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

Jump to navigation Jump to search

An introduction to head and neck pathology (view source)

Revision as of 17:37, 4 March 2022

20,243 bytes removed ,  17:37, 4 March 2022
→‎Anatomy
 
(119 intermediate revisions by the same user not shown)
Line 1: Line 1:
'''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.   
 
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]]''.
Cytopathology of the head and neck is dealt with in a separate article called ''[[head and neck cytopathology]]''.


==Clinical==
=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>
Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
*Leukoplakia.
*[[Leukoplakia]].
**Homogeneous.
**Homogeneous.
**Non-homogeneous.
**Non-homogeneous.
*Erythroplakia - more worrisome for cancer than leukoplakia.
*Erythroplakia - more worrisome for cancer than leukoplakia.


===Leukoplakia===
==Leukoplakia==
Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
:''[[Hairy leukoplakia]] is dealt with in a separate section''.
*Unidentified white lesion.
:''The typical [[benign leukoplakia]] is dealt with in a separate section''.
*Often associated with epithelial thickening ([[hyperkeratosis]], acanthosis).
{{Main|Leukoplakia}}
*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>
 
**Non-homogenous leukoplakia has a greater risk of malignancy than homogenous.<ref name=pmid16545712/>
==Erythroplakia==
===General===
*Non-specific clinical finding - may be benign or [[malignant]].
*Strong association with non-keratinizing squamous lesions (invasive and dysplastic).


===Erythroplakia===
===Microscopic===
Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
*Unidentified red lesion.
*Unidentified red lesion.
*Often erosion.
*Often [[erosion]].
*Strong association with non-keratinizing squamous lesions (invasive and dysplastic).
 
=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=
=Benign cystic lesions=
:Cytology dealt with in ''[[Head and neck cytopathology]]''.
:Cytology dealt with in ''[[Head and neck cytopathology]]''.


==DDx==
===Cystic lesions - overview===
Lateral:
Lateral cystic lesions:
*[[Brachial cleft cyst]].
*[[Branchial cleft cyst]].
*[[Cystic hygroma]].
*[[Cystic hygroma]].


Medial:
Medial cystic lesions:
*[[Thyroglossal duct cyst]].
*[[Thyroglossal duct cyst]].


Both:
Lateral & medial lesions:
*[[Epidermoid cyst]].
*[[Epidermoid cyst]].
*Cystic [[squamous cell carcinoma]].
*Cystic [[squamous cell carcinoma]].
Line 45: Line 93:


==Thyroglossal duct cyst==
==Thyroglossal duct cyst==
===General===
{{Main|Thyroglossal duct cyst}}
*Congenital.
*Midline.
 
Treatment:
*Surgical excision (with piece of hyoid bone).
 
===Microscopic===
Features:
*Cyst.
**Lining:
***Squamous or respiratory epithelium.
***Cyst contents: debris.
*+/-Thyroid gland.
*+/-Granulomatous inflammation (phagocytosis of debris).
 
Images:
*[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>
*[http://150.59.224.157/pathology/system/data/image_data/117116931536.jpg TDC - thyroid gland (150.59.224.157)].


==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>
*Treatment: excision.
 
Clinical image: [http://medical-dictionary.thefreedictionary.com/_/viewer.aspx?path=mosby&name=500051-fx23.jpg Branchial cleft cyst (thefreedictionary.com)].
 
===Microscopic===
Features:
*Cystic space lined by squamous epithelium - usually.
*Connective tissue:
**+/-Adipose tissue.
**+/-Cartilage.
**+/-Bone.
**+/-Muscle.
 
Image:
*[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>


==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>
 
===Microscopic===
Features:
*Lymphocytes.
*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>
 
Note:
*'''Must''' rule-out (MALT) [[MALT lymphoma|lymphoma]].
 
===IHC===
*CD20, CD3 -- mixed population.
*Kappa ~ lambda.


=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}}


===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.
*Late:
*#Subepithelial hyaline / stromal hyaline.
*#Blood vessels - dilated.
 
Notes:
*No inflammation.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(1).jpg?uselang=en Laryngeal nodule - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(2).jpg?uselang=en Laryngeal nodule (WC)].


