Lecture + Case: Head/Neck Tumors (3)-Leah*

Question 1

Two “fibrous” lesions of the oral cavity:

Which is fast growing and might scare people?

Answer 1

1. Fibroma

2. Pyogenic granuloma: rapidly growing scary looking vascular proliferation

Question 2

Three infections commonly involving the oral cavity?

Which two are similar? How can they be distinguished?

Answer 2

1. HSV (primary gingivostomatosis; “cold sores”)

• These two are both white “coatings” of the tongue:
  2. Candidia (thrush)– whole mouth; scrapes off
  3. Hairy leukoplakia (EBV)– lateral; doesn’t scrape off

Question 3

Name the two precancerous lesions of the oral cavity.

Which is MORE LIKELY to become malignant.

Answer 3

1. Leukoplakia
2. Erythroplakia
   * Erythroplakia has a higher rate of malignant transformation.

Question 4

Cancerous lesion of the mouth is most often:

Answer 4

Squamous cell

Question 5

Three types of rhinitis

Answer 5

1. Infectious
2. Allergic
3. Chronic

Question 6

Benign mass found in the nose following recurrent rhinitis:

Answer 6

Nasal polyps

Question 7

Rare but commonly tested caused of recurrent sinusitis:

Answer 7

Ciliary dysfunction –> Kartagener Syndrome
Note: chronic sinusitis = POLYPS.

• *First Aid Fact this is also one cause of SITUS INVERSUS**
• *First Aid Fact: mutant L–>R Dynein**

Question 8

Two infections that are considered nasopharyngeal infections:

Answer 8

Pharyngitis

Tonsillitis

Question 9

Two nasopharyngeal masses:

Answer 9

• Sinonasal (Scheiderian) papilloma

- Nasopharyngeal carcinoma

Question 10

Two infections of the larynx:

Answer 10

• Laryngitis

- Croup (Fenger note= paramyxo –> parainfluenza virus!!)

Question 11

Three types of laryngeal masses:

Answer 11

• Polyps
• Papilloma
• Carcinoma

Question 12

How common are ear tumors?

What types exist?

Answer 12

• Rare

- Squamous cell and Basal cell carincomas

Question 13

What is otosclerosis?

With what disease should you associate it?

Answer 13

Thickening of bones in middle ear = hearing loss.
Fibrous Deposition–> Bone

• **You can see this in OSTEOPETROSIS!!!
• **AD disease causing OSTEOCLAST DYSFUNCTION!!!

Question 14

Three lesions you may see in the neck? (3)
What are two important midline structures in the neck?
How can these be associated with pathology?

Answer 14

There are SO SO many but she lists….

1. Branchial cleft cysts
2. Thyroglossal duct remnants
3. Paraganglioma

• Side note: thymus and thyroid are important midline neck structures!
• Hyperthyroid = goiter (can be hypothyroid too: ^ TSH w/out response)
• Thymus in babies = fat looking heart on CXR. This is also important. No thymus in babies = DiGeorge or SCID.*

Question 15

Two benign masses affecting glands:

Answer 15

• Pleomorphic adenoma

- Warthin tumor

Question 16

Two malignant masses affecting glands

Answer 16

• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma

a note about Adenoid cystic carcinoma: yes, it happens in salivary glands. But it can be ANYWHERE that has epithelium including SECRETORY cells. Even the uterus. I saw it up a lady’s nose. It’s definitely not just a glandular tumor.

Question 17

Glandular condition assc with Sjorgens? Trauma?

Answer 17

Xerostoma: dry mouth/ eyes. Sjorgens.
Saildenitis: can be caused by trauma, among other things.

Question 18

Autoimmune related lesion of the oral cavity:

Answer 18

Aphthous ulcers (Canker sore)

**Fun fact: according to other sources, including Dr. Fry, this is part of BEHCETS disease…
= Aphthous ulcers, iritis, genital lesions; (it’s a vasculidity in Japan/China)

Question 19

Overall: what is the most common tumor of both the head and the neck?

Answer 19

Squamous cell carcinoma represents NINETY FIVE% of head and neck masses!!!!!

Question 20

Hyperplasia and Dysplasia are _______.

Cancer is not.

Answer 20

Reversible.

Question 21

How does tissue progress from normal to cancerous?

