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| '''Head and neck pathology''' is squamous cell carcinoma and weird stuff. The [[thyroid]] is dealt with in its own article, as is pathology of the [[salivary gland]]. | | This article is '''an introduction to head and neck pathology'''. Most of head and neck pathology is squamous cell carcinoma and its variants. |
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| | The [[thyroid gland]] is dealt with in its own article, as is pathology of the [[salivary gland]]. |
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| Cytopathology of the head and neck is dealt with in a separate article called ''[[head and neck cytopathology]]''. | | Cytopathology of the head and neck is dealt with in a separate article called ''[[head and neck cytopathology]]''. |
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| | =Anatomy= |
| | [[Image:Blausen_0872_UpperRespiratorySystem.png|thumb|Head and neck anatomy (BruceBlaus/WC).]] |
| | *Oropharynx - includes: tonsil, tonsillar pillar, base of tongue, soft palate.<ref>URL: [https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html]. Accessed on: 1 April 2021.</ref><ref>URL: [http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/ http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/]. Accessed on: 15 November 2016.</ref> |
| | *Oral cavity - includes floor of mouth, bucca, anterior 2/3 of tongue,<ref>URL: [http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/ http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/]. Accessed on: 15 November 2016.</ref> lips, [[hard palate]], upper & lower alveolar ridge, retromolar trigone.<ref>URL: [http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/ http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/]. Accessed on: 15 November 2016.</ref> |
| | *Laryngopharynx. |
| | *Nasopharynx. |
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| =Clinical= | | =Clinical= |
| Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> | | Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> |
| *Leukoplakia. | | *[[Leukoplakia]]. |
| **Homogeneous. | | **Homogeneous. |
| **Non-homogeneous. | | **Non-homogeneous. |
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| :''[[Hairy leukoplakia]] is dealt with in a separate section''. | | :''[[Hairy leukoplakia]] is dealt with in a separate section''. |
| :''The typical [[benign leukoplakia]] is dealt with in a separate section''. | | :''The typical [[benign leukoplakia]] is dealt with in a separate section''. |
| | | {{Main|Leukoplakia}} |
| ===General===
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| *Non-specific clinical finding - may be benign ''or'' malignant.
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| *Associated with tobacco use.<ref name=pmid11336117>{{Cite journal | last1 = Bánóczy | first1 = J. | last2 = Gintner | first2 = Z. | last3 = Dombi | first3 = C. | title = Tobacco use and oral leukoplakia. | journal = J Dent Educ | volume = 65 | issue = 4 | pages = 322-7 | month = Apr | year = 2001 | doi = | PMID = 11336117 }}</ref>
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| Risk of malignancy:
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| *In twos series ~13% were associated with an invasive lesion.<ref name=pmid19953947>{{Cite journal | last1 = Lan | first1 = AX. | last2 = Guan | first2 = XB. | last3 = Sun | first3 = Z. | title = [Analysis of risk factors for carcinogenesis of oral leukoplakia]. | journal = Zhonghua Kou Qiang Yi Xue Za Zhi | volume = 44 | issue = 6 | pages = 327-31 | month = Jun | year = 2009 | doi = | PMID = 19953947 }}</ref><ref name=pmid16545712>{{Cite journal | last1 = Lee | first1 = JJ. | last2 = Hung | first2 = HC. | last3 = Cheng | first3 = SJ. | last4 = Chen | first4 = YJ. | last5 = Chiang | first5 = CP. | last6 = Liu | first6 = BY. | last7 = Jeng | first7 = JH. | last8 = Chang | first8 = HH. | last9 = Kuo | first9 = YS. | title = Carcinoma and dysplasia in oral leukoplakias in Taiwan: prevalence and risk factors. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 101 | issue = 4 | pages = 472-80 | month = Apr | year = 2006 | doi = 10.1016/j.tripleo.2005.07.024 | PMID = 16545712 }}</ref>
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| *Non-homogenous leukoplakia has a greater risk of malignancy than homogenous.<ref name=pmid16545712/>
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| *Location matters - floor of mouth and ventral tongue lesions higher risk for malignancy.<ref name=pmid7548621>{{Cite journal | last1 = Sciubba | first1 = JJ. | title = Oral leukoplakia. | journal = Crit Rev Oral Biol Med | volume = 6 | issue = 2 | pages = 147-60 | month = | year = 1995 | doi = | PMID = 7548621 | URL = http://cro.sagepub.com/content/6/2/147.long }}</ref>
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| ===Gross===
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| *White lesion - may be subdivided:
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| **Non-homogenous.