==Pemphigus vulgaris==
==Pemphigus vulgaris==
Line 131: Line 118:
*[[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).
===General===
*May lead to blindness.
*Oral lesion is classically: ''first to show & last to go''.
**Oral lesions usually precede the skin lesions.
Etiology:
*Autoimmune disease.
**Antibodies against: desmoglein 1, desmoglein 3.
===Microscopic===
Features:<ref>{{Ref PBoD8|1193}}</ref>
*Suprabasilar blistering.
DDx: [[Hailey-Hailey disease]].


==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''.
*Seen in children, young adults, pregnant women.
 
Clinical:
*May grow quickly - clinically suspicious for a malignancy.
 
Notes:
*Name of entity is a misnomer:
**Not pyogenic, i.e. infectious.
**Not [[granuloma|granulomatous]].
*The WMSP advocates the name ''lobular capillary hemangioma''.<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
 
===Gross===
Features:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
*Erythematous.
*Hemorrhagic.
 
Usually location:<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
*Lips.
*[[Tongue]].
*Gingiva.
 
===Microscopic===
Features:<ref name=Ref_PBoD775>{{Ref PBoD|775}}</ref>
*Polypoid ''or'' peduculated.
*Vascular, i.e. many blood vessels, with plump endothelium.
*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>
*Lobular arrangement of vascular (seen at low power).<ref>S. Sade. 8 September 2011.</ref>
 
DDx:
*[[Capillary hemangioma]].
*[[Myopericytoma]] (???).
*[[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>
 
Why it is not...
*[[Glomus tumour]] - cookie cutter arrangement of cells.
 
Image:
*[http://www.sciencephoto.com/images/download_lo_res.html?id=670066054 Pyogenic granuloma (sciencephoto.com)].
 
===IHC===
Features - positive for vascular markers:<ref name=Ref_WMSP12>{{Ref WMSP|12}}</ref>
*CD34 +ve.
*CD31 +ve.
*Factor VIII +ve.
 
==Hairy leukoplakia==
===General===
Features:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
*Oral lesion.
**Often on [[tongue]].
*Thought to be caused by [[EBV]].
 
Gross:
*White confluent patches (icing sugar).
 
===Microscopic===
Features:<ref>URL: [http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia].</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>
*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==
Line 217: Line 128:
*Glossitis.
*Glossitis.
*Esophageal dysphagia (usually related to webs).
*Esophageal dysphagia (usually related to webs).
==Oral candidiasis==
*Fungus.
*May be associated with immunodeficiency, e.g. [[AIDS]], organ transplant/immunosuppression.
Forms:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref>
*Pseudomembranous (thrush).
*Erythematous.
*Hyperplastic.


==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>
 
===Gross===
*Nasal mass - may be deforming.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Wolkowitsch1.jpg Rhinoscleroma (WC)].
 
===Microscopic===
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>
*Macrophages - clear-to-foamy cytoplasm.
*Lymphocytes.
*Plasma cells.
 
DDx:
*[[Rosai-Dorfman disease]].
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Rhinoscleroma_-_intermed_mag.jpg Rhinoscleroma - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Rhinoscleroma_-_very_high_mag.jpg Rhinoscleroma - very high mag. (WC)].
*www:
**[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/rhinoscleroma2.html Rhinoscleroma (brown.edu)].
**[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>
 
===Stains===
*Warthin-Starry stain +ve (rod-shaped organisms).
*[[Dieterle stain]] +ve (rod-shaped organisms).


=Neoplasms=
=Neoplasms=
Line 283: 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. December 2008.</ref>
*One large hospital:
**[[LMWK]] ([[CAM5.2]]).  
**LMWK (CAM5.2).  
**[[pankeratin]] ([[AE1/AE3]]).
**Pankeratin ([[AE1/AE3]]).
*UHN.
*Another large hospital:
**Nothing.
**Nothing.


==Sinonasal undifferentiated carcinoma==
==Laryngeal neoplasms==
*Abbreviated ''SNUC''
{{Main|Laryngeal carcinoma}}
These are dealt with in a separate article.


===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}}


===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.
*Small-to-moderate cytoplasm.
*+/-Distinct nucleoli.
*Tumour cell size variable (small to large).
 
Note:
*Glandular and squamous differentiation are absent by definition.<ref name=pmid11904342/>
 
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)].
*[http://www.pathologypics.com/PictView.aspx?ID=249 SNUC (pathologypics.com)].
 
===IHC===
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 401: 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 498: 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 547: 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/>
*Low risk of malignant transformation.
 
====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=
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/14553...51887"

Navigation menu