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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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| ==Clinical== | | =Anatomy= |
| ===Oral lesions=== | | [[Image:Blausen_0872_UpperRespiratorySystem.png|thumb|Head and neck anatomy (BruceBlaus/WC).]] |
| DDx:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
| | *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> |
| *Leukoplakia. | | *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> |
| **Unidentified white lesion. | | *Laryngopharynx. |
| **More worrisome than erythroplakia. | | *Nasopharynx. |
| **Often assoc. with epithelial thickening ([[hyperkeratosis]], acanthosis). | | |
| *Erythroplakia. | | =Clinical= |
| **Unidentified red lesion. | | Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> |
| **Often erosion. | | *[[Leukoplakia]]. |
| | **Homogeneous. |
| | **Non-homogeneous. |
| | *Erythroplakia - more worrisome for cancer than leukoplakia. |
| | |
| | ==Leukoplakia== |
| | :''[[Hairy leukoplakia]] is dealt with in a separate section''. |
| | :''The typical [[benign leukoplakia]] is dealt with in a separate section''. |
| | {{Main|Leukoplakia}} |
| | |
| | ==Erythroplakia== |
| | ===General=== |
| | *Non-specific clinical finding - may be benign or [[malignant]]. |
| | *Strong association with non-keratinizing squamous lesions (invasive and dysplastic). |
| | |
| | ===Microscopic=== |
| | Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> |
| | *Unidentified red lesion. |
| | *Often [[erosion]]. |
| | |
| | =Overview= |
| | ==Cysts== |
| | *[[Rathke cleft cyst]] - nasal cavity. |
| | *[[Thyroglossal duct cyst]] - midline, neck. |
| | *[[Branchial cleft cyst]] - lateral neck. |
| | |
| | ==Larynx== |
| | *[[Vocal cord nodule]]. |
| | *[[Laryngeal papilloma]]. |
| | |
| | ==Oral== |
| | {{Main|Oral pathology}} |
| | Infectious: |
| | *[[Hairy leukoplakia]]. |
| | *[[Oral candidiasis]]. |
| | |
| | Other: |
| | *[[Pemphigus vulgaris]]. |
| | |
| | Vascular: |
| | *[[Pyogenic granuloma]]. |
| | |
| | Pigmentation: |
| | *Focal: |
| | **[[Amalgam tattoo]]. |
| | **[[Melanocytic lesions]]. |
| | ***[[Melanotic macule]]. |
| | ***[[Blue nevus]]. |
| | ***[[Malignant melanoma]] |
| | *Diffuse |
| | **[[Peutz-Jeghers syndrome]]. |
| | **[[Addison's disease]]. |
| | |
| | ==Nasal cavity/nose== |
| | *[[Rhinoscleroma]]. |
| | *Nasal glial heterotopia.<ref>{{Cite journal | last1 = Penner | first1 = CR. | last2 = Thompson | first2 = L. | title = Nasal glial heterotopia: a clinicopathologic and immunophenotypic analysis of 10 cases with a review of the literature. | journal = Ann Diagn Pathol | volume = 7 | issue = 6 | pages = 354-9 | month = Dec | year = 2003 | doi = | PMID = 15018118 }}</ref> |
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| =Benign cystic lesions= | | =Benign cystic lesions= |
| :Cytology dealt with in ''[[Head and neck cytopathology]]''. | | :Cytology dealt with in ''[[Head and neck cytopathology]]''. |
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| ==DDx== | | ===Cystic lesions - overview=== |
| Lateral: | | Lateral cystic lesions: |
| *Brachial cleft cyst. | | *[[Branchial cleft cyst]]. |
| *Cystic hygroma. | | *[[Cystic hygroma]]. |
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| Medial: | | Medial cystic lesions: |
| *Thyroglossal duct cyst. | | *[[Thyroglossal duct cyst]]. |
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| Both:
| | Lateral & medial lesions: |
| *Epidermoid cyst. | | *[[Epidermoid cyst]]. |
| *Cystic squmaous cell carcinoma. | | *Cystic [[squamous cell carcinoma]]. |
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| ==Rathke cleft cyst== | | ==Rathke cleft cyst== |
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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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| *[http://150.59.224.157/pathology/system/data/image_data/117116921705.jpg TDC (150.59.224.157)].<ref>URL: [http://150.59.224.157/pathology/index.php?now_position=1&first_category_id=2&second_category_id=19 http://150.59.224.157/pathology/index.php?now_position=1&first_category_id=2&second_category_id=19]. Accessed on: 4 February 2011.</ref>
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| *[http://150.59.224.157/pathology/system/data/image_data/117116931536.jpg TDC - thyroid gland (150.59.224.157)].