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| **Homogenous.
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
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| *Often associated with epithelial thickening ([[hyperkeratosis]], [[acanthosis]]).
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| DDx:
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| *Food debris.
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| *[[Oral candidiasis]].
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| *[[Lichen planus]].
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| *[[Benign alveolar ridge keratosis]] (oral [[lichen simplex chronicus]]).<ref name=pmid18158926>{{Cite journal | last1 = Natarajan | first1 = E. | last2 = Woo | first2 = SB. | title = Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. | journal = J Am Acad Dermatol | volume = 58 | issue = 1 | pages = 151-7 | month = Jan | year = 2008 | doi = 10.1016/j.jaad.2007.07.011 | PMID = 18158926 }}</ref>
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| *[[Squamous cell carcinoma of the head and neck]].
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| *Others - see ''[[Dermatopathology#Leukoplakia]]''.
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| ==Erythroplakia== | | ==Erythroplakia== |
| ===General=== | | ===General=== |
| *Non-specific clinical finding - may be benign or malignant. | | *Non-specific clinical finding - may be benign or [[malignant]]. |
| *Strong association with non-keratinizing squamous lesions (invasive and dysplastic). | | *Strong association with non-keratinizing squamous lesions (invasive and dysplastic). |
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| ===Cystic lesions - overview=== | | ===Cystic lesions - overview=== |
| Lateral cystic lesions: | | Lateral cystic lesions: |
| *[[Brachial cleft cyst]]. | | *[[Branchial cleft cyst]]. |
| *[[Cystic hygroma]]. | | *[[Cystic hygroma]]. |
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| ==Thyroglossal duct cyst== | | ==Thyroglossal duct cyst== |
| ===General===
| | {{Main|Thyroglossal duct cyst}} |
| *Congenital.
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| *Midline.
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| Treatment:
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| *Surgical excision (with piece of hyoid bone).
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| ===Microscopic===
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| Features:
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| *Cyst.
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| **Lining:
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| ***Squamous or respiratory epithelium.
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| ***Cyst contents: debris.
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| *+/-Thyroid gland.
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| *+/-Granulomatous inflammation (phagocytosis of debris).
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| Images:
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| *[https://wiki.uiowa.edu/display/protocols/Case+example++thyroglossal+duct+cyst+with+tract+through+to+oropharynx Thyroglossal duct cyst - several images (wiki.uiowa.edu)].
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| ===Sign out===
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| ====No history provided====
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| <pre>
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| MASS, SUBMENTAL (MIDLINE), EXCISION:
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| - SQUAMOUS LINED CYST WITH EXTENSIVE DENUDATION AND, ACUTE AND CHRONIC INFLAMMATION.
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| - BENIGN SKELETAL MUSCLE.
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| - NEGATIVE FOR MALIGNANCY.
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| COMMENT:
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| No definite thyroid tissue is identified. The findings may represent a thyroglossal
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| duct cyst.
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| </pre>
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| ==Branchial cleft cyst== | | ==Branchial cleft cyst== |
| *[[AKA]] ''branchial cleft remnant''. | | *[[AKA]] ''branchial cleft remnant''. |
| ===General===
| | {{Main|Branchial cleft cyst}} |
| *Benign congenital thingy in the lateral neck.<ref>URL: [http://www.childrenshospital.org/az/Site663/mainpageS663P0.html http://www.childrenshospital.org/az/Site663/mainpageS663P0.html]. Accessed on: 15 March 2011.</ref>
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| *Most common cystic neck lesion in young adults.<ref name=pmid19593684>{{Cite journal | last1 = Pietarinen-Runtti | first1 = P. | last2 = Apajalahti | first2 = S. | last3 = Robinson | first3 = S. | last4 = Passador-Santos | first4 = F. | last5 = Leivo | first5 = I. | last6 = Mäkitie | first6 = AA. | title = Cystic neck lesions: clinical, radiological and differential diagnostic considerations. | journal = Acta Otolaryngol | volume = 130 | issue = 2 | pages = 300-4 | month = Feb | year = 2010 | doi = 10.3109/00016480903127450 | PMID = 19593684 }}</ref>
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| *Treatment: excision.
