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Pulmonology (CP) > 27 Head and Neck Pathology > Flashcards

27 Head and Neck Pathology Flashcards

1
Q

Describe the presentation of Herpes in the oral cavity

A
  • HSV type I, transmission person to person
  • Virus persists in the dormant state (asymptomatic)
  • Reactivation results in vesicles:
    • intraepithelial edema -> clear fluid -> rupture -> ulcer
    • multinucleated cells with intranuclear viral inclusions
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2
Q

What is the test for Herpes?

A

Tzanck test (swab ulcer and smear on slide)​

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3
Q

What histology is observed in Herpes of the oral cavity?

A
  • “3 Ms”:
    • Multinucleation
    • Molding (conformity of adjacent cell nuclei to one another)
    • Margination (chromatin “marginated” near the edge of the cell)
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4
Q

What is the most common fungal infection? What are some common causes?

A
  • Candidiasis/Thrush
  • Causes:
    • Dentures
    • Diabetes mellitus
    • Steroids/prolonged antibiotics
    • Immunosuppression (AIDS, transplant, chemo)
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5
Q

Describe the appearance of candidiasis

A

White plaque-like pseudomembrane

**scrapes off (erythematous base below)

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6
Q

What stain is used for candidiasis?

A

GMS silver stain

**Observe fungal hyphae superficially attached to the underlying mucosa

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7
Q

What is the most common cancer of the oral cavity/larynx? What is its etiology/risk factors?

A
  • 95% of cancers are squamous cell carcinoma
  • 50-70 years old
  • M>F
  • Risk factors:
    • tobacco and alcohol (synergistic if both)
    • family history
    • HPV infection (especially 16 and 18)
    • Leukoplakia (rare) and erythroplakia (common)
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8
Q

Contrast leukoplakia and erythroplakia

A
  • leukoplakia
    • white patch caused by epidermal thickening/hyperkeratosis
    • CANNOT be scraped off (unlike thrush)
    • occasionally associated with epithelial dysplasia
    • 5-25% risk of maligancy
  • erythroplakia
    • red granular area (may or may not be elevated)
    • poorly defined boundaries
    • usually associated with epithelial dysplasia
    • ~50% risk of maligancy
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9
Q

What is epithelial dysplasia?

A

Progressive proliferation, loss of polarity, and increased mitotic figures of the immature (basal) cells

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10
Q

Where does squamous cell carcinoma often occur in the oral cavity? What is the prognosis?

A
  • most occur on the tongue and floor of the mouth
  • also on gingiva, hard/soft palates, dorsal tongue, mucosa
  • prognosis much better when found in early stages
  • common metastasis to lymph nodes, lung, liver, and bone
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11
Q

How does a patient present with squamous cell carcinoma of the larynx?

A

Differs depending on location:

  • Glottis/true vocal cords= hoarseness
    • most common location of laryngeal carcinoma (thicker epithelium and more damage)
    • diagnosed earlier because of symptoms
  • Supraglottic or infraglottic= asymptomatic
    • diagnosed at later stages (symptoms not until mass spreads and causes hemoptysis, dysphagia, etc)
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12
Q

What is the treatment and prognosis for squamous cell carcinoma of the larynx?

A
  • Treatment:
    • surgery (laryngectomy)
    • radiation
  • 5 year survival:
    • stage 1= 70%
    • stage 4= 30%
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13
Q

What are the two major variants of squamous cell carcinoma?

A

Classic keratinizing and HPV associated non-keratinizing

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14
Q

What feature of a squamous cell carcinoma is very likely to increase recurrence of the tumor even after resection?

A

“Perineural” involvement (aka when the tumor grows around nerves)

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15
Q

What is Waldeyer’s ring?

A
  • Tonsillar type lymphoid tissue “ring” in the back of the mouth composed of:
    • palatine tonsils
    • base of tongue
    • adenoids
  • HPV-associated squamous cell carcinoma likes to infect Waldeyer’s ring (increased permeability due to lymphatic function)
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16
Q

Describe HPV-associated squamous cell carcinoma

A
  • occurs in the oropharynx/tonsils
  • common serotypes= HPV 16 and 18
  • p16 positive IHC staining
  • HPV proteins E6 and E7 inactivate p53 and Rb (tumor suppressors)
  • frequently metastasizes to neck lymph nodes early in disease
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17
Q

What is seen histologically in HPV-associated squamous cell carcinoma?

A
  • no keratinization
  • sheets/strips of cohesive cells with basaloid morphology
  • nuclear atypia
  • increased mytotic activity
  • +/- necrosis
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18
Q

What is rinosinusitis? What is a possible complication?

A
  • viral (common cold), allergic, or obstructive process (e.g. deviated septum)
  • edematous nasal mucosa/enlarged turbinates on gross examination
  • microscopy= mixed inflammatory infiltrate, edema, thickened basement membrane
  • complication= nasal polyps
19
Q

What are 2 examples of malignant tumors of the nasal cavity?

A

Olfactory neuroblastoma and nasopharyngeal carcinoma

20
Q

Describe olfactory neuroblastoma

A
  • arises in superior/lateral mucosa of the nose
  • median age= 50 years
  • symptoms= epistaxis (nose bleed), nasal obstruction, headache
21
Q

What is seen microscopically in olfactory neuroblastoma?

A
  • Composed of uniform cells with round nuclei, scant cytoplasm, “salt and pepper” chromatin
  • EM= neurosecretory granules
  • IHC= neuroendocrine markers (synaptophysin and chromogranin)
  • “rosette” formation common in low grade
22
Q

Contrast pseudorosettes versus rosettes

A
  • “homer wright” pseudorosettes= no lumen
  • “flexner-wintersteiner” rosettes= lumen
  • both common in low grade olfactory neuroblastoma
23
Q

What is the prognosis of olfactory neuroblastoma?

