid carcinoma

Invasive encapsulated follicular variant papillary carcinoma

Papillary thyroid carcinoma

Oncocytic carcinoma of the thyroid

Follicular derived carcinomas, high grade

Anaplastic follicular derived thyroid carcinoma

Thyroid C-cell Derived Carcinoma

Medullary thyroid carcinoma

Salivary-Gland Type Carcinomas

Mucoepidermoid-type carcinoma

Secretory carcinoma

Thyroid Tumours of Uncertain Histogenesis

Sclerosing mucoepidermoid carcinoma

Cribriform morular thyroid carcinoma

Thymic Tumours within the Thyroid

Thymoma, thymic carcinoma, SETTLE

Thyroblastoma

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8
Q

Synoptic Report Thyroid

A

Clinical

Predisposing conditions e.g. radiation exposure, family history

Pre and post operative serum markers (thyroglobulin, calcitonin)

Specimen

Procedure / type of specimen

Tumour focality (uni or multi), site, size of tumour

Histologic subtype

Mitotic rate

Tumour Necrosis

Angioinvasion

Lymphatic invasion

Perineural invasion

Extrathryoidal extension

Margin Status

Lymph nodes: number, nodal levels involved, size of largest metastatic deposit, ENE

Distant Metastases

Additional Findings: Parathyroid glands, thyroiditis, MNG

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9
Q

Synoptic Report Larynx

A

Specimen type

Tumour focality (uni or multi)

Tumour site: supraglottic, glottic, subglottic

Tumour laterality (right, left, midline)

Tumour size

Histologic type (SCC & variants, Salivary gland type, NEC)

Histologic grade

Lymphovascular invasion

Perineural invasion

Margins (in situ and invasive)

Regional lymph nodes (number, laterality, size of largest deposti, ENE)

Distant metastases

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10
Q

DDx Small Round Blue Cell Tumours in Sinonasal Tract

A

NOSE ALARM

N: NUT carcinoma

O: Olfactory neuroblastoma

S: SMARCB2 deficient, small cell carcinoma, SCC, SNUC

E: Ewing sarcoma

A: Adenocystic carcinoma, HPV-related multiphenotypic sinonasal ca

L: Lymphoma

A: Alverolar

R: Rhabdomysosarcoma

M: Melanoma, Metastases

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11
Q

HPV Testing in H&N Cancers

A

p16 immunohistochemistry

HPV DNA or mRNA ISH

PCR on FFPE blocks

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12
Q

Cut up Malignant Thyroid

A
  1. PPE, 3 forms of ID, orient specimen
  2. Review MDM notes - imaging, size, site, adjacent structures, FNA, previous treatment
  3. Weigh, measure in 3D, ink anterior blue/ posterior black, fix
  4. Serially section, lay out slices with orientation markers and photo
  5. Identify tumour - number, site, size, closest margins, evidence of extrathyroid extension. If small and B4 / follicular neoplasm all in. Otherwise block 1 - 2 / cm to margins / structures, record on photo.
  6. Describe and sample background thyroid
  7. Carefully wrap in case need to go back (eg whole periphery through if follicular neoplasm or NIFTP).
  8. Nodes - neck dissection
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13
Q

Cut up Larynx

A
  1. PPE, 3 forms of ID, orient specimen
  2. Review MDM notes / imaging / biopsy - size, site of tumour (r/ship to glottis), extent of invasion, pre operative treatment
  3. Photograph exterior. Ink right blue, left black, anterior green. Fix for 24 - 48 hours.
  4. Section from superior to inferior on bone saw (leave room for perpindicular margins if needed or shave trachea margin. Lay out and photograph with orientation indicators.
  5. Describe site of tumour (glottis), size of tumour and extent of invasion. Block shave and perpindicular margins and full face sections to closest margins (in macroblocks). Fix further if needed then decal for 24 - 48 hours.
  6. Document everything on blocking diagram. Measure and sample thyroid gland if included.
  7. Node dissections if included.
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14
Q

Size of thyroid micropapillary carcinoma

A

< 1cm and incidentally found

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15
Q
A
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