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Pathology > Head & Neck Path > Flashcards

Head & Neck Path Flashcards

1
Q

HSV1

A

“cold sores”
Clusters of vesicles (acute gingivostomatitis)
Tzanck test
-Observe multinucleated giant cells in floor of lesion

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2
Q

Herpetic Stomatitis

A

caused by HSV-1 (genital herpes is HSV-2).
most cases are mild “cold sores”
-but in children & in immunocompromised persons:
severe diffuse gingivostomatitis with clusters of vesicles & shallow ulcers
healing occurs in few weeks, but the virus remains dormant in the trigeminal ganglion
the virus becomes reactivated on exposure to cold,
sunlight & infections  “cold sores”
recurrent lesions are usually milder & heal faster than the primary ones

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3
Q

Aphthous Stomatitis

A

Also call aphthous ulcers or canker sores
Occur in up to 40% of the population
Superficial ulcerations of oral mucosa
Appear as single shallow hyperemic ulcerations
-Covered by a thin exudate
-Variable course
-Cause is unknown

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4
Q

Canker sore etiology

A

40% of us have had them, painful, and you can bet there are inflammatory cells at the base.
Things related to them include: stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, and deficiencies in vitamin B12, iron, and folic acid (wikipedia). Whenever a condition is associated with LOTS of things, like this, we call this an “obscure” etiology

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5
Q

Oral Candidiasis (Thrush)

A

Appears as a superficial curdy, white inflammatory membrane
-Can be scraped off
Caused by a fungus Candida albicans
Disease observed in infants, diabetics, neutropenia, immunocompromised patients, patients with xerostomia, and antibiotic Tx
Otherwise not observed in normal healthy people

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6
Q

Glossitis

A

Implies inflammation of the tongue
Often applied to the beefy red tongue of various nutrient deficiency states
Ulcerations may be associated with jagged carious teeth, ill-fitting dentures
Part of the Plummer-Vinson or Patterson-Kelly syndrome (combined with iron deficiency anemia and esophageal dysphagia).

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7
Q

Xerostomia

A

Dry mouth
Major feature of Sjögren syndrome
-Associated with inflammatory enlargement of salivary glands
May also be radiation or drug induced

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8
Q

Reactive lesions

A

Present as tumor masses, but are reactive
Suspicious lesions should be biopsied
1) Irritation fibroma
2) Pyogenic granuloma
-A capillary hemangioma of the gingiva
Seen in kids, young adults and pregnant women (i.e., pregnancy tumor)

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9
Q

Oral Manifestations of Systemic Disease

A

Many systemic diseases associated with oral lesions
-E.g., scarlet fever, measles (Koplik spots)
Chronic ingestion of drugs for example phenytoin
hairy leukoplakia

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10
Q

Hairy leukoplakia

A

Observed in immunocompromised individuals
Virtually restricted to HIV infected patients
-May be first inkling of the disease
Appears as white confluent patches of fluffy hyperkeratotic thickening situated on the lateral border of the tongue that cannot be scrapped off
-May be superimposed with thrush
Sometimes associated with HPV
EBV (Epstein-Barr virus) is accepted as the cause

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11
Q

Tumors and Precancerous Lesions

A

Leukoplakia and erythroplakia

Squamous Cell Carcinoma

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12
Q

Leukoplakia and erythroplakia

A

Leukoplakia means “white plaque”
Erythroplakia means “red plaque”
85-90% caused by epidermal proliferations
-Cannot be removed by scraping and cannot be classified clinically or microscopically as another disease entity
Range from benign lesions to carcinoma in situ
Considered precancerous until proven otherwise

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13
Q

Erythroplakia (dysplastic leukoplakia)

A

Epithelial changes markedly atypical with much higher risk of malignant transformation
Males (ages 40-70) predominate
Occurs anywhere in oral cavity
Most common antecedent is tobacco use
-Other associated irritants: Alcohol, HPV
Need for biopsy with persistent post avoidance of irritants

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14
Q

Squamous Cell Carcinoma

A

95% of the cancers of oral cavity
Early detection is paramount
Linked to alcohol and tobacco use
-Especially oral tobacco use
HPV also associated
-A substantial increase in the past 30 years of these cancers that are not associated with alcohol or tobacco, but possibly related to a change in sexual practices in the population (oral sex)
Actinic radiation and pipe smoking factors in lower lip Ca
Genetics also a factor
Favored locations: floor of mouth, ventral surface of tongue, gingiva, and soft palate
keratin pearl