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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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| *Treatment: excision.
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| Clinical image: [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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| *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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| Image:
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| *[http://www.pathology.med.ohio-state.edu/residents/InternalGate/Area51/ResidentSlideCollection/images%2FB403.jpg Branchial cleft cyst (med.ohio-state.edu)].<ref>URL: [http://www.pathology.med.ohio-state.edu/residents/InternalGate/Area51/ResidentSlideCollection/RSLdx.asp http://www.pathology.med.ohio-state.edu/residents/InternalGate/Area51/ResidentSlideCollection/RSLdx.asp]. Accessed on: 15 March 2011.</ref>
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| ==Benign lymphoepithelial lesion== | | ==Benign lymphoepithelial lesion== |
| *[[AKA]] ''benign lymphoepithelial cyst'' | | *[[AKA]] ''benign lymphoepithelial cyst'' |
| | | {{Main|Benign lymphoepithelial lesion}} |
| ===General===
| |
| *Usually parotid gland.
| |
| *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= |
| ==Vocal cord nodule== | | ==Vocal cord nodule== |
| ===General===
| |
| *Benign.
| |
| *[[AKA]] ''singer's nodule''. | | *[[AKA]] ''singer's nodule''. |
| *Etiology: overuse, mechanical trauma (?). | | *[[AKA]] ''vocal cord polyp''. |
| | {{Main|Vocal cord nodule}} |
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| ===Microscopic=== | | ==Squamous papilloma== |
| Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970310-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970310-2]. Accessed on: 4 February 2011.</ref>
| | :Caruncle lesion is dealt with in ''[[papilloma of the caruncle]]''. |
| *Early:
| | :The lesion in the [[esophagus]] is dealt with in ''[[squamous papilloma of the esophagus]]''. |
| *#Edema.
| | {{Main|Squamous papilloma}} |
| *#Fibroblasts proliferation.
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| *Late:
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| *#Subepithelial hyaline / stromal hyaline.
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| *#Blood vessels - dilated.
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| Notes:
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| *No inflammation.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(1).jpg?uselang=en Laryngeal nodule - low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(2).jpg?uselang=en Laryngeal nodule (WC)].
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| ==Pemphigus vulgaris== | | ==Pemphigus vulgaris== |
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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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| DDx: [[Hailey-Hailey disease]].
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| ==Pyogenic granuloma== | | ==Pyogenic granuloma== |
| *[[AKA]] ''lobular capillary hemangioma''.<ref name=pmid21839350>{{Cite journal | last1 = Baglin | first1 = AC. | title = [Vascular tumors and pseudotumors. Pyogenic granuloma (lobular capillary hemangioma)]. | journal = Ann Pathol | volume = 31 | issue = 4 | pages = 266-70 | month = Aug | year = 2011 | doi = 10.1016/j.annpat.2011.05.014 | PMID = 21839350 }}</ref> | | *[[AKA]] ''lobular capillary hemangioma''.<ref name=pmid21839350>{{Cite journal | last1 = Baglin | first1 = AC. | title = [Vascular tumors and pseudotumors. Pyogenic granuloma (lobular capillary hemangioma)]. | journal = Ann Pathol | volume = 31 | issue = 4 | pages = 266-70 | month = Aug | year = 2011 | doi = 10.1016/j.annpat.2011.05.014 | PMID = 21839350 }}</ref> |
| ===General===
| | {{Main|Lobular capillary hemangioma}} |
| *Sometimes ''pregnancy tumour''.
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| *Seen in children, young adults, pregnant women.
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| Clinical:
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| *May grow quickly - clinically suspicious for a malignancy.
