Lecture + Case: Head/Neck Tumors (3)-Leah* Flashcards
Two “fibrous” lesions of the oral cavity:
Which is fast growing and might scare people?
- Fibroma
2. Pyogenic granuloma: rapidly growing scary looking vascular proliferation
Three infections commonly involving the oral cavity?
Which two are similar? How can they be distinguished?
- HSV (primary gingivostomatosis; “cold sores”)
- These two are both white “coatings” of the tongue:
2. Candidia (thrush)– whole mouth; scrapes off
3. Hairy leukoplakia (EBV)– lateral; doesn’t scrape off
Name the two precancerous lesions of the oral cavity.
Which is MORE LIKELY to become malignant.
- Leukoplakia
- Erythroplakia
* Erythroplakia has a higher rate of malignant transformation.
Cancerous lesion of the mouth is most often:
Squamous cell
Three types of rhinitis
- Infectious
- Allergic
- Chronic
Benign mass found in the nose following recurrent rhinitis:
Nasal polyps
Rare but commonly tested caused of recurrent sinusitis:
Ciliary dysfunction –> Kartagener Syndrome
Note: chronic sinusitis = POLYPS.
- *First Aid Fact this is also one cause of SITUS INVERSUS**
- *First Aid Fact: mutant L–>R Dynein**
Two infections that are considered nasopharyngeal infections:
Pharyngitis
Tonsillitis
Two nasopharyngeal masses:
- Sinonasal (Scheiderian) papilloma
- Nasopharyngeal carcinoma
Two infections of the larynx:
- Laryngitis
- Croup (Fenger note= paramyxo –> parainfluenza virus!!)
Three types of laryngeal masses:
- Polyps
- Papilloma
- Carcinoma
How common are ear tumors?
What types exist?
- Rare
- Squamous cell and Basal cell carincomas
What is otosclerosis?
With what disease should you associate it?
Thickening of bones in middle ear = hearing loss.
Fibrous Deposition–> Bone
- **You can see this in OSTEOPETROSIS!!!
- **AD disease causing OSTEOCLAST DYSFUNCTION!!!
Three lesions you may see in the neck? (3)
What are two important midline structures in the neck?
How can these be associated with pathology?
There are SO SO many but she lists….
- Branchial cleft cysts
- Thyroglossal duct remnants
- Paraganglioma
- Side note: thymus and thyroid are important midline neck structures!
- Hyperthyroid = goiter (can be hypothyroid too: ^ TSH w/out response)
- Thymus in babies = fat looking heart on CXR. This is also important. No thymus in babies = DiGeorge or SCID.*
Two benign masses affecting glands:
- Pleomorphic adenoma
- Warthin tumor
Two malignant masses affecting glands
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
a note about Adenoid cystic carcinoma: yes, it happens in salivary glands. But it can be ANYWHERE that has epithelium including SECRETORY cells. Even the uterus. I saw it up a lady’s nose. It’s definitely not just a glandular tumor.
Glandular condition assc with Sjorgens? Trauma?
Xerostoma: dry mouth/ eyes. Sjorgens.
Saildenitis: can be caused by trauma, among other things.
Autoimmune related lesion of the oral cavity:
Aphthous ulcers (Canker sore)
**Fun fact: according to other sources, including Dr. Fry, this is part of BEHCETS disease…
= Aphthous ulcers, iritis, genital lesions; (it’s a vasculidity in Japan/China)
Overall: what is the most common tumor of both the head and the neck?
Squamous cell carcinoma represents NINETY FIVE% of head and neck masses!!!!!
Hyperplasia and Dysplasia are _______.
Cancer is not.
Reversible.
How does tissue progress from normal to cancerous?
- Normal –> 2. Hyperplasia –> 3. Mild/moderate dysplasia –> 4. Severe dysplasia (carcinoma in situ) –> 5. Cancer
Note: hyperplasia = ^^^number of cell layers.
Dysplasia = change in the cells themselves.
