trans 44 and 45 tumors of the head and neck Flashcards
primary etiologic agent in the
pathogenesis of nasopharyngeal carcinoma.
EBV
rule of 80s in salivary gland neoplasm
Rule of 80’s
o 80% of parotid tumors are benign
o 80% of parotid tumors are Pleomorphic adenomas
o 80%ofsalivaryglandPleomorphicadenomasoccurinthe
parotid
o 80% of Pleomorphic adenomas occur in the superficial
lobe
o 80% of untreated Pleomorphic adenomas remain benign
histology of what?
Mixture of epithelial, myoepithelial and stromal components • Epithelial cells: nests, sheets, ducts, trabeculae
• Stroma: myxoid, chondroid, fibroid, osteoid
• No true capsule
• Solid
• Cystic changes • Myxoid stroma
Figure 1. Pleomorphic Adenoma
II. TUMORS OF THE HEAD AND NECK
A. SALIVARY GLAND NEOPLASMS
• Tumor pseudopods False feet
pleomorphic adenoma
aka Papillary cystadenoma lymphomatosum • 6-10% of parotid neoplasms • Older, Caucasian, Males • 10% bilateral or multicentric • 3% with associated neoplasms The key here is there is a cystic and lymphoid component in the tumor
warthin’s tumor
Most common salivary gland malignancy • 5-9% of salivary neoplasms • Parotid 45-70% of cases • Palate 18% • 3rd-8th decades, peak in the 5th decade • F>M • Caucasians > African American
MUCOEPIDERMOID CARCINOMA
Overall 2nd most common malignancy • Most common in submandibular, sublingual and minor salivary glands • M=F • 5th decade
ADENOID CYSTIC CARCINOMA
Cribriform pattern
o Mostcommon
o “swisscheese”appearance
ADENOID CYSTIC CARCINOMA
2nd most common parotid and pediatric malignancy
• 5th decade
• F>M
• Bilateral parotid disease in 3%
Acinic Cell Carcinoma
sistrunk procedure?
The Sistrunk procedure consists of removing a thyroglossal duct cyst and surrounding tissues.
Congenital, remnants of thyroglossal tract
• Mostly infrahyoid
• Can appear at any age (mostly 15-30)
• Painless lump in the midline of the neck
• Pain and redness if infected (fistula)
• Spherical, smooth, mobile cyst in the midline
• Moves with swallowing and tongue protrusion
• Required surgery (Sistrunk procedure)
Thyroglossal Duct Cyst
- Cystic mass behind the anterior margin of the SCM
- Remnant of 2nd Branchial clefts
- Appear at any age (mostly 15-25)
- Painless swelling
- Hard, smooth, not very mobile
- Full of yellowish golden material, cholesterol crystals
- Cannot be reduced or compressed
- May have small sinus tract into tonsillar fossae
Branchial Cleft Cyst
Cyst swelling floor of mouth (ranula = little frog)
• Mucus extravasations from sublingual salivary gland
• May extend through FOM muscles into neck
Ranula
Collection of lymphatic sacs which contain clear colorless lymph
• Congenital
• Present at birth or within the first years of life
• Commonly found at the base of the neck, occupying large
space
• Lobulated and flattened cysts
• Smooth and very close to skin and contain clear fluid →
Transillumination
CYSTIC HYGROMA (LYMPHANGIOMA)
Purplish mass typical for diagnosis
• Can be found at any place in the body
The most common benign tumor of the body in children • Treatment
o Surgery/laser/Steroids/Beta blockers
Nowadays, they found out that the most effective
treatment are the Beta blockers
HEMANGIOMA
Rare tumor of the chemoreceptor tissue of the carotid body (Chemodectoma)
• 40-60 years of age
• Painless slowly growing pulsating lump
• Upper part of the ant triangle
• Solid, hard, pulsating spherical or irregular mass
• Can move from side to side but not up and down
Carotid Body Tumor
Most common is lymphoma (Hodgkin’s and non-Hodgkin’s) • Common in children and young adults
• Symptoms:
o Painless slowly growing neck lump, malaise, weight loss, pallor, pruritus, fever, night sweat
PRIMARY LYMPH NODE NEOPLASM
Enlarged lymph node
Asymmetric • Adults • Fixed “immobile” • Hard • Non-tender initially • Look for primary tumor
METASTATIC LYMPH NODES
Benign lesion derived from follicular epithelium
• Usually single, well encapsulated
• Discrete lesions with grandular/acinar follicular pattern
• Papillary change is not typical but if + suggest Papillary Ca
THYROID ADENOMA
Most common type of thyroid ca – 60 to 80%
• Female: Male: 2:1
• Mean age at presentation – 35 yrs
• More common in persons exposed to radiation
• Macroscopic – Hard, whitish, calcified, unencapsulated • Microscopic features:
- Cuboidal cells with abundant cytoplasm
- Intranuclear cytoplasmic inclusions
- Orphan Annie cell
- Fibrovascular stroma with calcium
“psammona bodies
PAPILLARY THYROID CARCINOMA
PAPILLARY THYROID CARCINOMA – 7PS
- Popular – most common thyroid CA
- Psammoma bodies
- Palpable lymph nodes (seen in 33% of patients)
- Positive 131 I(iodine) uptake
- Positive prognosis
- Postoperative 131 I(iodine) scan to diagnose/treat metastasis
- Pulmonary metastases
- Female: Male: 3:1
- Accounts for 30 to 50% of all thyroid Ca
- Mean age at presentation – 50 yrs
- More frequent in iodine deficient areas
- History of long standing goiter
- FOLLICULAR THYROID CARCINOMA
FOLLICULAR THYROID CARCINOMA 4FS
Far-away metastasis – hematogenous spread
• Female (3:1)
• FNA…. Can’t diagnose this CA
• Favorable prognosis
• Type of follicular cell carcinoma
• Derived from “Oxyphil cell” of thyroid.
