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Respiratory > Head & Neck Pathology > Flashcards

Head & Neck Pathology Flashcards

1
Q

Noninfectious ulcers of
oral mucosa of unknown etiology that are extremely common usually in the first two decades of life and resolve in 7-10 days or can persist for weeks

A 
Aphthous ulcer (canker 
sore)
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2
Q

What is Herpes Stomatitis?

A

HSV type I can persist in the dormant state (asymptomatic) and then reactivate as vesicles (cold sore)

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3
Q

What do Herpes Stomatitis vesicles look like?

A

Intraepithelial edema → clear fluid → rupture → ulcer with multinucleated cells with intranuclear viral inclusions

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4
Q

What test can we used to diagnose Herpes Stomatitis?

A

Tzanck test usually see 3 M’s: Multinucleation, molding, margination

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5
Q

What is the most common fungal infection of the oral cavity?

A

Candidiasis aka “thrush”

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6
Q

What are the causes of thrush?

A 
Dentures
Diabetes mellitus
Steroids / prolonged antibiotic therapy
Widespread cancer 
Immunosuppression: transplant, AIDS
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7
Q

What does oral candidiasis look like?

A

White plaque-like
pseudomembrane that can be Scraped off → reveals erythematous base

Microscopic:Fungal hyphae superficially attached to underlying mucosa seen with special stain = GMS (silver)

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8
Q

What is Squamous Papilloma?

A

Benign, non-contagious epithelial hyperplasia associated with HPV (low risk subtypes 6 and 11) usually between the ages of 30-50

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9
Q

What does Squamous papilloma look like (gross and micro)?

A

Site: Lingual, labial, buccal, larynx

Gross: Soft, finger like projections

Micro: Papillary hyperplasia of squamous mucosa with fibrovascular cores

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10
Q

What is the difference between vocal cord nodule and polyps?

A

Nodules are bilateral on opposing surfaces of the middle third of vocal cord

Polyps are single in the ventricle or Reinke’s space

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11
Q

What causes vocal cord nodules and polyps?

A

smoking and vocal abuse usually in males more than females

no cancer risk

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12
Q

What is Leukoplakia?

A

clinical diagnosis of WHITE patch caused by epidermal thickening or hyperkeratosis that cannot be scraped off

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13
Q

What is Erythroplakia?

A

clinical diagnosis of RED granular area that may or may not be elevated with poorly defined boundaries

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14
Q

Are Leukoplakia or Erythroplakia associated with malignancy?

A

Leukoplakia: Occasionally associated with epithelial dysplasia with risk of malignancy: 5-25%

Erythroplakia: Usually associated with epithelial dysplasia with risk of malignancy: ~50%

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15
Q

95% of cancers of the Oral Cavity and Larynx are what kind?

A

Squamous Cell Carcinoma

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16
Q

When do Squamous Cell Carcinoma of the oral cavity and larynx occur?

A

Age: 50 – 70 years

M>F

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17
Q

What factors tend to be associated with Squamous Cell Carcinoma?

A

– Tobacco: cigarettes, chewing tobacco, snuff
– Alcohol (Synergistic effect between alcohol & tobacco)
– Family history
– Human papillomavirus (HPV) infection: High Risk Serotypes: 16 & 18
– Leukoplakia (occasionally)
– Erythroplakia (commonly)

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18
Q

Where in the oral cavity do SCC usually occur?

A

Most occur on the tongue and floor of mouth

Also on gingiva, hard/soft palates, dorsal tongue, mucosa

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19
Q

What the prognosis of Oral Squamous Cell Carcinoma?

A

5-year survival
– Early stage oral SCC: 80%
– Late stage oral SCC: 19%

Sites of metastasis:
– Regional lymph nodes (submental, cervical)
– Distant: lung, liver, bone, mediastinal lymph nodes

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20
Q

Where does Carcinoma of the Larynx usually occur?

A

Most common is Glottis (true vocal cords) presents with hoarseness

can be Supraglottic or infraglottic usually asymptomatic so diagnosed at later stages

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21
Q

How does you treat carcinoma of the larynx?

A

– Surgery: Laryngectomy
– Radiation

5 year survival
– Stage 1 = 70%
– Stage 4 = 30%

22
Q

This cancer is associated with:

  • HPV associated
  • Waldeyer’s Ring: Base of tongue/Tonsils
  • Neck Mass

What is it?

A

Nonkeratinizing Squamous Cell Carcinoma

23
Q

What can cause Rhinosinusitis?

A

Viral (common cold), allergic, obstructive process (e.g. deviated septum)

24
Q

What does Rhinosinusitis look like (gross and micro)?

A

Gross: Edematous nasal mucosa &Turbinates enlarged

Microscopy: Mixed inflammatory infiltrate, edema, thickened basement membrane

25
Q

What is Schneiderian Papillomas?

A

Benign neoplastic papillomatous proliferations associated with HPV (6 and 11) arising from Schneiderian membrane: nasal mucosa consisting of ciliated columnar epithelium

26
Q

What are the clinical symptoms of Schneiderian Papillomas?

A

nasal obstruction, headaches, epistaxis, rinorrhea, facial pressure

27
Q

What is the prognosis of Schneiderian Papillomas?

A

Excellent prognosis if no malignant transformation

High recurrence rate (~60%), most commonly in inverted type

28
Q

What is Olfactory Neuroblastoma (Esthesioneuroblastoma)?

