Head & Neck PathologyHead & Neck PathologyOTOLARYNGOLOGYOTOLARYNGOLOGY

March. 29. 2015

Nasopharynx

Oropharynx

Laryngopharynx

Soft Palate

Epiglottis

Esophagus

ENT

Oropharynx

• Viral

• Bact. Infection (Pharyngitis).

- B H Strept.• Tonsillitis

- Peritonsilar abscess “Quinsy”

- GN, & RH H Dis.

• Laryngitis- TB- Diphtheritic pharyngitis.• Tumors of tonsilsTumors of tonsils

Pharyngitis

Tonsillitis & peritonsillar abscess “Quinsy”

Diphtheria

“UPPER” AIRWAYS

• NOSE: Inflammation, Tumors• NASOPHARYNX: Inflammation, Tumors• PARANASAL SINUSES: Inflammation,

Tumors• LARYNX: Inflammation, Tumors

Nose

Skin of the nose;• DLE• Sebaceous hyperplasia• BCCa.

Nasal #; • Hematoma• Deviation of septum• Deviation of nose.

Nose

• Rhinitis

• Sinusitis• Epistaxis Benign nasal tumors;• Hemangioma

• Juvenile Angiofibroma

• Papilloma.• Sq & Trans. Cell ca.

Rhinitis/Sinusitis

• Very often allergic.• Very often associated with URI’s, usually

viral• about every organism has been implicated

at one time or another, bacteria, virus, fungus, etc.

NOSE/SINUS/NASOPHARYNX“TUMORS”

• “Polyps”---really NOT a tumor• Angiofibroma• Papilloma• Neuroblastoma

• Nasopharyngeal Carcinoma

INFLAMMATORY “POLYPS” OF NASAL CAVITY

Necrotizing ulcerating lesions of URT:• Acute fungal infections (e.g mucormycosis;, in

immunosuppressed patients) • Wegener granulomatosis • lethal midline granuloma and now known to be

a lymphoma of natural killer cells infected with EBV.

“NECROTIZING” Upper Airway Lesions

• “WEGENER” Granulomatosis• “Lethal” Midline Granuloma

PAPILLOMA “INVERTED” PAPILLOMA

ANGIOFIBROMA

NEUROBLASTOMA(OLFACTORY)

ESTHESIONEUROBLASTOMA

ROSETTE

Nasopharyngeal carcinomas

• often clinically occult for long periods, • present as metastases in the cervical lymph

nodes in as many as 70% of the patients. • Radiosensitive

• 5 Year survival; 50% to 70%

Nasopharyngeal cancer

PET/CT Scan of a patient with nasopharyngeal cancer. Transverse slice demonstrating positive primary site

Undifferentiated nasopharyngeal Ca.

“lymphoepitheliomas”Nasopharyngeal carcinoma

Three histologic variants;• Keratinizing SqCCa• Nonkeratinizing SqCCa,• Undifferentiated Ca.

• EBV• Genetic

NASOPHARYNGEALCARCINOMA

The Larynx

Vocal Cord

The Larynx

Normal vocal cords

LARYNGITIS

Vocal cord nodule “singer’s nodes” smokers or singers

Nodules• bilateral symmetric

epithelial swelling of ant/mid third of TVF

• More in children, adolescents, females – softer intensity

of voice causes hyperfunction

• Result of abuse or misuse, ch. Irritation in heavy smokers

Vocal fold polyps

• Unilateral • Broad-based vs. Pedunculated• Formed by capillary break with leakage of blood

resulting in local edema and organization with hyalinized stroma

Laryngeal papilloma

• HPV (6 & 11).• 2% malignant

transformation (HPV 16 &18)

• single in adults

• in childre, multiple & recurrent.

recurrent respiratory papillomatosis (RRP),

“Juvenile papillomatosis”

Laryngeal Papilloma

Papilloma

Leukoplakia• Spectrum of change in epithelium• HyperkeratosisDysplasia (mild, moderate, severe),CIS• 8% to 14% rate of malignant transformation

Carcinoma of larynx, Epidemiology

• > 40 years

• men /women = (7 : 1). • nearly all cases, in smokers, alcoholic, +/- asbestos • HPV• About 95% typical Sq C Ca..

• Incidence by Site • Supraglottic 25 - 40% • Glottic 60% to 75%• Subglottic < 5% • begin as in situ lesions, later appear as plaques, then

ulcerating and fungating

Carcinoma of the larynx• persistent hoarseness. • The location of the tumor has a significant bearing on

prognosis;• glottic tumors; 90% are confined to larynx at diagnosis. 1. symptoms early in the course of disease; 2. the glottic region has a sparse lymphatic supply,

and spread beyond the larynx is uncommon. • the supraglottic larynx is rich in lymphatic spaces, and

nearly a 1/3 of these tumors metastasize to regional (cervical) lymph nodes.

The subglottic tumors• remain clinically quiescent, • 1/3 die of the disease. • The usual cause of death is; - infection of the distal respiratory passages or - metastases and cachexia.

Glottic SCC

Gross/ laryngeal carcinoma

Dysplasia without Keratosis

Microinvasive or Superficially Invasive Squamous Cell Carcinoma

Invasive Squamous Cell Carcinoma

SQUAMOUS CELL CARCINOMA OF LARYNX/Mic

The 10 leading cancers by gender. site Iraqi Tumor Regestry 2007

Breast Lung & bronchus Leukemia Bladder Brain &CNS NHL Colorectal

Larynx Skin excluding Melanoma Stomach Uterus including Cervix and corpus) Hodgkin disease Thyroid Kidney, pelvis& ureter Ovary Prostate Pancreas Bone & cartilage Liver &bile ducts Esophagus

Type of cancer, in Iraq, by primary tumor site (2004)6

EARS

• DEGENERATION: OTOSCLEROSIS• INFLAMMATION:

• NEOPLASMS:

The Tympanic Cavity

Chorda Tympani N. (CN VII)

Tendon of Tensor Tympani M. (V3)

Incus

Tendon of Stapedius M. (CN VII)

Stapes

Cut edge of tympanum Malleus

CERUMEN CAST

OTOSCLEROSIS

NECK

• Lymph node• BRANCHIAL (cleft) CYST• THYROGLOSSAL (duct/tract) CYST• PARAGANGLIOMA (Carotid Body

Tumor)• Other

CAROTID BODY TUMOR“balls of cells”

“zellballen”

ZELLBALLEN

Whole-body PET scan using 18F-FDG