Revision as of 14:08, 1 April 2021

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

Rathke cleft cyst - nasal cavity.
Thyroglossal duct cyst - midline, neck.
Branchial cleft cyst - lateral neck.

Larynx

Oral

Main article: Oral pathology

Infectious:

Other:

Pemphigus vulgaris.

Vascular:

Pyogenic granuloma.

Pigmentation:

Focal:
- Amalgam tattoo.
- Melanocytic lesions.
Diffuse
- Peutz-Jeghers syndrome.
- Addison's disease.

Nasal cavity/nose

Rhinoscleroma.
Nasal glial heterotopia.^[6]

Benign cystic lesions

Cytology dealt with in Head and neck cytopathology.

Cystic lesions - overview

Lateral cystic lesions:

Medial cystic lesions:

Thyroglossal duct cyst.

Lateral & medial lesions:

Epidermoid cyst.
Cystic squamous cell carcinoma.

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

AKA pemphigus.
- Should not be confused with bullous pemphigoid (which is less serious).

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:

Metastatic small cell carcinoma of the lung.

Granular cell tumour

Main article: Granular cell tumour

Olfactory neuroblastoma

Craniopharyngioma

Main article: Craniopharyngioma

Cystic lesion +/- calcifications +/-squamous nests.
Related to Rathke cleft cyst.

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

References

↑ URL: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html. Accessed on: 1 April 2021.
↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/. Accessed on: 15 November 2016.
↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/. Accessed on: 15 November 2016.
↑ URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/. Accessed on: 15 November 2016.
↑ ^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.
↑ 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.
↑ 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.
↑ 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.
↑ S. Raphael. December 2008.

External links

[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.

[Ref_PBoD780-5] 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.

[pmid21839350-7] 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.

[Ref_PBoD776-8] 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.

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@@ Line 6: / Line 6: @@
 =Anatomy=
-[[Image:Blausen_0872_UpperRespiratorySystem.png|thumb|Head and neck anatomy (Bruce Blaus).]]
+[[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>

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