Severe dysplasia takes up entire epithelium but does not invade the basement membrane of tissue.
(Mild = 1/3, Moderate = 2/3 dysplastic)
Describe an aphthous ulcer (gross appearance)
- round, erythematous
- central white exudate
These guys hurt like heck but go away by themselves.
Fibroma histologic appearance:
_______proliferation of ________tissue
Causative factor:
Treatment:
Submucosal proliferation of fibrous tissue
Response to trauma
Won’t go away; have to cut it out.
(NOT malignant. Just annoying.)
Pyogenic granuloma:
- one alternative name
- histo appearance
(2 cells on _______stroma)
Pregnancy tumor (common in pregnant patients probably due to ^^VEGF?)
Vascular granulomas composed of:
lymphs + fibroblasts on an erythematous stroma
Two possible oral manifestations of herpes in the mouth:
Acute gingivostomatosis (primary) Herpetic stomatosis (reactivation of latent virus)
Most common fungal infection in the mouth?
Candida albicans
What predisposes patients to Candida albicans/thrush?
Use of abs (+ immunocompromised)
Cause of hairy leukopenia
EBV infection in an Immunocompromised patient
- lesions on lateral tongue, can not scrape off
Who is susceptible to deep fungal infections?
Common ending for names of infections fungal species?
Which one is a bid deal in WV?
Immunocompromised patients; –osis
Histoplasmosis = local problem
Who gets leukoplakia and erythroplakia in their oral cavity?
What’s the significance?
Middle aged male smokers.
These lesions can transform and become malignant.
Higher risk assc with erythoplakia than leukoplakia.
E comes before L in the alphabet.
Leukoplakia gross appearance:
________ _________ plaque that ___________.
Histo shows full ________.
Small white plaque that doesn’t scrape off in the presence of no better diagnosis.
Histo shows full thickness dysplasia! This thing is waiting to invade at any time.
Gross appearance of ERYTHroplakia:
Red velvety lesion in the mouth +/- erosion .
Full thickness dysplasia like leukoplakia.
What are some risks for oral squamous cell ca? (4)
What does it look like grossly?
- tobacco, pipes, alcohol
- chewing “betel quid and pann” (Asian stimulant)
- HPV (as with any squamous cell)
- sunlight
- I’m really confused about how you expose your mouth to sunlight….but she said it…..*
SCC is an ulcerated irregular lesion
Describe the histologic appearance of oral squamous cell carcinoma or ANY squamous cell carcinoma:
Full INVASIVE dysplasia +/- keratin pearls
Common causes of acute rhinitis?
Allergic rhinitis is called?
What might chronic rhinitis cause?
Acute rhinitis: viral, especially adenovirus and rhinovirus (PicORNaviridae)
Allergic = hay fever
Chronic –> nasal polyps
Polyp (mucosal proliferation):
Histo appearance
Loose CT surrounded by respiratory epi in the case of nasal polyps.
GI polyps surrounded by GI epi.
Will also see “vascular congestion”.
Sinonasal papilloma is a proliferation of _______.
Benign Or malignant?
Population and assc?
BENIGN proliferation of mucosal tissue (like a polyp)
Assc with HPV 6, HPV 11
Middle aged males
Will recur and can transform (unlike a polyp)
Three growth patterns of sinonasal papillomas
- Exophytic
- Endophytic
- Cylindrical
Ddx for a suspicious lesion in the nose:
Sinonasalpapilloma (benign) vs nasopharyngeal carcinoma (bad)
Three important things to remember about nasopharyngeal carcinoma
- Likes lymphoid tissue
- Has a geographic distribution
- EBV +
Nasopharyngeal carcinoma:
- Presentation (symptomatic)
- Treatment
Nose bleeds and obstruction
Poor prognosis; but accepted treatment is radiotherapy
Three possible patterns assc with nasopharyngeal carcinoma:
- Keratinizing
- Non keratinizing
- Undifferentiated (has basaloid- small blue cells)
Histo appearance of nasopharyngeal carcinoma is:
_______ surrounded by _________.
___________ stain is positive.
Syncitiums surrounded by dark lymphs
Positive for EBER1 stain. (For EBV)
Small bilateral lesions on the vocal cord of a singer are what?