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15
Q

Infectious rhinitis (the common cold)

A 
Viral in origin
-Adenoviruses, echoviruses, rhinoviruses
Clinical course
 -Catarrhal discharge
-Edematous nasal mucosa
-May extend to pharyngotonsillitis
-Secondary bacterial infection possible
-Clears up in 7 days, if treated; 1 week, if ignored
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16
Q

Allergic rhinitis (hay fever)

A 
Initiated by sensitivity to an allergen
-Plant pollen, fungi, animal allergens
Affects 20% of population
IgE-mediated with early and late phases
Marked mucosal edema, erythema, mucus secretion, and eosinophilic infiltrate
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17
Q

Nasal polyps

A

Caused by recurrent rhinitis leading to mucosal protrusions
May become ulcerated or infected with chronicity
If large, may encroach on airway and impair sinus drainage
Most patients not atopic

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18
Q

Chronic rhinitis

A

Due to repeated attacks of rhinitis
Superimposed bacterial infection develops
May be ulceration or desquamation of mucosa and an inflammatory infiltrate
May extend into the air sinuses

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19
Q

Acute Sinusitis

A

Usually preceded by acute or chronic rhinitis
Nonspecific inflammatory reaction
Impairment of sinus drainage important factor
-May lead to empyema of sinuses
May give rise to chronic sinusitis

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20
Q

Chronic sinusitis

A

Usually a mixed microbial flora consisting of normal oral inhabitants
Can be caused by fungi also (mucormycosis in diabetics)
May spread to the orbit or other cranial structures

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21
Q

NECROTIZING LESIONS OF THE NOSE AND UPPER AIRWAYS

A

Spreading fungal infections
Wegener granulomatosis
Extranodal NK/T Cell LYMPHOMA

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22
Q

Pharyngitis and tonsillitis

A

Result from usual viral upper respiratory infections
-E.g., rhinoviruses, echoviruses, adenovirues
-Also respiratory syncytial and influenza viruses
Bacterial infections may be primary or secondary
-Most commonly, group A, ß-hemolytic streptococci
-Occasionally, Staphylococcus aureus
Particularly severe forms seen in those who are immunocompromised, neutropenic, diabetic, small children
Usually see erythema and edema in the pharyngeal mucosa
-May be covered by an exudative membrane (pseudomembrane)
-Tonsils may be enlarged and covered also
The major importance of streptococcal “sore throats” is possible development of poststreptococcal complications
-E.g., rheumatic fever, glomerulonephritis

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23
Q

Tumors of the nose, sinuses, and naso- pharynx

A

Tumors are infrequent, but cover the whole range of neoplasms

  1. Nasopharyngeal angiofibroma
  2. Inverted papilloma
  3. Isolated plasmacytomas
  4. Olfactory neuroblastoma
  5. Nasopharyngeal carcinomas
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24
Q

Nasopharyngeal angiofibroma

A

Highly vascular tumor in adolescent males

Benign, but bleeds profusely during surgery

25
Q

Inverted papilloma

A

Benign, but locally aggressive
Occur in nose and paranasal sinuses
Inverted papillomatous growth into the mucosa
-Consists of squamous epithelium
Potential invasion into the orbit or cranial vault

26
Q

Isolated plasmacytomas

A

A solitary myeloma

If not adequately excised can recur and invade orbit and cranial vault

27
Q

Olfactory neuroblastoma

A

Uncommon, highly malignant tumor arising from neuroendocrine cells dispersed in the olfactory mucosa

28
Q

Nasopharyngeal carcinomas

A

Characterized by distinctive geographic location, a close anatomic relationship to lymphoid tissue, and an association with the Epstein-Barr virus (EBV)
Influenced by heredity, age, and EBV
Three histologic patterns:
-Keratinizing squamous cell carcinomas
-Nonkeratinizing squamous cell carcinomas
-Undifferentiated carcinomas
Tend to grow silently until unresectable
-By then, have spread to cervical nodes or beyond

29
Q

Laryngitis

A

May be sole manifestation of allergic, viral, bacterial, or chemical insult (e.g., tobacco smoke)
May be the result of infection
-More commonly, part of a generalized upper respiratory infection

