Anatomy

Salivary glands are exocrine organs responsible for the production and secretion of saliva. They comprise the three paired major glands, the parotid, sub-mandibular and sublingual, and the minor glands. The latter are numerous and are widely distributed throughout the mouth and oropharynx and similar glands are present in the upper respiratory and sinonasal tracts, and the paranasal sinuses. The functional unit of salivary glands is the secretory acinus and related ducts, and myoepithelial...

Mrs

Fig. 2.11 Nasopharyngeal nonkeratinizing carcinoma with papillary architecture. A The tumour forms exophytic papillae with fibrovascular cores. B The lining cells show features of differentiated nonkeratinizing carcinoma. plasmic clear cell change, but this is such an uncommon feature that the alternative diagnosis of lymphoma or salivary gland-type carcinoma should always be considered. Exceptionally, there is accumulation of extracellular edema fluid or mucosubstance, breaking up the tumour...

Sinonasal undifferentiated carcinoma

A highly aggressive and clinicopatholog-ically distinctive carcinoma of uncertain histogenesis that typically presents with locally extensive disease. It is composed of pleomorphic tumour cells with frequent necrosis, and should be differentiated from lymphoepithelial carcinoma and olfactory neuroblastoma. The tumour is rare, with fewer than 100 reported cases. The age range is broad (third to ninth decade), and the median age is in the sixth decade 350,1216 . There is a male predominance (2-3...

Histopathology

Oral melanoma may have in-situ (radial) and invasive growth phases, but the histological classification is not analogous to cutaneous lesions. Mucosal lesions are similar to acral lentiginous melanoma of the skin 2652 , with junctional activity and upward migration but Pagetoid invasion is unusual. Atypical melanocytic lesions may progress to malignant melanoma but there is little evidence for progression of oral benign melanocytic naevi to invasive malignancy 1085, 2652 . Oral mucosal melanoma...

Yve

A Sheet-like growth pattern of large pleomorphic cells with abundant eosinophilic cytoplasm and prominent nucleoli. B Strong immunoreactivity for cytokeratin. Fig. 5.42 Large cell carcinoma. A Sheet-like growth pattern of large pleomorphic cells with abundant eosinophilic cytoplasm and prominent nucleoli. B Strong immunoreactivity for cytokeratin. Fig. 5.43 Large cell carcinoma. A Organoid growth pattern. B Solid growth with peripheral palisading and rosette-like...

Sentinel node biopsy

This is currently an experimental technique 2057 that is under active evaluation by prospective clinical trials and it is not practised at all centres. It is a technique used primarily for staging a clinically N0 neck. in an effort to avoid a neck dissection. If a clinically N0 neck is followed untreated until tumour development occurs, the prognosis can be very poor 57,977 . Studies on the incidence of occult metastases in N0 necks 753 have shown tumour spread in only a small minority of...

Info

Fig. 2.4 Positron emission tomography coupled with computed tomography (PET-CT) of nasopharyngeal carcinoma. Physical examination and biochemistry did not show any sign suggestive of distant metastases. X-ray chest was normal. PET-CT revealed multiple distant metastases in lung, liver and spleen, in addition to extensive local infiltration and bilateral cervical lymph nodes. Fig. 2.4 Positron emission tomography coupled with computed tomography (PET-CT) of nasopharyngeal carcinoma. Physical...

Oral Cavity

The oral cavity extends from the lips to the palatoglossal folds. The outer vestibule is enclosed by the cheeks and lips and forms a slit-like space separating it from the gingivae and teeth. It is limited above and below by mucosal reflections from the lips and cheeks. The space bordered by the teeth and gin-givae is the oral cavity proper. It is bounded inferiorly by the floor of the mouth and tongue and superiorly by the hard palate. The buccal mucosa extends from the commissure of the lips...

Wxu

A Squamous differentiation. B Chondroid differentiation. C Osseous differentiation. D Lipomatous differentiation. Fig. 5.51 Pleomorphic adenoma. A Squamous differentiation. B Chondroid differentiation. C Osseous differentiation. D Lipomatous differentiation. typically is positive with stains for elastin. This material can push apart epithelial elements to give a cylindromatous or cribriform appearance that is readily mistaken for adenoid cystic carcinoma. Some...