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| ===Gross===
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| *Lateral neck mass.
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| Image - clinical:
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| *[http://medical-dictionary.thefreedictionary.com/_/viewer.aspx?path=mosby&name=500051-fx23.jpg Branchial cleft cyst (thefreedictionary.com)].
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| ===Microscopic===
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| Features:
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| *Cystic space lined by squamous epithelium - usually.
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| **+/-Inflammation.
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| *Connective tissue:
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| **+/-Adipose tissue.
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| **+/-Cartilage.
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| **+/-Bone.
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| **+/-Muscle.
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| DDx:
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| *Cystic [[squamous cell carcinoma]] - may be deceptively benign appearing.<ref name=pmid19593684>{{Cite journal | last1 = Pietarinen-Runtti | first1 = P. | last2 = Apajalahti | first2 = S. | last3 = Robinson | first3 = S. | last4 = Passador-Santos | first4 = F. | last5 = Leivo | first5 = I. | last6 = Mäkitie | first6 = AA. | title = Cystic neck lesions: clinical, radiological and differential diagnostic considerations. | journal = Acta Otolaryngol | volume = 130 | issue = 2 | pages = 300-4 | month = Feb | year = 2010 | doi = 10.3109/00016480903127450 | PMID = 19593684 }}</ref>
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| ====Images====
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| *[http://www.flickr.com/photos/jian-hua_qiao_md/8599213842/in/photostream/ BCC (flickr.com/Qiao)].
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| *[http://www.flickr.com/photos/jian-hua_qiao_md/8599214250/in/photostream/ BCC (flickr.com/Qiao)].
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| ===IHC===
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| *p16 -ve.
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| **May be done to exclude a [[HPV-associated head and neck squamous cell carcinoma]].
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| *Ki-67 low.
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| ==Benign lymphoepithelial lesion== | | ==Benign lymphoepithelial lesion== |
| *[[AKA]] ''benign lymphoepithelial cyst'' | | *[[AKA]] ''benign lymphoepithelial cyst'' |
| | | {{Main|Benign lymphoepithelial lesion}} |
| ===General===
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| *Usually parotid gland.
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| *Associated with autoimmune disease, e.g. [[Sjoegren disease]], may not remain benign.<ref name=pmid12058269>{{Cite journal | last1 = Goto | first1 = TK. | last2 = Shimizu | first2 = M. | last3 = Kobayashi | first3 = I. | last4 = Chikui | first4 = T. | last5 = Kanda | first5 = S. | last6 = Toshitani | first6 = K. | last7 = Shiratsuchi | first7 = Y. | last8 = Yoshida | first8 = K. | title = Lymphoepithelial lesion of the parotid gland. | journal = Dentomaxillofac Radiol | volume = 31 | issue = 3 | pages = 198-203 | month = May | year = 2002 | doi = 10.1038/sj/dmfr/4600690 | PMID = 12058269 }}</ref>
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| ===Microscopic===
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| Features:
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| *Lymphocytes.
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| *Ductal epithelial cells.<ref name=pmid12761623>{{Cite journal | last1 = Metwaly | first1 = H. | last2 = Cheng | first2 = J. | last3 = Ida-Yonemochi | first3 = H. | last4 = Ohshiro | first4 = K. | last5 = Jen | first5 = KY. | last6 = Liu | first6 = AR. | last7 = Saku | first7 = T. | title = Vascular endothelial cell participation in formation of lymphoepithelial lesions (epi-myoepithelial islands) in lymphoepithelial sialadenitis (benign lymphoepithelial lesion). | journal = Virchows Arch | volume = 443 | issue = 1 | pages = 17-27 | month = Jul | year = 2003 | doi = 10.1007/s00428-003-0824-0 | PMID = 12761623 }}</ref>
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| Note:
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| *'''Must''' rule-out (MALT) [[MALT lymphoma|lymphoma]].