Answer 21

1. Normal –> 2. Hyperplasia –> 3. Mild/moderate dysplasia –> 4. Severe dysplasia (carcinoma in situ) –> 5. Cancer

Note: hyperplasia = ^^^number of cell layers.
Dysplasia = change in the cells themselves.
Severe dysplasia takes up entire epithelium but does not invade the basement membrane of tissue.
(Mild = 1/3, Moderate = 2/3 dysplastic)

Question 22

Describe an aphthous ulcer (gross appearance)

Answer 22

• round, erythematous
• central white exudate

These guys hurt like heck but go away by themselves.

Question 23

Fibroma histologic appearance:
_______proliferation of ________tissue
Causative factor:
Treatment:

Answer 23

Submucosal proliferation of fibrous tissue
Response to trauma
Won’t go away; have to cut it out.
(NOT malignant. Just annoying.)

Question 24

Pyogenic granuloma:
- one alternative name
- histo appearance
(2 cells on _______stroma)

Answer 24

Pregnancy tumor (common in pregnant patients probably due to ^^VEGF?)

Vascular granulomas composed of:
lymphs + fibroblasts on an erythematous stroma

Question 25

Two possible oral manifestations of herpes in the mouth:

Answer 25

``` Acute gingivostomatosis (primary) Herpetic stomatosis (reactivation of latent virus) ```

Question 26

Most common fungal infection in the mouth?

Answer 26

Candida albicans

Question 27

What predisposes patients to Candida albicans/thrush?

Answer 27

Use of abs (+ immunocompromised)

Question 28

Cause of hairy leukopenia

Answer 28

EBV infection in an Immunocompromised patient | - lesions on lateral tongue, can not scrape off

Question 29

Who is susceptible to deep fungal infections? Common ending for names of infections fungal species? Which one is a bid deal in WV?

Answer 29

Immunocompromised patients; --osis | *Histoplasmosis = local problem*

Question 30

Who gets leukoplakia and erythroplakia in their oral cavity? What's the significance?

Answer 30

Middle aged male smokers. These lesions can transform and become malignant. Higher risk assc with erythoplakia than leukoplakia. E comes before L in the alphabet.

Question 31

Leukoplakia gross appearance: ________ _________ plaque that ___________. Histo shows full ________.

Answer 31

Small white plaque that doesn't scrape off in the presence of no better diagnosis. Histo shows full thickness dysplasia! This thing is waiting to invade at any time.

Question 32

Gross appearance of ERYTHroplakia:

Answer 32

Red velvety lesion in the mouth +/- erosion . | Full thickness dysplasia like leukoplakia.

Question 33

What are some risks for oral squamous cell ca? (4) | What does it look like grossly?

Answer 33

- tobacco, pipes, alcohol - chewing "betel quid and pann" (Asian stimulant) - HPV (as with any squamous cell) - sunlight * I'm really confused about how you expose your mouth to sunlight....but she said it.....* SCC is an ulcerated irregular lesion

Question 34

Describe the histologic appearance of oral squamous cell carcinoma or ANY squamous cell carcinoma:

Answer 34

Full INVASIVE dysplasia +/- keratin pearls

Question 35

Common causes of acute rhinitis? Allergic rhinitis is called? What might chronic rhinitis cause?

Answer 35

Acute rhinitis: viral, especially adenovirus and rhinovirus (PicORNaviridae) Allergic = hay fever Chronic --> nasal polyps

Question 36

Polyp (mucosal proliferation): | Histo appearance

Answer 36

Loose CT surrounded by respiratory epi in the case of nasal polyps. GI polyps surrounded by GI epi. Will also see "vascular congestion".

Question 37

Sinonasal papilloma is a proliferation of _______. Benign Or malignant? Population and assc?

Answer 37

BENIGN proliferation of mucosal tissue (like a polyp) Assc with HPV 6, HPV 11 Middle aged males Will recur and can transform (unlike a polyp)

Question 38

Three growth patterns of sinonasal papillomas

Answer 38

- Exophytic - Endophytic - Cylindrical

Question 39

Ddx for a suspicious lesion in the nose:

Answer 39

Sinonasalpapilloma (benign) vs nasopharyngeal carcinoma (bad)

Question 40

Three important things to remember about nasopharyngeal carcinoma

Answer 40

1. Likes lymphoid tissue 2. Has a geographic distribution 3. EBV +

Question 41

Nasopharyngeal carcinoma: 1. Presentation (symptomatic) 2. Treatment

Answer 41

Nose bleeds and obstruction | Poor prognosis; but accepted treatment is radiotherapy

Question 42

Three possible patterns assc with nasopharyngeal carcinoma:

