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| 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]]''. |
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| | =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. |
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| =Clinical= | | =Clinical= |
| Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> | | Common lesions:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref> |
| *Leukoplakia. | | *[[Leukoplakia]]. |
| **Homogeneous. | | **Homogeneous. |
| **Non-homogeneous. | | **Non-homogeneous. |
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| :''[[Hairy leukoplakia]] is dealt with in a separate section''. | | :''[[Hairy leukoplakia]] is dealt with in a separate section''. |
| :''The typical [[benign leukoplakia]] is dealt with in a separate section''. | | :''The typical [[benign leukoplakia]] is dealt with in a separate section''. |
| | | {{Main|Leukoplakia}} |
| ===General===
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| *Non-specific clinical finding - may be benign ''or'' malignant.
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| *Associated with tobacco use.<ref name=pmid11336117>{{Cite journal | last1 = Bánóczy | first1 = J. | last2 = Gintner | first2 = Z. | last3 = Dombi | first3 = C. | title = Tobacco use and oral leukoplakia. | journal = J Dent Educ | volume = 65 | issue = 4 | pages = 322-7 | month = Apr | year = 2001 | doi = | PMID = 11336117 }}</ref>
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| Risk of malignancy:
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| *In twos series ~13% were associated with an invasive lesion.<ref name=pmid19953947>{{Cite journal | last1 = Lan | first1 = AX. | last2 = Guan | first2 = XB. | last3 = Sun | first3 = Z. | title = [Analysis of risk factors for carcinogenesis of oral leukoplakia]. | journal = Zhonghua Kou Qiang Yi Xue Za Zhi | volume = 44 | issue = 6 | pages = 327-31 | month = Jun | year = 2009 | doi = | PMID = 19953947 }}</ref><ref name=pmid16545712>{{Cite journal | last1 = Lee | first1 = JJ. | last2 = Hung | first2 = HC. | last3 = Cheng | first3 = SJ. | last4 = Chen | first4 = YJ. | last5 = Chiang | first5 = CP. | last6 = Liu | first6 = BY. | last7 = Jeng | first7 = JH. | last8 = Chang | first8 = HH. | last9 = Kuo | first9 = YS. | title = Carcinoma and dysplasia in oral leukoplakias in Taiwan: prevalence and risk factors. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 101 | issue = 4 | pages = 472-80 | month = Apr | year = 2006 | doi = 10.1016/j.tripleo.2005.07.024 | PMID = 16545712 }}</ref>
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| *Non-homogenous leukoplakia has a greater risk of malignancy than homogenous.<ref name=pmid16545712/>
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| *Location matters - floor of mouth and ventral tongue lesions higher risk for malignancy.<ref name=pmid7548621>{{Cite journal | last1 = Sciubba | first1 = JJ. | title = Oral leukoplakia. | journal = Crit Rev Oral Biol Med | volume = 6 | issue = 2 | pages = 147-60 | month = | year = 1995 | doi = | PMID = 7548621 | URL = http://cro.sagepub.com/content/6/2/147.long }}</ref>
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| ===Gross===
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| *White lesion - may be subdivided:
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| **Non-homogenous.
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| **Homogenous.
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| ===Microscopic===
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| Features:<ref name=Ref_PBoD780>{{Ref PBoD|780}}</ref>
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| *Often associated with epithelial thickening ([[hyperkeratosis]], [[acanthosis]]).
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| DDx:
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| *Food debris.
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| *[[Oral candidiasis]].
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| *[[Lichen planus]].
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| *[[Benign alveolar ridge keratosis]] (oral [[lichen simplex chronicus]]).<ref name=pmid18158926>{{Cite journal | last1 = Natarajan | first1 = E. | last2 = Woo | first2 = SB. | title = Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. | journal = J Am Acad Dermatol | volume = 58 | issue = 1 | pages = 151-7 | month = Jan | year = 2008 | doi = 10.1016/j.jaad.2007.07.011 | PMID = 18158926 }}</ref>
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| *[[Squamous cell carcinoma of the head and neck]].
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| *Others - see ''[[Dermatopathology#Leukoplakia]]''.
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| ==Erythroplakia== | | ==Erythroplakia== |
| ===General=== | | ===General=== |
| *Non-specific clinical finding - may be benign or malignant. | | *Non-specific clinical finding - may be benign or [[malignant]]. |
| *Strong association with non-keratinizing squamous lesions (invasive and dysplastic). | | *Strong association with non-keratinizing squamous lesions (invasive and dysplastic). |
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| ===Cystic lesions - overview=== | | ===Cystic lesions - overview=== |
| Lateral cystic lesions: | | Lateral cystic lesions: |
| *[[Brachial cleft cyst]]. | | *[[Branchial cleft cyst]]. |
| *[[Cystic hygroma]]. | | *[[Cystic hygroma]]. |
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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. December 2008.</ref> | | *One large hospital: |
| **[[LMWK]] ([[CAM5.2]]). | | **LMWK (CAM5.2). |
| **[[pankeratin]] ([[AE1/AE3]]). | | **Pankeratin ([[AE1/AE3]]). |
| *UHN. | | *Another large hospital: |
| **Nothing. | | **Nothing. |
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| :See also: ''[[Angiofibroma]]''. | | :See also: ''[[Angiofibroma]]''. |
| *[[AKA]] ''juvenile nasopharyngeal angiofibroma''. | | *[[AKA]] ''juvenile nasopharyngeal angiofibroma''. |
| ===General===
| | {{Main|Nasopharyngeal angiofibroma}} |
| *Classically adolescent males with recurrent nose bleeds.