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| ===IHC===
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| *CD20, CD3 -- mixed population.
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| *Kappa ~ lambda.
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| =Other benign= | | =Other benign= |
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| *[[AKA]] ''pemphigus''. | | *[[AKA]] ''pemphigus''. |
| **Should not be confused with ''[[bullous pemphigoid]]'' (which is less serious). | | **Should not be confused with ''[[bullous pemphigoid]]'' (which is less serious). |
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| ===General===
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| *May lead to blindness.
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| *Oral lesion is classically: ''first to show & last to go''.
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| **Oral lesions usually precede the skin lesions.
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|
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| Etiology:
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| *Autoimmune disease.
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| **Antibodies against: desmoglein 1, desmoglein 3.
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|
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| ===Microscopic===
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| Features:<ref>{{Ref PBoD8|1193}}</ref>
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| *Suprabasilar blistering.
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|
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| DDx: [[Hailey-Hailey disease]].
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| ==Pyogenic granuloma== | | ==Pyogenic granuloma== |
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| Work-up of negative H&E Bx differs by site: | | Work-up of negative H&E Bx differs by site: |
| *Sunnybrook:<ref>S. Raphael. December 2008.</ref> | | *One large hospital: |
| **[[LMWK]] ([[CAM5.2]]). | | **LMWK (CAM5.2). |
| **[[pankeratin]] ([[AE1/AE3]]). | | **Pankeratin ([[AE1/AE3]]). |
| *UHN. | | *Another large hospital: |
| **Nothing. | | **Nothing. |
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| ==Sinonasal undifferentiated carcinoma== | | ==Sinonasal undifferentiated carcinoma== |
| *Abbreviated ''SNUC'' | | *Abbreviated ''SNUC''. |
| | | {{Main|Sinonasal undifferentiated carcinoma}} |
| ===General===
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| *Aggressive/poor prognosis.
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| **In the past, survival was measured in months.<ref name=pmid17170968>{{Cite journal | last1 = Pitman | first1 = KT. | last2 = Costantino | first2 = PD. | last3 = Lassen | first3 = LF. | title = Sinonasal undifferentiated carcinoma: current trends in treatment. | journal = Skull Base Surg | volume = 5 | issue = 4 | pages = 269-72 | month = | year = 1995 | doi = | PMID = 17170968 | PMC = 1656535 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1656535/ }}</ref>
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| **With (aggressive) combined modality treatment, the overall five-year survival is approximately 75%.<ref name=pmid22476411>{{Cite journal | last1 = Al-Mamgani | first1 = A. | last2 = van Rooij | first2 = P. | last3 = Mehilal | first3 = R. | last4 = Tans | first4 = L. | last5 = Levendag | first5 = PC. | title = Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature. | journal = Eur Arch Otorhinolaryngol | volume = | issue = | pages = | month = Apr | year = 2012 | doi = 10.1007/s00405-012-2008-5 | PMID = 22476411 }}</ref>
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| ===Microscopic===
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| Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
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| *Architecture: nested, trabecular or lobular.
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| *Distinct cellular borders.
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| *Small-to-moderate cytoplasm.
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| *+/-Distinct nucleoli.
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| *Tumour cell size variable (small to large).
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| Note:
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| *Glandular and squamous differentiation are absent by definition.<ref name=pmid11904342/>
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| Images:
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| *www:
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| **[http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880522f7.html SNUC (nature.com)].<ref name=pmid11904342>{{Cite journal | last1 = Mills | first1 = SE. | title = Neuroectodermal neoplasms of the head and neck with emphasis on neuroendocrine carcinomas. | journal = Mod Pathol | volume = 15 | issue = 3 | pages = 264-78 | month = Mar | year = 2002 | doi = 10.1038/modpathol.3880522 | PMID = 11904342 | URL = http://dx.doi.org/10.1038/modpathol.3880522 }}</ref>
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| **[http://www.pathologypics.com/PictView.aspx?ID=244 SNUC (pathologypics.com)].
