Gi Pathology, Lecture 3: Pathology Of The Upper Aerodigestive Tract

Front 1

PREMALIGNANT LESIONS AND CANCER OF THE UPPER RESPIRATORY AND DIGESTIVE TRACTS

Epidemiology:

Back 1

Men> woman (3:1) (Before 1940, 10:1)

50-70 years in men
60-80 years in women

In India, oral cancer has 10-15 years earlier onset

In China, nasopharyngeal carcinoma shows increased incidence after the age 20 years

Front 2

PREMALIGNANT LESIONS AND CANCER OF THE UPPER RESPIRATORY AND DIGESTIVE TRACTS

Etiologic Factors:

Back 2

Tobacco habits:
Alcohol abuse:
Sun light:
Oncogenic viruses:
Environmental and occupational carcinogens:

Front 3

Premalignant Lesions:

Definition:

Examples:

Back 3

a morphologically altered tissue in which cancer is likely to occur.

The tissue changes precede the development of invasive cancer.

Examples:
leukoplakia,
erythroplakia,
and carcinoma in situ.

Front 4

Premalignant Lesions:

Leukoplakia:

Back 4

a white patch or a plaque that cannot be characterized clinically or pathologically as any other specific disease. Microscopically, it could show hyperkeratosis or various grades of dysplasia and even invasive carcinoma. About 20% of __________ show epithelial dysplasia. 3-5% of _________ are early squamous cell carcinoma and 2-6% will undergo malignant transformation on follow-up.

Front 5

Premalignant Lesions:

Erythroplakia,

Back 5

- a bright red velvety patch that cannot be characterized clinically or pathologically as being due to any other condition.

- Histologically ________ shows epithelial atrophy with high connective tissue papillae and dysplasia.

- About 50% of _________ show either severe dysplasia or carcinoma in situ. The other 50% are early squamous cell carcinoma.

- ___________ or mixed red and white (speckled _________) is the most common clinical presentation of early asymptomatic oral carcinoma

Front 6

Precancerous Conditions:

Definition:

Examples:

Back 6

Is a generalized state in which there is an increased risk for development of cancer.

Examples: Plummer-Vinson syndrome, lichen planus, discoid lupus, epidermolysis bullosa and xeroderma pigmentosum.

Front 7

Carcinoma of the lip:

Clinical presentation:

Back 7

- About 25% of all oral cancer

- Almost exclusively limited to the lower lip vermilion border, particularly common in white males.

- Usually preceded by solar keratosis.

- Slow growing commonly detected in the early stages

- Usually ulcerated but might be exophytic.

- Lymph node metastasis is late and occurs in less than 10% of the cases, usually in the submental group.

- Parasthesia of the lower lip indicates mental nerve involvement.

Front 8

Oral and oropharyngeal carcinoma:

(Name most common intraoral site & oropharyngeal sites)

Clinical presentation:

Back 8

Floor of the mouth, lateral and ventral surfaces of the tongue and retromolar trigon are the most common sites of intraoral carcinoma.

The tonsils and base of tongue are the most common oropharyngeal sites.

Clinical Presentation:
Early lesions are leukoplakic, erythroplakic or more commonly a combination of both (speckled erythroplakia)

A painless mass develops which might be exophytic or ulcerated.

Later lesions might be symptomatic including dysphagia, sore throat, slurred speech, bleeding, foul odor, pathologic fracture and trismus.

Cervical lymph node metastasis is common, occurring in 50-70% of the cases.

Node metastases may be a presenting sign, particularly in the case of the tonsil and base of tongue tumors.

Contralateral and bilateral metastases might occur, especially in lesions that involve or approach the midline

Front 9

Carcinoma of the larynx:

3 different Subtypes:

Back 9

Heavy smoking is an important risk factor, and heavy drinking in case of supraglottic carcinoma.

60-65% = glottic.
30-35% = supraglottic.
5% = subglottic.

Hoarseness is a common early symptom. Due to paucity of lymphatics in the true vocal cord, glottic carcinoma tends to stay localized for extended periods of time and could be cured if detected early.

Front 10

Carcinoma of the larynx:

Clinical Presentation:

Back 10

Clinical Presentation:

Feeling of a foreign body in the throat, dyspnea, stridor, hemoptysis in addition to hoarseness are manifestations of laryngeal carcinoma.