A
  • locally invasive
  • metastasizes widely (to local lymph nodes and lungs)
  • 5 year survival= 50-70%
24
Q

What are some etiologic factors for nasopharyngeal carcinoma?

A
  • EBV infection
  • Environment (fish diet, smoking)
    • common in northern Africa, China, SE Asia
    • rare in US
  • Hereditary (some consistent molecular abnormalities)
25
Q

What are three main types of nasopharyngeal carcinoma?

A
  1. keratinizing squamous cell
  2. non-keratinizing squamous cell (HPV associated)
  3. lymphoepithelial carcinoma (a type of undifferentiated non-keratinizing squamous cell; EBV associated)
26
Q

Describe lymphoepithelial carcinoma

A
  • a type of undifferentiated non-keratinizing squamous cell nasopharyngeal carcinoma
  • EBV associated
  • positive cytokeratin IHC
  • numerous lymphocytes between tumor cells obscure the epithelial derivation
27
Q

What is the prognosis for nasopharyngeal carcinoma? What is the treatment?

A
  • grow silently until they become unresectable (invade skull base or brain tissue)
  • local regional lymph node involvement and distant metastasis
  • 50-70% 3 year survival
  • treatment= radiotherapy
28
Q

What are the major salivary glands and the type of saliva they secrete?

A
  • Parotid gland (on the side of the face)
    • Serous
  • Submandibular gland
    • Mixed, mainly serous
  • Sublingual gland (midline, under tongue)
    • Mainly mucinous
29
Q

What are the minor salivary glands?

A

Innumerable, distributed throughout the mucosa of the oral cavity (lips, gingiva, cheek, hard/soft palates, tonge, tonsils, oropharynx)

30
Q

What is sjogren syndrome?

A
  • Autoimmune disease (anti SSB)
  • Often in association with other autoimmune diseases (RA, lupus, etc)
  • Observe “lymphoepithelial islands” (benign lesions)
  • Pathology= lymphocytic infiltration of salivary and lacrimal glands with eventual gland destruction causing:
    • xerostomia (dry mouth)
    • keratoconjunctivitis (dry eyes)
31
Q

Describe neoplasms of the salivary glands

A
  • <2% of all human tumors
    • 65-80% in parotid gland
    • 10% in submandibular gland
    • remainder in minor salivary glands
  • mostly in adults (50-70 yo), possibly malignant when older
  • slight female precominance
32
Q

Give examples of benign and malignant neoplasms of the salivary glands

A
  • benign
    • pleomorphic adenoma (60%)
    • warthin tumor (5-10%)
  • malignant
    • mucoepidermoid carcinoma (15%)
    • adenocarcinoma (10%)
    • adenoid cystic carcinoma (5%)
33
Q

Describe a pleomorphic adenoma

A
  • most common salivary gland tumor
  • wide age range
  • 75-85% in the parotid gland
  • benign mixed tumor
    • epithelial cells
    • myoepithelial cells
    • mesenchymal components (myxoid, hyaline, chondroid)
34
Q

What is the clinical course of a pleomorphic adenoma?

A
  • painless, slow growing
  • local recurrence ~4%
  • malignant transformation 2-10% (increased likelihood for tumors present longer)
35
Q

Describe a warthin tumor

A
  • most common bilateral salivary gland tumor
    • 2nd most common overall
  • restricted to parotid gland
  • M>F
  • associated with smoking
36
Q

What is the gross and microscopic appearance of a warthin tumor?

A
  • gross= often undergoes papillary cystic change
  • microscopy= bilayered oncocytic epithelial cells (pink; lots of mitochondria) with numerous lymphocytes
37
Q

Describe a mucoepidermoid carcinoma

A
  • most common malignant tumor of the salivary glands
    • 50% in parotid, 40% in minor glands
  • occurs in both adults and children
  • mixture of squamoid, mucous (intracellular mucin), and intermediate cells
38
Q

What is the treatment and prognosis of a mucoepidermoid carcinoma?

A
  • treatment= surgical resection + radiation
  • low grade tumors
    • invade locally
    • rarely metastasize
    • >90% 5 year survival
  • intermediate/high grade tumors
    • recur more frequently
    • 30% metastasize
    • ~50% 5 year survival
39
Q

Describe an adenoid cystic carcinoma

A
  • 10% of all salivary gland carcinomas
  • wide age rande (peak at 50-70 years old)
  • major AND minor salivary glands
  • wide/radical surgical resection because of common local recurrence
40
Q

What is commonly seen on histology in adenoid cystic carcinoma?

A
  • perineural invasion (envelopes nerves; locally aggressive)
  • cribriform architecture (“like swiss-cheese”)
41
Q

What is a thyroglossal duct cyst?

A
  • midline developmental cyst that presents <40 years old
  • always connected to the hyoid bone (moves when swallowing)
  • lined by respiratory or squamous epithelium, thyroid tissue in the wall of the cyst
42
Q

What is a branchial cleft cyst?

A
  • arises from the 2nd branchial pouch
  • 75% of patients 20-40 years old
  • laterally placed in the neck along the anterior border of the SCM
  • differential diagnosis= HPV associated squamous cell carcinoma (similar appearance and age range!)
43
Q

Describe the gross and micro appearance of a branchial cleft cyst

A
  • gross= thin walled, filled with “cheesy” mucoid material
  • micro= squamous lining, numerous lymphocytes

Pulmonology (CP) (23 decks)

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