D

Fig. 1.90 Melanotic neuroectodermal tumour. A Section of maxilla shows tumour infiltration of bone. Note fibrous stroma containing neoplastic cellular infiltrate. B Dual population of neoplastic cells, including smaller blue neuroblastic cells and larger pigmented epithelial cells. C There is a trabecular, tubular, or alveolar arrangement of the biphasic cell population, with the larger pigmented cells surrounding groups of the smaller round, blue neuroectodermal cells. The trabeculae are...

ICDOcode88503

Well Differentiated Whabdomyosarcoma

Primary liposarcomas of the larynx are rare, comprising less than 20 of all head and neck liposarcomas and fewer than 0.5 of all laryngeal neoplasms. Patients of all ages are affected, with a median of 64 years. There is a marked male to female predominance (nearly 10 1). The tumours, which occur almost exclusively in the supraglottic larynx or hypopharynx (pyriform sinus), most commonly cause airway obstruction. Imaging, especially with MR or CT, will document the lipomatous nature and extent...

Prognosis and predictive factors

PSCC is considered a relatively highgrade, aggressive salivary carcinoma. Five-year disease specific survival is approximately 25-30 . Local-regional recurrence develops in at least half of patients and distant metastases are found in 20-30 2329 . Overall, 75 die of their disease, usually within 5 years 1456,2329 . In the largest published specific analysis of PSCC 2329 , tumour stage was the most important prognostic factor. Age greater than 60 years, ulceration, and fixation also had a...

Median rhomboid glossitis

A Two lesions of chronic candidiasis of the median rhomboid glossitis form. That on the left is flat and more typical, that on the right more nodular and irregular. B Typical median rhomboid glossitis with active candidal infection showing long bulbous rete hyperplasia and suprapapillary atrophy. Note the broad band of dense fibrosis separating the inflamed superficial corium from the underlying muscle. Fig. 4.31 Median rhomboid glossitis. A Two lesions of...

Pathology and Genetics of Head and Neck Tumours

Eveson Peter Reichart David Sidransky World Health Organization Classification of Tumours Pathology and Genetics of Head and Neck Tumours Leon Barnes, M.D. John W. Eveson, M.D. Peter Reichart, M.D. David Sidransky, M.D. Vanessa Meister Marlen Grassinger Stephan Rappo Sibylle S ring International Agency for Research on Cancer (IARC) 69008 Lyon, France This volume was produced in collaboration with the International Academy of Pathology (IAP) Department of Pathology,...

Ptcciii

APTCC, papillary tubular cylinder cell 'Survival data derived from Kleinsasser and Schroeder 1333 reactivity (43 to 93 of cases) 800 . CDX-2, a nuclear transcription factor involved in the differentiation of intestinal epithelial cells and diffusely expressed in intestinal adenocarcinomas, is commonly expressed in ITACs 800 . Information on CEA staining in ITACs is conflicting 1687,2660 . Scattered or groups of chromogranin-positive cells are frequently identified 1687 these neuroendocrine...

AND 1 awdWt J

Fig. 1.22 Sinonasal small cell carcinomas, neuroendocrine type (SCCNET) are aggressive tumours with a mortality rate of > 60 despite multimodal therapy. (DOD, dead of disease AWD, alive with disease AND, alive no disease DOC, dead other causes). type is a high-grade carcinoma composed of small to intermediate sized cells resembling those of small cell carcinoma of pulmonary or extrapulmonary origin. Necrosis, large numbers of apop-totic cells, high mitotic rate, and lack of neurofibrillary...

Tns

A Schematic illustration of promoter swapping between PLAG1 and CTNNB1 in pleomorphic adenomas wit are indicated by filled boxes. Breakpoints are indicated by arrows. B Schematic illustration of the HMGA2 gene. Coding exons are indic Breakpoints are indicated by arrows. imas with t(3 8). Coding exons are indicated by filled boxes. imas with t(3 8). Coding exons are indicated by filled boxes. play a major role in the genesis of pleomorphic adenomas 2700 . The...

