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

3,480 bytes removed ,  17:37, 4 March 2022
→‎Anatomy
 
(198 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=
===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>
 
=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]].


=Benign=
==Rathke cleft cyst==
==Rathke cleft cyst==
:{{Main|Rathke cleft cyst}}
:{{Main|Rathke cleft cyst}}
Line 21: Line 92:
*Related to ''[[craniopharyngioma]]''.
*Related to ''[[craniopharyngioma]]''.


==Pemphigus vulgaris==
==Thyroglossal duct cyst==
*See the ''[[bullous disease]]'' article.
{{Main|Thyroglossal duct cyst}}


===General===
==Branchial cleft cyst==
*[[AKA]] ''pemphigus''.
*[[AKA]] ''branchial cleft remnant''.
**Should not be confused with ''bullous pemphigoid'' (which is less serious).
{{Main|Branchial cleft cyst}}
*May lead to blindness.
*Oral lesion is classically: ''first to show & last to go''.
**Oral lesions usually precede the skin lesions.


===Etiology===
==Benign lymphoepithelial lesion==
*Autoimmune disease
*[[AKA]] ''benign lymphoepithelial cyst''
*Antibodies: desmoglein 1, desmoglein 3.
{{Main|Benign lymphoepithelial lesion}}


==Pyogenic granuloma==
=Other benign=
===General===
==Vocal cord nodule==
*Sometimes ''pregnancy tumour''.
*[[AKA]] ''singer's nodule''.
*Seen in children, young adults, pregnant women.
*[[AKA]] ''vocal cord polyp''.
{{Main|Vocal cord nodule}}


===Gross===
==Squamous papilloma==
Features:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
:Caruncle lesion is dealt with in ''[[papilloma of the caruncle]]''.
*Erythematous.
:The lesion in the [[esophagus]] is dealt with in ''[[squamous papilloma of the esophagus]]''.
*Hemorrhagic.
{{Main|Squamous papilloma}}


===Microscopic===
==Pemphigus vulgaris==
Features:<ref name=Ref_PBoD775>{{Ref PBoD|775}}</ref>
{{Main|Pemphigus vulgaris}}
*Vascular.  
*[[AKA]] ''pemphigus''.
*Peduncular lesion.
**Should not be confused with ''[[bullous pemphigoid]]'' (which is less serious).


DDx:
==Pyogenic granuloma==
*Capillary hemangioma.
*[[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>
 
{{Main|Lobular capillary hemangioma}}
==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==
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>
*Pseudomembranous (thrush).
*Erythematous.
*Hyperplastic.


=Neoplasms=
=Neoplasms=
Line 91: Line 139:


It includes:
It includes:
*Keratocystic odontogenic tumour.
*[[Keratocystic odontogenic tumour]].
*Radicular cyst.
*[[Radicular cyst]].
*Dentigerous cyst.
*[[Dentigerous cyst]].
*Ameloblastoma.
*[[Ameloblastoma]].
*Adenomatoid odontogenic tumour.
*[[Adenomatoid odontogenic tumour]].
*Ameloblastic fibroma.
*[[Ameloblastic fibroma]].
*Odontogenic myxoma.
*[[Odontogenic myxoma]].


==Pharyngeal/nasopharyngeal specimens==
==Pharyngeal/nasopharyngeal specimens==
Line 108: 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.
==Laryngeal neoplasms==
{{Main|Laryngeal carcinoma}}
These are dealt with in a separate article.
==Human papillomavirus-associated head and neck squamous cell carcinoma==
*Abbreviated ''HPV-HNSCC''.
{{Main|Human papillomavirus-associated head and neck squamous cell carcinoma}}
==Sinonasal undifferentiated carcinoma==
*Abbreviated ''SNUC''.
{{Main|Sinonasal undifferentiated carcinoma}}


==Nasopharyngeal carcinoma==
==Nasopharyngeal carcinoma==
===General===
*Abbreviated ''NPC''.
*"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term.
{{Main|Nasopharyngeal carcinoma}}
*Strong association of EBV.
 
===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 with small/indistinct nucleoli.


==Squamous lesions==
==Squamous lesions==
Line 139: Line 190:
**There are several subtypes of SCC.
**There are several subtypes of SCC.


==Squamous cell carcinoma==
==Squamous dysplasia of the head and neck==
===General===
{{Main|Squamous dysplasia of the head and neck}}
*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]]''.
 
===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:
*Need keratinization. (???)
 
DDx:
*Neuroendocrine tumour.


====Lymphoepithelial (squamous cell) carcinoma====
==Squamous cell carcinoma of the head and neck==
*Rare.
{{Main|Squamous cell carcinoma of the head and neck}}
*+/-EBV.


==Small cell anaplastic carcinoma==
==Small cell anaplastic carcinoma==
Line 228: Line 200:


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


==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==
===General===
:See also: ''[[neuroblastoma]]''.
*[[AKA]] ''esthesioneuroblastoma''.
*[[AKA]] ''esthesioneuroblastoma''.
*Prognosis: poor. (???)
{{Main|Olfactory neuroblastoma}}
 
===Microscopic===
Features:
*Small round (blue) cell tumour.


==Craniopharyngioma==
==Craniopharyngioma==
Line 259: Line 216:


==Nasopharyngeal angiofibroma==
==Nasopharyngeal angiofibroma==
===General===
:See also: ''[[Angiofibroma]]''.
*[[AKA]] ''juvenile nasopharyngeal angiofibroma''.
*[[AKA]] ''juvenile nasopharyngeal angiofibroma''.
*Classical adolescent males with recurrent nose bleeds.
{{Main|Nasopharyngeal angiofibroma}}
 
===Microscopic===
Features:<ref name=Ref_Klatt144>{{Ref Klatt|144}}</ref>
*Fibroblastic cells with plump (near cuboidal) nuclei.
*Fibrous stroma.
*Abundant capillaries.
 
Image: [http://en.wikipedia.org/wiki/File:Angiofibroma.jpg Angiofibroma (WP)].
 
=Nasal Polyps=
==Overview==
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:
*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).
 
==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==
===General===
*[[AKA]] ''Schneiderian polyp''.
*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 - most common ~60-65%.
*Fungiform - less common ~ 30-35%.
*Oncocytic - least common ~5%.
 
===Microscopic===
====Inverted papilloma====
Features:<ref name=pmid11904343/>
*Well-demarcated epithelial islands in the stroma.
*+/-Neutrophils.
*+/-Surface keratinization.


Notes:
==Biphenotypic sinonasal sarcoma==
*May mimic invasive SCC.
*[[AKA]] ''low grade sinonasal sarcoma with neural and myogenic features''.
{{Main|Biphenotypic sinonasal sarcoma}}


Images:
=Nasal polyps=
*[http://path.upmc.edu/cases/case32.html Inverted papilloma & verrucous carcinoma (upmc.edu)].
{{Main|Nasal polyps}}


=See also=
=See also=
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/3088...51887"

Navigation menu