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| **[http://www.pathologypics.com/PictView.aspx?ID=249 SNUC (pathologypics.com)].
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Sinonasal_undifferentiated_carcinoma_-_low_mag.jpg SNUC - low mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Sinonasal_undifferentiated_carcinoma_-_high_mag.jpg SNUC - high mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Sinonasal_undifferentiated_carcinoma_-_very_high_mag.jpg SNUC - very high mag. (WC)].
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| ===IHC===
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| Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
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| *Pankeratin +ve.
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| *[[EMA]] +ve.
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| *CK7 +ve.
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| *CK5/6 -ve.
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| Others:
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| *NSE +ve/-ve.
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| *Chromogranin A -ve.
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| *Synaptophysin -ve.
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| *p63 +ve/-ve.<ref name=pmid21805120>{{Cite journal | last1 = Wadsworth | first1 = B. | last2 = Bumpous | first2 = JM. | last3 = Martin | first3 = AW. | last4 = Nowacki | first4 = MR. | last5 = Jenson | first5 = AB. | last6 = Farghaly | first6 = H. | title = Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). | journal = Head Neck Pathol | volume = 5 | issue = 4 | pages = 349-54 | month = Dec | year = 2011 | doi = 10.1007/s12105-011-0285-8 | PMID = 21805120 | PMC = 3210220 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210220/ }}</ref>
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| ==Nasopharyngeal carcinoma== | | ==Nasopharyngeal carcinoma== |
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| ==Granular cell tumour== | | ==Granular cell tumour== |
| {{Main|Granular cell tumour}} | | {{Main|Granular cell tumour}} |
| ===General===
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| *May mimic (well-differentiated) squamous cell carcinoma - histopathologically.
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| **There is a well-described phenomenon called ''[[pseudoepitheliomatous hyperplasia]]''.<ref name=pmid16487362>{{cite journal |author=Abu-Eid R, Landini G |title=Morphometrical differences between pseudo-epitheliomatous hyperplasia in granular cell tumours and squamous cell carcinomas |journal=Histopathology |volume=48 |issue=4 |pages=407–16 |year=2006 |month=March |pmid=16487362 |doi=10.1111/j.1365-2559.2006.02350.x |url=}}</ref>
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| *Usually a benign tumour.
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|
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| ===Microscopic===
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| Features:
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| *Large polygonal cells with abundant (eosinophilic) granular cytoplasm.
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|
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Granular_cell_tumor_%283%29_skin.jpg Granular cell tumour (WC)].
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| ==Olfactory neuroblastoma== | | ==Olfactory neuroblastoma== |
| :See also: ''[[neuroblastoma]]''. | | :See also: ''[[neuroblastoma]]''. |
| *[[AKA]] ''esthesioneuroblastoma''. | | *[[AKA]] ''esthesioneuroblastoma''. |
| ===General===
| | {{Main|Olfactory neuroblastoma}} |
| Epidemiology:<ref name=pmid20596981/>
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| *Prognosis: poor.
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| *Wide age range with bimodal distribution - teens and 60s.
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| *No sex predilection.
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| Clinical presentation:<ref name=pmid20596981>{{Cite journal | last1 = Thompson | first1 = LD. | title = Olfactory neuroblastoma. | journal = Head Neck Pathol | volume = 3 | issue = 3 | pages = 252-9 | month = Sep | year = 2009 | doi = 10.1007/s12105-009-0125-2 | PMID = 20596981 | PMC = 2811627 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811627/?tool=pubmed }}</ref>
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| *Nasal obstruction ~ 70%.
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| *Epistaxis ~ 50%.
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| *Anosmia.
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| *Headache.
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| ===Gross===
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| *Arises from olfactory mucosa - upper nasal cavity.<ref name=Ref_WMSP41>{{Ref WMSP|41}}</ref>
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| ===Microscopic===
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| Features:<ref name=pmid20596981/>
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| *[[Small round cell tumour|Small round (blue) cell tumour]] with:
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| **Stippled chromatin.
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| **High NC ratio.
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| *+/-Flexner-Wintersteiner [[rosette]] - rosette with empty centre (donut hole).
