Pathology Lab-Head & Neck Flashcards
A 65-year-old retiree presents with a white patch on his tongue. He states he first noticed it a several months ago, but he did not feel the need to have it examined because it did not hurt. He is referred to a surgeon for evaluation. He has been a smoker for the last 40 years, and enjoys “relaxing with a few beers now and then.” Why is it better that he has a white patch vs. a red patch on his tongue?
Leukoplakia is characterized by acanthosis (thickening of keratin layer), dysplasia and parakaratosis (increased depth of larger cells) as seen below. It has a better prognosis than erythroplakia, which has a higher tendency to become malignant.
A young active duty recruit presents to sick call with a chief complaint of a “sore throat.” He has otherwise been healthy. Temp 101°F, BP 120/80 mm Hg, Pulse 90 and RR 15/ minute. Physical exam reveals hyperemia and erythema of pharyngeal and tonsillar mucosa accompanied by pain. What are likely etiologies of his condition?
90% Viral: adenovirus, enterovirus, rhinovirus, RSV, EBV, parainfluenza and influenza. 10% Bacterial: strep pyogenes and staph aureus.
A 73-year-old male presents with the onset of persistent, progressive hoarseness. Recently this hoarseness has been accompanied by pain and difficulty in swallowing. The patient has a 35-pack-year history of tobacco use and admits to frequent alcohol use. What are risk factors for this condition?
This patient has laryngeal carcinoma. Risk factors include: tobacco, alcohol, irradiation, asbestos, HPV and nutritional factors.
An 18-year-old male presented with a semi cystic mass on the left side of his neck that had been present for 3 months. The patient denied pain or tumor enlargement. His MRI is shown below. What would you expect to see on biopsy of this lesion?
This patient has a thyroglossal duct cyst. You would see a pseudostratified or squamous epithelial lined cyst with lymphoid tissue (mostly mononuclear).
A 42-year-old man presents to the clinic with a painful and ulcerated oral lesion. In addition he noticed that his urine color changed to dark-brown. Frontal sinuses, maxillary sinuses & the facial region are painful to palpation. He has palpable purpuric skin lesions. Labs: Elevated ESR and CRP. Urinalysis revealed Sp Gr 1.010, numerous RBC, WBC and RBC casts. BUN is 80 mg/dL and creatinine 7.2 mg/dL. Chest X-ray reveal focal bilateral pulmonary fibronodular changes. Imaging studies disclose maxillary sinus opacifications and air-fluid levels. What vessels are affected in this patient?
This patient has Wegener’s granulomatosis. This affects small to medium sized vessels.
How does the location of an oral squamous cell carcinoma hint towards the etiology of the pathology?
Smoke/Drink: tongue & floor of mouth. UV: lower lip. HPV: oropharynx. EBV: nasopharynx.
Incidence of what disease would be largely decreased if a vaccine for EBV were developed?
Burkitt’s lymphoma, nasopharyngeal carcinoma and mononucleosis.
What demographic gets mononucleosis?
Adults. It does not present in children.
What is your diagnosis? Where would you look next to determine risk for malignancy and metastasis?
Note the “heaped up” margin with a central ulceration, indicative of a malignancy. This is a very likely squamous cell carcinoma. These tumors drain to the cervical lymph nodes, so you would look there next.
What would you expect the histology of biopsy of this tongue to look like?
Invasion of squamous cells into the parenchyma, keratin pearls and intercellular bridges.
A 33 year old male with HIV comes to see the doctor because he has a sore throat. Physical exam reveals fever and erythematous oropharynx. What are likely etiologies of pharyngitis in patients who are immunosuppressed?
Opportunistic fungal infections: Aspergillus and candida.
How would you differentiate EBV pharyngitis from other pharyngitis?
Hepatosplenomegaly, atypical lymphocytes (activated CD8+ cells) and adenopathy.
How do you differentiate bacterial pharyngitis from viral pharyngitis?
Purulent exudate = bacterial.
What is the etiology of this condition?
This is herpangina (vesicles & ulcerations). Coxsackie and HSV can cause this.
A patient comes to see you with pharyngitis for the third time this year. Biopsy of the pharynx is shown below. What is your diagnosis?
HSV pharyngitis. Note the Tzanck epithelial cells characteristic of HSV.
A 2 year old boy presents with this condition shortly after developing and ear infection. History reveals no immunizations. What would you expect to see on biopsy and lab testing?
This is acute epiglottitis. You would likely see gram-negative Haemophylus influenzae and neutrophils.
Why are alcohol and tobacco such good triggers for laryngeal carcinoma?
They cause dysplasia and then metaplasia of respiratory epithelium into squamous epithelium. It then becomes a squamous cell tumor.
Why are patients with this condition at risk for infection?
Note the large fungating laryngeal carcinoma. Blockade of the respiratory tract puts the patient at risk for infection distal to the blockade.
What is this?
An aggressive squamous cell carcinoma. Note the mitotic activity indicated by the arrow.
A patient comes in complaining of increasing hoarseness over the past few months. An image from the laryngoscopy is shown below. What would you expect to see on biopsy of this lesion?
This is a reactive laryngeal polyp. These are caused by voice abuse. Note the epithelial proliferation with edema. Also note that singer’s nodules have similar etiology.
A patient comes in complaining of increasing hoarseness over the past few months. An image from the laryngoscopy is shown below. What would you expect to see on biopsy of this lesion?
This is a laryngeal papilloma. These are caused by HPV. Note the exophytic neoplastic growths of squamous epithelium.
A 22 year old male comes to see you in clinic with the presentation seen below. He also has respiratory and renal symptoms. What would you expect to see on biopsy of the maxillary sinus and kidney?
This is Wegener’s granulomatosis. You would expect to see granulomas and glomerular crescents.