30
Q

Infectious laryngitis

A

Most nonspecific involvements are self-limited
Occurs in systemic diseases (TB, diphtheria)
May be serious in infants and young children when obstruction occurs
-Laryngoepiglottitis
-Croup

31
Q

Laryngoepiglottitis

A

Caused by Hemophilus influenzae or group B ß-streptococci

Sudden swelling of epiglottis or vocal cords is a potential medical emergency

32
Q

Croup (laryngotracheobronchitis)

A

Inflammatory narrowing of the airway producing inspiratory stridor

33
Q

Reactive nodules (vocal cord polyps)

A

Develop most often in people who are heavy smokers or impose great strain on their vocal cords
Usually located on the “true” vocal cords
Ulcerations may occur if cords impinge on each other
Characteristically change the character of the voice
-Often cause progressive hoarseness
Virtually never give rise to cancers

34
Q

Larygeal carcinoma

A

There is a spectrum of epithelial alterations
-Range from hyperplasia to invasive carcinoma
-Initially the thickened lesions have little potential for malignant transformation
*Risk rises 1-2% over 5-10 years with mild dysplasia
*Risk rises 5-10% over 5-10 years with severe dysplasia
Therefore, level of atypia when patient presents determines likelihood of malignant development
-ONLY HISTOLOGICAL EXAMINATION CAN EVALUATE THE GRAVITY OF THE CHANGES
Changes most often related to tobacco smoke
Alcohol and HPV (HPV 16 cause > 90%) are also risk factors

35
Q

Carcinoma morphology

A

~ 95% are typical squamous cell carcinomas
Usually develops directly on the vocal cords
-May arise above or below the cords, on the epiglottis or on the aryepiglottic folds. Or in the pyriform sinuses
May be intrinsic or extrinsic in relation to the larynx

36
Q

Carcinoma clinical course

A

Manifests as persistent hoarseness
At presentation, 60% confined to larynx
Later may produce pain, dysphagia, and hemoptysis
-Patients vulnerable to infection of the ulcerating lesion
With treatment, ⅓ of patients still die
-Usually of infection or metastases

37
Q

laryngeal Squamous papilloma & papillomatosis

A

Benign neoplasms usually on “true” vocal cords
-Form raspberry-like excrescences
Usually single in adults, multiple in kids (juvenile laryngeal papillomatosis)
Lesions caused by HPV types 6 and 11 usually do not become malignant
-Frequently recur

38
Q

Acute Otitis media

A

Occurs mostly in infants and young children
When viral, produces a serous exudate
Bacterial infections are suppurative
-Common offenders: nontypeable Hemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarhalis

39
Q

Chronic Otitis Media

A

Occurs with repeated bouts of otitis media without resolution
Caused by Pseudomonas aeruginosa (in diabetics may cause necrotizing otitis media), Staphylococcus aureus, and fungi
May cause eardrum perforation and spread to the mastoid spaces or into the cranial vault

40
Q

Cholesteatomas

A

Not neoplasms and don’t necessarily contain cholesterol
Are cystic lesions filled with amorphous squamous debris
By progressive enlargement can erode into the structures of the inner ear and may produce visible neck masses

41
Q

Otosclerosis

A

Abnormal bone deposition in the middle ear about the rim of the oval window into which the footplate of the stapes fits
Both ears usually affected
Ankylosis of the structures results in hearing loss
Usually familial

42
Q

Ear Tumors

A

The tumors of the ear are many and varied but RARE except for squamous cell carcinomas of the pinna

  • Usually seen in elderly men and associated with actinic radiation
  • Squamous cell carcinomas arising in the external canal may invade the cavity or metastasize to regional nodes
43
Q 
Branchial cyst (lymphoepithelial cyst)
(neck)
A

Benign cysts usually occurring in the anterolateral aspect of the neck
Rise either from branchial arch elements or from developmental salivary gland inclusions within cervical lymph nodes
Rarely are cancerous and readily excised
Similar lesions may appear in the parotid gland or beneath the tongue

44
Q

Thyroglossal tract cyst (neck)

A

Originates embryologically in the thyroid anlage in the region of the foramen cecum
The developing gland descends to its normal position in the anterior neck
Remnants of this tract may persist producing cysts
-May harbor lymphoid aggregates or thyroid tissue
Incomplete excision may allow recurrence

