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Flashcards in Neuro: Head and Neck Deck (36):
1

  • White patch or plaque, can’t be scraped off
  • Gross: single or multiple, sharply demarcated, flat or raised, white patch or plaque 
  • Can’t be characterized as any other disease
  • A/w Tobacco, Alcohol, and Ill-fitting dentures 
  • Any age, but usually 40-70 y/o 
  • Buccal mucosa, Floor of mouth, Ventral tongue, Palate, Gingiva

  • ~80% are non-neoplastic; ~15% dysplastic; ~3% cancer

  • Hyperkeratosis

Leukoplakia

2

  • Red patch or Plaque
  • Can’t be Scraped off
  • Can’t be characterized as any other disease 
  • 90% are pre-malignant or malignant
  • Severe dysplasia, Carcinoma in situ, or Minimally-invasive SCC 

Erythroplakia

3

  • Slowly developing Scaly, White-gray Plaque
  • Fissuring or Cracking of the mucosa, typically at the corners of the mouth
  • A/w Sun Exposure

Actinic Cheilitis

'Actinic Keratosis'

4

  • Small Round Blue cell Tumor

  • Arises from Neuroectodermal Olfactory cells

  • Expresses neuroendocrine markers (chromogranin, synaptophysin, CD56)

  • Bimodal age: Peaks at 15 & 50 y/o

  • Nasal obstruction or Epistaxis

  • Tx: Surgery + XRT + Chemo

  • Prognosis: (5-year survival)

    • Confined to nasal cavity & fully resected → 75%

    • Extension beyond paranasal sinus → 40% 

Esthesioneuroblastoma

(Olfactory Neuroblastoma)

5

Lymphoma

6

  • Benign tumor of the Nasal mucosa composed of Large Blood Vessels and Fibrous Tissue
  • Classically seen in Adolescent males only (Fair skinned and Red-headed)
  • Presents w/ Profuse Epistaxis (Nosebleeds) and Obstruction
  • Posterior lateral wall of Nasal cavity, near roof
  • Tx: Surgery

Nasopharyngeal Angiofibroma

7

  • Arise from & surface lined by respiratory mucosa 
  • M>F; typically 30-60 y/o
  • Nasal cavity or paranasal sinuses
  • (3) Types:
    • Exophytic / Fungating: Most Common type; HPV 6 & 11 
    • Endophytic / Inverted: Most Aggressive type; HPV 6 & 11 (Benign but locally aggressive) "gopher holes filled with squamous cells"
    • Cylindrical 

Schneiderian Papilloma (Sinonasal)

8

  • Most occur in Adrenal medullaPheochromocytoma 
  • Aorticopulmonary parasympathetic chain (near great vessels of the neck)  - have a "Bland" appearance but metastasize
  • Zellballen pattern: Balls of Round to Oval cells (chief cells) w/ abundant Pink, Granular cytoplasm
  • S-100 positive Sustentacular cells, Chromogranin
  • Carotid Body: most common location
  • Sporadic: Solitary; slow-growing; painless; 5th to 6th decade
  • Familial: MEN 2 Syndrome, multiple; earlier 
  • Tx: Surgery
  • Can metastasize and up to 50% are fatal 

Paraganglioma

9

  • One of the most common diseases worldwide
  • #1 cause of tooth loss in patients < 35 y/o
  • Pathogenesis: poor oral hygiene 
    • Bacteria + Acidic product + Teeth = Deminiralization

Dental Caries

10

  • Inflammation of Oral Mucosa surrounding Teeth
  • Most Prevalent and Severe in Adolescence
  • Pathogenesis: poor oral hygiene 
    • Accumulation of Dental Plaque
    • Mineralization
    • Tartar formation (calculus)

Gingivitis

11

  • Inflammation of supporting structures of teeth (ligaments, alveolar bone and cement)
  • Can lead to infective Endocarditis and Abscesses
  • A/w Actinobacillus
  • Pathogenesis: poor oral hygiene & alteration of flora 
    • Normal Facultive Gram Positive Organisms
    • Replaced by Anaerobic and Microaerophilic Gram Negatives
  • ​​Tx: Fluoride and Hygiene

Periodontitis

12

  • Painful, superficial Ulceration of the Oral mucosa due to Stress: "Canker-sores"
  • Arises in relation to Stress and Resolves Spontaneously, but often recurs
  • A/w a mononuclear Infiltrate
  • Characterized by a Grayish Base (granulation tissue) surrounded by Erythema