What do you do about this?
Laryngeal polyps!
The equivalent of a nasal polyp in the larynx.
Caused by overuse or smoking.
Cut them out.
Cauliflower lesion on one of the true vocal cords?
What do you do about this?
Squamous papilloma
Resect it.
How do you tell a branchial cyst apart from a thyroglossal duct remnant?
Location!!
Thyroglossal will be MIDLINE.
Branchial cyst is LATERAL (and may leak fluid).
Both branchial cleft cysts and thyroglossal duct remnants have what two tissue types?
Squamoid and lymph tissue
When do these congenital neck masses presnt?
Not until MIDDLE AGE!!!
Paraganglioma:
ONE characteristic Histo appearance; positive stain
Most COMMON Location
NEUROENDOCRINE TUMOR
-salt and pepper cells; catecholamines +
-rare tumor; most common at the CAROTID BODIES
(Can be paravertebral or assc with vasculature)
Sialdentis is caused by?
See a ______ grossly and a _______ on Histo.
Trauma to a salivary gland.
See a mucocele grossly; pseudocyst on Histo
Pleomorphic adenoma:
Why is it called pleomorphic?
How does the patient describe the lesion?
What is the assc chromosomal rearrangement?
Pleomorphic because it’s Histo has many possible patterns. May get bone, cartilage, epi. (epi + mesenchyme)
Painless, MOBILE mass
P in pleomorphic = P in PLAG1 rearrangement.
Location of a warthog tumor/ papillary cyst adenoma lymphomatosum?
Who gets these?
Parotid gland of old male smokers!
Poor old grandpa Warthin has a big fat lump in his neck but he keeps smoking those cigarettes!!!
t(11,19) (q21, p13) // MECT1; MAML2 is assc with what malignancy?
Where is it?
What does its name mean?
Mucoepidermioid carcinoma in the salivary glands.
Called MUCO-EPI-Dermoid because it has mucous, epi (squamous cells/ mucus neck cells) and intermediate cells on Histo
Adenoid Cyctic Ca:
Location
How does the patient describe the lesion?
Histo pattern + strange ability of this tumor?
It’s PAINFUL (only one that hurts!)
Minor salivary glands = most common.
When in major salivary glands: parotid, submandibular
It can INVADE NERVES!!!! …. Which means you can get cranial nerve deficits!
It has a cribiform pattern.
It is malignant.
HPV is related to what two head and neck masses?
EBV?
HPV- sinonasal papilloma; squamous cell carcinoma
EBV- hairy leukoplakia; nasopharyngeal carcinoma
Tell me again: what are the translocations/ mutations associated with mucoepidermoid ca of the salivary glands?
t(11,19) (q21, p13) // MECT1; MAML2
You find a white oral plaque. What do you want to know about it first?
Can you scrape it off? Yes- then candidiasis, no- something else (hairy Leukoplakia, leukoplakia, squamous cell)
Hyperkeratosis means?
Parakeratosis means?
Hyper- extra cell layers
Para- cells retain their nuclei in the upper layers of skin (where there should only be dead cells)
Mild vs moderate vs severe dysplasia?
Mild = irregular cells in 1/3 of the epidermis, moderate 2/3, severe- all layers but NO INVASION of the basement membrane.
When can you use a fine needle aspirate?
on superficial nodes not in close proximity to vital structures.
What should you do for patients who smoke, drink, work outside?
Thorough oral cavity exam
Neural involvement is a red flag for?
Adenoid cystic carcinoma
“Motor oil fluid” is a buzz word for?
Warthins
Blue always means…..
Bad
Lesion that may masquerade as a primary tongue cancer?
Mucoepidermoid (because it is most commonly in the minor salivary glands)
