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Path - disease of head and neck 1&2
Terms in this set (99)
What are the parts/disease of the body covered in the head and neck path lectures?
2. Reactive oral masses
3. Oral Cavity
4. Odontogenic cysts
5. Upper airways
7. Nasopharyngeal tumors
11. Salivary glands
What are Caries?
- very common, tooth decay caused by bacteria fermenting sugars that produces acid which dissolves the enamel
What is in U.S. drinking water that is used to inc enamels resistance to that acid the bacterium produce?
- Fluoride, which produces fluoro-apatite in enamel
What is Gingivitis?
- inflammation of squamous mucosa that usually causes edema and bleeding. can progress to peridontitis
- think bleeding when you floss
What is Periodontitis?
- inflammation of deeper supportive structures of the teeth; can lead to tooth loss and systemic diseases (sepsis, infective endocarditis, local/systemic abscesses)
- there is inc risk in systemic disease (AIDs, DM, Crohn's, Leukemia)
What does the anatomy of teeth look like?
What is Tori?
- Common benign nodular bony overgrowth of the jaw bones; can arise from the maxillary portion of the jaw or from the mandible;
- related to bruxism
- present in about1/3 of the US population
- hard palate is MC location
What are the possible Reactive Oral Masses?
2. Pyogenic Granuloma
3. Peripheral giant cell granuloma
What is a Fibroma?
- reactive fibrous papule from chronic irritation
What is a Fibroma of the mouth ass/w?
- ass/w jagged teeth of ill fitting dentures
What is a Pyogenic Granuloma?
- Exuberant reparative granulation tissue or true endothelial cell tumor (lobular capillary hemangioma)
In what people are Pyogenic Granulomas common?
- pregnant women
- young people
Is a Pyogenic Granuloma benign or malignant?
Do Pyogenic Granulomas have rapid growth?
- as well as high mitotic activity and cellularity
What Reactive Oral mass it characterized by gingival proliferation of giant cells and fibrous stroma?
Peripheral Giant Cell Granuloma
What is Reactive Oral mass considered to be an accumulation of mucin called?
What does a Mucocoele look like under a microscope?
What are the 2 types of Mucocoeles?
Extravasation - traumatic injury (biting lip) to minor salivary gland with spilling of mucin in soft tissue
Retention - blocked salivary duct with mucin filled epithelial lined cyst
What is an Aphthous Ulcer (canker sore)
- a Canker Sore, common in children that is painful and may be ass/w celiac disease or inflammatory bowl disease
- decrease with age, very common
What is inflammation of the tongue called?
What causes Glossitis?
- nutritional deficiencies (vit B, iron)
- not usually contagious
What virus lies dormant in local nerve ganglia and may result in acute herpeic gingiovstomatitis if not treated?
HSV1 - Oral Herpes Simplex virus
How is Acute herpes Gingivostomatitis Dx?
Tzanck Smear Cytology
What are the s/s of Gingivostomatitis?
- abrupt onset of vesicles in the mouth
- clears in 3-4 weeks
What causes Oral Thrush?
Over growth of candida Albicans do to immunodeficiency or altered oral flora
What does Oral Thrush look like under a microscope and can Oral Thrush be scrapped off?
What is Hairy Leukoplakia?
- Hairy Leukoplakia is a clinical sign, white fluffy patches on the lateral border of the tongue.
- patches CANNOT be scraped off; is a sign of immunodeficiency (AIDS related illness)
- caused by EBV
What is the mc Oral Cancer?
Oral Squamous cell CA
What are the predisposing factors to Oral Squamous cell CA?
What are the precursor lesions to Oral Squamous cell CA
- leukoplakia - appearance from hyperkeratosis
- erythroplakia - often ulceration or eroded lesions that is usual dysplasia or cancer
What does the progression or Oral Squamous cell CA look like
- progresses similarly to how Cervical CA does
What is Fieldcancerization?
a growth pattern used to describe Oral Squamous Cell CA where multiple primary tumors occur individually over time
What is a Periapical cyst?
- mc cyst of the JAW, it is an inflammatory cyst at the apex of a tooth.
- occurs due to long standing caries or trauma
- lining will show inflammation, squamous epithelium and debris
What sort of odontogenic cyst arises around the crown of the tooth?
