Difference between revisions of "An introduction to head and neck pathology"

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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.   


==Oral lesions==
The [[thyroid gland]] is dealt with in its own article, as is pathology of the [[salivary gland]].
Clinical:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
*Leukoplakia.
**Unidentified white lesion.
**More worrisome than erythroplakia.
**Often assoc. with epithelial thickening (hyperkeratosis, acanthosis).
*Erythroplakia.
**Unidentified red lesion.
**Often erosion.


==Pyogenic granuloma==
Cytopathology of the head and neck is dealt with in a separate article called ''[[head and neck cytopathology]]''.
 
=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.
 
=Clinical=
Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
*[[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===
===General===
*Sometimes ''pregnancy tumour''.
*Non-specific clinical finding - may be benign or [[malignant]].
*Seen in children, young adults, pregnant women.
*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>
 
=Benign cystic lesions=
:Cytology dealt with in ''[[Head and neck cytopathology]]''.
 
===Cystic lesions - overview===
Lateral cystic lesions:
*[[Branchial cleft cyst]].
*[[Cystic hygroma]].
 
Medial cystic lesions:
*[[Thyroglossal duct cyst]].
 
Lateral & medial lesions:
*[[Epidermoid cyst]].
*Cystic [[squamous cell carcinoma]].


===Gross===
==Rathke cleft cyst==
Features:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
:{{Main|Rathke cleft cyst}}
*Erythematous.
*Arises from ''intermediate lobe'' - embryonic remnant.
*Hemorrhagic.
*Benign cystic lesion without calcification.
*Related to ''[[craniopharyngioma]]''.


===Microscopic===
==Thyroglossal duct cyst==
Features:<ref name=Ref_PBoD775>{{Ref PBoD|775}}</ref>
{{Main|Thyroglossal duct cyst}}
*Vascular.
 
*Peduncular lesion.
==Branchial cleft cyst==
*[[AKA]] ''branchial cleft remnant''.
{{Main|Branchial cleft cyst}}
 
==Benign lymphoepithelial lesion==
*[[AKA]] ''benign lymphoepithelial cyst''
{{Main|Benign lymphoepithelial lesion}}


DDx:
=Other benign=
*Capillary hemangioma.
==Vocal cord nodule==
*[[AKA]] ''singer's nodule''.
*[[AKA]] ''vocal cord polyp''.
{{Main|Vocal cord nodule}}


==Hairy leukoplakia==
==Squamous papilloma==
Features:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
:Caruncle lesion is dealt with in ''[[papilloma of the caruncle]]''.
*Oral lesion.
:The lesion in the [[esophagus]] is dealt with in ''[[squamous papilloma of the esophagus]]''.
*Often on tongue.
{{Main|Squamous papilloma}}
*Thought to be caused by EBV.


Gross:
==Pemphigus vulgaris==
*White confluent patches (icing sugar).  
{{Main|Pemphigus vulgaris}}
*[[AKA]] ''pemphigus''.
**Should not be confused with ''[[bullous pemphigoid]]'' (which is less serious).


===Microscopic===
==Pyogenic granuloma==
Features:<ref>URL: [http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia].</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>
*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>
{{Main|Lobular capillary hemangioma}}
*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>
*"Balloon cells" in upper stratum spinosum - perinuclear clearing.


==Plummer-Vinson syndrome==
==Plummer-Vinson syndrome==
Triad:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
Triad:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
*Iron-deficiency anemia.
*Iron-deficiency [[anemia]].
*Glossitis.
*Glossitis.
*Esophageal dysphagia (usually related to webs).
*Esophageal dysphagia (usually related to webs).


==Oral candidiasis==
==Rhinoscleroma==
*Fungus.
{{Main|Rhinoscleroma}}
*May be associated with immunodeficiency, e.g. AIDS, organ transplant/immunosuppression.


