Path- head and neck

Question 1

Peridontitis

Answer 1

inflammation involving peridontal ligs, alveolar bone, cementum
-Associations: DM, HIV/AIDS, granulocyte problems

-Morphology: alveolar bone; ligaments destroyed

Question 2

Aphthous Ulcer (canker sore)

Answer 2

• Associations: Diet, GI disease- Celiac; AI disease- SLE, HIV
• Morphology: shallow, hyperemic, rimmed by erythema w/ mononuclear cell infiltrates

Question 3

Pyogenic granuloma

Answer 3

-Associations: gingiva of children and pregnant women, bleeds readily

• Morphology: red/purple pedunculated; gumline proliferation of granulation tissue
• may mature into peripheral ossifying fibroma

Question 4

Irritation fibroma

Answer 4

• Associations: bite line, reaction to trauma

- Morphology: located on buccal mucosa

Question 5

ossifying fibroma

Answer 5

• Associations: arises from pyogenic granuloma; young teenage females
• Morphology:

Question 6

*Periapical cyst (periapical “granuloma”)

Answer 6

inflammatory
-Associations: assoc. w/ caries, extends from pulpitis inflammation (chronic) - may give rise to dental abcess

-Morphology: granulation tissue,

• may be lined by epithelium;
• hygiene related

Question 7

*Dentigerous cyst

Answer 7

developmental- odontogenic epithelium
-Associations: impacted molar (not hygiene related

-Morphology: cyst origin around crown of unerupted tooth/impacted molar

• lined by squamous epithelium
• dense lymphocytic infiltrate

Question 8

*Keratocystic odontogenic tumor

Answer 8

developmental- odontogenic epithelium

• Associations: YOUTH, M>Fe
• Gorlin syndrome: nevoid basal cell, wide set eyes, asymmetry of mandible, palmar pits
• -PTCH gene mutation
• Morphology:
• lines by squamous epithelium
• PROMINENT basal cells
• locally aggressive, recurrence common

Question 9

*Ameloblastoma

Answer 9

neoplastic- tumor of odontogenic (squamous) epithelium
-Associations: neoplasma-benign/malignant (most indolent)

• Morphology: squamous/cystic
• slow growing, prone to recurrence

Question 10

*Odontoma

Answer 10

neoplastic- odontogenic epithelium
-Associations: hamartoma

-Morphology: tooth like (mixture of enamel, dentin, and epithelium)

Question 11

Glossitis

Answer 11

• Associations: B-vit & iron deficiencies

- Morphology: red tongue: atrophy, thin mucosa

Question 12

*Hairy Leukoplakia

Answer 12

• Associations: Immunosuppressed (80% occur in HIV)
• *EBV infection implicated
• Morphology: white-hairy on LATERAL border of tongue
• micro: hyperkeratosis, acanthosis
• ballloon cells in upper spinous layer

Question 13

*Leukoplakia

Answer 13

• Associations: Tobacco/EtOH, HPV, immunosupressed; risk for squamous carcinoma
• CANNOT be removed by scraping and cannot be classified as another disease (thrush, lichen planus)

-Morphology: white, dysplasia squamous epithelium

Question 14

Erythroplakia

Answer 14

• Associations: Tobacco/EtOH, HPV, immunosupressed; HIGH RISK for squamous carcinoma
• Morphology: red, velvet. eroded, epi usually very atypical

Question 15

Nasal angiofibroma*

Answer 15

• Nasal tumor; benign
• Associations: post puberty males (gingers); nose bleeds
• Morphology: may be fatal by extension into cranium
• arises in stroma of post. lateral wall of roof of nasal cavity

Question 16

Nasal polyp

Answer 16

• benign
• Associations: recurrent attacks of rhinitis
• may be assoc w/ allergic rhinitis; ASA sensitivity; cystic fibrosis
• Morphology: loose stroma w/ EOSINOPHILS, lymps and plasma cells, edema of submucosa
• Gross- glistening

Samter triad:

• asprin sensitive
• nonreaginic (not allergy) asthma
• nasal polyps

Question 17

*Sinonasal/Inverted papilloma

Answer 17

benign
-Associations: some HPV 6, 11, males 30-60

• Morphology: nests of squamous; aggressive growth
• inward growth
• prone to recurrence
• extension into cranium

Question 18

Olfactory neuroblastoma

Answer 18

malignant
-Associations: young adult

• Morphology: aggressively malignant, neuroendocrine cells
• NSE, synaptophysin, chromogranin, CD56

Question 19

Solitary plasmacytoma

Answer 19

• Associations: not associated with myeloma (M protein neg.)
• unlikely to progress to multi myeloma