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| *+/-Fibrillary, eosinophilic material (neuropil-like).<ref name=Ref_WMSP41>{{Ref WMSP|41}}</ref>
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| DDx:
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| *[[Lymphoma]].
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| *[[Small cell carcinoma]].
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| *Other [[small round cell tumours]].
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| *Basaloid squamous carcinoma.{{fact}}
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| Images:
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| *[http://path.upmc.edu/cases/case467/images/fig02.jpg Olfactory neuroblastoma - crappy image (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case467.html http://path.upmc.edu/cases/case467.html]. Accessed on: 21 January 2012.</ref>
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811627/figure/Fig6/ Olfactory neuroblastoma (nih.gov)].<ref name=pmid20596981/>
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| ===IHC===
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| *S100:
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| **Sustentacular cells +ve.
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| **Small round cells -ve.
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| *Neuroendocrine markers +ve (CD56, synaptophysin).
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| Others:
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| *CD45 -ve (r/o [[lymphoma]]).
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| *AE1/AE3 usu. -ve (r/o carcinoma).
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| *CAM5.2 usu. -ve -- up to 35% +ve.<ref name=Ref_WMSP41>{{Ref WMSP|41}}</ref>
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| ==Craniopharyngioma== | | ==Craniopharyngioma== |
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| :See also: ''[[Angiofibroma]]''. | | :See also: ''[[Angiofibroma]]''. |
| *[[AKA]] ''juvenile nasopharyngeal angiofibroma''. | | *[[AKA]] ''juvenile nasopharyngeal angiofibroma''. |
| ===General===
| | {{Main|Nasopharyngeal angiofibroma}} |
| *Classically adolescent males with recurrent nose bleeds.
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|
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| ===Microscopic=== | | ==Biphenotypic sinonasal sarcoma== |
| Features:<ref name=Ref_Klatt144>{{Ref Klatt|144}}</ref>
| | *[[AKA]] ''low grade sinonasal sarcoma with neural and myogenic features''. |
| *Fibroblastic cells with plump (near cuboidal) nuclei.
| | {{Main|Biphenotypic sinonasal sarcoma}} |
| *Fibrous stroma.
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| *Abundant capillaries.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_intermed_mag.jpg Nasopharyngeal angiofibroma - intermed. mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_2_-_high_mag.jpg Nasopharyngeal angiofibroma - high mag. (WC)].
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|
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|
| =Nasal polyps= | | =Nasal polyps= |
| ==Overview==
| | {{Main|Nasal polyps}} |
| DDx (benign - multiple):<ref name=emedicine994274>URL: [http://emedicine.medscape.com/article/994274-overview http://emedicine.medscape.com/article/994274-overview]. Accessed on: 16 March 2011.</ref>
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| *Autoimmune/idiopathic:
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| **Asthma.
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| **Allergic rhinitis.
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| **[[Churg-Strauss syndrome]] (AKA ''allergic granulomatous angiitis'').
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| ***Features: [[asthma]], eosinophilia, granulomatous inflammation, necrotizing systemic [[vasculitis]], and necrotizing glomerulonephritis.<ref name=emedicine333492>[http://emedicine.medscape.com/article/333492-overview http://emedicine.medscape.com/article/333492-overview]</ref>
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| **Nonallergic rhinitis with eosinophilia syndrome (NARES).
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| *Infectious:
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| **Fungal infection (with allergic component - ''AFS'' = allergic fungal sinusitis).
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| **Chronic rhinosinusitis.
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| *Genetic:
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| **Primary ciliary dyskinesia.
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| **[[Cystic fibrosis]].
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| *Associations:
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| **Alcohol intolerance ~ 50%.
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| **Aspirin intolerance - upto ~ 25%.
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| *Tumours:
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| **Juvenile [[nasopharyngeal angiofibroma]] - young males.
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| **[[Nasopharyngeal carcinoma]]s.
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| **[[Sarcoma]]s.
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| **[[Hemangioma]].
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| **[[Schneiderian papilloma]].
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| **Other.
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| | |
| Memory devices:
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| *''GAIT'' = '''G'''enetic, '''A'''llergic/idiopathic, '''I'''nfectious, '''T'''umours.
