Professional Documents
Culture Documents
Head
[Congenital/malformations/inflammation acute;chronic/tumours]
Oral cavity
o HSV1 cold sores very common, lips ; nose, single lesions/diffuse form ->
acute herpetic gingivostomatitis. Children/adults. Infection direct contact
(per os) neurotropism (basal ganglia of CNXII dormancy)
Predispositions exposure to cold, sunlight, wind, before menstruation,
stress,allergic reactions
Clinically local redness, swelling, pain
Morphology vesicles (small bullous), serous fluid crusts
o Angular cheilitis common, adults, M=F
Risks xerostomia, cigarette, Fe defit anemia, vitB defit, malab
syndromes, Zn defit, impaired IS (DownS, HIV, DM, cancer), lip
anomalies, dental prosthesis
Etiology candida, G+ bacteria (Staph), mechanical injury (skin
maceration elderly pts w toothlessness
Clinical pain, erythema, fissures, erosioness, crusts, atrophy
o Aphthous ulcers = Canker sore
Very common
Etiology unknown (dysreg of IS?), children/teens
Gross single/multiple, erosioness /ulcerations, erythema around
ulcerations
Clinical painful lesion, secondary infection purulent inflamm, self-
limit 7days/ persistent form, recurrent lesion // OR non-infective lesion!
o Oral candidiasis = thrush
o Opportunistic infection
AIDS, DM, neutropenia (leukemia, aplastic anemia), iatrogenic
infection long term Ab therapy
o Clinical angular cheilitis, painful, yellowish-gray superf membs,
erythematous background
Upper airways (nasal cav, nasopharynx, sinuses, larynx, throat)
o Throat pharyngitis/tonsillitis
V common, children/adults
Etiology viruses (rhino, echo, adeno, influ), bac (secondary! ; b-hemo
strep, staph), fungi (candida ; long term Ab therapy)
Opportunistic infection neutropenia, immunodefit processes
congenital/acquired), DM
Head and Neck Pathology
Clinical acute rapid onset sore throat, fever, malaise, headache,
cervical LN enlarged
Swelling and red colour of mucosa
Enlarged tonsils
Suppurative exudate pseudomembs (bact infec)
Abcesses of tonsillar crypts (bac infec)
Consequences Rheumatic fever, glomerulonephritis
Morphology exudative inflamm, reactive lymphoid hyperplasia
(follicular tonsillitis)
o Rhinitis
Acute/chronic
Etiology viral (common cold ; adenovirus, echo, rhino), bacterial
(secondary infection), allergic (hay fever ; plant [pollens, fungi, animal
allergen, dust mites)
Clinical runny nose (serous/suppurative exudate), weakness,
headache, dyspnea, fever
Morphology thick, edematous mucosa, deep pink/red, serous muco
purulent exudate
o Nasal polyps
39-year-old woman has been bothered by headache, facial pressure, nasal obstruction with
discharge, and diminished taste sensation for the past 6 months. On physical examination there is
discomfort on palpation over her left maxillary sinus. No oral lesions are noted. Rhinoscopy shows
nasal erythema, marked edema, and purulent discharge
Complication of infalammatory nasal polyp = nasopharyngeal carcinoma
Polypous overgrowths of the mucosa reaching even 3-4 cm, as a result of
repeated inflamm process (either infectious or allergic in nature)
Polyps are composed of hyperplastic, frequently chronically inflamed
and swollen mucosa w hyperplastic glands
Laryngeal squamous cell carcinoma - large, fungating neoplasm that has the typical
appearance of a laryngeal squamous cell carcinoma. The most common risk factor is smoking, although chronic
Head and Neck Pathology
alcohol abuse also plays a role; some patients harbor human papillomavirus sequences. Invasive cancers arise from
squamous epithelial dysplasias. . Squamous cell carcinomas arise in the buccal mucosa and are invasive.
Benign
True vocal cords
Adults single nodule
CHILDREN multiple (juvenile laryngeal papillomatosis)
1. Recurrent, HPV6,11, no malignant transformation, spont
regression at puberty
Tumors of the larynx may be reactive proliferations or neoplastic growths. The
laryngeal nodule is a
common abnormality formed as a reactive process to excessive use; as such it may
be found in singers and is called a singers nodule. These nodules are solitary,
produce hoarseness, and histologically reveal a polyp consisting of fibrosis, dilated
vascular spaces, and myxomatous degeneration of
the stroma. Reactive nodules (vocal cord polyps, or singers nodules) occur most
often in men who are heavy smokers or who strain their vocal cords. The nodules
are generally only a few millimeters in size and have a fibrovascular core covered by
hyperplastic and hyperkeratotic squamous epithelium. They are not premalignant.