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| Notes:
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| *Name of entity is a misnomer:
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| **Not pyogenic, i.e. infectious.
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| **Not [[granuloma|granulomatous]].
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| *The WMSP advocates the name ''lobular capillary hemangioma''.<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
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| ===Gross===
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| Features:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
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| *Erythematous.
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| *Hemorrhagic.
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| Usually location:<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
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| *Lips.
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| *[[Tongue]].
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| *Gingiva.
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD775>{{Ref PBoD|775}}</ref>
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| *Polypoid ''or'' peduculated.
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| *Vascular, i.e. many blood vessels, with plump endothelium.
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| *Usu. thinned epithelium<ref>URL: [http://basicpathology-histopathology.blogspot.com/2009/10/head-and-neck-oral-cavity-reactive_3282.html http://basicpathology-histopathology.blogspot.com/2009/10/head-and-neck-oral-cavity-reactive_3282.html]. Accessed on: 2 February 2011.</ref> or ulcerated.<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
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| *Lobular arrangement of vascular (seen at low power).<ref>S. Sade. 8 September 2011.</ref>
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| DDx:
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| *[[Capillary hemangioma]].
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| *[[Myopericytoma]] (???).
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| *[[Bacillary angiomatosis]].<ref name=pmid16310070>{{Cite journal | last1 = Levy | first1 = I. | last2 = Rolain | first2 = JM. | last3 = Lepidi | first3 = H. | last4 = Raoult | first4 = D. | last5 = Feinmesser | first5 = M. | last6 = Lapidoth | first6 = M. | last7 = Ben-Amitai | first7 = D. | title = Is pyogenic granuloma associated with Bartonella infection? | journal = J Am Acad Dermatol | volume = 53 | issue = 6 | pages = 1065-6 | month = Dec | year = 2005 | doi = 10.1016/j.jaad.2005.08.046 | PMID = 16310070 }}</ref>
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| Why it is not...
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| *[[Glomus tumour]] - cookie cutter arrangement of cells.
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| Image:
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| *[http://www.sciencephoto.com/images/download_lo_res.html?id=670066054 Pyogenic granuloma (sciencephoto.com)].
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| ===IHC===
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| Features - positive for vascular markers:<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
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| *CD34 +ve.
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| *CD31 +ve.
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| *Factor VIII +ve.
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| ==Hairy leukoplakia==
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| ===General===
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| Features:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
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| *Oral lesion.
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| **Often on [[tongue]].
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| *Thought to be caused by [[EBV]].
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| Gross:
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| *White confluent patches (icing sugar).
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| ===Microscopic===
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| Features:<ref>URL: [http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia].</ref>
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| *Hyperkeratosis (thicker stratum corneum).<ref>URL: [http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis].</ref>
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| *Acanthosis (thicker stratum spinosum).<ref>URL: [http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis].</ref>
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| *"Balloon cells" in upper stratum spinosum - perinuclear clearing.
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| ==Plummer-Vinson syndrome== | | ==Plummer-Vinson syndrome== |
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| *Glossitis. | | *Glossitis. |
| *Esophageal dysphagia (usually related to webs). | | *Esophageal dysphagia (usually related to webs). |
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| ==Oral candidiasis==
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| *Fungus.
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| *May be associated with immunodeficiency, e.g. [[AIDS]], organ transplant/immunosuppression.
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|
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| Forms:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
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| *Pseudomembranous (thrush).
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| *Erythematous.
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| *Hyperplastic.
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|
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| ==Rhinoscleroma== | | ==Rhinoscleroma== |
| ===General===
| | {{Main|Rhinoscleroma}} |
| *Caused by ''Klebsiella rhinoscleromatis''.
| |
| *Nose involved +95% of the time.<ref name=pmid17359555>{{Cite journal | last1 = Chan | first1 = TV. | last2 = Spiegel | first2 = JH. | title = Klebsiella rhinoscleromatis of the membranous nasal septum. | journal = J Laryngol Otol | volume = 121 | issue = 10 | pages = 998-1002 | month = Oct | year = 2007 | doi = 10.1017/S0022215107006421 | PMID = 17359555 }}</ref>
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| ===Gross===
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| *Nasal mass - may be deforming.
