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
