Neck Pathology

Question 1

What are the types of laryngeal lesions?

Answer 1

• Singers’ node - Papilloma - Cancer on vocal cord - Chronic trauma of vocal chords: e.g. singer’s nodules (rest should resolve)

Question 2

Risk factors of laryngeal SCC

Answer 2

• Smoking* - Alcohol* - Radiation exposure -Asbestos exposure - ? HPV infection *most common

Question 3

Sequence of laryngeal SCC

Answer 3

Hyperpasia -> Dysplasia -> Carcinoma

Question 4

What does this show?

Answer 4

Squamous hyperplasia and parakeratosis - thickening of top layer; will often appear white when you look at the larynx (DDx candida infection) therefore must do cytology to determine cause

Question 5

What does this show?

Answer 5

Low grade (mild) dysplasia analogy of ice cream: chocolate -> choc chip -> choc chunks (progressively more dysplastic cells)

Question 6

What does this show?

Answer 6

High grade (severe) dysplasia (in situ)

Question 7

What does this show?

Answer 7

Invasive SCC

Question 8

Rx of laryngeal SCC

Answer 8

• Treatment:
Laser excision plus radiation therapy

Partial or total laryngectomy

Question 9

What are the DDx of a neck lump?

Answer 9

• Branchial cleft cyst - located along the anterior border of sternocleidomastoid muscle from the hyoid bone to the suprasternal notch
• Thyroglossal duct cyst - midline, associated with hyoid bone, moves with protruding tongue, contains thyroid tissue
• Bronchial cyst - contains respiratory mucosa, smooth muscle and bronchial glands
• Thymic cyst - contains thymic Hassall’s corpuscles
• Thyroid gland goitre or solitary nodule - hyper/hypothyroidism, moves with swallowing
• Carotid body tumour - pulsatile
• Cervical lymph node - reactive or neoplastic (lymphoma, metastatic SCC)
• Salivary gland – inflammation (mumps, calculi) or neoplastic
• Other: Lipoma; Epidermoid “sebaceous” cyst; Cervical rib

Think: does it move with swallowing, move with the skin, unilateral, midline etc?

Question 10

Ix of neck lumps

Answer 10

1. FNA: intial Ix in assessing head and neck lumps; usually 23G needle; must be quick action back-forth (cutting motion)

NB: not histology - if tumour, may drag cells out and worsen

2. Core biopsy: another mode of intial Ix

Question 11

What is a branchial cleft cyst?

Answer 11

Cyst lined by stratified squamous epithelium (90%), respiratory epithelium (8%) or both (2%)

(developmental abnormality)

Congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the secondbranchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

Often DDx: SCC in LN (both look very similar cytology) - nuclear changes determines if malignant or benign (cyst)

Question 12

What happens if the cyst ruptures?

Answer 12

Inflammation response provoked

Question 13

Ad/Disadvantage of FNA

Answer 13

• Advantages
– Highdiagnos7caccuracyforbenignandmalignantheadandnecklesions – Isasafe,quickandminimallyinvasivetest
– Lowcost
– Fewercomplica7onscomparedwithcorebiopsy(CBX).

• Disadvantages
– Inadequatesamplesin10-15%ofcases
– Falsenega7veinterpreta7ons(smalllesions,difficultaspira7on) – Inabilitytodis7nguishinvasivefrominsitulesions

Question 14

Ad/Disadvantage of core biopsy

Answer 14

Advantages

– Can get a larger tissue sample and assess tissue architecture (invasive carcinoma and in-situ carcinoma)

– Can use special histological and immunohistochemical stains

• Disadvantages
– More complications than FNA e.g. bleeding

– Takes longer to get result

– Theoretical increased risk of tumour seeding related to increased needle diameter

Question 15

What is the most common cancer of salivary gland?

Answer 15

Pleomorphic adenoma

Question 16

Describe the composition of a pleomorphic adenoma.

Answer 16

Aka “Mixed Tumour” due to remarkable histologic diversity

Most common salivary gland tumour (50%)

Most commonly occur in parotid gland (60%)

Composed of mixed epithelial and myoepithelial cells set within a myxoid/chondroid matrix, occasionally osseous tissue

Question 17

Prognosis of pleomorphic adenoma

Answer 17

Prognosis: benign, recurrence rate high (25%) with simple “enucleation” surgery therefore patients require parotidectomy

Rare for transformation into malignancy

Question 18

What is the second most common salivary gland tumour?

Answer 18

Warthin’s Tumour

• benign

Question 19

What are the most common malignant cancers of the salivary gland?

Answer 19

Mucoepidermoid Carcinoma

Adenoid cystic carcinoma

Malignant carcinoma only makes up 2% of salivary gland cancers