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Wolkowitsch1.jpg Rhinoscleroma (WC)].
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| ===Microscopic===
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| Features:<ref>URL: [http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/rhinoscleroma2.html http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/rhinoscleroma2.html]. Accessed on: 18 January 2012.</ref>
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| *Macrophages - clear-to-foamy cytoplasm.
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| *Lymphocytes.
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| *Plasma cells.
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| DDx:
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| *[[Rosai-Dorfman disease]].
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| Images:
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Rhinoscleroma_-_intermed_mag.jpg Rhinoscleroma - intermed. mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Rhinoscleroma_-_very_high_mag.jpg Rhinoscleroma - very high mag. (WC)].
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| *www:
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| **[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/rhinoscleroma2.html Rhinoscleroma (brown.edu)].
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| **[http://www.jameswpattersonmd.com/images/pages/rhinoscleroma_mic324.jpg Rhinoscleroma (jameswpattersonmd.com)].<ref>URL: [http://www.jameswpattersonmd.com/case_studies/index.cfm?CFID=387434 http://www.jameswpattersonmd.com/case_studies/index.cfm?CFID=387434]. Accessed on: 21 February 2012.</ref>
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| ===Stains===
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| *Warthin-Starry stain +ve (rod-shaped organisms).
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| *[[Dieterle stain]] +ve (rod-shaped organisms).
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| =Neoplasms= | | =Neoplasms= |
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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== | | ==Laryngeal neoplasms== |
| *Abbreviated ''SNUC''
| | {{Main|Laryngeal carcinoma}} |
| | These are dealt with in a separate article. |
|
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| ===General=== | | ==Human papillomavirus-associated head and neck squamous cell carcinoma== |
| *Very aggressive/poor prognosis - survival 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> | | *Abbreviated ''HPV-HNSCC''. |
| | {{Main|Human papillomavirus-associated head and neck squamous cell carcinoma}} |
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| ===Microscopic=== | | ==Sinonasal undifferentiated carcinoma== |
| Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
| | *Abbreviated ''SNUC''. |
| *Architecture: nested, trabecular or lobular.
| | {{Main|Sinonasal undifferentiated carcinoma}} |
| *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:
| |
| *[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> | |
| *[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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| ===IHC===
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| Features:<ref name=Ref_WMSP38>{{Ref WMSP|38}}</ref>
| |
| *Pankeratin +ve.
| |
| *EMA +ve.
| |
| *CK7 +ve.
| |
| *CK5/6 -ve.
| |
| | |
| Others:
| |
| *NSE +ve/-ve.
| |
| *Chromogranin A -ve.
| |
| *Synaptophysin -ve.
| |
|
| |
|
| ==Nasopharyngeal carcinoma== | | ==Nasopharyngeal carcinoma== |
| *Abbreviated ''NPC''. | | *Abbreviated ''NPC''. |
| ===General===
| | {{Main|Nasopharyngeal carcinoma}} |
| *"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term.
| |
| *Strong association with [[Epstein-Barr virus]] (EBV).
| |
| | |
| Note:
| |
| *A morphologically identical tumour elsewhere is called ''[[lymphoepithelioma-like carcinoma]]''.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref Klatt|145}}</ref>
| |
| *Prominent lymphoid component - '''key feature'''.
| |
| *Features of squamous cell carcinoma:
| |
| **Cohesive cells with:
| |
| ***Abundant dense eosinophilic cytoplasm.
| |
| ***Central nuclei +/- small/indistinct nucleoli.
| |
| | |
| Image(s):
| |
| *[http://commons.wikimedia.org/wiki/File:Lymphoepithelioma_met_to_LN_6.jpg?uselang=de Nasopharyngeal carcinoma - in a LN (WC)].
| |
| | |
| ====Histologic subclassification====
| |
| World Health Classification (2005) for NPC:<ref>{{Ref WMSP|39}}</ref>
| |
| {| class="wikitable"
| |
| ! Type
| |
| ! Histology
| |
| ! Description
| |
| ! EBV
| |
| ! Prevalence
| |
| ! Prognosis
| |
| |-
| |
| | 1
| |
| | keratinizing SCC
| |
| | graded poorly-well-diff.