Forms:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
=Neoplasms=
*Pseudomembranous (thrush).
==Odontogenic tumours and cysts==
*Erythematous.
{{main|Odontogenic tumours and cysts}}
*Hyperplastic.


==Tonsillar lymphangiomatous polyps==
This is a rather large topic and dealt with in a separate article.
Features:<ref>http://www.nature.com/modpathol/journal/v13/n10/full/3880208a.html</ref>
*Polyp with lymph channels.


==Pharyngeal carcinoma/nasopharyngeal carcinoma==
It includes:
*[[Keratocystic odontogenic tumour]].
*[[Radicular cyst]].
*[[Dentigerous cyst]].
*[[Ameloblastoma]].
*[[Adenomatoid odontogenic tumour]].
*[[Ameloblastic fibroma]].
*[[Odontogenic myxoma]].
 
==Pharyngeal/nasopharyngeal specimens==
*Specimens may be challenging to interpret as there is normally an abundance of lymphoid cells.
*Specimens may be challenging to interpret as there is normally an abundance of lymphoid cells.
*Malignant tissue can look benign.<ref>S. Raphael</ref>.
*Malignant tissue can look benign.<ref>S. Raphael. December 2008.</ref>
*May be difficult to differentiate from other malignancies.
*May be difficult to differentiate from other malignancies.


Line 72: Line 156:


Work-up of negative H&E Bx differs by site:
Work-up of negative H&E Bx differs by site:
*Sunnybrook<ref>S. Raphael</ref>
*One large hospital:
**[[LMWK]] ([[CAM5.2]]).  
**LMWK (CAM5.2).  
**[[pankeratin]] ([[AE1/AE3]]).
**Pankeratin ([[AE1/AE3]]).
*UHN.
*Another large hospital:
**Nothing.
**Nothing.


===Classification===
==Laryngeal neoplasms==
SCC is subdivided by the WHO into:<ref>Sternberg P.975.</ref>
{{Main|Laryngeal carcinoma}}
*Keratinizing type (KT).
These are dealt with in a separate article.
**Worst prognosis.
*Undifferentiated type (UT).
**Intermediate prognosis.
**EBV association.
*Nonkeratinizing type (NT).
**Good prognosis.
**EBV association.


===Histology of SCC===
==Human papillomavirus-associated head and neck squamous cell carcinoma==
Features:<ref>Sternberg P.975.</ref>
*Abbreviated ''HPV-HNSCC''.
*KT subtype:
{{Main|Human papillomavirus-associated head and neck squamous cell carcinoma}}
**Keratinization & intercellular bridges through-out most of the malignant lesion.
 
*UT:
==Sinonasal undifferentiated carcinoma==
**Non-distinct borders/syncytial pattern.
*Abbreviated ''SNUC''.
**Nucleoli.
{{Main|Sinonasal undifferentiated carcinoma}}
*NT:
 
**Well-defined cell borders.
==Nasopharyngeal carcinoma==
*Abbreviated ''NPC''.
{{Main|Nasopharyngeal carcinoma}}


==Squamous lesions==
==Squamous lesions==
Line 111: Line 190:
**There are several subtypes of SCC.
**There are several subtypes of SCC.


==Squamous cell carcinoma==
==Squamous dysplasia of the head and neck==
===Microscopy===
{{Main|Squamous dysplasia of the head and neck}}
Invasive cancer look for:
*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]]''.
 
===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.
==Squamous cell carcinoma of the head and neck==
 
{{Main|Squamous cell carcinoma of the head and neck}}
===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:
*Need keratinization. (???)
 
DDx:
*Neuroendocrine tumour.
 
===Lymphoepithelial (squamous cell) carcinoma===
*Rare.
*+/-EBV.


==Small cell anaplastic carcinoma==
==Small cell anaplastic carcinoma==
Line 177: Line 200:


DDx:
DDx:
*Metastatic small cell carcinoma of the lung.
*Metastatic [[small cell carcinoma]] of the lung.


