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Head and Neck path

RUSM Pathology Sem 3 - Mini 3 - Head & Neck

QuestionAnswer
Possible complications of acute and chronic sinusitis Osteomyelitis, mucocele, and pyocele
Cause of nasal polyps Allergic rhinitis
Potential cause of sinusitis in a diabetic? Fungal infxon (mucomycosis)
Mucomycosis Fungal infxious cause of sinusitis seen freq in diabetics
What cell type is numerous in mucosa of pt with allergic rhinitis eosinophils
Inflammatory nasal polyps are lined by what kind of epithelium? Respiratory epithelium
Child with what disease are prone to inflammatory polyps? Cystic fibrosis
Nasopharyngial angiofibroma: Features, Common in what group Highly vascular unencapsulated tumor common in teenage adolescents.
Highly vascular unencapsulated tumor common in teenage adolescents. Nasopharyngial angiofibroma
Locally aggressive (highly recurrent neoplasm of nose / paranasal sinuses. Rarly progresses to carcinoma Schneiderian pappiloma
Schneiderian pappiloma Locally aggressive (highly recurrent neoplasm of nose / paranasal sinuses. Rarly progresses to carcinoma
Olfactory neuroplastoma is commonly assoiated with what translocation? 11:22. ALso positive for neuron-specific enolase (NSE) and S100
11:22 translocation with postive neuron specific enolase ans s100. dx? Olfactory neuroblastoma
"Staghorn vessels" (look like horns of deer) are a sign of what neoplasia Nasopharyngeal angiofibroma
What neoplasia should never be biopsied due to it's high level of vascularity Nasopharyngeal angiofibroma
Two possible type of Schneiderian pappilomas Exophytic (mushroom shaped) and inverted. Always submit these for biopsy - important prognostic differences between these two types.
3 major features of a schneiderian papilloma 1) Squamous or respiratory epithelium with goblet cells, 2)Fibrovascular cores (as with all papillomas) 3) NEUTROPHILS!!!!
THe following are features of waht kind of neoplasia?: 1) Squamous or respiratory epithelium with goblet cells, 2)Fibrovascular cores (as with all papillomas) 3) NEUTROPHILS schneiderian papilloma
Epithelium translocation: what is it? What disease is it seen in? Epithelial transmigration of neutrophils (this doesn't usually occur. This is a feature of schneiderian papilloma
What type of Schneiderian papilloma has an associated risk of carcinoma? Inverted type. It has a 10% risk of invasive carcinoma. Exophytic has virtually no risk?
Olfactory neuroblastoma is most common in what age group? 30-40
Homer wright rosettes are common in what head/neck neoplasia? Olfactory neuroblastoma (HOMER WRIGHT (angelhairs) IS CHARACTERISTIC OF NEUROBLASTOMAS)
What are the 3 types of nasopharyngeal carcinoma? How are they treated Keratanizing squamous cell carcinoma (WHO I), Nonkeratanizing differentiated carcinoma (WHO II), and lastly: nonkeratanizing UNDIFFERENTIATED carcinoma (WHO III). THESE ARE NEVER TREATED BY SURGICAL RESECTION. Treated by radiotherapy
EBV is associated with what type of nasopharyngeal carcinoma? WHO I and WHO II. Nonkaratanizing differentiated carcinoma and nonkeratanizing UNDIFFRENTIATED carcinoma. These respnse
Diseases associated with EBV Mono, X-linked lymphoproliferative disease, Burkitt's and Hodgkin's lymphoma, B-cell lymphoma in immunocomp'd pts, Nasal NK t-cell carcinoma, leiomyosarcoma in immunocomp'd pt, rheumatoid arthritis, SLE, MS, breast ca, Chronic fatigue
What is one of the key characteristic of undifferentiated type nasopharyngeal carcinoma **Sea of lymphocytes** surrounding islands of undiffentiated squamous cells
What a laryngeal nodules? Are they premalignant? Laryngeal nodules (AKA Singer's nodules) are small reactive polypoid lesions that form on the true vocal cords of singers and teachers leading to horseness of voice. They never progress to ca.
Laryngeal papilloams? Are tbe premalignant? True neoplasms with delicate, finger like papillae, that are covered by squamous cell epithelium. Rarely progress to canceer
What virus are Laryngeal papilloams associated with? HPV 6 and 11
Prognosis of Laryngeal papilloams Rarely progress to cancer, but tend to recur after excision. Cancerous Laryngeal papilloams is associated with HPV 16 and 18 superinfection)
Hyperkeratosis is seen on which of the following: Lyrangeal papilloma or larygeal nodules? larygeal nodules
What is a koilocyte? The VIRAL induced change seen in cells infected with HPV virus. Cytoplasm appears as a HALO around the nucleus
Halo appearance around nucleus, DX? This is a koilocyte, indicative of HPV infxon
Laryngeal dysplasia is most associate with what environmental facto? smoking
Most common type of vocal cord carcinoma? Glottic carcinoma (ON THE CORD)
Well differentiated squamous cell carcinoma is diagnosed by the presence of what two thing? Pearls of keratanization and desmosomes (intercellular bridges)
Cholesteatoma. What is it? What causes it? CAUSED BY CHRONIC OTITIS MEDIA: Cysts lined by keratinizing squamous epithelium and filled with desquamated debris and cholesterol --> ***giant cell granulomatous RXN***
Is a cholesteatoma a tumor? NO! it is not a neoplasm despite the increase in cell proliferation
Three major elements of a Cholesteatoma 1) keratin, 2) Strat Sq Epi, 3 fibrous and/or granulation tissue
Complications of Cholesteatoma erosions of ossicles and bony wall of middle ear
Exuberant epithelium with lots of keratin. Dx? Cholesteatoma
Cold sores is caused by what herpes virus? Genital herpes? HSV-1 = cold sores. HSV-2 = Genital herpes
Where does HSV-1 remain dormant after herpetic stomatitis heals? Lies dormant in the trigeminal ganglion.