| |
| | -ve
| |
| | ?
| |
| | bad
| |
| |-
| |
| | 2a
| |
| | nonkeratinizing carcinoma, differentiated
| |
| | well def. cell borders & tumour nest borders, mimics appearance of [[UCC]]
| |
| | +ve
| |
| | ?
| |
| | good
| |
| |-
| |
| | 2b
| |
| | nonkeratinizing carcinoma, undifferentiated
| |
| | sheets/syncytial, vescicular nuclei, prominent nucleoli, pink cytoplasm
| |
| | ?
| |
| | most common
| |
| | ?
| |
| |-
| |
| | 3
| |
| | basaloid SCC
| |
| | mimics BCC - see [[basaloid SCC]]
| |
| | ?
| |
| | least common
| |
| | ?
| |
| |}
| |
| | |
| ===IHC===
| |
| *EBER +ve.
| |
| *p16 -ve.<ref name=pmid9546345>{{cite journal |author=Gulley ML, Nicholls JM, Schneider BG, Amin MB, Ro JY, Geradts J |title=Nasopharyngeal carcinomas frequently lack the p16/MTS1 tumor suppressor protein but consistently express the retinoblastoma gene product |journal=Am. J. Pathol. |volume=152 |issue=4 |pages=865–9 |year=1998 |month=April |pmid=9546345 |pmc=1858242 |doi= |url=}}</ref>
| |
| | |
| Notes:
| |
| *[[HPV]] associated squamous cell carcinomas are p16 +ve.
| |
|
| |
|
| ==Squamous lesions== | | ==Squamous lesions== |
| Line 392: |
Line 190: |
| **There are several subtypes of SCC. | | **There are several subtypes of SCC. |
|
| |
|
| ==Squamous cell carcinoma== | | ==Squamous dysplasia of the head and neck== |
| {{Main|Squamous cell carcinoma}}
| | {{Main|Squamous dysplasia of the head and neck}} |
| ===General===
| |
| *Most common tumour of the head & neck.
| |
| | |
| ===Microscopic===
| |
| ====Classification====
| |
| SCC is subdivided by the WHO into:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
| |
| *Keratinizing type (KT).
| |
| **Worst prognosis.
| |
| *Undifferentiated type (UT).
| |
| **Intermediate prognosis.
| |
| **EBV association.
| |
| *Nonkeratinizing type (NT).
| |
| **Good prognosis.
| |
| **EBV association.
| |
| | |
| Features based on classification:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref>
| |
| *KT subtype:
| |
| **Keratinization & intercellular bridges through-out most of the malignant lesion.
| |
| *UT:
| |
| **Non-distinct borders/syncytial pattern.
| |
| **Nucleoli.
| |
| *NT:
| |
| **Well-defined cell borders.
| |
| | |
| ====Invasion====
| |
| Features:
| |
| *Eosinophilia.
| |
| *Extra large nuclei/bizarre nuclei.
| |
| *Inflammation (lymphocytes, plasma cells).
| |
| *Long rete ridges.
| |
| *Numerous beeds/blobs of epithelial cells that seem unlikely to be rete ridges.
| |
| | |
| Pitfalls:
| |
| *Tangential cuts.
| |
| **If you can trace the squamous cells from a gland to the surface it is less likely to be invasive cancer.
| |
| | |
| Notes on invasion:
| |
| *Nice review paper by ''Wenig''.<ref name=pmid11904340>{{cite journal |author=Wenig BM |title=Squamous cell carcinoma of the upper aerodigestive tract: precursors and problematic variants |journal=Mod. Pathol. |volume=15 |issue=3 |pages=229–54 |year=2002 |month=March |pmid=11904340 |doi=10.1038/modpathol.3880520 |url=http://www.nature.com/modpathol/journal/v15/n3/pdf/3880520a.pdf}}</ref>
| |
| *See ''[[SCC of the cervix versus CIN III]]''.
| |
| | |
| Image(s):
| |
| *[http://commons.wikimedia.org/wiki/File:Oral_cancer_(1)_squamous_cell_carcinoma_histopathology.jpg?uselang=de Invasive oral SCC (WC)].
