Head, Neck & Endocrine Flashcards
Weight of normal parathyroid gland
Most weigh between 20 - 40 mg
Over 60 mg usually considered abnormal
Syndromes Associated with Phaeochromocytoma
SDH deficiency syndromes
NF1
MEN2A
MEN2B
Von Hippel Lindau
MAXX (MEN5)
Prognostic Features in Phaeo / Paraganglioma
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
Prognostic Features in Adrenal Cortical Neoplasms
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
Staging of Primary Salivary Gland Carcinoma
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
Molecular Alterations in Salivary Gland Tumours
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
WHO 2022 Thyroid Neoplasms
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
Synoptic Report Thyroid
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
Synoptic Report Larynx
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
DDx Small Round Blue Cell Tumours in Sinonasal Tract
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
HPV Testing in H&N Cancers
p16 immunohistochemistry
HPV DNA or mRNA ISH
PCR on FFPE blocks
Cut up Malignant Thyroid
- PPE, 3 forms of ID, orient specimen
- Review MDM notes - imaging, size, site, adjacent structures, FNA, previous treatment
- Weigh, measure in 3D, ink anterior blue/ posterior black, fix
- Serially section, lay out slices with orientation markers and photo
- 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.
- Describe and sample background thyroid
- Carefully wrap in case need to go back (eg whole periphery through if follicular neoplasm or NIFTP).
- Nodes - neck dissection
Cut up Larynx
- PPE, 3 forms of ID, orient specimen
- Review MDM notes / imaging / biopsy - size, site of tumour (r/ship to glottis), extent of invasion, pre operative treatment
- Photograph exterior. Ink right blue, left black, anterior green. Fix for 24 - 48 hours.
- 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.
- 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.
- Document everything on blocking diagram. Measure and sample thyroid gland if included.
- Node dissections if included.
Size of thyroid micropapillary carcinoma
< 1cm and incidentally found
