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.   
 
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=
=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 squmaous cell carcinoma.
*Cystic [[squamous cell carcinoma]].


==Rathke cleft cyst==
==Rathke cleft cyst==
Line 36: 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:
==Benign lymphoepithelial lesion==
*[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>
*[[AKA]] ''benign lymphoepithelial cyst''
{{Main|Benign lymphoepithelial lesion}}


=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===
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>
*Early:
*#Edema.
*#Fibroblasts proliferation.
*Late:
*#Subepithelial hyaline / stromal hyaline.
*#Blood vessels - dilated.
 
Notes:
*No inflammation.


Images:
==Squamous papilloma==
*[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(1).jpg?uselang=en Laryngeal nodule - low mag. (WC)].
:Caruncle lesion is dealt with in ''[[papilloma of the caruncle]]''.
*[http://commons.wikimedia.org/wiki/File:Laryngeal_nodule_(2).jpg?uselang=en Laryngeal nodule (WC)].
:The lesion in the [[esophagus]] is dealt with in ''[[squamous papilloma of the esophagus]]''.
{{Main|Squamous papilloma}}


==Pemphigus vulgaris==
==Pemphigus vulgaris==
*See the ''[[bullous disease]]'' article.
{{Main|Pemphigus vulgaris}}
 
===General===
*[[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).
*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: desmoglein 1, desmoglein 3.


==Pyogenic granuloma==
==Pyogenic granuloma==
===General===
*[[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>
*Sometimes ''pregnancy tumour''.
{{Main|Lobular capillary hemangioma}}
*Seen in children, young adults, pregnant women.
 
===Gross===
Features:<ref name=Ref_PBoD776>{{Ref PBoD|776}}</ref>
*Erythematous.
*Hemorrhagic.
 
===Microscopic===
Features:<ref name=Ref_PBoD775>{{Ref PBoD|775}}</ref>
*Vascular, i.e. many blood vessels.
*Peduncular lesion - polypoid.
*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>
 
DDx:
*Capillary hemangioma.
 
Image:
*[http://www.sciencephoto.com/images/download_lo_res.html?id=670066054 Pyogenic granuloma (sciencephoto.com)].
 
Notes:
*Name of entity is a misnomer:
**Not pyogenic, i.e. infectious.
**Not [[granuloma|granulomatous]].
 
==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 178: 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 195: 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.


==Nasopharyngeal carcinoma==
==Laryngeal neoplasms==
===General===
{{Main|Laryngeal carcinoma}}
*"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term.
These are dealt with in a separate article.
*Strong association of EBV.
 
==Human papillomavirus-associated head and neck squamous cell carcinoma==
*Abbreviated ''HPV-HNSCC''.
{{Main|Human papillomavirus-associated head and neck squamous cell carcinoma}}


===Microscopic===
==Sinonasal undifferentiated carcinoma==
Features:<ref>{{Ref Klatt|145}}</ref>
*Abbreviated ''SNUC''.
*Prominent lymphoid component - '''key feature'''.
{{Main|Sinonasal undifferentiated carcinoma}}
*Features of squamous cell carcinoma:
**Cohesive cells with:
***Abundant dense eosinophilic cytoplasm.
***Central nuclei +/- small/indistinct nucleoli.


Image(s):
==Nasopharyngeal carcinoma==
*[http://commons.wikimedia.org/wiki/File:Lymphoepithelioma_met_to_LN_6.jpg?uselang=de Nasopharyngeal carcinoma - in a LN (WC)].
*Abbreviated ''NPC''.
{{Main|Nasopharyngeal carcinoma}}


==Squamous lesions==
==Squamous lesions==
Line 229: 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]]''.
 
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:
*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 321: 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 cell tumour|Small round (blue) cell tumour]].


==Craniopharyngioma==
==Craniopharyngioma==
Line 352: 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'').
***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=

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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