| |
| | |
| ===Overview of subtypes===
| |
| There are several subtypes:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970297-2]. Accessed on: March 9, 2010.</ref>
| |
| *Basaloid - poor prognosis, usu. diagnosed by recognition of typical SCC.
| |
| *Warty (Condylomatous).
| |
| *Verrucous - good prognosis, rare.
| |
| *Papillary.
| |
| *Lymphoepithelial, rare.
| |
| *Spindle cell, a common spindle cell lesion of the H&N.
| |
| | |
| ====Verrucous squamous cell carcinoma====
| |
| Features:
| |
| *Exophytic growth.
| |
| *Well-differentiated.
| |
| *"Glassy" appearance.
| |
| *Pushing border.
| |
| | |
| DDx: papilloma.
| |
| | |
| ====Spindle cell squamous carcinoma====
| |
| *Key to diagnosis is finding a component of conventional squamous cell carcinoma.
| |
| | |
| IHC:
| |
| *Typically keratin -ve.
| |
| *p63 +ve.
| |
| | |
| DDx:
| |
| *Spindle cell [[melanoma]].
| |
| *Mesenchymal neoplasm.
| |
| | |
| ====Basaloid squamous cell carcinoma====
| |
| *May mimic ''[[adenoid cystic carcinoma]]''.
| |
| *Classically base of tongue.<ref>URL: [http://www.biomedcentral.com/1471-2407/6/146 http://www.biomedcentral.com/1471-2407/6/146]. Accessed on: March 9, 2010.</ref>
| |
| *Typically poor prognosis.
| |
|
| |
|
| Features:
| | ==Squamous cell carcinoma of the head and neck== |
| *Need keratinization. (???)
| | {{Main|Squamous cell carcinoma of the head and neck}} |
| | |
| DDx:
| |
| *Neuroendocrine tumour.
| |
| | |
| ====Lymphoepithelial (squamous cell) carcinoma==== | |
| *Rare.
| |
| *+/-EBV.
| |
|
| |
|
| ==Small cell anaplastic carcinoma== | | ==Small cell anaplastic carcinoma== |
| Line 489: |
Line 204: |
| ==Granular cell tumour== | | ==Granular cell tumour== |
| {{Main|Granular cell tumour}} | | {{Main|Granular cell tumour}} |
| ===General===
| |
| *May mimic (well-differentiated) squamous cell carcinoma - histopathologically.
| |
| **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>
| |
| *Usually a benign tumour.
| |
|
| |
| ===Microscopic===
| |
| Features:
| |
| *Large polygonal cells with abundant (eosinophilic) granular cytoplasm.
| |
|
| |
| Image:
| |
| *[http://commons.wikimedia.org/wiki/File:Granular_cell_tumor_%283%29_skin.jpg Granular cell tumour (WC)].
| |
|
| |
|
| ==Olfactory neuroblastoma== | | ==Olfactory neuroblastoma== |
| :See also: ''[[neuroblastoma]]''. | | :See also: ''[[neuroblastoma]]''. |
| *[[AKA]] ''esthesioneuroblastoma''. | | *[[AKA]] ''esthesioneuroblastoma''. |
| ===General===
| | {{Main|Olfactory neuroblastoma}} |
| *Prognosis: poor.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *[[Small round cell tumour|Small round (blue) cell tumour]].
| |
| | |
| DDx:
| |
| *Lymphoma.
| |
| *Small cell carcinoma.
| |
| *Other [[small round cell tumours]].
| |
| *Basaloid squamous carcinoma. (???)
| |
| | |
| Image:
| |
| *[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>
| |
| | |
| ===IHC===
| |
| *S100:
| |
| **Sustentacular cells +ve.
| |
| **Small round cells -ve.
| |
| *Neuroendocrine markers +ve (CD56, synaptophysin).
| |
| | |
| Others:
| |
| *CD45 -ve (r/o [[lymphoma]]).
| |
| *AE1/AE3 -ve (r/o carcinoma).