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| ===Microscopic===
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| Features:<ref name=Ref_Klatt144>{{Ref Klatt|144}}</ref>
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| *Fibroblastic cells with plump (near cuboidal) nuclei.
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| *Fibrous stroma.
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| *Abundant capillaries.
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| Images:
| | ==Biphenotypic sinonasal sarcoma== |
| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_intermed_mag.jpg Nasopharyngeal angiofibroma - intermed. mag. (WC)]. | | *[[AKA]] ''low grade sinonasal sarcoma with neural and myogenic features''. |
| *[http://commons.wikimedia.org/wiki/File:Nasopharyngeal_angiofibroma_-_2_-_high_mag.jpg Nasopharyngeal angiofibroma - high mag. (WC)].
| | {{Main|Biphenotypic sinonasal sarcoma}} |
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| =Nasal polyps= | | =Nasal polyps= |
| ==Overview==
| | {{Main|Nasal polyps}} |
| DDx (benign - multiple):<ref name=emedicine994274>URL: [http://emedicine.medscape.com/article/994274-overview http://emedicine.medscape.com/article/994274-overview]. Accessed on: 16 March 2011.</ref>
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| *Autoimmune/idiopathic:
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| **Asthma.
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| **Allergic rhinitis.
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| **[[Churg-Strauss syndrome]] (AKA ''allergic granulomatous angiitis'').
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| ***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>
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| **Nonallergic rhinitis with eosinophilia syndrome (NARES).
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| *Infectious:
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| **Fungal infection (with allergic component - ''AFS'' = allergic fungal sinusitis).
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| **Chronic rhinosinusitis.
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| *Genetic:
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| **Primary ciliary dyskinesia.
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| **[[Cystic fibrosis]].
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| *Associations:
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| **Alcohol intolerance ~ 50%.
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| **Aspirin intolerance - upto ~ 25%.
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| *Tumours:
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| **Juvenile [[nasopharyngeal angiofibroma]] - young males.
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| **[[Nasopharyngeal carcinoma]]s.
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| **[[Sarcoma]]s.
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| **[[Hemangioma]].
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| **[[Schneiderian papilloma]].
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| **Other.
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| Memory devices:
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| *''GAIT'' = '''G'''enetic, '''A'''llergic/idiopathic, '''I'''nfectious, '''T'''umours.
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| *Allergic causes '''A'''s - '''a'''llergic, '''a'''sthma, '''a'''llergic granulomatous angiitis (Churg-Strauss syndrome), non'''a'''llergic rhinitis with eosinophilia.
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| ===Epidemiology===
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| *More commonly assoc. with nonallergic conditions.<ref name=emedicine994274/>
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| ===Treatment===
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| *Recurrent polyps: functional endoscopic sinus surgery (FESS).
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| ==Inflammatory polyps with neutrophils==
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| ===General===
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| *Histologic findings are non-specific; DDx includes:<ref name=emedicine994274dx>URL: [http://emedicine.medscape.com/article/994274-diagnosis http://emedicine.medscape.com/article/994274-diagnosis]. Accessed on: 16 March 2011.</ref>
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| **[[Cystic fibrosis]].
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| **Primary ciliary dyskinesia syndrome.
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| **Young syndrome
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| ===Microscopic===
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| Features:
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| *Neutrophil predominant.
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| *Edema.
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| *+/-Mucus-impaction (dilated glands with mucus).
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| **Suggestive of cystic fibrosis.<ref name=pmid15554502>{{cite journal |author=Beju D, Meek WD, Kramer JC |title=The ultrastructure of the nasal polyps in patients with and without cystic fibrosis |journal=J. Submicrosc. Cytol. Pathol. |volume=36 |issue=2 |pages=155–65 |year=2004 |month=April |pmid=15554502 |doi= |url=}}</ref>
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| ===Sign out===
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| <pre>
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| A. Nasal sinus tissue, right, excision:
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| - Inflamed edematous sinonasal mucosa with abundant neutrophils.
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| - Negative for malignancy.
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| B. Nasal sinus tissue, left, excision:
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| - Inflamed edematous sinonasal mucosa with abundant neutrophils and fragments of bone.
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| - Negative for malignancy.
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| </pre>
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| ==Allergic nasal polyp==
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| ===General===
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| *People with allergies.
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| **Same type of polyps seen in those without allergies.<ref name=pmid8441521>{{Cite journal | last1 = Davidsson | first1 = A. | last2 = Hellquist | first2 = HB. | title = The so-called 'allergic' nasal polyp. | journal = ORL J Otorhinolaryngol Relat Spec | volume = 55 | issue = 1 | pages = 30-5 | month = | year = 1993 | doi = | PMID = 8441521 }}</ref>
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| ===Gross===
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| *Polypoid mass - several millimetres to centimetres in size.