Papillary hyperplasia

Papillary hyperplasia is an asymptomatic nodular or papillary mucosal lesion typically seen in the palate of patients who wear dentures. Most patients wear ill-fitting dentures, wear dentures continuously 2645 or have poor denture hygiene. Lesions also arise in non-denture wearers, in xerostomia or individuals with a high arched palate. Florid and extensive presentations occur in immunosuppres-sion 937 and HIV infection 2150 . There is sessile nodular papillomatous hyperplasia of epithelium and...

Papillomas and papillomatosis in immunodeficiency

More florid presentations of HPV-induced lesions are found in immunosuppression, particularly in HIV infection. Lesions may be larger, multiple and coalesce to form extensive patches of affected mucosa. Occasionally the entire oral mucosa may become papillomatous and some of these presentations are not easily classified. Unusual HPV subtypes and multiple HPV subtypes are more frequent in immunosuppression. Occasional lesions in HIV infection are dysplastic and are of uncertain malignant...

Schneiderian Papilloma Exophytic

Mucous Papillomas

Fig. 1.29 Inverted papilloma A Low magnification showing hyperplastic aggregates of well-demarcated squamous and respiratory epithelium extending throughout the stroma. Note the absence of mucoserous glands. B Papilloma composed partially of hyperplastic, ciliated respiratory epithelium. Note the epithelial transmigration of neutrophils and the delicate basement membrane. C HPV nuclear and cytoplasmic reactivity can be seen in some inverted papillomas, usually in the same nuclei which exhibit...

Haematolymphoid tumours

Cheung S.B. Kapadia Primary non-Hodgkin lymphomas (NHL) of the nasal cavity or paranasal sinuses are defined as lymphoid cell neoplasms in which the bulk of disease occurs in these anatomic sites. Most cases described in the past as polymorphic reticulosis, malignant mid-line reticulosis, lethal midline granuloma or angiocentric immunoproliferative lesion, are now reclassifiable as extran-odal NK T cell lymphoma of nasal-type. Malignant lymphoma is the second most...

Tumours of the nasopharynx Introduction

Squamous Cell The Nose

Wenig A.W.M. Lee Fig. 2.1 Sagittal section of the head showing the nasopharynx, nasal cavity and paranasal sinuses. 3797 1 - Sphenoidal sinus 2 - Superior meatus 3- Middle meatus 4 - Tubal elevation 5 - Pharyngeal tonsil 6 -Pharyngeal orifice of Eustachian tube 7 - Salpingopharyngeal fold 8 - Pharyngeal recess 9 - Soft palate 10- Uvula 11- Frontal sinus 12 - Sphenoethmoidal recess 13 - Superior nasal concha 14 - Middle nasal concha 15 - Inferior nasal concha...

Tumours of the hypopharynx larynx and trachea Introduction

Paraglottic Space

Zidar P. Boffetta With emphasis now on accurate staging and conservative surgery to retain as many functions as possible, especially in the larynx, the pathologist has emerged as an invaluable member of the health care team. Precise and detailed examination of resected head and neck specimens regarding the site of origin of the tumour, structures involved, tumour grade, adequacy of resection margins, and the presence of lymph node metastasis, extranodal spread...

Tumour spread and staging

Staging is carried out according to the TNM classification 947,2418 . Recent additions to the coding have been provided for micrometatses, isolated tumour cells, findings in sentinel nodes and tumour detection by molecular methods. Some of these are discussed in the following sections. Local spread of oral SCC, in the early stages, is relatively predictable in tissues that have not been previously irradiated. It is influenced by local anatomical features. Lip SCC spreads superficially and then...

Carcinoma ex pleomorphic adenoma

Carcinoma Pleomorphic Adenoma

Lesions involving the oral and oropharyngeal minor glands formed 17.5 of the AFIP series 669 . 63 of cases were in the palate and 10.5 were in the upper lip. There were no cases in the lower lip. Other sites included the tongue, buccal Fig. 4.33 Pleomorphic adenoma which started at palate involving the mid face and entire oral cavity. Fig. 4.34 A Pleomorphic adenoma. Tumour presenting as a firm swelling on the lateral aspect of the junction between the hard and soft palate. B Plasmacytoid, or...