- squamous lining
- complete excision curitive; will recur if not completely excised
What is a Odontogenickeratocyst(OKC)?
- a developmental cyst that is more locally aggressive than other odontogenic cysts
- it has high recurrence rate in the parakeratotic variant
Wht is it called when there are multiple OKCs+ many cutaneous basal cell CA ?
Nevoid Basal Cell CA syndrome (gorlin's syndrome)
What is an Ameloblastoma?
- a low grade malignant tumor from odontogenic epithelium
- locally invasive
- recurs if not completely excised
What is Rhinitis?
- inflammation of the nasal mucosa
- most common infectious rhinitis is common cold
- usually caused by viruses, secondary infection can be bacterial
What is Rhinitis that is IgE mediated and involves eosinophil infiltrates?
What is Chronic Rhinitis?
- repeated bouts of infectious or allergic rhinitis usually bacterially imposed
- can lead to nasal polyps
What is edematous mucosa and inflamed stroma called when found in the nose?
How large can nasal polyps be?
up to 4cm or more!
What is Pharyngitis & Tonsilitis?
- viral or bacterial infections that may result in RF or post-strep GN
- usually bacterial superimposed on viral
What do the sinuses look like?
What is the biggest complication of sinusitis?
- can invade to cranial vault and cause meningitis
What is Unusual Sinusitis?
- a condition in which the cilia beat in the wrong direction or not at all due to a issue with the protein dynein
- Kartagener Syndrome is an example of this
- occurs in patients who are immunocompromised or that have DM
- condition is also called primary ciliary dyskinesia or immotile cilia syndrome
What is mucomycosis?
- (zygomycosis) fungal sinusitis that is necrotizing and aggressive due to vascular invasion
- no a problem unless the patient is immunocompromised
What is a Sinonasal Papilloma?
- benign tumor of squamous (or columnar) mucosa
What are the 2 types of Sinonasal Papillomas?
- exophytic--> grow up
- inverted--> most aggressive, invasive and recurrent
What is an AngioFibroma?
- a benign, large vesseled fibrous stromal tumor that is make of tissue that is erectile-like
- contains androgen receptors
- found in adolescent males
What is the Danger with AngioFibromas?
They bleed excessively
What is the name for a Malignant Neuroblastic tumor of the olfactory nerve?
- usually small blue cell tumor w long cytoplasmic processes (fibrillar background)
- invasive suviviral depends on grade and stage
Where anatomically is a Olfactory Neuroblastoma found?
What is the most common African Childhood Cancer?
- risk factors include: EBV, Nitrosamines in diet, and smoking
- contains lymphocytic background
- lymph metastesis common
What are the 3 histological subtypes of Nasopharyngeal CA?
- Keratinizing squamous cell (least radiosensitive)
- non-keratinizing squamous cell
- undifferentiated (most radiosensitive)
What is a clue that Nasopharyngeal CA can be the underlying primary lesion?
- when a pt has squamous or undifferentiated CA in cervical nodes without a known primary
What bug is an NK cell Lymphoma ass/w
- Necrosis and angio-invasion common
- Often have secondary
What is the prognosis for NK cell Lymphoma?
What is the CD marker used in identification of NK cell Lymphoma?
What are the Necrotizing Ulcerative Lesions of the nose and upper airways?
• NK T cell lymphoma
• Acute fungal infection
(such as Mucormycosis)
• Granulomatosis with polyangiitis
(new term for Wegener granulomatosis)
What is Otitis media?
- Inflammation/infection of the middle ear
- can be acute or chronic and can lead to ear drum perforation
What is a complication of Otitis Media?
Cholesteatoma - a keratinous cyst due to repeated bout of otitis media, that can rupture and cause a local inflammatory rxn
What is Otosclerosis?
- Abnormal bone deposition in the middle ear causing hearing loss, due to immobilization of the stapes.
- familial (AD, but with variable penetrance)
What is an Ear Tumor?
Basal cell & Squamous cell "skin cancers" from sun exposure to outer ear
- squamous cell in the middle ear
- can metastasize if ignored
What is a brachial cyst?
- a benign remnant of the lateral neck (SCM) found in early childhood that is usually fluid filled and causes chronic inflammation and is made of a fibrous tissue wall lines by squamous or respiratory columnar epithelium and rarly has malignant transformation
What is a Thyroglossal cyst?
