An introduction to head and neck pathology

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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

  • Oropharynx - includes: tonsil, tonsillar pillar, base of tongue, soft palate.[1]
  • Oral cavity - includes floor of mouth, bucca, anterior 2/3 of tongue,[2] lips, hard palate, upper & lower alveolar ridge, retromolar trigone.[3]
  • Laryngopharynx.
  • Nasopharynx.

Clinical

Common lesions:[4]

  • 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.

Erythroplakia

General

  • Non-specific clinical finding - may be benign or malignant.
  • Strong association with non-keratinizing squamous lesions (invasive and dysplastic).

Microscopic

Features:[4]

  • Unidentified red lesion.
  • Often erosion.

Overview

Cysts

Larynx

Oral

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

  • 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

Other benign

Vocal cord nodule

  • AKA singer's nodule.
  • AKA vocal cord polyp.

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.

Pemphigus vulgaris

Pyogenic granuloma

  • AKA lobular capillary hemangioma.[6]

Plummer-Vinson syndrome

Triad:[7]

  • Iron-deficiency anemia.
  • Glossitis.
  • Esophageal dysphagia (usually related to webs).

Rhinoscleroma

Neoplasms

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.[8]
  • 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

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.

Nasopharyngeal carcinoma

  • Abbreviated NPC.

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

Squamous cell carcinoma of the head and neck

Small cell anaplastic carcinoma

  • Rare.

DDx:

Granular cell tumour

Olfactory neuroblastoma

See also: neuroblastoma.
  • AKA esthesioneuroblastoma.

Craniopharyngioma

  • Cystic lesion +/- calcifications +/-squamous nests.
  • Related to Rathke cleft cyst.

Nasopharyngeal angiofibroma

See also: Angiofibroma.
  • AKA juvenile nasopharyngeal angiofibroma.

Biphenotypic sinonasal sarcoma

  • AKA low grade sinonasal sarcoma with neural and myogenic features.

Nasal polyps

See also

References

  1. URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/throat-cancer/oropharyngeal-cancer/soft-palate-cancer/. Accessed on: 15 November 2016.
  2. URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/tongue-cancer/. Accessed on: 15 November 2016.
  3. URL: http://www.headandneckcancerguide.org/teens/cancer-basics/explore-cancer-types/oral-cancers/oromandibular-cancer/. Accessed on: 15 November 2016.
  4. 4.0 4.1 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.
  5. 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.
  6. 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.
  7. 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.
  8. S. Raphael. December 2008.

External links