• Function of these cells is not known
• Cells are stuffed with mitochondria & possess the TSH
receptors and produce thyroglobulin
• Compared to follicular type -usually multifocal & bilateral and
more likely to metastasize to lymph nodes 25%
HURTHLE CELL TUMOR
• Female: Male: 1.5: 1
• Accounts for 1 to 2 % of all thyroid cancers
• Mean age at presentation – 50 to 60 yrs
• Sporadic - 75% cases, usually unilateral
• Familial - 25% cases, usually bilateral
o MutationinRETproto-oncogeneinchromosome10 o AspartofmultipleendocrineneoplasiatypeIIa
o As part of multiple endocrine neoplasia type IIb
medullary thyroid carcinoma
Usually occurs in upper poles
• Originates from Parafollicular/ C cells
• Microscopic – why called Medullary
• Sheets of spindle shaped neoplastic cells with AMYLOID
(Altered Calcitonin) in between
• Cells stains for Calcitonin, CEA, Serotonin, VIP
• Spreads via lymphatics to cervical nodes
Medullary Thyroid Carcinoma
Accounts for 2% of all thyroid cancers
• Female: Male: 1.5:1
• Mean age at presentation - 70 to 80 yrs
• Most Aggressive thyroid malignancy, with median survival
only 3 months
• Iodine deficiency goiter is precursor
• All patients are considered to have stage IV disease
ANAPLASTIC THYROID CARCINOMA
• Accounts for 1 % of all thyroid Ca
• Women >70 yrs are usually affected
• In 70 to 80%, it arises in preexisting chronic lymphocytic
thyroiditis with subclinical or overt hypothyroidism, in
association with Hashimoto’s thyroiditis
• Almost always Non-Hodgkin B-cell Lymphoma
• Usually presents as rapidly growing mass, with obstructive
symptoms as dyspnea and dysphagia
THYROID LYMPHOMA
• It is a benigh tumor of nasopharynx
• Exact etiology is not known
• It is a rare tumor
• Most commonly patient present with recurrent epistaxis or
profuse epistaxis
• Seen in adolescent males in 2nd decade of life (most
commonly at age 14 year with range 7-19 years)
• Its growth is thought to be testosterone dependent
o Origin of tumor: it is believed to arise from the posterior part of nasal cavity close to the superior margin of sphenopalatine foramen
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA (JNA)
- Common in China particularly in southern states and Taiwan • Incidence of NPCA in China is 30-50/100,000 population
- Sex: male: female = 2-3:1
- Age: in Chinese risk start by 15-19 years of age
- Average age group is 25-64 yrs
NASOPHARYNGEAL CARCINOMA (NPCA)
Difference in gross appearance of proliferative, ulcerative, infiltrative nasopharyngeal carcinoma
Proliferative – When a polypoid tumour fills the nasopharynx, it causes obstructive nasal symptoms
Ulcerative – Epistaxis is the common symptom
Infiltrative – Growth infiltrate submucosally
Treatment of choice for nasophangraeal carcinoma
Radiotherapy:
o treatment of choice, megavoltage radiation of 6000-
7000 rads
Represent less than 5 % of all sinonasal tumors.
• Affects most commonly 5th -8th decade and rare before 40
years
• Usually unilateral.
• Association with HPV 6 & 11
• Symptoms: airway obstruction, epistaxis, asymptomatic
mass and pain
SCHNEIDERIAN PAPILLOMA (SINONASAL PAPILLOMA)
• •
Arise in inflammatory conditions of nasal mucosa (Rhinosinusitis), disorders of ciliary motility or abnormal composition of nasal mucus
what polyp?
BILATERAL ETHMOIDAL POLYPS
sampter’s triad?
nasal polyps, asthma and aspirin intolerance.
kartagener syndrome
Bronchiectasis sinusitis, situs
inversus and ciliary dyskinesis.
young syndrome
Sinopulmonary disease and
azoospermia.
Churg-Strauss syndrome
Asthma, fever, eosinophilia, vasculitis and granuloma.
This polyp arises from the mucosa of maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity.
D. ANTROCHOANAL POLYP (KILLIAN’S POLYP)
Malignant neuroectodermal neoplasm arising from olfactory membrane of sinonasal tract.
• Olfactory placode tumor, esthesioneuroblastoma, esthesioneuroepithelioma.
Another name
• Uncommon -2% SNT tumors
• Wide age ranges from 3 years to 9th decade
• Radiographically opacification of SNT with calcification
(speckled pattern)
D. OLFACTORY NEUROBLASTOMA
site of olfactory neuroblatoma?
what are the clinical signs?
cribriform plate;
clinical signs:
anosmia
headache
nasal obstruction
location of benign nodules in the larynx is where?
anterior 1/3
Wart-like lesions in respiratory tract, causing recurrent obstruction.
• Young patients with stridor
recurrent papillomatosis
• Mostly affects male above
• 40 years of age
• Growth is either exophytic, ulcerative and deeply infiltrative
• Because of large size of pyriform sinus growth of this region
remain asymptomatic for long time
• Metastatic neck nodes is the most common presenting
symptom
CARCINOMA PYRIFORM SINUS