==Granular cell tumour==
==Granular cell tumour==
*May mimic (well-differentiated) squamous cell carcinoma - histopathologically.
{{Main|Granular cell tumour}}
*Usually a benign tumour.
 
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==
*AKA ''esthesioneuroblastoma''.
:See also: ''[[neuroblastoma]]''.
 
*[[AKA]] ''esthesioneuroblastoma''.
===Microscopic===
{{Main|Olfactory neuroblastoma}}
Features:
*Small round (blue) cell tumour.
 
==Rathke cleft cyst==
===Microscopic===
Features:
*Lined by cuboidal or columnar epithelial +occasional goblet cells.<ref>URL: [http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html]. Accessed on: 27 May 2010.</ref>
*+/-Squamous metaplasia.
 
Image: [http://www.endotext.org/neuroendo/neuroendo3/figures/figure11.jpg Rathke's cleft cyst (endotext.org)].


==Craniopharyngioma==
==Craniopharyngioma==
===General===
{{Main|Craniopharyngioma}}
*Develop from remains of Rathke's pouch.
*Cystic lesion +/- calcifications +/-squamous nests.
 
*Related to ''Rathke cleft cyst''.
===Microscopic===
Features:<ref name=Ref_DCHH184>{{Ref DCHH|184}}</ref>
*Well-circumscribed or pseudoinvasive border.
*Squamoid appearance - papillary arch.
 
Image: [http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p039r.jpg Craniopharyngioma (lmp.ualbera.ca)].
 
==Keratocystic odontogenic tumour==
===General===
*[[AKA]] ''odontogenic keratocyst''.
 
===Microscopic===
Features: <ref>Thompson LDR. Head and neck pathology - (Foundations in diagnostic pathology). Goldblum JR, Ed.. Churchill Livingstone. 2006. ISBN 0-443-06960-3.</ref>
* Resembles squamous epithelium - however:
** Lacks [[rete ridges]].
** Artefactual separation of epithelium from the basement membrane.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour1.jpg KOT (WC)].
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour2.jpg KOT - showing artefactual separation (WC)].
 
Notes:
*Vaguely resembles squamous epithelium.
 
==Ameloblastoma==
===General===
*Osteous lesion.
 
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970616-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970616-7]. Accessed on: March 9, 2010.</ref>
*Stellate reticulum - star-shaped cells, found in a developing tooth.<ref>URL: [http://en.wikipedia.org/wiki/Stellate_reticulum http://en.wikipedia.org/wiki/Stellate_reticulum]. Accessed on: March 9, 2010.</ref>
*Tall columnar cells.
**Nuclei distant from the basement membrane (reverse polarization of the nuclei).
*+/-Giant cells.
 
Images:
*[http://www.estomatologia.com.br/diagnosticos_det2.asp?cod_diag=12 Ameloblastoma - several images (estomatologia.com.br)].
*[http://www.cytochemistry.net/microanatomy/digestive/devtooth9.jpg Stellate reticulum (cytochemistry.net)].
 
==Nasal polyps==
DDx (benign - multiple):<ref name=emedicine994274>[http://emedicine.medscape.com/article/994274-overview http://emedicine.medscape.com/article/994274-overview]</ref>
*Autoimmune/idiopathic:
**Asthma.
**Allergic rhinitis.
**Churg-Strauss syndrome (AKA ''allergic granulomatous angiitis'') - considered a type of Polyarteritis nodosa (PAN).
***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:
==Nasopharyngeal angiofibroma==
*Juvenile nasopharyngeal angiofibroma (young males).
:See also: ''[[Angiofibroma]]''.
*Nasopharyngeal carcinomas.
*[[AKA]] ''juvenile nasopharyngeal angiofibroma''.
*Sarcomas.
{{Main|Nasopharyngeal angiofibroma}}
*Hemangioma.
*Papilloma.
*Other.


