HEAD AND NECK PATHOLOGY

Transcription

1 Bosnian-British School of Pathology November 2012 HEAD AND NECK PATHOLOGY Slide seminar: Oral Pathology Preferred Diagnoses Dr A Sandison, Slide seminar: Pathology of the Oral Cavity Page 1 of 5

2 1. Female 86y Warty lesions buccal mucosa. Cooper JR, Hellquist H, Michaels,L; J.Pathol WELL DIFFERENTIATED SQUAMOUS CELL CARCINOMA (VERRUCOUS TYPE) Clinical: Characterised by exophytic warty growth that is locally invasive. 75% occurring oral cavity (buccal and gingival mucosa) 15% larynx (vocal cords). Rarely does it affect sinonasal tract and nasopharynx. Micro: Hyperplastic squamous epithelium with broad club shaped villiform projections. Marked surface keratosis. Amphibian cells are large with vesicular nuclei and prominent nucleoli and can be multinucleate. Numerous dyskeratototic cells are usually present and suprabasal mitoses with atypical forms may be present. Usually prominent inflammatory infiltrate is present at the epithelial stromal interface often rich in eosinophils. Notes: Thought to be related to tobacco and betel leaf use. HPV 16/18 also implicated. Main differential verrucous hyperplasia, papilloma, well diff and papillary SCC. Slide seminar: Pathology of the Oral Cavity Page 2 of 5

3 2. Male 29y 1 year history of ulcerated lesion soft palate, presumed SCC. de Pontual L, Ovetchkine P, Rodriguez D, et al. Rhinoscleroma: a French national retrospective study of epidemiological and clinical features. Clin Infect Dis. Dec ; 47(11): RHINOSCLEROMA Clinical: Chronic progressive inflammatory condition usually affecting the nose, in which large deforming masses of tissue distend the nasal cavity. It may spread to the pharynx, larynx, trachea, major bronchi and rarely the orbit (18) Nasal Cavity (95-100%) Nasopharynx (18-43%) Larynx (15-40%) Trachea (12%) Bronchi (2-7%); Other: Oral cavity, paranasal sinuses, soft tissues of the lips and nose and in rare cases the orbit. It is related to infection by the organism Klebsiella Rhinoscleromatis. In one rare case K pneumoniae subspecies ozaenae was isolated from the pharynx of a woman with laryngeal scleroma. Symptoms: Rhinorrhea, epistaxis, nasal deformity, anesthesia of the soft palate, difficulty breathing that progresses to stridor, dysphonia, anosmia. Imaging shows a homogenous and nonenhancing soft tissue mass with well defined edges. Adjacent fascial planes not invaded Micro: Large nodular tumour like masses containing large macrophages with foamy cytoplasm (Mikulitz cells). Although the organisms are occasionally visible on standard H&E stains, they are more readily demonstrated by using silver impregnation Warthin- Starry stains. Differential: Syphilis, Tuberculosis, Leprosy, Yaws, Wegener Granulomatosis, Lethal midline granuloma, Mucocutaneous Leishmaniasis, Malignancy. Slide seminar: Pathology of the Oral Cavity Page 3 of 5

4 3. Male 72y 8month history of slow growing swelling left palate mucosa/alveolar ridge lower 3-6 region; painless, rubbery to feel and does not bleed. s Nosfinger et al; Laryngoscope : Kapadia et l; Medicine Liu, HY et al: J of Int Med Res (1) EXTRAMEDULLARY PLASMACYTOMA Clinical: Nasal cavity paranasal sinuses and pharynx are the most common site in the Head and Neck. Patients a re usually male (M: F 4:1) with a mean age of 60y. Lesions are usually solitary (90%). Micro: Histology shows a monoclonal proliferation of plasma cells. Welldifferentiated lesions may be mistaken for reactive proliferations and can mimic Rhinoscleroma or Rosai - Dorfman. Poorly differentiated lesions may mimic melanoma or metastatic carcinoma (EMA is commonly positive) Notes: 80% extraosseous plasmacytomas occur in head and neck 22% nasopharynx; 16-18% larynx; 7%. Good prognosis. 4. Female 53 Tumour mandible s Soung Min et al J. Craniofacial & Maxillofacial Surgery : Potter, BO et all; Surg Oncol N Am (2) METASTATIC LEIOMYOSARCOMA Clinical: Rarely involves the oral cavity very few (7) reported cases. Aggressive behaviour. Micro: Identical to the soft tissue counterpart. This case pleomorphic spindle cells with atypical mitoses. Slide seminar: Pathology of the Oral Cavity Page 4 of 5

5 5. Male 70y Previous SCC 5 years ago. Large fast growing tumour. Left hemiglossectomy. Chuang & Crowe: Int J OfOncol 2007: 30: SPINDLE CELL (SARCOMATOID) SQUAMOUS CELL CARCINOMA Clinical: Occurs most frequently in larynx oral cavity then skin, tonsil, sinonasal and pharynx. Micro: Malignant spindle cell component with conventional SCC (CIS or invasive). May be cytokeratin negative and express Vimentin and SMA. Metastases usually more differentiated or mixed, rarely spindle cells. Beware the paucicellular spindle cell SCC which may mimic inflammatory reaction. Notes: Associated with smoking and alcohol. Also seen post-irradiation (estimated incidence in H&N is 8-9%). Histogenesis uncertain thought to be monoclonal proliferation. 6. Female 50y Slowly enlarging lesion left lateral border of tongue. Denture wearer. GRANULAR CELL TUMOUR Clinical: Rare lesions. 50% occur in head and neck and 50% of these are in the tongue. They occur in all ages peak y % are multiple. F>M 2:1. Appear smooth and sessile macroscopically 1-2 cm diameter and poorly demarcated. Micro: Histologically there is a proliferation of large cells with granular cytoplasm and a central small nucleus. They express S100, NSE, and PGP9.5 CD68. 30% have associated pseudoepitheliomatous hyperplasia. Differential Diagnosis - SCC & Xanthoma 7. Slide seminar: Pathology of the Oral Cavity Page 5 of 5