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

1,671 bytes removed ,  17:37, 4 March 2022
→‎Anatomy
m (PBoD refs redo)
 
(223 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.   


==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>DCHH P.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]]
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/979...51887"

Navigation menu