Head & Neck - Larnyx, Neck & Salivary Glands Flashcards
laryngotrachealbronchitis
- etiologic agent
- presentation
= croup
- parainfluenza virus
- presentation:
- barking cough
- inspiratory stridor
- respiratory distress
laryngoepiglotitis
- etiologic agent
- clinical presentation
- treatment
- h. influenza (m/c), n. meningitis, strep
- presentation:
- medical emergency in children!!
- airway MUST be secured (intubation)
- cherry red epiglottis
- drooling
- child in tripod posture
- medical emergency in children!!
what are the benign nodules/polyps of the larynx?
what do they all have in common?
what populations are each likely to be seen in?
- are all reactive polyps/nodules since they are a reaction to some stressor
- all cause progressesive hoarseness
- reinker’s edema - in heavy smokers
- singer’s nodules - pts who pose great strain on vocal cords
- contact ulcers - ps who pose great strain on vocal cords/reflux/intubation
singers nodules
people who strain vocal cords
smooth, rounded, sessile nodules on true vocal cords
benign laryngeal nodule –> progressive hoarseness
renke’s edema - edematous thickening of vocal cords
heavy smokers
benign laryngeal nodule –> progressive hoarseness
squamous papilloma (of larynx)
- anatomical location
- morphology - gross and histologic
- clinical?
- like pharyngeal nodule / ulcers / reinke’s edmea…
- located on true vocal cords
- benign & cause progressive hoarseness
- gross: soft, rasbery like < 1 cm
- microscopic: slender, finger like projections covered w/ stratified squamous epithelium
juvenile laryngeal papillomatosis
condition where multiple laryngeal squamous papillomas occur in children
HPV-6, HPV-II
carincoma of the larynx
- anatomical location
- morphology - gross and microscopic
- clinical / demographics
- on true vocal cords
- gross - large, ulceracting fungating legion
- microscopic - squamous cell dysplasia
- cinical
- malignant –> progressive hoarseness/dysphonia/dysphagia
- seen in chronic smokers in 6th decade
- worse w/ alcohol
label the laryngeal growths
all on true vocal cords & cause progressive hoarseness
- singers node - one little bump going into the lumen
- squamous papillomas - finger-like bump going into the lumen
- carincoma - less in the lumen, invades cords & surrounding tissues
brachial cysts
- pathogenesis
- anatomic location
- morphology
- from remnants of 2nd brachial arch
- in young adults (20-40)
- LATERAL UPPER NECK: along sternocleidomastoid
-
fibrous wall
- lined by stratified squamous or psueodstratified columnar
- containeing lymphoid tissue w/ prominent germinal centers*
thyroglossal duct cyst
- pathogenesis
- anatomic location
- morphology
- remnant of thyroid gland development
- ANTERIOR NECK
- cyst
- lined with stratified squamous or psueodstratified columnar
- containing CT harboring l_ymphyoid aggregates_ and/or thyroid tissue
paraganglioma
- pathogenesis
- anatomic location
- morphology
- associations
- tumor of parasympathetic ganglia –> slow growing, painless mass in 5th/6th decade
- location: anterior neck triangle (bruit can be felt*)
- morphology: nests (zeballen) of oval chief cells surrounded by delicate vascular septae and bound by sustentacular cells
- oval chief cells are neuroectodermal in origin - stain w/ chromogranin
- associations:
- LOF-SDH gene mutation
- MEN-2 syndrome (ppl in high altitudes)
what are zabellen and in what condition are they seen?
