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Difference between revisions of "An introduction to head and neck pathology"
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An introduction to head and neck pathology (view source)
Revision as of 06:13, 14 November 2010
, 06:13, 14 November 2010→Neoplasms: re-arrange/format
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*Odontogenic myxoma. | *Odontogenic myxoma. | ||
==Pharyngeal | ==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. | ||
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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> | *Sunnybrook:<ref>S. Raphael</ref> | ||
**[[LMWK]] ([[CAM5.2]]). | **[[LMWK]] ([[CAM5.2]]). | ||
**[[pankeratin]] ([[AE1/AE3]]). | **[[pankeratin]] ([[AE1/AE3]]). | ||
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**Nothing. | **Nothing. | ||
===Classification=== | ==Nasopharyngeal carcinoma== | ||
===General=== | |||
*"Nasopharyngeal carcinoma" is the name of an entity - it is not a descriptive term. | |||
*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== | |||
*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 cell carcinoma== | |||
===General=== | |||
*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> | SCC is subdivided by the WHO into:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref> | ||
*Keratinizing type (KT). | *Keratinizing type (KT). | ||
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**EBV association. | **EBV association. | ||
Features based on classification:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref> | |||
Features:<ref name=Ref_Sternberg4_975>{{Ref Sternberg4|975}}</ref> | |||
*KT subtype: | *KT subtype: | ||
**Keratinization & intercellular bridges through-out most of the malignant lesion. | **Keratinization & intercellular bridges through-out most of the malignant lesion. | ||
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**Well-defined cell borders. | **Well-defined cell borders. | ||
== | ====Invasion==== | ||
Features: | |||
=== | |||
*Eosinophilia. | *Eosinophilia. | ||
*Extra large nuclei/bizarre nuclei. | *Extra large nuclei/bizarre nuclei. | ||
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*Spindle cell, a common spindle cell lesion of the H&N. | *Spindle cell, a common spindle cell lesion of the H&N. | ||
===Verrucous squamous cell carcinoma=== | ====Verrucous squamous cell carcinoma==== | ||
Features: | Features: | ||
*Exophytic growth. | *Exophytic growth. | ||
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DDx: papilloma. | DDx: papilloma. | ||
===Spindle cell squamous carcinoma=== | ====Spindle cell squamous carcinoma==== | ||
*Key to diagnosis is finding a component of conventional squamous cell carcinoma. | *Key to diagnosis is finding a component of conventional squamous cell carcinoma. | ||
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*Mesenchymal neoplasm. | *Mesenchymal neoplasm. | ||
===Basaloid squamous cell carcinoma=== | ====Basaloid squamous cell carcinoma==== | ||
*May mimic ''adenoid cystic 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> | *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> | ||
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*Neuroendocrine tumour. | *Neuroendocrine tumour. | ||
===Lymphoepithelial (squamous cell) carcinoma=== | ====Lymphoepithelial (squamous cell) carcinoma==== | ||
*Rare. | *Rare. | ||
*+/-EBV. | *+/-EBV. | ||