Malignant neoplasms of the larynx are most often squamous cell carcinomas.
Squamous cell carcinomas of the pharynx and larynx form irregular, ulcerating
masses, are more common in smokers, but generally are seen in individuals older
than this patient.
3. cylindrical
o Naropharyngeal carcinoma
Assoc w EBV!!!, and to a lesser extent heredity, nitrozamines and
smoking,
Incidence of subtypes varies with geography
Rare in most pops, but common in a few well defined pops incl. natives
of southern China, SEAsia (adults), the Arctic and MEast/NAfrica (in
Africa cancer of children)
Tx radiotherapy esp of poorly differentiated cases
Patterns
1. keratinizing squamous cell carcinomas
o microscopicqlly evident keratinization
o 25% of all nasopharyngeal carcinomas
o M>F, 4-6 decade
o Weaker assoc w EBV compared to other two
o Invasive carcinoma demonstrating obvious squamous
differentiation as intercellular bridges and keratinization
d. MUCOSAL MELANOMA
Ear
1. Acute otitis
a. Infants/ children,adults Rare
b. Middle ear + mastoid
c. Etiology
Head and Neck Pathology
i. Viral serous exudate
ii. Bacterial pus (streptococci)
d. Clinical pain, tenderness, headache, fever, decreased appetite, transient
deafness
e. Increased risk of recurrence
f. Recurrent acute otitis chronic otitis
2. Chronic otitis
a. Repeated acute otitis with failure of resolution
b. Etiology bacterial pseudomonas aeruginosa (DM destructive necrotizing
otitis media), staph aureus, fungi, mixed flora
c. Clinical attacks of symptoms typical for acute otitis (exacerbation)
d. Complications perforation of ear drum, involvement of
ossicles/labyrinth/mastoid space, purulent .. ??
Cholesteatoma
Non-neoplastic tumour in the middle ear
Morphology cyst, small 1-4cm dia), fibrous wall, keratinizing squamous epithelium,
cholesterol crystals, chronic inflamm (multinucleated giant cells)
Slow enlargement
Erosion if ossicles, labyrinth, skull, soft tiss
Can mimic primary brain
Otosclerosis
Abnormal fibrosis/ calcifications, bone deposition in the middle ear about the rim of
the oval window immobilisation of the footplate of the stapes
Unilat/bilat
Younger pts (30-40y)
Familial condition (AD!)
Slow progression
Clinical hearing loss
Neck
Congenital anomalies
o 1. Branchial cyst = lymphoepithelial
Unilat/bilat
Origin remnants of the branchial arches, development salivary gland
inclusions within cervical LNs
Slow enlargement
Head and Neck Pathology
Gross cyst dia 2-5cm
Morphology fibrous wall, squamous/pseudostratified columnar
epithelium, lymphocytic infiltrate lymphatic tiss, cystic content is
clear and watery/muinous
BRONCHIAL CYSTS ARE LATERALLY Branchial cleft cysts, which arise from
remnants of the branchial (pharyngeal) apparatus, may contain lymphoid tissue A 25-
year-old woman is concerned about a lump on the left side of her neck that has remained the same
size for the past year. Physical examination shows a painless, movable, 3-cm nodule beneath the skin
of the left lateral neck just above the level of the thyroid cartilage. There are no other remarkable
findings. Fine-needle aspiration of the mass is performed. Her physician is less than impressed by the
pathology report, which notes, Granular and keratinaceous cellular debris. Fortunately, she has
saved her Robbins pathology textbook from medical school. She consults the head and neck chapter
to arrive at a diagnosis, using the data from the report. There are several types of cysts that
occur in and around the oral cavity.
Branchial cysts, also known as lymphoepithelial cysts, may be remnants of an
embryonic branchial arch or a salivary gland inclusion in a cervical lymph node. They
are distinguished from thyroglossal duct cysts by their lateral location, the absence
of thyroid tissue, and their abundant lymphoid tissue. Occult thyroid carcinoma,
often a papillary carcinoma, may manifest as a metastasis to a node in the neck, but
the microscopic pattern is that of a carcinoma. About 5% of squamous cell
carcinomas of the head and neck initially manifest as a nodal metastasis, without an
obvious primary site. This patient is quite young for such an event, however.