===Epidemiology===
==Biphenotypic sinonasal sarcoma==
*More commonly assoc. with nonallergic conditions.<ref name=emedicine994274/>
*[[AKA]] ''low grade sinonasal sarcoma with neural and myogenic features''.
{{Main|Biphenotypic sinonasal sarcoma}}


===Treatment===
=Nasal polyps=
*Recurrent polyps: Functional endoscopic sinus surgery (FESS).
{{Main|Nasal polyps}}


==See also==
=See also=
*[[Salivary gland]].
*[[Salivary gland]].
*[[Thyroid gland]].
*[[Thyroid gland]].
*[[Breast]].
*[[Breast]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=
*[http://education.vetmed.vt.edu/curriculum/vm8054/labs/Lab17/Lab17.htm Oral cavity histology (vetmed.vt.edu)].
*[http://education.vetmed.vt.edu/curriculum/vm8054/labs/Lab17/Lab17.htm Oral cavity histology (vetmed.vt.edu)].
*[http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html Endocrine pathology - pituitary (endotext.org)].
*[http://www.endotext.org/neuroendo/neuroendo3/neuroendo3.html Endocrine pathology - pituitary (endotext.org)].


[[Category:Head and neck pathology]]
[[Category:Head and neck pathology]]

Latest revision as of 17:37, 4 March 2022

This article is an introduction to head and neck pathology. Most of head and neck pathology is squamous cell carcinoma and its variants.

The thyroid gland is dealt with in its own article, as is pathology of the salivary gland.

Cytopathology of the head and neck is dealt with in a separate article called head and neck cytopathology.

Anatomy

Head and neck anatomy (BruceBlaus/WC).
  • Oropharynx - includes: tonsil, tonsillar pillar, base of tongue, soft palate.[1][2]
  • Oral cavity - includes floor of mouth, bucca, anterior 2/3 of tongue,[3] lips, hard palate, upper & lower alveolar ridge, retromolar trigone.[4]
  • Laryngopharynx.
  • Nasopharynx.

Clinical

Common lesions:[5]

  • 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 article: Leukoplakia

Erythroplakia

General

  • Non-specific clinical finding - may be benign or malignant.
  • Strong association with non-keratinizing squamous lesions (invasive and dysplastic).

Microscopic

Features:[5]

  • Unidentified red lesion.
  • Often erosion.

Overview

Cysts

Larynx

Oral

Main article: Oral pathology

Infectious:

Other:

Vascular:

Pigmentation:

Nasal cavity/nose

Benign cystic lesions

Cytology dealt with in Head and neck cytopathology.

Cystic lesions - overview

Lateral cystic lesions:

Medial cystic lesions:

Lateral & medial lesions:

Rathke cleft cyst

Main article: Rathke cleft cyst
  • Arises from intermediate lobe - embryonic remnant.
  • Benign cystic lesion without calcification.
  • Related to craniopharyngioma.

Thyroglossal duct cyst

Main article: Thyroglossal duct cyst

Branchial cleft cyst

  • AKA branchial cleft remnant.
Main article: Branchial cleft cyst

Benign lymphoepithelial lesion

  • AKA benign lymphoepithelial cyst
Main article: Benign lymphoepithelial lesion

Other benign

Vocal cord nodule

  • AKA singer's nodule.
  • AKA vocal cord polyp.
Main article: Vocal cord nodule

Squamous papilloma

Caruncle lesion is dealt with in papilloma of the caruncle.
The lesion in the esophagus is dealt with in squamous papilloma of the esophagus.
Main article: Squamous papilloma

Pemphigus vulgaris

Main article: Pemphigus vulgaris

Pyogenic granuloma

  • AKA lobular capillary hemangioma.[7]
Main article: Lobular capillary hemangioma

Plummer-Vinson syndrome

Triad:[8]

  • Iron-deficiency anemia.
  • Glossitis.
  • Esophageal dysphagia (usually related to webs).