- A thyroid migration remnant that can develop into a secondary thyroid tumor
What is a Carotid Body Tumor?
- Arises from Paraganglia (neuroendocrine cells part of ANS & Adrenal medulla)
What does a Paraganglioma look like histologically?
What are the possible etiologies of Laryngitis?
What is Laryngoepiglottitis?
Another name for Croup
- usually do to haemophilus influenza
What are Laryngeal Polyps and Nodules due to?
- Squamous polyps are reactive lesions with squamous epithelium overlying edematous stroma with fibrin
- usually occur in singers "singer nodules, or people or yell often and smoke
What is a Laryngeal Papilloma?
Papillary benign squamous proliferation most commonly found on the true vocal cords unilaterally due to HPV 6/11.
- Can cause papillomatosis-->leading to airway obstruction and can rarely lead to squamous cell CA "koilocytes"
What are the MC risk factors for Laryngeal CA?
- cigarette smoke
What is death due to most commonly in pts with Laryngeal CA?
What is Xerostomia?
Dry mouth due to dec in saliva production
What is Sjogren's Syndrome?
- chronic disease with dry mouth and dry eyets resulting from AI destruction of salivary and lacrimal glands
- can be a primary isolated disorder ( sicca syndrome) or secondary to another AI disease (RA or Lupus)
What is Mikulicz disease?
- Inflammatory rxn seen in salivary glands in Sjogren's Syndrome
- involves lymphocytic infiltrates and germinal center
- proliferation of ductal epithelium is seen and can develop secondary lymphomas
- NO HISTO NEEDED!
What is Mucocele?
- most common salivary gland lesion, usually found on the lower lip; when salivary gland is blocked or ruptured
- call Ranula when on the floor of the mouth
What is the term for inflammation of a salivary gland?
- cause by AI, bacterial(staph or strep) or viral infection(mumps)
What are the types of salivary gl tumors?
1. pleomorphic adenoma
2. warthin tumor
3. Mucoepidermoid CA
4. Adenoid cystic CA
5. Acinic cell CA
Where do Pleomorphic Adenomas usually arise?
- it is a benign but of the most common parotid gl tumors derived from myoepithelial cells
- painless, slow growing, mobile mass
- can recur if not completely excised due to small extensions
What is the MC bilateral salivary gl tumor?
- from salivary gland inclusion within intra-parotid lymph nodes.
- grossly resemble necrotic lymph node (cystic with brown fluid)
- is double layered, with pink granular epithelium packed with mitochondia and lymphoid infiltrate
What is the MC primary salivary gland cancer?
- composed of squamous cells, mucin producing glandular cells and intermediate cells
- grade influences prognosis
What salivary gland tumor is found in cribiform patterns?
Adenoid Cystic CA
- Malignant tumor found in tubular solid and cribiform patterns of cell with reduplicated basal lamina
- Perineurial invasion is key!
- slow but relentless
What type of salivary gland tumor has zymogen granules?
Acinic cell CA
- Acinar cell differentiation with zymogen granules
- slow growing
- involves facial nerve
- recurs after surgery
What can severe sinusitis turn into?
What condition beings with a cold and hoarseness and can result in difficult breathing and swallowing the next day, caused by H.influenza?
Acute Bacterial Epiglottis
What disease is ass/w steeple sign?
LTB or Croup
- caused by para-influenza
What virus is Ass/w Nasopharyngeal CA?
Do Laryngeal papillomas usually recur after excision?
YES, atleast until puberty
T/F: Otosclerosis is a familial condition
- especially if its severe
What is another name for Brachial Cysts?
- Char histologically as being granular and keratinous
What sort of tissue usually surrounds a Thyroglossal Duct Cyst?
Lymphoid - low chance of malignancy
What stain are Paragangliomas positive for?
What is the most common cause of xerostomia and xero-ophthalmia ?
What is the most common tumor of the parotid gland?
What is the histological description of a Pleomorphic Adenoma?
Ductal epithelial cells in a myxoid stroma containing islands of chrondro-like tissue and bone
What is the second most common tumor of the parotid gl, that is usually bilateral has lymphoid infiltrate and has spaces lined by a double layer of superficial columnar and basal cuboidal epithelium
What Tumor account for the majority of tumors in salivary glands
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