ENT Pathology

Question 1

Most common head and neck cancer?

Answer 1

Squamous cell carcinoma

Question 2

Most common epidemiologic assoications with squamous cell carcinoma of the head and neck?

Answer 2

Smokingt/tobacco, alcohol, HPV.

Question 3

Most common salivary gland to get a tumor?

Answer 3

Parotid - most are benign.

Question 4

Pre-malignant lesions of the oral cavity?

Answer 4

Leukoplakia, erythroplakia

if you see them, you must biopsy

Question 5

Are all leukoplakia pre-malignant?

Answer 5

No. Some are from trauma.

Question 6

Why are leukoplakia white?

Answer 6

Hyperkeratosis, due to dysplasia

Question 7

Where should you look for dysplasia in a biopsy of leukoplakia?

Answer 7

In the basal layers. (just like with cervical cancer… it starts with dysplasic cells in basal layers)

Question 8

Which is more likely to be dysplastic / cancerous: leukoplakia or erythoplakia?

Answer 8

Erythroplakia - 50%

vs. leukoplakia - 5%

Question 9

Why is erythroplakia red?

Answer 9

Vascular proliferation.

Question 10

High risk genotypes of HPV?

Answer 10

HPV 16 and 18.

the lecture slides only have 16… but 18’s definitely important too

Question 11

Is squamous cell carcinoma of the oral cavity slow-growing?

Answer 11

Yes. Just like cervical carcinoma… prognosis is good if found early.

Question 12

Histologic appearance of squamous cell carcinoma of oral cavity?

Answer 12

Same as other squamous cell carcionmas…

slide highlighted ulcerated surface and keratin pearls.

Question 13

3 non-cancerous lesions of the oropharynx?

Answer 13

Idiopathic - apthous ulcers.
Infections - herpes, candida.
Systemic - pemphigus

Question 14

Most common cancer of larynx?

Answer 14

Squamous cell carcinoma again.

Question 15

2 benign tumors of the larynx?

Answer 15

Vocal cord nodules and papillomas.

Question 16

What’s unique about the larynx that allows it to develop nodules? What precipitates their formation?

Answer 16

Smoking / trauma (e.g. lots of singing) -> edema.

The vocal cords have no lymphatic drainage -> nodules firm -> horseness, voice changes.

Question 17

What does a vocal cord nodule look like histologically?

Answer 17

Well defined. The mesenchyma tissue is just separated out with edema.

Question 18

Why can papillomatosis (multiple papules) be life-threatening even if not malignant?
Etiology?

Answer 18

Can progress down tracheobronchial, block airways.

Associated with HPV 6/11 infection. Usually in children < 6 years.

Question 19

What causes a nasal polyp to form?

Why are they a problem?

Answer 19

Recurrent nonspecific or allergic rhinitis…

The obstruct airway, and the inflammation predisposes to proliferation/malignancy.

Question 20

Acute invasive fungal sinusitis is quite bad.

Answer 20

Yeah, it can invade the brain, esp. via the cavernous sinus.

Question 21

What’s a nasopharyngeal angiofibroma?

Answer 21

A highly vascularized benign tumor… often expressing androgen receptors and seen in adolescent males.

Question 22

2 types of nasal papilloma?

Answer 22

Exophitic.

Endophytic…

Question 23

Epidemiologic risk factors for nasopharyngeal carcinoma?

Answer 23

EBV infection.

Question 24

What is nasopharyngeal carcinoma?

Answer 24

aka. undifferentiated or lymphoepithelial carcinoma…

Question 25

3 forms of nasopharyngeal carcinoma?

How does this affect treatment?

Answer 25

Keratinizing - squamous cell carcinoma - usu. radioresistant.
Non-keratinizing squamous cell carcinoma.
Undifferentiated -radiosensitive.

Question 26

Example of a benign tumor of salivary glands?

Answer 26

Pleomorphic adenoma.

Question 27

Example of a malignant tumor of salivary glands?

Answer 27

Mucoepidermoid carcinoma.

Question 28

How does size of gland relate to likelihood that a tumor found there is malignant?

Answer 28

The smaller the gland, the more likely that a tumor there is malignant.
(high risk in sublingual glands, low risk in parotid)

Question 29

Appearance of pleomorphic adenoma of a salivary gland?

Answer 29

Histologic heterogeneity -“mixed tumor” - loose myxoid tissue, with some cartilage, occassionally bone.

Question 30

Common epidemiological association with mucoepidermoid carcinoma?

Answer 30

Radiation.