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| **Translucent.{{fact}}
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| ===Microscopic===
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| Features:<ref>{{Ref Klatt|144}}</ref>
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| *Normal respiratory epithelium.
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| *Stroma with:
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| **Edema.
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| **Eosinophils.
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| **+/-Other inflammatory cells (plasma cells, lymphocytes, neutrophils).
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| DDx:
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| *Inflammatory nasal polyp with abundant neutrophils.
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| *[[Vasculitis]].
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| **[[Wegener's granulomatosis]].
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| **[[Churg-Strauss syndrome]].
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| ===Sign out===
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| <pre>
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| A. Nasal sinus tissue, right, excision:
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| - Inflamed edematous sinonasal mucosa with abundant eosinophils.
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| - Negative for malignancy.
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| B. Nasal sinus tissue, left, excision:
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| - Inflamed edematous sinonasal mucosa with abundant eosinophils and fragments of bone.
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| - Negative for malignancy.
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| </pre>
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| <pre>
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| A. NASAL SINUS TISSUE, RIGHT, EXCISION:
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| - INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS.
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| - NEGATIVE FOR MALIGNANCY.
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| B. NASAL SINUS TISSUE, LEFT, EXCISION:
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| - INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS AND FRAGMENTS OF BONE.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==Tonsillar lymphangiomatous polyp==
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| ===Microscopic===
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| Features:<ref>http://www.nature.com/modpathol/journal/v13/n10/full/3880208a.html</ref>
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| *Polyp with lymph channels.
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| ==Schneiderian papilloma==
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| *[[AKA]] ''Schneiderian polyp''.
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| *[[AKA]] ''sinonasal papilloma''.<ref>URL: [http://emedicine.medscape.com/article/862677-overview http://emedicine.medscape.com/article/862677-overview]. Accessed on: 19 November 2011.</ref>
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| ===General===
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| *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>
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| [http://www.nature.com/modpathol/journal/v15/n3/fig_tab/3880524t1.html#figure-title Subclassification]:<ref name=pmid11904343/>
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| *Inverted (Schneiderian) - most common ~60-65%.
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| *Fungiform (Schneiderian) - less common ~30-35%.
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| *Oncocytic (Schneiderian) - least common ~5%.
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| ====Inverted====
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| *[[AKA]] ''[[inverted papilloma]]''.<ref name=pmid8189990>{{Cite journal | last1 = Vrabec | first1 = DP. | title = The inverted Schneiderian papilloma: a 25-year study. | journal = Laryngoscope | volume = 104 | issue = 5 Pt 1 | pages = 582-605 | month = May | year = 1994 | doi = | PMID = 8189990 }}</ref>
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| *Usually lateral wall (as the septum as little soft tissue to grow into).<ref name=pmid11904343/>
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| *May transform to carcinoma.
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| ====Fungiform====
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| *[[AKA]] exophytic papilloma, [[AKA]] septal papilloma.<ref name=pmid11904343/>
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| *Low risk of malignant transformation.
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| ====Oncocytic====
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| *[[AKA]] ''cylindrical cell papilloma''.<ref>{{Cite journal | last1 = Bravo Domínguez | first1 = O. | last2 = Vela Cortina | first2 = M. | last3 = Ramírez Ruiz | first3 = RD. | last4 = Ros Vergara | first4 = A. | last5 = Dinarés Jaumeandreu | first5 = D. | last6 = Encina Ruiz | first6 = L. | last7 = Arias Cuchí | first7 = G. | last8 = Ardíaca Bosch | first8 = MC. | last9 = Cánovas Robles | first9 = E. | title = [Oncocytic schneiderian papilloma. A case report]. | journal = An Otorrinolaringol Ibero Am | volume = 32 | issue = 2 | pages = 115-23 | month = | year = 2005 | doi = | PMID = 15929584 }}</ref>
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| *Lateral nasal wall.<ref name=pmid11904343/>
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| ===Microscopic===
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| ====Inverted Schneiderian papilloma====
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| Features:<ref name=pmid11904343/>
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| *Well-demarcated epithelial islands in the stroma.
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| *Squamous +/-surface keratinization ''or'' respiratory type epithelium (with cilia).
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| *+/-Neutrophils.
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| *+/-Goblet cells.
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| Notes:
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| *May mimic invasive SCC.
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| Images:
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| *[http://path.upmc.edu/cases/case32.html Inverted papilloma & verrucous carcinoma (upmc.edu)].
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| *[http://commons.wikimedia.org/wiki/File:Sinonasal_papilloma_-_very_low_mag.jpg Schneiderian papilloma - very low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Sinonasal_papilloma_-_cropped_-_very_high_mag.jpg Schneiderian papilloma - very high mag. (WC)].
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| ====Fungiform Schneiderian papilloma====
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| Features:
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| *Exophytic growth pattern - '''key feature'''.
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| ====Oncocytic Schneiderian papilloma====
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| Features:
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| *Oncocytes - '''key feature'''.
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| *Exophytic or endophytic growth pattern.
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| =See also= | | =See also= |