What causesherpetic stomatitis HSV-1 (AKA cold sores)
Herpetic ulcerations are most associated with what type of lesion. (primary or recurrent) Primary. Recurrent ones are milder and healed faster
Where should the bx be taken from a herpetic lesion> From the edges! The center is all necrotic tissue
Ground glass smudgy multinucleated cells is a feature of what infection herpes
Oral hairy leukoplakia is a sign of... early sign of HIV
Cause of Oral hairy leukoplakia ? EBV
white, fluffy, confluent patches on lateral tongue. Microscopically appearing as piled-up layers of keratotic squames on underlying mucosal aconthosis. dx oral hairy leukoplakia/ caused by EBV, and is an indicator of early HIV
Dysplatic cells 1/3 to the keratanized layer mild squamous dysplasia. >2/3 is severe.
Full thicknes displasia all the way to, but not breaching the basement membrane carcinona in situ
What is the primary mechanim of head and neck squamous cell carcinoma. genomic instability
Upon finding leukoplakia, what is the first step for dx biopsy
Viral association with squamous cell carcinoma HPV
A slide showing lots of keratanization / presence of a keratin pearl is what stage sq cell carcinoma? Well differentiated. More keratin and intercellular bridges = more differentiation
What type of salivary gland has least amount of malignant tumors? What salivary gland most commonly get tumor? Parotid gland. Parotid gland is also most common
What salivary gland tumor has highest chance of malignancy? Minor salivary gland. (these tumors are least common ~10%)
Pleomorphic adenoma: malignant or benign? Benign
Warthin tumor: malignant or benign? Benign
What is a pleomorphic adenoma *BENIGN* MIXED tumor of the parotid gland. Has epithelial and cartilagenous components
What is the treatment for pleomorphic adenoma PARODECTOMY! simply enucleating the tumor will leave finger like projections in the pt, 25% chance of recurrence!
A paradectomy is indicated for what tumor type? pleomorphic adenoma. Do not enucleate! it will leave tumor behind (finger like protrusions remain). This could lead to carcinoma expleomorphic adenoma
Carcinoma ex-pleomorphic adenoma is caused by... (rare 1-3% of cases) Enucleation of a pleomorphic adenoma rather than performing a paradectomy. (enucleation leaves behind finger like projection.)
Possible outcomes of enucleation of a pleomorphic adenoma Recurrence of the pleomorphic adenoma (25%) or carcinoma ex-pleomorphic adenoma(1-3%). The finger like projections left behind could lead to either one of these outcoms
pleomorphic adenoma vs warthin tumor Both benign tumors of the parotid gland. pleomorphic adenoma is mixed type: contains cartilage and epithelial cells. Warthin is only epithelial. pleomorphic adenoma indicates a parodectomy needs to be performed.
More common in male smokers: pleomorphic adenoma or warthin? Warthin
Papillary cystadenoma lymphamatosum: AKA WARTHIN (bening parotid gland tumor)
Describe key feature of warthin tumor **Double layer of epithelial cells **resting on dense lymphocystic stroma (lymphocytes are very dark and granular)
What are oncocytes Marked acidophilia (pinkness) and granularity seen in the lymphocytes present in the acini and ducts of normal salivary gland
Adenoid cystic carcinoma: benign or malignant? Where does it invade? Invades the perineural space (obviously maligant)
What head & neck neoplasia is associated with poorly encapsulated, small cells that invade the perineural space? adenoid cystic carcinoma. **Maligant carcinoma of the MINOR salivary glands**A
Aenoid cystic carcinoma is a cancer of: malignant cancer of the minor salivary glands *invades perineural space--> causes pain!!*
What is the MOST COMMON MALIGNANT tumor of the salivary glands mucoepidermoid (ALSO MOST COMMON CHILDHOOD SALIVARY GLAND TUMOR)
What promotes the onset of mucoepideroid carcinoma? RADIATION!!
What is the most common pediatric salivary gland carcinoma MUCOIDEPIDERMAL
What translocation gives a better prognosis in mucoidepidermal carcinoma? t(11;19)
t(11;19) associated with associated with a good prognosis in mucoidepidermal carcinoma!
Created by: rkirchoff