Patho/Radio Flashcards
reactive lesions (benign fibroepithelial lesions)
etiology
chronic irritation
pyogenic granuloma vs peripheral fibroma vs irritation fibroma
both gingival
pyogenic - more vascular
peripheral fibroma - more fibrous
irritation fibroma - buccal, more fibrous
denture-induced proliferations
epulis fissuratum, gravidarum
leukoplakia (white plaque)
etiology
cannot be ascribed to any identifiable etiology
leukoplakia (white plaque)
histology
sq hyperplasia w hyperkeratosis (white bc of keratin)
parakeratosis - w nuclei
acanthosis
elongation of rete ridges
most important determinant of premalignant potential
dysplastic features (pleiomorphism, nucleoli, inc mitosis, hyperchromasia)
most common presentation of EARLY ORAL CANCERS
erythroplakia (red plaque)
erythroplakia (red plaque)
histology
thin, atropic epithelium, without keratin
LP with engorged capillaries
erythroplakia (red plaque)
grading
2/3 sq epith replaced by atypical cells = SEVERE
1/3 replaced = mild
full thickness = carcinoma in situ (intact BM/no invasion)
major oral cavity cancer
SCCA
non-keratinizing oral cavity cancer etiology
HPV 16, 18
oral cancer histology
keratin pearls, intercellular bridges (well differentiated)
poorly differentiated if hardly any (more aggressive)
oral cancer treatment (3)
surgery
radiotherapy/chemo
targeted molecular therapy/EGFR targeted drugs
oral cancer prognosis (best and worst)
best - lip
worst - floor of the mouth, base of tongue
most common ODONTOGENIC TUMOR
ameloblastoma
ameloblastoma presentation (lesions)
lytic cysts (soap bubble lesions) - multi-locular radioluscencies (with scalloped margins)
*slow-growing, painless, benign but locally invasive and recurrent
ameloblastoma microscopic landmarks/pathologic hallmarks (3)
peripheral palisading cells
reverse nuclear polarization (nuclei at inner edge)
central stellate reticulum
ameloblastoma treatment (2)
hemimandelectomy
total mandiblectomy
fibrous dysplasia affects
pediatric age group, stops growing near skeletal maturation
ossifying fibroma; osteosarcoma
affects?
OF - middle age
osteosarcoma - late teens/ early 20’s
inflammatory nasal polyps etiology
chronic inflammation (systemic allergies, asthma)
inflammatory nasal polyps histology
PCCE
stroma w edematous inflammatory cells (glistening polyp)
inflammatory nasal polyps treatment (2)
polypectomy
treat underlying cause
inflammatory nasal polyps radio
thinned out skull bones (due to pressure, chronic sneezing?)
tonsilitis etiology (2)
viral
bacterial (b-hemolytic strep most common -> rheumatic fever, rh heart disease)
tonsilitis treatment
medical treatment
tonsillectomy if obstructing airflow (kissing tonsils)
necrotizing lesions (“lethal midline granuloma”) (3)
fungal (mucor - invasive, aspergillus - non-invasive)
auto-immune (wegener’s granulomatosis)
t/nk lymphoma
most neoplasms in nasopharynx are
scca
nasopharyngeal angiofibroma (juvenile angiofibroma) histology
branching thin-walled bv in fibrous stroma
*unilateral
nasopharyngeal angiofibroma treatment
surgery (but complications may arise e.g. hemorrhage)
most common benign nasopharyngeal mass
nasopharyngeal (juvenile) angiofibroma
nasopharyngeal angiofibroma imaging (2)
angiography with contrast
ct/mri: like sinusitis/polyp; bony structures intact
tonsillitis vs asymmetrical tonsils
ddx by persistence of asymmetry
sinonasal (schneiderian) papilloma etiology
hpv 6, 11
sinonasal (schneiderian) papilloma histology
inverting type papilloma: sq invaginates into stroma
sinonasal (schneiderian) papilloma treatment
excision (but formidable; high recurrence)
olfactory neuroblastoma (esthesioneuroblastoma) - how to ddx from other nasopharyngeal neoplasms?
*malignant; roof of nasal cavity; glabellar protrusions
anosmiaaa
olfactory neuroblastoma histology
small round dark blue cells (ddx lymphoma)
homer-wright pseudorosettes!
olfactory neuroblastoma treatment
surgery, chemo
nasopharyngeal carcinoma
affects?
bimodal - young adults, 30-60 y/o
endemic in africa & asia
nasopharyngeal carcinoma etiology
EBV
nasopharyngeal carcinoma presentation (4)
lateral neck mass (late sign of cervical LN metastasis) - most common
hot potato voice
nasal obstruction
unilateral HL & otalgia
nasopharyngeal carcinoma histo
small blue round cells ulit
undifferentiated - no keratin pearls/intercellular bridges
ddx: IHC (detect cytokeratin, present in carcinoma)
nasopharyngeal carcinoma treatment
radiotherapy (primary modality) - very effective
difficult surgical access. “swing-out method”
nasopharyngeal carcinoma imaging
mass at nasopharynx can extend in all directions
bone invasion (characteristic of CA; ddx from angiofibroma)
laryngeal cancer treatment
total or partial laryngectomy
branchial cleft cyst presentation, etiology
anterior end of scm
does not move with swallowing!