Apthous Ulcer

13

  • AKA “traumatic fibroma”
  • Buccal mucosa (along bite line) or on the gingiva
  • Caused by repetitive Trauma
  • Tx: simple Excision curative 

Irritation Fibroma

14

  • Gingiva of children, young adults & pregnant woman
  • May grow rapidly; most eventually regress
  • Gross: ulcerated, dark red nodule on gingival mucosa
  • Histo: consists of highly vascular, granulation tissue 

Pyogenic Granuloma

15

  • Vesicles involving Oral mucosa that Rupture, resulting in Shallow, Painful, Red ulcers, "cold sores"
  • Usually HSV-1 (above the belt), HSV-2 (below the belt)
  • Primary infection occurs in Childhood; Lesions heal, but virus remains dormant in the Ganglia of the Trigeminal never (CN V)
  • Stress and Sunlight cause reactivation of the virus --> Leads to Vesicles that often arise on the lips

Oral HSV Infection

16

  • White membrane overlying Erythematous base 
  • Necrotic squamous epithelium w/ yeast & hyphae overlying an inflamed submucosa
  • Often seen in Immunocompromised individuals as a Yellowish Plaquelike area
  • Candida Albicans: normal part of oral flora in 50%
  • Most common Fungal Infection in oral cavity
  • White Lesion that can be Scraped off 

Oral Candidiasis (Thrush)

17

  • Immunocompromised patients
  • Usually on Lateral border of Tongue
  • Caused by Epstein-Barr Virus (EBV)
  • Confluent, fluffy white patches that can’t be Scraped off
  • Hyperparakeratosis, Acanthosis, Balloon cells 

Hairy Leukoplakia

18

  • Protrusion of Edematous, Inflamed Nasal mucosa
  • Usually Secondary to repeated bouts of Rhinitis
  • A/w Allergic rhinitis, Type 1 Hypersensitivity --> "Hay Fever" --> HIGH IgE lvls in the Serum
  • A/w Cystic fibrosis and Aspirin-Intoleratnt-Asthma
  • ASA-intolerant characterized by the triad of Asthma, Aspirin-induced Bronchospasms, and Nasal polyps (10% asthmatic kids)
  • A consequence of repeated bouts of Rhinitis

Nasal Polyp

19

  • Benign neoplasm on True vocal cord
  • Caused by HPV types 6 & 11
  • May recur but DOES NOT become Malignant
  • Usually Single in Adults; often Multiple in Children
  • Often spontaneously Regress at Puberty 

Squamous Papilloma

20

  • Nodule that arises on the True vocal cord
  • Due to Excessive use of vocal cords; usually Bilateral
  • Produces "Reactive nodules"
  • Composed of Degenerative (Myxoid) Connective Tissue
  • Wear and Tear issue and resolves with Rest of Voice

Singer's Nodules

21

  • Anterior Lateral (along sternocleidomastoid muscle) 
  • Lymphoid tissue with prominent germinal centers
  • Lymphoepithelial cysts
  • Remnants of an Embryonic Branchial arch or Salivary gland inclusion in a Cervical lymph node - absence of thyroid tissue
  • Tx: Surgical Cystectomy 

Branchial Cleft Cyst

22

  • Cyst of the Anterior Midline (foramen cecum to middle of neck) 
  • Thyroid tissue 
  • Tx: Cystectomy plus middle 3rd of hyoid bone 

Thyroglossal Duct Cyst

23

  • Inflammation of the Nasal Mucosa (resp. epithelium)
  • Adenovirus is the most common cause
  • Presents w/ Sneezing, Congestion, and Runny nose (common cold)
  • Allergic subtype is due to Type I Hypersensitivity rxn
    • Inflammation Infiltrate w/ Eosinophils
    • A/w Asthma and Eczema
  • Repeated bouts can lead to Nasal polyps

Rhinitis

24

  • Extremely common; “Sore throat
  • Edematous, Congested nasopharyngeal mucosa (+/- exudate)
  • Viral culprits a/w Rhinitis, plus RSV, Influenza, and bacteria
  • Rule out Group A, β-hemolytic strep to avoid complications: (Rheumatic Fever & Post-Strep Glomerulonephritis)
  • Rapid Strep Antigen test +/- Culture 

Pharynginitis

25

  • Inflammation of the Upper Airway
  • Parainfluenza virus is the most common cause
  • Presents w/ Hoarse, 'Barking cough' and Inspiratory stridor

Laryngotracheo Bronchitis ('Croup')

