Pathology-Head & Neck Flashcards
What salivary gland tumors have higher rates of malignancy?
Those in the smaller salivary glands. Sublingual > Submandibular > Parotid. Note, however, that parotid tumors are the most common occurring (65-80% of all salivary gland tumors)
A 60 year old man presents with the large lump seen below. Histological analysis of the lump reveals ductal and myoepithelial cells. What structure is at risk for damage on resection of the mass?
This is a Benign Mixed Tumor (Pleomorphic adenoma). You are at risk of damaging CN VII (facial nerve) when cutting through parotid gland. Note that this is the most common salivary gland tumor.
A 53 year old man presents with a lump in his right parotid gland. He has a history of smoking. Biopsy of the lump is shown below. What is your diagnosis?
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum). Note the dual layer of pink epithelial cell proliferation with lymphocytic background. These are the only salivary gland tumors that have a higher incidence in men than women.
A 59 year old male presents with a right mass in his parotid gland. He has a history of cancer for which he received radiation therapy. Biopsy is shown below. What genetic malformation is this condition associated with and what other cancer must you rule out when assessing this patient?
Mucoepidermoid Carcinoma. You must also rule out B-cell lymphomas because both of these are malignant. Note that the slide has 1) epidermoid squamous cells 2) vacuolated mucocytes and 3) intermediate cells. This is associated with chromosome 11:19 translocation and irradiation therapy. Translocation fuses the MECI 1 and MAML2 that affects cAMP pathways.
A 59 year old male presents with a right mass in his parotid gland. He has a history of cancer for which he received radiation therapy. Biopsy is shown below. What is the prognosis for patients with this condition?
This is a mucoepidermoid carcinoma. Note the epithelial squamous cells, mucous cells and mucus-filled cysts. There are low, medium and high grade tumors with low and medium having best prognosis w/resection.
What type of cancer most often occurs in the oral cavity?
Squamous cell carcinomas (tobacco and alcohol being largest risk factors). This is because tobacco and alcohol cause cellular damage -> hyperplasia -> dysplasia -> carcinoma in situ -> squamous cell carcinoma.
What virus is often associated with oral cancer?
HPV
Which premalignant squamous cell lesion would you rather have on your tongue?
Leukoplakia. 80% are benign, erythroplakia has a higher chance of becoming malignant.
What lesions are seen on the lip that are premalignant squamous cell carcinomas? What about on the tongue?
Lip: Actinic Keratosis. Tongue: Leukoplakia and Erythroplakia
What are the most common places to find oral squamous cell carcinoma?
Ulcerated, non-healing lesions on the tongue and floor of the mouth
A 37 year old woman presents with hoarseness. What is your differential if you know the lesion involves the larynx?
Laryngeal nodules (opera singer), laryngeal polyps (voice abuse), laryngeal papillomatosis (HPV 6 & 11) or squamous cell carcinoma (alcohol, smoking, asbestos).
A 42 year old singer presents with hoarseness. Her biopsy is shown below. What is your diagnosis?
Note the normal epithelium, edema and stroma proliferation.
A 6 year old boy presents with hoarseness and nodules in his larynx. Biopsy is shown below. What is your diagnosis? How do you treat this?
Laryngeal papillomatosis from HPV 6 or HPV 11. Note the polyps of squamous cell epithelium. These will usually regress at puberty, but can be resected if they don’t regress.
A 62 year old woman presents with hoarseness, dysphagia, dyspnea and hemoptysis. She has a long history of tobacco and alcohol use. Her biopsy is shown below, what is the most common site for this tumor?
She has laryngeal carcinoma. Note the keratin pearls. The most common site being the glottis.
What lesions can cause epistaxis?
Pyogenic granulomas (hemangioma) and juvenile nasopharyngeal angiofibroma (fibrous hemangioma)
A 32 year old pregnant woman presents with recurrent bloody noses. Physical exam reveals a polypoid mass in her nose. Biopsy of the mass is shown below. What is your diagnosis?