-Morphology: plasma cells

Question 20

Nasopharyngeal carcinoma

Answer 20

-Associations: EBV in genetically predisposed

• Morphology: undifferentiated/basaloid malignant squamous cells w/ prominent lymphocytic infiltrate
• aggressively malignant
• often unresectable

Question 21

Brachial cyst (cervical lymphoepithelial cyst)

Answer 21

Developmental neck cyst
-Associations: young adult; located anterolateral neck

-Morphology: epithelium surrounded by lymphs

Question 22

Thyroglossal tract cyst

Answer 22

Developmental neck cyst
-Associations: child

-Morphology: midline neck, epithelial lined cyst

Question 23

Paraganglioma/carotid body tumor

Answer 23

Neck tumor
-Associations: older adults; multiple in MEN 2

-Morphology: Zellballen (nests of cells); chromogranin

Question 24

Sialadenitis

Answer 24

inflammation of salivary glands

• Associations:
• Lymphoid/ AI, Sjogrens
• Acute/bacterial
• mumps, HIV
• Morphology: ANA+
• duct obstruction → sialolithiasis → infect

Question 25

*Mucocele

Answer 25

- Associations: lip, gland trauma, fluctuates in size - -trauma → blockage or rupture of salivary gland duct -Morphology: cystic space lined by inflammatory cells; granulation tissue resect completely

Question 26

*Pleomorphic adenoma

Answer 26

Benign neoplasm -Associations: most common, parotid, tends to RECURS following surgery -**Morphology: epithlium forming glands + matrix (myxoid, chondroid, osseous tissue)

Question 27

*Warthin

Answer 27

Benign neoplasm- second most common salivary tumor -Associations: SMOKERS, MULTIFOCAL, recurrence uncommon - **Morphology: double layer of oncocytic cells (pink cyto w/ abundant mito) lining spaces papillary, lymphs infiltrate of stroma - almost exlusive to parotid

Question 28

Mucoepidermoid

Answer 28

Malignant- most common malignant -Associations: radiation - Morphology: mucin producing malignant glands, and sheets of squamous cells - more than 1/2 in parotids

Question 29

Adenoid cystic; acinic cell

Answer 29

- Associations: slow growth, invades nerves | - Morphology:

Question 30

Acute-serous otitis media

Answer 30

- Associations: viral infection - give tubes can lead to conductive hearing loss COMPLICATIONS: - rupture of TM - labrynithitis -cholesteatoma- keratotic squamous lined cyst that grows and can impinge on local structures; arises from tretraction or perforation of ear drum - dissolution of the bone- conductive hearing loss - mastoiditis- temporal cerebritis/ abcess

Question 31

Acute-suppurative otitis media

Answer 31

-Associations: pyogenic bacteria → strep. pneuomia, H. influenzae, moraxella COMPLICATIONS: - rupture of TM - labrynithitis cholesteatoma- keratotic squamous lined cyst that grows and can impinge on local structures; arises from tretraction or perforation of ear drum - dissolution of the bone- conductive hearing loss - mastoiditis- temporal cerebritis/ abcess

Question 32

Chronic otitis media

Answer 32

- Associations: pseudomonas: necrotizing infection in diabetes - Morphology: risk of necrosis COMPLICATIONS: - rupture of TM - labrynithitis -cholesteatoma- keratotic squamous lined cyst that grows and can impinge on local structures; arises from tretraction or perforation of ear drum - dissolution of the bone- conductive hearing loss - mastoiditis- temporal cerebritis/ abcess

Question 33

Otosclerosis

Answer 33

-Associations: most common hearing loss in aging: CONDUCTION type; also genetic -Morphology: ankylosis of stapes at oval window

Question 34

Laryngeal Nodule

Answer 34

-Associations: vocal overuse; not neoplastic - Morphology: Myxoid stroma, hyperplastic squamous epi. punctate vasculatrity - may have mirror image nodules - present w/ hoarseness

Question 35

Papilloma

Answer 35

-Associations: HPV-usually single in adults; often multiple, reccurent in children - Morphology: BENIGN papillary squamous epithelium - not precancerous

Question 36

Squamous cell carcinoma of larynx

Answer 36

- Associations: Tobacco, EtOH most common assoc - -Intrinsic: w/in larynx, most common, better prognosis - -Extrinsic: supra/subglottic tumors -Morphology: death by local invasion

Question 37

HIV associations

Answer 37

- HSV - Candida - aphthous ulcers - cheilitis - kaposi sarcoma - HAIRY leukoplakia - (peridontitis)