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| *Allergic causes '''A'''s - '''a'''llergic, '''a'''sthma, '''a'''llergic granulomatous angiitis (Churg-Strauss syndrome), non'''a'''llergic rhinitis with eosinophilia.
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| | |
| ===Epidemiology===
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| *More commonly assoc. with nonallergic conditions.<ref name=emedicine994274/>
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| | |
| ===Treatment===
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| *Recurrent polyps: functional endoscopic sinus surgery (FESS).
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| | |
| ==Inflammatory polyps with neutrophils==
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| ===General===
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| *Histologic findings are non-specific; DDx includes:<ref name=emedicine994274dx>URL: [http://emedicine.medscape.com/article/994274-diagnosis http://emedicine.medscape.com/article/994274-diagnosis]. Accessed on: 16 March 2011.</ref>
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| **[[Cystic fibrosis]].
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| **Primary ciliary dyskinesia syndrome.
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| **Young syndrome
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| | |
| ===Microscopic===
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| Features:
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| *Neutrophil predominant.
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| *Edema.
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| *+/-Mucus-impaction (dilated glands with mucus).
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| **Suggestive of cystic fibrosis.<ref name=pmid15554502>{{cite journal |author=Beju D, Meek WD, Kramer JC |title=The ultrastructure of the nasal polyps in patients with and without cystic fibrosis |journal=J. Submicrosc. Cytol. Pathol. |volume=36 |issue=2 |pages=155–65 |year=2004 |month=April |pmid=15554502 |doi= |url=}}</ref>
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| | |
| ===Sign out===
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| <pre>
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| A. Nasal sinus tissue, right, excision:
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| - Inflamed edematous sinonasal mucosa with abundant neutrophils.
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| - Negative for malignancy.
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| | |
| B. Nasal sinus tissue, left, excision:
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| - Inflamed edematous sinonasal mucosa with abundant neutrophils and fragments of bone.
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| - Negative for malignancy.
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| </pre>
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| | |
| ==Allergic nasal polyp==
| |
| ===General===
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| *People with allergies.
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| **Same type of polyps seen in those without allergies.<ref name=pmid8441521>{{Cite journal | last1 = Davidsson | first1 = A. | last2 = Hellquist | first2 = HB. | title = The so-called 'allergic' nasal polyp. | journal = ORL J Otorhinolaryngol Relat Spec | volume = 55 | issue = 1 | pages = 30-5 | month = | year = 1993 | doi = | PMID = 8441521 }}</ref>
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| | |
| ===Gross===
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| *Polypoid mass - several millimetres to centimetres in size.
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| **Translucent.{{fact}}
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| ===Microscopic===
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| Features:<ref>{{Ref Klatt|144}}</ref>
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| *Normal respiratory epithelium.
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| *Stroma with:
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| **Edema.
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| **Eosinophils.
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| **+/-Other inflammatory cells (plasma cells, lymphocytes, neutrophils).
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| | |
| DDx:
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| *Inflammatory nasal polyp with abundant neutrophils.
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| *[[Vasculitis]].
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| **[[Wegener's granulomatosis]].
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| **[[Churg-Strauss syndrome]].
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| | |
| ===Sign out===
| |
| <pre>
| |
| A. Nasal sinus tissue, right, excision:
| |
| - Inflamed edematous sinonasal mucosa with abundant eosinophils.
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| - Negative for malignancy.
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| | |
| B. Nasal sinus tissue, left, excision:
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| - Inflamed edematous sinonasal mucosa with abundant eosinophils and fragments of bone.
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| - Negative for malignancy.
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| </pre>
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| | |
| | |
| <pre>
| |
| A. NASAL SINUS TISSUE, RIGHT, EXCISION:
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| - INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS.
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| - NEGATIVE FOR MALIGNANCY.
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| B. NASAL SINUS TISSUE, LEFT, EXCISION:
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| - INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS AND FRAGMENTS OF BONE.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| | |
| ==Tonsillar lymphangiomatous polyp==
| |
| ===Microscopic===
| |
| Features:<ref>http://www.nature.com/modpathol/journal/v13/n10/full/3880208a.html</ref>
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| *Polyp with lymph channels.