Pyogenic granuloma. Note the benign vascular proliferation indicative of a hemangioma.
What patients present with this condition?
Young male patients. Note the large vascular proliferations in fibrous tissue. This is juvenile nasopharyngeal angiofibroma.
A 22 year old woman presents with rhinorrhea, nasal obstruction and headaches. Physical exam reveals inflammation of the sinonasal mucosal bilaterally. Nasal biopsy is shown below. What underlying conditions may exist in this patient?
She has sinonasal inflammatory polyps. Note the benign epithelial proliferation with increased stroma, edema and eosinophils (shown below). These can arise in people with cystic fibrosis, infection, diabetes, aspirin intolerance and allergies.
A 36 year old man presents with unilateral nasal obstruction, pain and bloody noses. His biopsy is shown below. What is this condition associated with? What is his prognosis?
He has an inverted sinonasal papilloma associated with HPV 6 and 11. Since the lesions are inverted surgical resection is very difficult and recurrence often occurs after resection.
A 27 year old woman and 61 year old man present to the clinic with unilateral nasal obstruction, epistaxis, headaches and visual disturbances. Biopsy is shown below. How do you further confirm your diagnosis and how do you treat them?
These patients have olfactory neuroblastomas. Note the small round blue cells. You would further confirm your diagnosis with chromogranin or S-100. You would have to treat them with resection, chemo and radiation.
A 31 year old immigrant from China presents with unilateral effusion in one ear and nasal obstruction. Biopsy is shown below. What histological characteristic gives this patient the best prognosis?
This patient has nasopharyngeal carcinoma. Note that it is from EBV and common in Chinese men and African children. There undifferentiated type has the best prognosis where the keratinizing type has the worst.
A patient presents with a cyst on the lateral surface of the neck 3 cm in diameter. The cyst is excised and biopsy shown below. What is your diagnosis?
Branchial cleft cysts. Note squamous epithelial wall with lymphoid infiltrate. This is from a remnant of the pharyngeal arches.
A patient presents with a cyst in the midline of the neck. The cyst is excised and biopsy shown below. What is your diagnosis?
Thyroglossal duct cyst. Note they cystic wall with lymphoid infiltration. This is a remnant of the thyroglossal duct as the thyroid made its descent from the posterior tongue during development.
A 30 year old woman comes to see you complaining of a mass in her neck. She also complains of anxiety, palpitations and headaches. Physical exam reveals an elevated blood pressure. Biopsy of the mass in her neck is shown below. What is your diagnosis?
Paraganglioma. Note the nests of neuroendocrine cells (zellballen pattern). These tumors commonly arise from the carotid body, can release catecholamines and are associated with pheochromocytomas when patients have MEN2.
A 22 year old man presents with rhinorrhea, sinusitis, nasal obstruction and pain. Physical exam reveals tissue loss in the nasal septum area. Labs reveal an elevated ESR, BUN and a + c-ANCA test. Tissue biopsy is shown below. How do you treat this patient?
Anytime you seen nose, lungs and kidney involvement you think Wegener’s granulomatosis. Note the granuloma on biopsy. You would treat him with steroids and cyclophosphamide for serious cases.
A 33 year old Chinese male presents with midline destruction of the nasal septum. Tissue biopsy is shown below and was positive for CD2, CD16, CD56, cytoplasmic CD3 and TIA -1. What is your diagnosis?
This patient has extra nodal NK T-cell lymphoma (angiocentric T-cell lymphoma). These tumors cause tissue damage due to vessel obstruction as seen in the biopsy. Note that these tend to occur where EBV is more prevalent.
A mother brings in her 3 month old baby who has been screaming throughout the night for the past three nights. Exam of the baby’s ear is shown below. What are common etiologies for this condition?
This child has acute otitis media. Common etiologies are pneumococcus, Hib, Moraxella, RSV, rhinovirus and coronavirus.
A mother brings in her 5 year old boy who has been unable to sleep at night because of a painful throat. Physical exam reveals swollen tonsils. What are common etiologies for this condition?