remnants of branchial arches
thyroglossal duct cyst presentation, etiology
anterior midline
moves with swallowing! or protrusion of tongue
remnants of thyroid cell left behind during migration (recall: from foramen cecum/floor of mouth migrate downward to throat)
thyroglossal duct cyst
imaging
beaking of infrahyoid strap muscles over cyst
thyroglossal duct cyst histo
sse (above hyoid)
pcce (below hyoid)
with (functional) thyroid tissue underneath (hyperplastic or resemble follicular/papillary CA)
thyroglossal duct cyst treatment
complete excision (cis-trunk). may necessitate removal of hyoid
*recurrence; malignant transformation
otitis imaging
*mastoiditis
chronic irritation can lead to mastoiditis and cholesteatoma
in mastoiditis: no honeycombing and air cells due to sclerosis
otitis treatment
ab for infections, surgery if severe
cholesteatoma etiology
(congenital or acquired)
severe otitis media w tm rupture, ingress of sse from external to middle ear (pcce)
very common cause of PREVENTABLE DEAFNESS (in child?); conduction deafness
cholesteatoma
cholesteatoma histo
sse with keratin debris
cholesteatoma treatment
surgical excision
tumors
pinna
pinna & canal
child middle ear
pinna - bcc
pinna and canal - scc
child middle ear - embryonal rhabdomyosarcoma
*ceruminous gland tumors
sialadenitis etiology (2)
viral - viral parotitis/mumps
bacterial - s. aureus; strep viridans
sialadenitis risk factors
dehydration -> viscous fluid -> obstruction (sialolithiasis may be seen in imaging) –> stasis –> infection
sialadenitis histo
neutrophilic infiltrates in duct & between acini - BACTERIAL
sialadenitis treatment
rarely surgical unless may stone
most common salivary gland TUMOR
benign mixed tumors/pleomorphic adenoma
benign mixed tumors/pleomorphic adenoma histo
pleomorphic;
epithelial (ducts)
mesenchymal (chondromyxoid stroma/loose cartilage-like)
benign mixed tumors/pleomorphic adenoma treatment
complete excision (mary recur/transform if not complete)
SECOND most common salivary gland TUMOR
warthin’s tumor (oncocytic papillary cystadenoma lymphomatosum)
most common BILATERAL salivary gland tumor
warthin’s tumor
*synchronous or metachronous (even decades)
warthin’s tumor location
exclusively in PAROTID
warthin’s tumor histo
papillary lined by ONCOCYTES (tall columnar eosinophilic)
abundance of LYMPHOCYTES
most common salivary gland MALIGNANCY, most common salivary gland malignancy in CHILDREN
mucoepidermoid carcinoma
mucoepidermoid carcinoma histo
epidermal - squamous cells
mucoid - mucus-secreting cells
mucoepidermoid carcinoma grading
low-grade = more mucin, more cystic high-grade = more squamous, more solid
mucoepidermoid carcinoma parameters
anaplasia, necrosis, solid component
mucoepidermoid carcinoma treatment
high-grade = total removal (facial nerve sacrifice)
low-grade = superficial parotidectomy
most common malignancy of MINOR salivary glands; oral cavity (also affects lacrimal)
adenoid cystic carcinoma
adenoid cystic carcinoma presentation
oral cavity ulcer (ddx oral cavity scc?)
pain due to perineural invasion
adenoid cystic carcinoma histology
cribriform (swiss cheese) + hyaline in the lumina
adenoid cystic carcinoma prognosis
can recur 10-15 yrs after surg so do long-term follow-up
2nd most common BILTERAL salivary gland MALIGNANCY in CHILDREN
acinic cell carcinoma
acinic cell carcinoma presentation
pre-auricular masses (well circumscribed and movable, usually in parotid)
acinic cell carcinoma histo
dark blue neoplastic acinar cells
acini look normal but no adipocytes and ductal system
acinic cell carcinoma treatment
complete excision
common in the elderly (6th-7th)
carcinoma ex-pleomorphic adenoma (from bmt)
*most commonly poorly differentiated
carcinoma ex-pleomorphic adenoma histo
residual cartilage (indicates lesions was benign dati)
carcinoma ex-pleomorphic adenoma treatment
practically hopeless :(
most common lacrimal gland tumor…?
adenoid cystic ca
*lacrimal is a specialized salivary gland so salivary gland-type tumor
most common MALIGNANT eye tumor of CHILDHOOD
retinoblastoma
retinoblastoma presentation
leukocoria
loss of ror –> cat’s eye (eye can still be salvaged)
retinoblastoma histo
blue small round cell
flexner-wintersteiner true rosettes (embryonic rods and cones; with central lumen!)
small blue round cell (4)
olfactory neuroblastoma
nasopharyngeal ca
lymphoma
retinoblastoma
retinoblastoma treatment
enucleation
laser/cryotherapy + chemotherapy (aggressive but chemoreactive)
retinoblastoma imaging
intraocular calcification
acute and chronic sinusitis imaging
air fluid levels seen with gravity
thickened mucosal swelling & periosteum (pressure)