A

Arises from neuroendocrine cells in superior and lateral mucosa of the nose (olfactory mucosa) usually around 50 years old

29
Q

What are the symptoms of Olfactory Neuroblastoma?

A

epistaxis, nasal obstruction, headache

30
Q

What does olfactory neuroblastoma look like?

A

Composed of uniform cells with round nuclei, scant cytoplasm, “salt and pepper” chromatin

EM: neurosecretory granules

Immunohistochemistry: neuroendocrine markers (synaptophysin, chromogranin)

31
Q

What is the prognosis for olfactory neuroblastoma?

A

– Locally invasive
– Also metastasizes widely: Local lymph nodes and lungs
– 5-year survival 50-70%

32
Q

What populations does Nasopharyngeal Carcinoma usually affect?

A

Geographic Distribution: Africa, Northern China and Southeast Asia (Hong Kong most frequent) but rare in U.S. due to etiologic factors (EBV, diet eg salted fish and smoking)

33
Q

What are the two types of Nasopharyngeal Carcinoma?

A

Keratinizing squamous cell carcinoma & Non-keratinizing squamous cell carcinoma (Lymphoepithelial)

34
Q

What is the prognosis for nasopharyngeal carcinoma?

A

Tend to grow silently until they become unresectable with local regional lymph nodes (cervical) and distant
metastasis

Radiotherapy is the standard modality of treatment with 50 – 70% 3-year survival rate

35
Q

What are the 4 kinds of salivary glands?

A

Major Salivary Glands: Parotid gland (Serous), Submandibular gland (Mixed, mainly serous), Sublingual gland (Mixed, mainly mucinous) and Minor Salivary Glands (Innumerable minor salivary glands distributed throughout the mucosa of the oral cavity)

36
Q

What is Sjogren Syndrome?

A

Autoimmune disease or associated with other autoimmune diseases usually with lymphocytic infiltration of salivary and lacrimal glands with eventual gland destruction causing Xerostomia (dry mouth) and Keratoconjunctivitis (dry eye)

37
Q

Which glands do Neoplasms of the Salivary Glands usually occur in?

A

65 – 80% arise in the parotid gland; 10% in submandibular

gland and emainder in the minor salivary glands

38
Q

What is the epidemiology for Neoplasms of the Salivary Glands?

A

– Adults mostly: 5% occur in children younger than 16 years
– Slight female predominance
– Benign tumors: 5th to 7th decades
– Malignant tumors: Slightly older

39
Q

What is the rule for malignancy of the neoplasms in salivary glands?

A

The likelihood of a salivary gland tumor being malignant is inversely proportional to the size of the gland.

– 15% of parotid gland
– 40% of submandibular gland
– 50% of minor salivary gland
– 70 – 90% of sublingual gland

40
Q

What are the two major benign neoplasms of the salivary glands?

A

Pleomorphic adenoma (60%) and Warthin tumor (5%–10%)

41
Q

What are the two major malignant neoplasms of the salivary glands?

A

Mucoepidermoid CA (15%) and Adenoid cystic carcinoma (5%)

42
Q

What is pleomorphic adenoma?

A

Most common salivary gland tumor

75-85% occur in the parotid

Benign Mixed Tumor with variable proliferation of cells (epithelial and myoepithelial) Well circumscribed, Encapsulated, Rubbery, firm (like cartilage)

43
Q

What is warthin tumor?

A

2nd most common salivary gland tumor restricted to parotid and associated with smoking

44
Q

What does the warthin tumor look like?

A

Gross pathology: Often undergoes papillary cystic change

Microscopy: Bilayered oncocytic (pink) epithelial cells and lymphocytes

45
Q

Most common malignant tumor of the salivary glands
• 50% occur in parotid gland
• 40% occur in minor salivary glands
• Occurs in both adults and children

A

Mucoepidermoid Carcinoma

46
Q

What does Mucoepidermoid Carcinoma look like?

A

Mixture of squamoid, mucous, & intermediate cells

47
Q

What is the prognosis for Mucoepidermoid Carcinoma?

A
  • Low grade tumors invade locally, rarely metastasize; 5 yr survival >90%
  • High-grade/ intermediate-grade tumors recur more frequently, metastasize in 30%; 5 yr survival approx 50%
  • Surgical resection followed by radiation
48
Q
  • 10% of all salivary gland carcinomas
  • Wide age range; peak 5th-7th decades
  • Major and minor salivary glands
  • Microscopy: Perineural invasion & Cribriform architecture
  • Local recurrence
  • Wide to radical surgical resection
A

Adenoid Cystic Carcinoma

49
Q

What is a Thyroglossal Duct Cyst?

A

Midline developmental cyst that presents prior to 4th decade and is always connected to the hyoid bone so it moves with swallowing

Lined by respiratory or squamous epithelium and has thyroid tissue in wall of cyst due to thyroid ascending during development

50
Q

What is a Branchial Cleft Cyst (Cervical Lymphoepithelial Cyst)?

A

Arises from the 2nd branchial pouch with 75% of patients between 20-40 yrs.

Laterally placed in the neck along the anterior border of the SCM

51
Q

What does Branchial Cleft Cyst look like?

A

Gross: Thin-walled, filled with cheesy, mucoid material

Micro: Squamous lining, lymphoid tissue

Respiratory (15 decks)

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