Pre-Cancerous Conditions of the Head and Neck Flashcards
Typical patient with neck cancer
Male 60-70 year old with Alcohol and Tobacco abuse
Poor Hygiene
Malnutrition
Where do head and neck tumors usually progress to?
Regional metastasis to the entire upper aerodigestive tract called Field Cancerization
40 year old patient comes in with dysphagia for more than 3 weeks. What do you do??
Have to do a biopsy!
55 year old come in with fullness of neck and unexplainable horaseness and abnormal breathing. What you do?
Work them up for cancer.
H&P
Needle Biopsy
CT
Patient presents with a premalignant lesion of white plaques on the left side of the tongue. It does not scrap off without bleeding. What could it be? A. Erythroplakia B. Leukoplakia C. Thrush D. Bacterial infection
B. Leukoplakia
only 5% cancerous but all will be within 10 years
With leukoplakia or erythroplakia, how can the severity of premalignant lesion be determined?
Biopsy can note the amount of dysplasia
65 year old presents with a raised, red area that when scraped begins to bleed. How does the likelihood of this lesion becoming cancerous compare to a whitish lesion?
Erythroplakias are 70% likely of becoming cancerous
What is the most common head and neck cancer?
Squamous cell carcinoma. (squamous cells are the cells that line most of the lining of the mucosa)
Cancers of the mouth and throat do not always metastasize, but those that do usually spread first to…
…the lymph nodes of the neck.
Upper lip cancer is usually what kind of cancer?
Basal-cell Carcinoma
Lip cancer 90% rule
90% are of the lower lip
90% are Squamous cell carcinoma
90% have no lymphatic spread
What is the ENT evaluation of a neck mass that has been present for more than 3 weeks?
- Full head and neck examination
- Fine needle aspirate of the neck
- Imaging of neck with CT (sometimes PET) to determine spread
Patient presents with a soreness of the throat and numbness of the face. She also notices drooping of the corner of her mouth. What is the workup for this patient?
Full H&P
Imaging (CT or MRI)
Refer to subspecialty
What is the histology of Human Papiloma Virus caused cancers?
Basaloid Squamous cell Carcinoma p16 positive
What is to account for the relative steady state of Squamous cell carcinoma and the decrease in smoking and tobacco?
Increase in HPV positive SCCA
23 year old patient presents in the office with nodule on his neck. He denies history of smoking or excessive alcohol usage. The mass has been there for the past month. You decide to do a fine needle biopsy and drain fluid from the mass. What kind of cancer are you concerned about?
HPV positive Basaloid squamous cell carcinoma
What aspects of gene dysregulation are common with HPV positive patients?
E6 which decrease p52 and E7 which decreases RB (retinoblastoma) activity
Who is more likely to survive, HPV positive without a history of tobacco and alcohol or HPV- with a history of tobacco and alcohol.
The patient without history of smoking and alcohol
HPV patients will present like?
Young
Sexually active
Cystic neck mass
The two theories that suggest that the wide variety of histopathology for salivary gland neoplasms are…
multicellular and bicellular
The theory that suggests salivary gland neoplasms arise from intercalated ducts and extcretory ducts is the…
Bicellular theory
Bicellular theory. What develops from the excretory duct?
A. Pleomorphic adenoma & Warthin’s tumor
B. Squamous cell carcinoma & Acinic cell carcinoma
C. Squamous cell carcinoma & mucoepidermoid carcinoma
D. Adenoid cystic carcinoma & Pleomorphic adenoma
C. Squamous cell carcinoma & mucopepidermoid carcinoma
Bicellular theory. What does not develop from the intercalated duct?
A. Warthin’s timor
B. oncocytoma
C. Acinic cell carcinoma
D. mucoepidermoid carcinoma
D. mucoepidermoid carcinoma
Multicellular theory states that neoplasms originate from what types of cells?
Striated duct
Acinar duct
excretory duct
intercalated duct (myoepithelial cells)
MC theory. Striated duct gives rise to what tumor?
A oncocytic tumor
B. squamous cell carcinoma
C. mucoepidermoid carcinoma
D. pleomorphic adenoma tumors
A. oncocytic tumor
Tumors from Acinar cells obviously give rise to…
acinic cell carcinoma
Tumors for the excretory duct give rise to
A. oncocytic tumor
B. mucoepidermoid carcinoma and squamous cell carcinoma
C. Pleomorphic adenoma tumors
D. the oviously not acinic cell carcinoma
B. mucoepidermoid carcinoma and the squamous cell carcinoma
Intercalated duct and ______ gives rise to _____tumors
myoepithelial cells; pleomorphic adenoma tumors
Which salivary gland becomes most common neoplasm?
Which salivary gland tends to be the most malignant?
Parotid (80%)
minor salivary glands (60% of minor SGs are malignant)
Facial nerve branches
Pes anserinus –> temporofacial & cervicofacial divisions –> temporal, zygomatic, buccal, marginal, and cervical
Besides the facial nerve what other vital structures are located within the Parotid gland?
(1) Facial nerve
(2) Retromandibular vein
(3) External Carotid artery
(4) Superficial temporal artery
(5) branches of the great auricular nerve
Patient present with a painless mass, slight drooping of the face and trismus. Mass is anterior to the External ear canal and around the jaw. Which salivary gland is affected?
Parotid gland
Non-tender solitary mass. No nerve paralysis.
Smooth or lobulated, well-encapsulated tumor with a myxoid stroma and transcapular growth peudopods.
Pleomorphic adenoma (MCT/BCT; intercalated duct)
Why is enucluation important in pleomorphic adenoma?
Rupture of the capsule and tumor spillage is believed to increase the risk of recurrence. Making sure to remove all soft tissue tumor (i.e. pseudopods) is necessary to prevent recurrence.
50 year old male with large Parotid masses found bilaterally. Patient had history of drinking and smoking. Aspiration revealed straw colored fluid.
Warthin’s Tumor (BCT; Intercalated duct)
Histology stain. Double layered epithelium with epithelial cells forming papillary projections into cystic spaces in a background of lymphoid stroma
Warthin’s Tumor (BCT; Intercalated duct)
70 year old patient with non-tender mass around the Parotid gland. Histology reveals acidophilic granular cytoplasm from large number of mitochondria arranged in a glandular pattern. Use of Bensley’s aniline-acid fuchsin stain.
Oncocytoma (MCT; striated duct / BCT; intercalated duct)
- Most common of all salivary gland tumor
2. Most common malignant salivary gland tumor
- pleomorphic adenoma
2. mucoepidermoid carcinoma
Rapid enlargement of a previously stable mass with symptoms of pain, fixation to surrounding tissues and facial paralysis.
What is the most common version of this lesions
High grade Mucoepidermoid carcinoma
How do you tell a low-grade mucoepidermoid carcinoma from a high-grade?
Low grade will have more mucus cells and low amounts of epithelial cells. A high grade will be the opposite.
How do you tell the difference between a squamous cell carcinoma and a high grade mucoepidermoid carcinoma?
Positive immunohistochemical staining for mucin indicates high grade mucoepidermoid carcinoma
42 year old african american male with right side facial weakness for two months. Non smoker. Right sided facial mass. FNA shows swiss cheese pattern.
Adenoid Cystic carcinoma
What is the concern with Adenoid Cystic Carcinoma?
(BCT; Intercalated duct) Metastatic to the lungs
42 year old with asymptomatic enlarging mass.
* CT shows well circumscribed without a capsule.
* cut surface is grayish, friable, and displays solid and cystic areas.
FNA shows dark staining and have granular or honeycomb cytoplasm
Acinic Cell Carcinoma