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| ==Schneiderian papilloma==
| |
| *[[AKA]] ''Schneiderian polyp''.
| |
| *[[AKA]] ''sinonasal papilloma''.<ref>URL: [http://emedicine.medscape.com/article/862677-overview http://emedicine.medscape.com/article/862677-overview]. Accessed on: 19 November 2011.</ref>
| |
| ===General===
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| *Lumpers vs. splitters debate about whether it is one entity or three.<ref name=pmid11904343>{{cite journal |author=Barnes L |title=Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck |journal=Mod. Pathol. |volume=15 |issue=3 |pages=279–97 |year=2002 |month=March |pmid=11904343 |doi=10.1038/modpathol.3880524 |url=http://www.nature.com/modpathol/journal/v15/n3/full/3880524a.html}}</ref>
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| | |
| [http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880524t1.html#figure-title Subclassification]:<ref name=pmid11904343/>
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| *Inverted (Schneiderian) - most common ~60-65%.
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| *Fungiform (Schneiderian) - less common ~30-35%.
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| *Oncocytic (Schneiderian) - least common ~5%.
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| ====Inverted====
| |
| *[[AKA]] ''[[inverted papilloma]]''.<ref name=pmid8189990>{{Cite journal | last1 = Vrabec | first1 = DP. | title = The inverted Schneiderian papilloma: a 25-year study. | journal = Laryngoscope | volume = 104 | issue = 5 Pt 1 | pages = 582-605 | month = May | year = 1994 | doi = | PMID = 8189990 }}</ref>
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| *Usually lateral wall (as the septum as little soft tissue to grow into).<ref name=pmid11904343/>
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| *May transform to carcinoma.
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| | |
| ====Fungiform====
| |
| *[[AKA]] exophytic papilloma, [[AKA]] septal papilloma.<ref name=pmid11904343/>
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| *Low risk of malignant transformation.
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| | |
| ====Oncocytic====
| |
| *[[AKA]] ''cylindrical cell papilloma''.<ref>{{Cite journal | last1 = Bravo Domínguez | first1 = O. | last2 = Vela Cortina | first2 = M. | last3 = Ramírez Ruiz | first3 = RD. | last4 = Ros Vergara | first4 = A. | last5 = Dinarés Jaumeandreu | first5 = D. | last6 = Encina Ruiz | first6 = L. | last7 = Arias Cuchí | first7 = G. | last8 = Ardíaca Bosch | first8 = MC. | last9 = Cánovas Robles | first9 = E. | title = [Oncocytic schneiderian papilloma. A case report]. | journal = An Otorrinolaringol Ibero Am | volume = 32 | issue = 2 | pages = 115-23 | month = | year = 2005 | doi = | PMID = 15929584 }}</ref>
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| *Lateral nasal wall.<ref name=pmid11904343/>
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| | |
| ===Microscopic===
| |
| ====Inverted Schneiderian papilloma====
| |
| Features:<ref name=pmid11904343/>
| |
| *Well-demarcated epithelial islands in the stroma.
| |
| *Squamous +/-surface keratinization ''or'' respiratory type epithelium (with cilia).
| |
| *+/-Neutrophils.
| |
| *+/-Goblet cells.
| |
| | |
| Notes:
| |
| *May mimic invasive SCC.
| |
| | |
| Images:
| |
| *[http://path.upmc.edu/cases/case32.html Inverted papilloma & verrucous carcinoma (upmc.edu)].
| |
| *[http://commons.wikimedia.org/wiki/File:Sinonasal_papilloma_-_very_low_mag.jpg Schneiderian papilloma - very low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Sinonasal_papilloma_-_cropped_-_very_high_mag.jpg Schneiderian papilloma - very high mag. (WC)].
| |
| | |
| ====Fungiform Schneiderian papilloma====
| |
| Features:
| |
| *Exophytic growth pattern - '''key feature'''.
| |
| | |
| ====Oncocytic Schneiderian papilloma====
| |
| Features:
| |
| *Oncocytes - '''key feature'''.
| |
| *Exophytic or endophytic growth pattern.
| |
|
| |
|
| =See also= | | =See also= |