o 2. Thyroglossal tract cysts (MOVES WHEN SWALLOWING)
A 56-year-old woman has noticed an enlarging lump on the right side of her neck for the past 7
months. On physical examination, there is a 3-cm nodule in the right upper neck, medial to the
sternocleidomastoid muscle and lateral to the trachea at the angle of the mandible. CT scan shows a
circumscribed, solid mass adjacent to the carotid bifurcation. Microscopic examination of the
excised mass shows nests of round cells with pink, granular cytoplasm. Tests for
immunohistochemical markers chromogranin and S-100 are positive. Electron microscopy shows
neurosecretory granules in the tumor cell cytoplasm. The tumor recurs 1 year later and is again
excised. A thyroglossal duct (tract) cyst is a developmental abnormality that arises from elements
of the embryonic thyroglossal duct extending from the foramen cecum of the tongue down to the
thyroid gland. One or more remnants of this tract may enlarge to produce a cystic mass. Although
lymphoid tissue often surrounds these cysts, malignant transformation does not occur
Mucocele cystic space filled w saliva (obstructed minor salivary gland) Mucoceles, which
typically occur on or near the lips due to a ruptured minor salivary gland, consist of a cyst filled with
mucous material. They lack an epithelial lining.
Head and Neck Pathology
A 95-year-old man, had local trauma, has noted swelling of his lower lip for the past month. On examination,
there is a fluctuant, 1-cm nodule with a blue, translucent hue just beneath the oral mucosa on the inside of
his lip. The lesion is excised, and on microscopic examination shows granulation tissue.
a mucocele of a minor salivary gland, which is most often the result of local trauma in the very
young and very old. There is either rupture or blockage of a salivary gland duct.
2.
a. Blocked outflow from the salivary duct (mucous retention) or rupture of the
duct (mucous extravasation cyst)
b. May be partially lined w epithelial cells, w chronic inflamm infiltrate
(granulation tiss) in the wall
Clinical local swelling (lump) or even polyp *RANULA mucocele in the
1. Benign
2. Parotid (60-85% ; 15-30% of it being malignant),
submandibular 10% of which 40% is malignant, sublingual and
other glands 5-25% of which 50-90% being malignant, minor,
salivary glands
3. F>M
4. Clinical single solitary nodule, swelling of the parotid, mobile
nodule, 2-4-6-10cm dia, painless, slow growth, encapsulated
5. Morphology epithelial (ductal) and mesenchymal
proliferation, myoepithelial cells, mesenchymal metaplasia
(chondroid-cartilaginous, myxoid, hyaline, bone, fat, tiss),
fibrous capsule, satelitary nodules, no pleomorphism,
decreased mitotic activity
Recurrency is COMMON (25% if tumour was only
enucleated)
Malignant transformation RARE (carcinoma-ex-pleomorphic
adenoma, malignant mixed tumour) risk is increasing w
time (10% after 15y)
Three malignant tumors of the salivary glands are mucoepidermoid carcinoma, adenoid cystic carcinoma,
and acinic cell carcinoma. Mucoepidermoid carcinomas consist of a mixture of squamous epithelial cells
and mucus-secreting cells. The mucus-secreting cells of a mucoepidermoid carcinoma can demonstrate
intracellular mucin with a special mucicarmine stain. Mucoepidermoid tumors are less common than
pleomorphic adenomas in major salivary glands. They may be high-grade and aggressive. Mucoepidermoid
carcinomas are infiltrative and form mucous cysts along with a population of squamoid cells.
A 60-year-old woman noticed an enlarging bump beneath her tongue for
the past year. She does not smoke or use alcohol. On physical examination,
there is a 2.5-cm, movable, submucosal mass arising in the minor salivary
glands on the buccal mucosa beneath the tongue on the right. Histologic
examination of the excised mass shows that it is malignant and locally
invasive. The tumor recurs within 1 year.
Mucoepidermoid carcinomas can arise in major and minor salivary glands. They account for most neoplasms that
arise within minor salivary glands, particularly malignant neoplasms. Low-grade mucoepidermoid carcinomas may be
invasive, but the prognosis is usually good, with a 5-year survival of 90%. High-grade mucoepidermoid carcinomas
can metastasize and have a 5-year survival of only 50%.
Adenoid cystic carcinomas form tubular or cribriform patterns histologically and have a tendency to invade
along perineural spaces, especially the facial nerve. Acinic cell carcinomas contain glands with cleared or
vacuolated epithelial cells.
Head and Neck Pathology
Acute necrotizing ulcerative gingivitis (Vincents angina or trench mouth) is caused by two
symbiotic organisms, a fusiform bacillus and a spirochete (B. vincentii), the combination
being termed fusospirochetosis.
Ameloblastoma - Histologic sections from a 3-cm mass found in the mandible of a 55-year-
old female reveal a tumor consisting of nests of tumor cells that appear dark and crowded at
the periphery of the nests and loose in the center (similar to the stellate reticulum of a
developing tooth). Grossly, the lesions consist of multiple cysts filled with a thick, motor
oillike fluid.
