An introduction to head and neck pathology
This article is an introduction to head and neck pathology. Most of head and neck pathology is squamous cell carcinoma and its variants.
Cytopathology of the head and neck is dealt with in a separate article called head and neck cytopathology.
- Oropharynx - includes: tonsil, tonsillar pillar, base of tongue, soft palate.
- Oral cavity - includes floor of mouth, bucca, anterior 2/3 of tongue, lips, hard palate, upper & lower alveolar ridge, retromolar trigone.
- Erythroplakia - more worrisome for cancer than leukoplakia.
- Hairy leukoplakia is dealt with in a separate section.
- The typical benign leukoplakia is dealt with in a separate section.
- Non-specific clinical finding - may be benign or malignant.
- Strong association with non-keratinizing squamous lesions (invasive and dysplastic).
- Unidentified red lesion.
- Often erosion.
- Rathke cleft cyst - nasal cavity.
- Thyroglossal duct cyst - midline, neck.
- Branchial cleft cyst - lateral neck.
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
- Arises from intermediate lobe - embryonic remnant.
- Benign cystic lesion without calcification.
- Related to craniopharyngioma.
Thyroglossal duct cyst
Branchial cleft cyst
- AKA branchial cleft remnant.
Benign lymphoepithelial lesion
- AKA benign lymphoepithelial cyst
Vocal cord nodule
- Caruncle lesion is dealt with in papilloma of the caruncle.
- The lesion in the esophagus is dealt with in squamous papilloma of the esophagus.
- Iron-deficiency anemia.
- Esophageal dysphagia (usually related to webs).
Odontogenic tumours and cysts
This is a rather large topic and dealt with in a separate article.
- Keratocystic odontogenic tumour.
- Radicular cyst.
- Dentigerous cyst.
- Adenomatoid odontogenic tumour.
- Ameloblastic fibroma.
- Odontogenic myxoma.
- Specimens may be challenging to interpret as there is normally an abundance of lymphoid cells.
- Malignant tissue can look benign.
- May be difficult to differentiate from other malignancies.
- 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:
These are dealt with in a separate article.
Human papillomavirus-associated head and neck squamous cell carcinoma
- Abbreviated HPV-HNSCC.
Sinonasal undifferentiated carcinoma
- Abbreviated SNUC.
- Abbreviated NPC.
- 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.
- Mild 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
Squamous cell carcinoma of the head and neck
Small cell anaplastic carcinoma
- Metastatic small cell carcinoma of the lung.
Granular cell tumour
- See also: neuroblastoma.
- AKA esthesioneuroblastoma.
- Cystic lesion +/- calcifications +/-squamous nests.
- Related to Rathke cleft cyst.
- See also: Angiofibroma.
- AKA juvenile nasopharyngeal angiofibroma.
Biphenotypic sinonasal sarcoma
- AKA low grade sinonasal sarcoma with neural and myogenic features.
- URL: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html. Accessed on: 1 April 2021.
- URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/. Accessed on: 15 November 2016.
- URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/. Accessed on: 15 November 2016.
- URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/. Accessed on: 15 November 2016.
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