Clinical features

Patients with small oral and oropharyngeal SCC are often asymptomatic or may present with vague symptoms and minimal physical findings. Hence, a high index of clinical suspicion is needed to diagnose small lesions, especially if the patients have tobacco and alcohol habits. Patients may present with red lesions, mixed red and white lesions, or white plaques. Co-existing white plaques leukoplakia may be observed adjacent to carcinomas and this implies an origin in a pre-existing white lesion...

Xli

Fig. 3.10 Squamous cell carcinoma SCC . A Well differentiated SCC. B Poorly differentiated SCC. the tracheostoma, is a well recognized, but infrequent complication after total laryngectomy. Patients with subglottic and postcricoid involvement and advanced stage of the primary SCC are at risk to develop this complication. Laryngeal, hypopharyngeal and tracheal SCC are likely to metastasize to the regional lymph nodes. The location and frequency of lymph node metastases depends upon the site of...

Model Of Development Of Nasopharyngeal Carcinoma

Spectral karyotyping SKY analysis of a nasopharyngeal carcinoma cell line C66-1 exhibiting multiple structural rearrangements. The mechanism of the entry of EBV into the nasopharyngeal epithelium has not yet been conclusively elucidated, but a receptor on nasopharyngeal epithelial cells, namely polymeric immunoglobulin receptor PIGR , has been proposed to be involved. It has been reported that one single nucleotide polymorphism SNP 1739C- gt T , located on...

Larynx Cancer Relative Risk Cigarettes

Fig. 3.2 A Diagram of the larynx and pre-epiglottic space. B Diagram and boundaries of the oropharynx and hypopharynx, with relationship to oral cavity and larynx, respectively. conus elasticus inferiorly, the thyroid cartilage laterally, the quadrangular membrane medially and the pyriform sinus posteriorly. The pre-epiglottic space, also filled with adipose and connective tissue, is triangular shaped. It is bounded anteriorly by the thyroid cartilage and thyrohyoid membrane, posteriorly by the...

Salivary glandtype carcinomas

A CT scan shows a nasal sinus mass focally extending into the bone. B The tumour T is inhomogenous and extends from the maxillary sinus into the infratemporal black arrowhead and the pterygopalatine fossa black arrow . Perineural spread follows the Vidian cana white arrowhead . Fig. 1.16 Adenoid cystic carcinoma. A CT scan shows a nasal sinus mass focally extending into the bone. B The tumour T is inhomogenous and extends from the maxillary sinus into the...

Lymphoepithelial carcinoma

Lymphoepithelial carcinoma is a poorly differentiated squamous cell carcinoma or histologically undifferentiated carcinoma accompanied by a prominent reactive lymphoplasmacytic infiltrate, morphologically similar to nasopharyngeal carcinoma. Undifferentiated carcinoma undifferentiated carcinoma with lymphocytic stroma undifferentiated carcinoma of nasopharyngeal type lymphoepithelioma-like carcinoma Sinonasal lymphoepithelial carcinoma is rare, and most reported cases have originated from...

Malignant tumours of bone and cartilage

Chondrosarcoma is a malignant tumour of hyaline cartilage. Mesenchymal chondrosarcoma is a malignant small round cell neoplasm with focal cartilaginous differentiation, and often with a pericytomatous vascular pattern. These tumours are rare in the facial skeleton. Chondrosarcomas account for lt 16 of all sarcomas of the nasal cavity, paranasal sinuses and nasopharynx 256,463,1367,4045 . Chondrosarcoma affects older adults, with a male predilection. Mesenchymal chondrosarcoma is extremely rare,...

Other precancerous conditions

Stage Squamous Cell Cancer

Precancerous conditions PCs are generalized clinical states associated with a significantly increased risk for SCC. Epithelial atrophy, increased mitotic activity and impaired epithelial repair mechanisms are fundamental to PCs of different etiology. Originally described in the context of sideropenic dysphagia, it is an important cause of epithelial atrophy. The association of iron deficiency with oropharyngeal squamous cell carcinomas has been observed since the mid-thirties of the 20th...