Head and Neck Pathology
A rare tumor of the oral cavity (found most commonly in
the mandible) that is similar to the enamel organ of the
tooth is the ameloblastoma. This locally aggressive tumor
consists of nests of cells that at their periphery are similar
to ameloblasts and centrally are similar to the stellate
reticulum of the developing tooth. A similar lesion occurs in
the sella turcica and is called a craniopharyngioma. In
contrast, pleomorphic adenomas, mucoepidermoid
carcinomas, adenoid cystic carcinomas, and acinic cell
carcinomas are all tumors that originate in salivary glands.
Retinoblastoma is the most common malignant tumor of the eye in children. Clinically,
retinoblastoma may produce a white pupil (leucoria). This is seen most often in young
children in the familial from of retinoblastoma, which is due to a deletion involving
chromosome 13. These familial cases of retinoblastoma are frequently multiple and bilateral,
although like all the sporadic, nonheritable tumors they can also be unifocal and unilateral.
Histologically, rosettes of various types are frequent (similar to neuroblastoma and
medulloblastoma). There is a good prognosis with early detection and treatment;
spontaneous regression can occur but is rare. Retinoblastoma belongs to a group of cancers
(osteosarcoma, Wilms tumor, meningioma, rhabdomyosarcoma, uveal melanoma) in which
the normal cancer suppressor gene (antioncogene) is inactivated or lost, with resultant
malignant
change. Retinoblastoma and osteosarcoma arise after loss of the same genetic locus
hereditary mutation in the q14 band of chromosome 13. In contrast, a blue sclera can be seen
Head and Neck Pathology
with osteogenesis imperfecta, while a yellow sclera is seen with jaundice. Lack of an iris
(aniridia) can sometimes be associated with Wilms tumor of the kidney, while a subluxed
lens can be found in individuals with either Marfans syndrome or homocystinuria.
Two cysts that occur in the neck are the branchial cleft cyst (usually located in the
anterolateral part of the neck) and the thyroglossal duct cyst (usually located in the anterior
part of the neck). Each of these cysts may histologically reveal a lining
composed of squamous epithelium or pseudostratified columnar epithelium.
Branchial cleft cysts, which arise from remnants of the branchial (pharyngeal)
apparatus, may contain lymphoid tissue, while thyroglossal duct cysts may move up and
down as the patient swallows. A 25-year-old woman is concerned about a lump on the left side of her
neck that has remained the same size for the past year. Physical examination shows a painless, movable, 3-
cm nodule beneath the skin of the left lateral neck just above the level of the thyroid cartilage. There are
no other remarkable findings. Fine-needle aspiration of the mass is performed. Her physician is less than
impressed by the pathology report, which notes, Granular and keratinaceous cellular debris. Fortunately,
she has saved her Robbins pathology textbook from medical school. She consults the head and neck
chapter to arrive at a diagnosis, using the data from the report. There are several types of cysts that
occur in and around the oral cavity. The most common type is the radicular cyst. These
cysts result from chronic inflammation of the tooth apex. Histologic sections reveal chronic
inflammation of the tooth apex with epithelialization of periapical granulation tissue. Other
types of oral cysts include follicular cysts (which arise from the epithelium of the tooth
follicle), odontogenic keratocysts (which consist of keratinized squamous epithelium), and
inclusion (fissural) cysts (which are fluid-filled cysts lined by squamous or respiratory
epithelial cells). Follicular cysts are called dentigerous cysts because the associated tooth is
unerupted, while odontogenic keratocysts are important because they may recur and act
aggressively. These keratocysts may also be associated
with basal cell carcinomas of the skin.
Head and Neck Pathology
Increased pressure with inflammation in the sinus can erode into adjacent bone, causing
osteomyelitis. A mucocele filled with nonpurulent secretions is more likely to occur in
frontal and ethmoid sinuses. Sinusitis is not a risk factor for malignancy. Nasopharyngeal
carcinomas are related to Epstein-Barr virus (EBV) infection. T-cell lymphomas typically
occur in men and are EBV positive. Papillomas most often occur in men and have an
exophytic growth pattern, but those that are endophytic aggressively extend into adjacent
soft tissue and bone, making removal difficult.
There is no effective antiviral therapy for human papillomavirus. Although the lesions can
arise throughout the airways, they are benign and do not become malignant.
The occurrence of the lesions is not related to the use of the voice, as is a laryngeal nodule,
which is quite small. This is not a congenital condition and is not part of a syndrome.
Non- Hodgkin lymphomas are found in adjacent cervical lymph nodes or in the Waldeyer
ring of lymphoid tissue.
In some parts of the world, the chewing of betel nut is a risk factor for oral cancer.