Usually viral: rhinovirus, echovirus and adenovirus. When bacterial: strep viridans & staph aureus.
A patient presents with pain, swelling and purulent otorrhea. He comes in a few weeks after symptoms developed and now has osteomyelitis in the middle ear and skull. What is causing this condition?
This patient has necrotizing external otitis. Common causes are pseudomonas or aspergillus. This is serious and can progress intracranially and cause cranial nerve palsies, meningitis, venous thrombosis and brain abscesses.
A patient comes to see you with facial disfiguration from an angioinvasive fungal infection that started in his sinonasal tract. What is your diagnosis?
Rhinocerebral Zygomycosis. This is an opportunistic fungal infection.
Risk factors for leukoplakia?
Pipe smoking and chew. Alcohol and ill-fitting dentures have weaker associations.
Leukoplakia histological characteristic:
Hyperkeratosis
Oral thrush histological characteristics:
Oral thrush: budding cells with pseudohyphae suggestive of candidal infection.
Histological characteristics of nasopharyngeal carcinoma:
Dysplasia of squamous epithelial cells
Sjogren cancer
Malignant lymphomas in the salivary glands
Familial deafness
Otosclerosis (from fibrous ankylosis induced bony growth in middle ear), neurofibromatosis (multiple Schwannomas in CN VIII, vestibulocochlear nerve)
Kid with cholesteatoma
Chronic otitis media in young adult or child.
Aphthous ulcers
Canker sores
Cheilosis association
Fissuring of mouth corners associated with B2 deficiency
Hairy leukoplakia association
EBV from marked hyperkeratosis
Multinucleate giant cells
HSV
Shiny red surface or ulcerations of tongue
Glossitis
Serous cell tumor of salivary gland w/ high metastasis rate
Acinic cell tumor
Hay fever presentation
Allergic rhinits, may present w/polyps
Diabetic ketoacidosis
Nasopharyngeal mucormycosis
Staph colonization of nose
No problems ususally
2nd most common salivary gland tumor
Warthin in the parotid
Mucous cysts w/squamous cells
Mucoepidermoid carcinoma
Non-hodgkin lymphoma
Sjogrens
Ductal epithelial cells in a myxoid stroma w/islands of chondroid and bone.
Pleomorphic adenomas
Local trauma of very young and old with purple borders.
Mucocele. Ruptured or blocked salivary gland duct.
Betel nut
Oral cancer risk factor
Oral thrush association
HIV (candidiasis)
Large fungating neoplasms
Laryngeal squamous cell carcinoma
Yellowish plaque like area
Oral thrush
Painful gingival nodule of granulation tissue
Pyogenic granuloma
Most neoplasms in minor salivary glands
Mucopidermoid carcinoma.
When do canker sores appear?
Stress (aphthous ulcer)
Inflammation of the salivary gland, producing a localized tender nodule in the oral cavity
Sialadenitis
Cystic masses lined by squamous epithelium w/ giant cells and keratin degenerates.
Cholesteatomas
Chronic otitis media lesions that are benign but can destroy the inner ear
Cholesteatomas
Cause of labyrinthitis
Viral infection
Thyroglossal duct location
Foramen cecum in posterior tongue to thyroid gland
Cysts w/o thyroid tissue
Branchial cysts
Solid tumors in the deep region of the carotid body
Paragangliomas. Note that they metastasize and recur.
Associated with older people and phenothiazine for schizophrenia
Sialadenitis. Dry mouth + dehydration causes stone formation and blockade of ducts that causes inflammation and infection
How many squamous cell carcinomas manifest as a single nodal metastasis in the neck?
5.00%
Fibrovascular core covered by hyper plastic and hyperkeratotis squamous epithelium
Vocal cord polyps
Parainfluenza virus
Croup “laryngotracheobronchitis”
Broad, nonseptated hyphae
Mucor
Pernicious anemia + glossitis
B12 deficiency