Rhinoscleroma

Main article: Rhinoscleroma

Neoplasms

Odontogenic tumours and cysts

Main article: Odontogenic tumours and cysts

This is a rather large topic and dealt with in a separate article.

It includes:

Pharyngeal/nasopharyngeal specimens

  • Specimens may be challenging to interpret as there is normally an abundance of lymphoid cells.
  • Malignant tissue can look benign.[9]
  • May be difficult to differentiate from other malignancies.

Histology

  • Upper airway distant from areas with friction: respiratory type epithelium.

Work-up of negative H&E Bx differs by site:

  • One large hospital:
    • LMWK (CAM5.2).
    • Pankeratin (AE1/AE3).
  • Another large hospital:
    • Nothing.

Laryngeal neoplasms

Main article: Laryngeal carcinoma

These are dealt with in a separate article.

Human papillomavirus-associated head and neck squamous cell carcinoma

  • Abbreviated HPV-HNSCC.
Main article: Human papillomavirus-associated head and neck squamous cell carcinoma

Sinonasal undifferentiated carcinoma

  • Abbreviated SNUC.
Main article: Sinonasal undifferentiated carcinoma

Nasopharyngeal carcinoma

  • Abbreviated NPC.
Main article: Nasopharyngeal carcinoma

Squamous lesions

  • Premalignant lesions
    • Mild dysplasia.
      • Low risk of progression to invasive lesions.
    • Moderate dysplasia.
    • Severe dysplasia/carcinoma in situ (CIS).
      • Histologically severe dysplasia and CIS cannot be differentiated reliably; ergo, there can be considered the same thing.
      • Severe dysplasia is not a necessary intermediate for cancer, i.e. invasive squamous cell carcinoma may be present with moderate dysplasia.
  • Invasive squamous cell carcinoma (SCC).
    • "Microinvasive" squamous cell carcinoma - term should be avoided as there is no concenus on what it means.
    • There are several subtypes of SCC.

Squamous dysplasia of the head and neck

Main article: Squamous dysplasia of the head and neck

Squamous cell carcinoma of the head and neck

Main article: Squamous cell carcinoma of the head and neck

Small cell anaplastic carcinoma

  • Rare.

DDx:

Granular cell tumour

Main article: Granular cell tumour

Olfactory neuroblastoma

See also: neuroblastoma.
  • AKA esthesioneuroblastoma.
Main article: Olfactory neuroblastoma

Craniopharyngioma

Main article: Craniopharyngioma
  • Cystic lesion +/- calcifications +/-squamous nests.
  • Related to Rathke cleft cyst.

Nasopharyngeal angiofibroma

See also: Angiofibroma.
  • AKA juvenile nasopharyngeal angiofibroma.
Main article: Nasopharyngeal angiofibroma

Biphenotypic sinonasal sarcoma

  • AKA low grade sinonasal sarcoma with neural and myogenic features.
Main article: Biphenotypic sinonasal sarcoma

Nasal polyps

Main article: Nasal polyps

See also

References

  1. ↑ URL: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html. Accessed on: 1 April 2021.
  2. ↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/. Accessed on: 15 November 2016.
  3. ↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/. Accessed on: 15 November 2016.
  4. ↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/. Accessed on: 15 November 2016.
  5. ↑ 5.0 5.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 780. ISBN 0-7216-0187-1.
  6. ↑ Penner, CR.; Thompson, L. (Dec 2003). "Nasal glial heterotopia: a clinicopathologic and immunophenotypic analysis of 10 cases with a review of the literature.". Ann Diagn Pathol 7 (6): 354-9. PMID 15018118.
  7. ↑ Baglin, AC. (Aug 2011). "[Vascular tumors and pseudotumors. Pyogenic granuloma (lobular capillary hemangioma)].". Ann Pathol 31 (4): 266-70. doi:10.1016/j.annpat.2011.05.014. PMID 21839350.
  8. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 776. ISBN 0-7216-0187-1.
  9. ↑ S. Raphael. December 2008.

External links

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