26

  • Inflammation of the Epiglottis of the Larynx
  • H influenzae Type B is the most common; in both Immunized and Non-immunized children
  • High fever, Sore throat, Drooling w/ Dysphagia, Muffled voice, and Inspiratory Stridor (airway compromise)
  • Risk of Airway obstruction --> Medical emergency

Acute Epiglottitis

27

  • Malignant tumor of Nasopharyngeal Epithelium
  • A/w EBV
  • Classically seen in African Children and Chinese Adults (young)
  • Biopsy usually reveals Pleomorphic Keratin-positive epithelial cells (poorly differentiated SCC)  in a background of Lymphocytes
  • Often presents w/ involvement of Cervical Lymph nodes
  • (3) Histologic variants:

    • Keratinizing: well-diff SCC; worst prognosis

    • Non-Keratinizing: poorly-diff SCC

    • Undifferentiated: syncytium of cells w/ lymphoid background; best prognosis; radiosensitive 

Nasopharyngeal Carcinoma

28

  • Full-thickness defect of Lip and Palate
  • Due to Failure of Facial Prominences to Fuse
  • During early pregnancy, Facial prominences (One from Superior, Two from the Sides, Two from Inferior) grow and fuse together to form the face (5 total)
  • Lip and Palate usually occur together, isolated version is less common

Cleft Lip and Palate

29

  • Recurrent Aphtous ulcersGenital ulcers and Uveitis (visual disturbances)
  • Due to Immune complex Vasculitis involving Small Blood Vessels
  • Can be seen after Viral Infection, but Etiology is unknown

Behcet Syndrome

30

  • Malignant neoplasm of the Oral mucosa
  • Tobacco and  Alcohol are major Risk Factors
  • Floor of Mouth is most common
  • Desmosomes and Keratin
  • Oral Leukoplakia and Erythroplakia are Precursor Lesions
  • Leukoplakia vs. Oral Candidiasis = is a white deposition which is easily scraped away, usually a/w immunocompromised states
  • Hairy leukoplakia is white, rough 'hairy' patch  that arises on the Lateral tongue - AIDS, EBV-induced SCHyperplasia - not pre-maliginant

Squamous Cell Carcinoma

31

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Pyogenic Granuloma

32

Erythroplakia

33

  • Congenital, Non-inherited (somatic), Developmental anomaly of Neural Crest derivatives (Mesoderm / Ectoderm) due to activating mutation of GNAQ gene
  • Affects small (capillary-sized) blood vessels
  • Port-wine stain of the Face (non-neoplastic "birthmark" in CN V1, V2 Distribution)
  • Ipsilateral Leptomeningeal Angioma --> Seizures / Epilepsy
  • Intellectual Disability and Episcleral Hemangioma --> Increase IOP --> Early-onse Glaucoma

Sturge-Weber Syndrome

  • SSTURGGE-Weber
    • Sporadic, port-wine Stain
    • Tram track Ca2+ (opposing gyri)
    • Unilateral
    • Retardation
    • Glaucoma, GNAQ gene
    • Epilepsy

34

  • HAMARTOMAS-S
     
  • Hamartomas in CNS and Skin
  • Angiofibromas
  • Mitral regurgitation
  • Ash-leaf spots
  • Rhabdomyoma - cardiac
  • Tuberous sclerosis
  • autosomal dOminant
  • Mental retardation
  • Angiomyolipoma - renal
  • Seizures, Shagreen patches
  • Increase Incidence of Subependymal Astrocytomas and Ungual Fibromas

Tuberous Sclerosis

35

  • Cafe-au-lait spots
  • Lisch nodules (pigmented iris hamartomas)
  • Neurofibromas in Skin, Optic gliomas, Pheochromocytomas (PCC)
  • Mutated NF-1 tumor suppressor gene (neurofibromin, a negative regulator of Ras) on Chrom. 17
  • Skin tumors of NF-1 are derived from Neural crest cells

Neurofibromatosis Type 1

(von Recklinghausen Disease)

36

  • Cavernous Hemangiomas in Skin, Mucosa, Organs, Bilateral Renal Cell Carcinoma
  • Hemangioblastoma (High vascularity w/ Hyperchromatic nuclei) in Retina, Brain stem, Cerebellum and Pheochromocytomas (PCC medulla of Adrenal Glands)
  • Autosomal Dominant
  • Mutated VHL tumor suppressor gene on Chrom. 3
  • Results in Constitutive expression of HIF (Transcription factor) and activation of Angiogenic growth factors

von Hippel-Lindau Disease