TNM classification of carcinomas of the larynx

TX Primary tumour cannot be assessed TO No evidence of primary tumour Tis Carcinoma in situ T1 Tumour limited to one subsite of supraglottis with normal vocal cord mobility T2 Tumour invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus without fixation of the larynx T3 Tumour limited to larynx with vocal cord fixation and or invades any of the following postcricoid...

Adenocarcinoma

These are glandular malignancies of the slnonasal tract, excluding defined types of salivary gland carcinoma. Two main categories are recognized 1 intestinal-type adenocarcinoma, and 2 non-intestinal-type adenocarcinoma, which can be further divided into low-grade and high-grade subtypes. Overall, adenocarcinomas and salivary-type carcinomas comprise 10-20 of all sinonasal primary malignant tumours. A primary malignant glandular tumour of the nasal cavity and paranasal sinuses histologically resembling adenocarcinoma or adenoma of the intestines, or exceptionally normal small intestinal mucosa. Colonic-type adenocarcinoma, enterictype adenocarcinoma. The frequency of intestinal type adenocarcinomas ITACs among primary sinonasal malignancies is difficult to ascertain. Most series report a pronounced male predominance, possibly because of occupational exposure. Patients have ranged in age from 12 to 86 years at the time of diagnosis mean 58 years 124 . The causal relationship of wood...

Malignant soft tissue tumours

Malignant Neoplasm Definition

A malignant tumour of fibroblastic myofi-broblastic phenotype. Fibromyxosarcoma chondromyxofibro-sarcoma. The incidence of sinonasal tract fibrosar-comas is difficult to determine because the diagnosis is often one of exclusion. These tumours are rare, accounting for lt 3 of all non-epithelial tumours. However, they are considered the second most common soft tissue sarcoma after rhabdomyosarcoma in the head and neck 168,345,349,826,1041,1317, 2511 . They occur in all ages, with a peak in the...

Tumours of the nasal cavity and paranasal sinuses Introduction

Frontal Sinus Malignancy

The nasal cavities are separated in the midline by the nasal septum. Each cavity is wide caudally, and narrow cranially. The roof of the nasal cavity is formed by the thin 0.5 mm cribriform plate. The floor is the hard palate, formed by the palatine processes of the maxillae and the horizontal portions of the palatine bones. The lateral nasal wall contains the maxillary and ethmoid ostia, plus three or four turbinates. These turbinates are delicate scroll-like projections of bone and vascular...

Borderline and low malignant potential tumours of soft tissues

Glomangiopericytoma

Fanburg-Smith B.M. Wenig A locally aggressive, cytologlcally bland tumour of myo fibroblastic phenotype. Extra-abdominal desmoid, extra-abdominal fibromatosis, desmoid tumour, aggressive fibromatosis, juvenile desmoid-type fibromatosis, infantile fibromatosis. Although 15 of cases of desmoid-type fibromatosis occur in the head and neck, the sinonasal tract is uncommonly involved 6,903,2643 . All ages can be affected, especially children 903 . There is a male predilection...

Germ cell tumours

Malignant germ cell tumours and terato-carcinosarcoma exhibiting histologic features similar to germ cell tumours of the gonads arise on rare occasions in the sinonasal tract. Immature teratomas and teratomas with malignant transformation are tumours of infancy and early childhood, whereas sinonasal yolk sac tumour and sinonasal teratocarcinosarcoma have only been documented in adults. Immature teratomas are rare in the sinonasal tract and nasopharynx, and are composed of variable quantities of...

Respiratory epithelial adenomatoid hamartoma

Respiratory Epithelial

Benign nonneoplastic overgrowth of indigenous glands of the nasal cavity, paranasal sinuses and nasopharynx associated with the surface epithelium, and devoid of ectodermal neuroectoder-mal, and or mesodermal elements. Glandular hamartoma seromucinous hamartoma. Hamartomas of the sinonasal tract and nasopharynx are uncommon. The majority of them are of pure epithelial type respiratory epithelial adenomatoid hamartoma 2766 , although pure mesenchymal hamartomas or mixed epithelial-mesenchymal...