Answer 42

- Keratinizing - Non keratinizing - Undifferentiated (has basaloid- small blue cells)

Question 43

Histo appearance of nasopharyngeal carcinoma is: _______ surrounded by _________. ___________ stain is positive.

Answer 43

Syncitiums surrounded by dark lymphs | Positive for EBER1 stain. (For EBV)

Question 44

Small bilateral lesions on the vocal cord of a singer are what? What do you do about this?

Answer 44

Laryngeal polyps! The equivalent of a nasal polyp in the larynx. Caused by overuse or smoking. Cut them out.

Question 45

Cauliflower lesion on one of the true vocal cords? | What do you do about this?

Answer 45

Squamous papilloma | Resect it.

Question 46

How do you tell a branchial cyst apart from a thyroglossal duct remnant?

Answer 46

Location!! Thyroglossal will be MIDLINE. Branchial cyst is LATERAL (and may leak fluid).

Question 47

Both branchial cleft cysts and thyroglossal duct remnants have what two tissue types?

Answer 47

Squamoid and lymph tissue

Question 48

When do these congenital neck masses presnt?

Answer 48

Not until MIDDLE AGE!!!

Question 49

Paraganglioma: ONE characteristic Histo appearance; positive stain Most COMMON Location

Answer 49

NEUROENDOCRINE TUMOR -salt and pepper cells; catecholamines + -rare tumor; most common at the CAROTID BODIES (Can be paravertebral or assc with vasculature)

Question 50

Sialdentis is caused by? | See a ______ grossly and a _______ on Histo.

Answer 50

Trauma to a salivary gland. | See a mucocele grossly; pseudocyst on Histo

Question 51

Pleomorphic adenoma: Why is it called pleomorphic? How does the patient describe the lesion? What is the assc chromosomal rearrangement?

Answer 51

Pleomorphic because it's Histo has many possible patterns. May get bone, cartilage, epi. (epi + mesenchyme) Painless, MOBILE mass P in pleomorphic = P in PLAG1 rearrangement.

Question 52

Location of a warthog tumor/ papillary cyst adenoma lymphomatosum? Who gets these?

Answer 52

*Parotid gland* of old male smokers! Poor old grandpa Warthin has a big fat lump in his neck but he keeps smoking those cigarettes!!!

Question 53

t(11,19) (q21, p13) // MECT1; MAML2 is assc with what malignancy? Where is it? What does its name mean?

Answer 53

Mucoepidermioid carcinoma in the salivary glands. Called MUCO-EPI-Dermoid because it has mucous, epi (squamous cells/ mucus neck cells) and intermediate cells on Histo

Question 54

Adenoid Cyctic Ca: Location How does the patient describe the lesion? Histo pattern + strange ability of this tumor?

Answer 54

It's PAINFUL (only one that hurts!) Minor salivary glands = most common. When in major salivary glands: parotid, submandibular It can INVADE NERVES!!!! .... Which means you can get cranial nerve deficits! It has a cribiform pattern. It is malignant.

Question 55

HPV is related to what two head and neck masses? | EBV?

Answer 55

HPV- sinonasal papilloma; squamous cell carcinoma | EBV- hairy leukoplakia; nasopharyngeal carcinoma

Question 56

Tell me again: what are the translocations/ mutations associated with mucoepidermoid ca of the salivary glands?

Answer 56

t(11,19) (q21, p13) // MECT1; MAML2

Question 57

You find a white oral plaque. What do you want to know about it first?

Answer 57

Can you scrape it off? Yes- then candidiasis, no- something else (hairy Leukoplakia, leukoplakia, squamous cell)

Question 58

Hyperkeratosis means? | Parakeratosis means?

Answer 58

Hyper- extra cell layers | Para- cells retain their nuclei in the upper layers of skin (where there should only be dead cells)

Question 59

Mild vs moderate vs severe dysplasia?

Answer 59

Mild = irregular cells in 1/3 of the epidermis, moderate 2/3, severe- all layers but NO INVASION of the basement membrane.

Question 60

When can you use a fine needle aspirate?

Answer 60

on superficial nodes not in close proximity to vital structures.

Question 61

What should you do for patients who smoke, drink, work outside?

Answer 61

Thorough oral cavity exam

Question 62

Neural involvement is a red flag for?

Answer 62

Adenoid cystic carcinoma

Question 63

"Motor oil fluid" is a buzz word for?

Answer 63

Warthins

Question 64

Blue always means.....

Answer 64

Bad

Question 65

Lesion that may masquerade as a primary tongue cancer?

Answer 65

Mucoepidermoid (because it is most commonly in the minor salivary glands)