- nests of oval cells (neurendocrine derived) separated by vascular septae
- characteristic of paragangliomas (carotid body tumors)
xerostemia
- definition
- causes
- dry mouth from lack of saliva production
- causes: old age, sjogren syndrome (also see dry eyes w/ this condition), anti-cholinergic drugs
salivary mucocele
- pathognesis
- morphology
m/c lesion of salivary gland
- leakage of saliva into CT stroma of lower lip following blockage/rupture of a salivary gland duct
- morphology
- gross - blue hue, fluid filled cyst
- microscopic - cystic:
- ductal epithelial lined cysts, or
- psuedocystss with cyst ilke spaces lined by granulation tissue
a ranula: a salivary mucocele that is arises from damage of the sublingual duct specifically
pleomphoric adenoma
- location
- demographics
- morphology
- clinical
- F > M
- painless, slow growing
- location
-
parotid (unilateral> bilateral) >>> submandibular/sublingual
- m/c parotid gland tumor
-
parotid (unilateral> bilateral) >>> submandibular/sublingual
- gross - well encapsulated, blue translucent (cartilage like) tumor
- microscopic - epitheliel elements admixed with myxoid / hyaline / chondroid / osseus tissue
warthrin tumor
- clinical
- location
- morphology - gross and clinical
- location: parotid ONLY (bilateral)
- clinical
- M > F
- smokers 8x risk
- morphology:
- gross - pale grey, transeced by cystic spaces filled with
- mucous secretions
- microscopic - cystic spaces lined with double layer of esionophillic epitheilum
- gross - pale grey, transeced by cystic spaces filled with
mucoepidermoid carcinoma
- clinical
- anatomic location
- morphology - gross, microscopic
- clinical
- F > M
-
malignant:
- m/c malignant tumor of salivary glands
- varies from indolent to highly aggressive
- location: parotid mostly
- morphlogy (microscopic):
- 3 cell types
- mucous secretion cells - eccentric nucleus & abundant mucin in cytoplasm
- squamoid (epidermoid) cells - cental nuclei
- intermediate (transition) cels
- 3 cell types
adenoid cystic carcinoma
- clinical
- anatomic location
- morphology
- clinical
- F > M
- malignant
- painful
- recur post tx
- location: minor salivary glands (palatine*), m/c
- morphology (microscopic):
-
cribiforming pattern: multiple cyst like spaces that contain secretions and & share epithelial walls
- mouse - in - cheese pattern
- perineural invasion: extend beyond salivary glands
-
cribiforming pattern: multiple cyst like spaces that contain secretions and & share epithelial walls
acinic cell carcinoma
- clinical
- anatomic location
- morphology
- clinical
- younger men
- malignant: 2nd most common malignant in children
- parotid mostly (unilateral/bilateral)
- morphology:
-
look like acinar cells of normal salivary gland (have granular cytoplasm) except that they
- are not ordered, structured, lobular
- are not adjacent to ductal structures - acinar carcinoma infiltrates the whole slide
-
look like acinar cells of normal salivary gland (have granular cytoplasm) except that they
salivary duct carcinoma
- clinical
- anatomic location
- morpholgy
- clinical:
- elderly males
- high aggresive
- for:
- androgen receptors
- Her-2/neu
- for:
- location: mostly parotid
- morphology:
- look exactly like breast cancer:
polymorphic adenocarcinoma
- clinical
- location
- morpholgoy
- clinical - malignant
- location: minor salivary glands (palatine) - 2nd m/c
- morphology:
-
look like innocuous ducts
- but are not associated with other salivary tissue
- +/- perineural invasion
-
look like innocuous ducts
which salivary gland tumors are found in the minor salivary glands (palatine glands) and what are their distinguishing characteristics?
both: perineural invasion & slow growing
1st m/c: adenoid cystic carcinoma
- cribifrom pattern: _cysts that enclose secretion_s & share epithelial walls (mouse in cheese)
- painful
2nd m/c: polymorphous adenocarcinoma
- normal duct appearing cysts
which salivary neoplasm resembles breast cancer histologically? what are its other features?
salivary duct carcinoma
- elderly males
- androgen receptor & her-neu +
brachial cyst (lateral neck)
lymphoid aggregates with germinal centers
thyroglossal duct cyst (anterior neck)
cyst surrounded by CT containing lymphoid aggregates and/or thyroid remnants
what manifestation is associated with MEN-2?
paraganglioma (carotid body tumor)
which salivary gland tumor is painful?
adenoid cystic carcinoma (minor salivary gland tumor)