| |
|
| |
|
| ==Craniopharyngioma== | | ==Craniopharyngioma== |
| Line 538: |
Line 218: |
| :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.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_Klatt144>{{Ref Klatt|144}}</ref>
| |
| *Fibroblastic cells with plump (near cuboidal) nuclei.
| |
| *Fibrous stroma.
| |
| *Abundant capillaries.
| |
|
| |
|
| Images:
| | ==Biphenotypic sinonasal sarcoma== |
| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_intermed_mag.jpg Nasopharyngeal angiofibroma - intermed. mag. (WC)]. | | *[[AKA]] ''low grade sinonasal sarcoma with neural and myogenic features''. |
| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_2_-_high_mag.jpg Nasopharyngeal angiofibroma - high mag. (WC)].
| | {{Main|Biphenotypic sinonasal sarcoma}} |
|
| |
|
| =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>
| |
| *Autoimmune/idiopathic:
| |
| **Asthma.
| |
| **Allergic rhinitis.
| |
| **[[Churg-Strauss syndrome]] (AKA ''allergic granulomatous angiitis'').
| |
| ***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>
| |
| **Nonallergic rhinitis with eosinophilia syndrome (NARES).
| |
| *Infectious:
| |
| **Fungal infection (with allergic component - ''AFS'' = allergic fungal sinusitis).
| |
| **Chronic rhinosinusitis.
| |
| *Genetic
| |
| **Primary ciliary dyskinesia.
| |
| **[[Cystic fibrosis]].
| |
| *Associations:
| |
| **Alcohol intolerance ~ 50%.
| |
| **Aspirin intolerance - upto ~ 25%.
| |
| | |
| Tumours:
| |
| *Juvenile nasopharyngeal angiofibroma (young males).
| |
| *Nasopharyngeal carcinomas.
| |
| *Sarcomas.
| |
| *Hemangioma.
| |
| *Papilloma.
| |
| *Other.
| |
| | |
| ===Epidemiology===
| |
| *More commonly assoc. with nonallergic conditions.<ref name=emedicine994274/>
| |
| | |
| ===Treatment===
| |
| *Recurrent polyps: Functional endoscopic sinus surgery (FESS).
| |
| | |
| ==Inflammatory polyps with neutrophils==
| |
| ===General===
| |
| *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>
| |
| **[[Cystic fibrosis]].
| |
| **Primary ciliary dyskinesia syndrome.
| |
| **Young syndrome
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Neutrophil predominant.
| |
| *Edema.
| |
| *+/-Mucus-impaction (dilated glands with mucus).
| |
| **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>
| |
| | |
| ==Allergic nasal polyp==
| |
| ===General===
| |
| *People with allergies.
| |
| | |
| ===Gross===
| |
| *Polypoid mass - several millimetres to centimetres in size.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref Klatt|144}}</ref>
| |
| *Normal respiratory epithelium.
| |
| *Stroma with:
| |
| **Edema.
| |
| **Eosinophils.
| |
| **+/-Other inflammatory cells (plasma cells, lymphocytes, neutrophils).
| |
| | |
| ==Tonsillar lymphangiomatous polyp==
| |
| ===Microscopic===
| |
| Features:<ref>http://www.nature.com/modpathol/journal/v13/n10/full/3880208a.html</ref>
| |
| *Polyp with lymph channels.
| |
| | |
| ==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===
| |
| *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>
| |
| | |
| [http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880524t1.html#figure-title Subclassification]:<ref name=pmid11904343/>
| |
| *Inverted (Schneiderian) - most common ~60-65%.
| |
| *Fungiform (Schneiderian) - less common ~30-35%.
| |
| *Oncocytic (Schneiderian) - least common ~5%.
| |
| ====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>
| |
| *Usually lateral wall (as the septum as little soft tissue to grow into).<ref name=pmid11904343/>
| |
| *May transform to carcinoma.
| |
| | |
| ====Fungiform====
| |
| *[[AKA]] exophytic papilloma, [[AKA]] septal papilloma.<ref name=pmid11904343/>
| |
| | |
| ====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>
| |
| *Lateral nasal wall.<ref name=pmid11904343/>
| |
| | |
| ===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)].
| |
| *[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= |