45
Q

Paraganglioma (carotid body tumor) (neck)

A

Are clusters of neuroendocrine cells (cells dispersed throughout the body)

  • Some are connected with the sympathetic nervous system
  • Largest collection is in the adrenal medulla where they give rise to pheochromocytomas
  • Tumors arising in extra-adrenal paraganglia are called paragangliomas
46
Q

Pargangliomas locations

A

1) Paravertebral ganglia
-Have sympathetic connections and are chromaffin positive
-Half elaborate catecholamines
2) Those related to the great vessels of the head and neck
E.g., Carotid body tumor

47
Q

Mucocele

A

MOST COMMON LESION OF SALIVARY GLAND

Results from blockage of duct with saliva leaking into the stroma

48
Q

Salivary gland Inflammation (sialadenitis)

A

May be viral, bacterial, or autoimmune
Mumps is the most common viral form
-Other glands may be affected (pancreas; testes)
Usually affects the major glands (particularly, the parotid [epidemic parotitis])
Autoimmune disease seen in Sjögren syndrome

49
Q

Sialolithiasis and nonspecific sialadenitis pathogenesis (salivary gland)

A

Nonspecific bacterial form usually involves major glands (particularly, submandibular)
Uncommon and usually secondary to ductal obstruction from calculi (sialolithiasis)
Common agents: Staphylococcus aureus and viridans streptococci

50
Q

Sialolithiasis

A

Stone formation related to obstruction by impacted food debris or edema secondary to trauma
Dehydration affecting secretory function may predispose to bacterial infection
Long-term phenothiazine therapy may predispose
When associated with pyogenic organisms may be associated with suppurative necrosis and abscess
Unilateral involvement is the rule
The inflammatory involvement causes painful enlargement and sometimes a purulent ductal discharge

51
Q

Salivary gland neoplasms

A

Give rise to a variety of benign and malignant tumors
Only a relatively few tumors make up >90%
Gland of origin
-65-80% occur in the parotid
-10% in the submandibular
-Rest in the minor glands and sublingual

52
Q

Salivary gland neoplasms gland of origin

A 
Malignant tumors found in:
15-30% of tumors of the parotid 
40% of tumors of the submandibular
50% of tumors in the minor glands
90% of tumors in the sublingual
Therefore malignancy is more or less inversely proportional to size of gland
53
Q

Salivary gland neoplasm occurrence

A 
Usually occur in adults
Slight female predominance
-Warthin tumors more common in males
5% occur in children under 16
Benign tumors occur most often in the 5th to 7th decades
54
Q

Salivary gland neoplasms clinical presentation

A

Regardless of histology, parotid tumors produce distinctive swellings in front of and below the ear
When first diagnosed, most tumors are 4-6 cm and mobile except for neglected malignancies
Biopsy is necessary for diagnosis of benign vs malignant

55
Q

Pleomorphic adenoma (salivary gland)

A

Benign tumors
Also called mixed tumors because of histologic diversity
-Show both epithelial and and mesenchymal differentiation
-See epithelial elements dispersed in cartilage or osseous tissue
Represent 60% of parotid tumors

56
Q

Pleomorphic adenoma clinical features

A

Present as painless, slow-growing discrete masses within the parotid or submandibular area or buccal cavity
May recur in ~ 4% of parotidectomies
Infrequently, a carcinoma arises within the tumor (called a carcinoma ex pleomorphic adenoma)
-Usually is an adenocarcinoma or undifferentiated
carcinoma

57
Q

Warthin tumor (papillary cystadenoma lymphomatosum)

A

Second most common salivary gland neoplasm
Almost always arises in the parotid gland
-Virtually restricted to this gland
-Occurs more commonly in males
-Usually appears in the 5th to 7th decades
-10% are mutifocal; 10% are bilateral
Smokers have 8 times the risk
pale gray surface
cystic spaces filled with mucinous/serous fluid

58
Q

Mucoepidermoid carcinoma

A

Represents 15% of all salivary tumors
Occurs preponderantly in the parotid
Accounts for a large fraction of tumors in other salivary glands
Overall most common primary malignant tumor in the salivary glands
Most common radiation-induced neoplasm

Pathology (16 decks)

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