Non Hodgkin lymphoma

Primary non-Hodgkin lymphomas NHL of the hypopharynx, larynx or trachea are very rare. They account for 1 of all primary extranodal NHL 809 . By contrast, secondary laryngeal lymphomas are more common and represent spread from cervical and mediastinal lymph nodes, and thyroid gland. Patients present with hoarseness, foreign body sensation, or mild airway obstruction. Supraglottic tumours are more frequent, but all regions of the larynx can be involved. Most primary laryngeal NHL are B-cell...

Verrucous carcinoma

Vocal Cord Keratosis Histopathology

A large lesion with abundant keratosis arranged in church-spire configuration. There is a broad, pushing border of infiltration. Fig. 3.13 Verrucous carcinoma. A large lesion with abundant keratosis arranged in church-spire configuration. There is a broad, pushing border of infiltration. Verrucous carcinoma VC is a non-metastasizing variant of well-differentiated squamous cell carcinoma SCC characterized by an exophytic, warty, slowly growing neoplasm with pushing...

C

Extension of tumour beyond the sinonasal cavities Proposed sources of origin of olfactory neuroblastoma include Jacobson's vomero-nasal organ, the sphenopalatine ganglion, the ectodermal olfactory placode, Loci's ganglion, autonomic ganglia in the nasal mucosa, and the olfactory epithelium. While a neuronal - neural crest origin is supported by the presence of neurofilaments in olfactory neuroblastoma 2634 , until recently 335 , few arguments linked olfactory neuroblas-toma directly to the...

Hla

There is an association between HLA phenotype and NPC risk. The association between HLA-A2 and NPC was first reported among Chinese in Singapore 2364 . Subsequent studies have confirmed the association of HLA A2-B46 haplotype with NPC in many different countries 382,1089,1223,1565,1567, 2365,2366 . In addition, increased risk of NPC has been found in individuals harbouring HLA B17 in southern China 1567,2874 , Singapore 382 and Malaysia 381 . Haplotypes A2-B17 2895 , A2-B38 1565 , and A2-B16...

Nasopharyngeal angiofibroma

Angiofibroma Nasal

Fig. 2.27 Nasopharyngeal angiofibroma. The intact respiratory epithelium overlies a richly vascular neoplasm which has variably-sized vessels surrounded by a cellular fibroblastic stroma with collagen. Fig. 2.27 Nasopharyngeal angiofibroma. The intact respiratory epithelium overlies a richly vascular neoplasm which has variably-sized vessels surrounded by a cellular fibroblastic stroma with collagen. The spectrum and clinicopathological features of nasopharyngeal soft tissue tumours are similar...

Salivary glandtype adenomas

Pleomorphic Adenoma

Among glandular tumours of the sinonasal tract, about one-quarter of cases are benign, and practically all of them are salivary gland-type neoplasms 1039 . For details see Chapter 5 on 'Tumours of salivary glands'. Most patients are between 20 and 60 years of age. Signs and symptoms are non-specific, and include unilateral nasal obstruction, epistaxis and a discernible mass. The tumour may resorb bone and extend into the maxillary sinuses. Most cases arise from the submucosa of the bony or...

4

Necrosis Nose

Fig. 1.46 Nerve sheath tumour of maxillary nerve. The nerve arrow at the entrance to foramen rotundum is enlarged compared to opposite side. This is similar to the appearance expected for perineural spread of malignancy. Note the carotid artery arrowhead . head and neck sarcomas 1231,1562 , arising de novo or less commonly In the setting of neurofibromatosis type 1 NF1 1059,1231,1795 . De novo MPNST peaks in the fourth decade, while those in the setting of NF1 occur at an earlier age. There is...

Squamous cell carcinoma

Squamous Cell Carcinoma Situ

Thompson A malignant epithelial neoplasm originating from the mucosal epithelium of the nasal cavities or paranasal sinuses that includes a keratinizing and a non-kera-tinizing type. Squamous cell carcinoma 8070 3 Verrucous carcinoma 8051 3 Papillary squamous cell carcinoma Spindle cell carcinoma 8074 3 Adenosquamous carcinoma Acantholytic squamous cell carcinoma 8075 3 Keratinizing squamous cell carcinoma squamous cell carcinoma. Nonkeratinizing carcinoma...