Front 11

Nasopharyngeal carcinoma:

Clinical presentation:

Back 11

Nasal discharge, otitis media, cranial nerve palsy, particularly III, V, and VI. Most of the non-keratinizing and undifferentiated tumors present with cervical masses (60-80%).

Front 12

Microscopic features and grading of squamous cell carcinoma:

well differentiated tumors show

Back 12

- obvious origin from squamous epithelium with marked keratinization,
- distinct cell membrane,
- intracellular bridges

- characteristically produce keratin pearls and individual cell keratinization

Front 13

Most of the cancer of the upper aerodigestive tract is

Back 13

well to moderately differentiated squamous cell carcinoma.

Front 14

Distant metastasis most common in....

(Name 3)

Back 14

lung, liver and bone are favored sites.

Front 15

Multiple Primary Tumors:

Up to 25% of patients with oral cancer have __________ or ____________ primaries, particularly in the pharynx, larynx, and esophagus.

Back 15

multiple synchronous,

metachronous,

Front 16

STRUCTURE AND FUNCTION OF SALIVARY GLANDS:

Back 16

The salivary glands are exocrine glands whose secretions flow into the mouth. There are three pairs of major salivary glands located extraorally (parotid, submandibular, and sublingual) and numerous small or minor glands that are widely distributed throughout the mucosa and submucosa of the oral cavity.

Front 17

NEOPLASTIC DISEASES OF THE SALIVARY GLANDS

Common sites affected:

Back 17

- 75% occur in the parotid and 70% are benign.

- 15% affect the minor glands and only 40-50% are benign.

- 10% occur in the submandibular gland (60% are benign).

- The sublingual salivary gland tumors are rare and the majority (70-80%) are malignant.

- In the mouth, the palate is the most common site, followed by the upper lip and buccal mucosa.

- Salivary gland type tumors in the upper respiratory tract and pharynx are relatively rare and limited in variety.

- The nasal septum and the subglottic area of the larynx are preferred sites.

Front 18

Benign salivary gland tumors:

Back 18

Pleomorphic adenoma
Warthins Tumor

Front 19

Malignant salivary gland tumors:

Back 19

Mucoepidermoid carcinoma
Adenoid cystic carcinoma

Front 20

* Pleomorphic adenoma (benign mixed tumor)

Back 20

- the most common of all tumors (60-70% of parotid and 40-50% of minor gland tumors)

- The neoplastic cells show both mesenchymal and epithelial phenotypes.

- A myoepithelial component is responsible for the mesenchymal differentiation of the stroma.

- Clinically, presents as a slow growing painless mass which could become very large.

- However, it does not usually ulcerate through overlaying skin or mucosa.

- _______ are most commonly diagnosed in patients between the ages of 30 and 50 years. However, they may occur in very young children.

- They are commonly found in the superficial lobe of the parotid.

- The tumor is encapsulated.

Front 21

Benign salivary gland tumors:

Warthins Tumor,

Back 21

also known as papillary cystadenoma lymphomatosum, which is an accurate descriptive name.

occurs almost exclusively in the parotid gland and develops from salivary tissue within lymph nodes, in or around the parotid gland.

- It is superficially located, usually at the tail of the gland.

- Histologically, the tumor has well defined borders and is composed of papillary projections and cystic spaces lined with a double layer of mitochondria-rich oncocytic cells showing granular eosinophilic cytoplasm. The supporting stroma is predominantly lymphoid.

Front 22

* Mucoepidermoid carcinoma

Back 22

- the most common malignant salivary gland tumor (about 30%).

- the mean age of incidence is 43, but it may also occur in children.

- the parotid is the most common major gland affected.

- Intraorally, the palate and retromolar tirgone are sites of predilection.

- the tumor is composed of three main cell types: epidermoid, mucous, and intermediate.

Front 23

T/F

Histologically, the low grade tumors show cystic spaces and few mucous cells.

Back 23

False

Histologically, the low grade tumors show cystic spaces and NUMEROUS mucous cells.

Front 24

T/F

High grade tumors are more cellular, tend to form solid growth patterns, and are more invasive.

Mucous cells are sparse and cellular atypia is more prominent.

Back 24

True

Front 25

Malignant salivary gland tumors:

Adenoid cystic carcinoma

Back 25

- the second most common malignant salivary gland tumor of the major glands and the intraoral minor glands.

- However, it is the most common malignant salivary tumor of the upper respiratory tract.

. It is rare under the age of 20.

Front 26

Malignant salivary gland tumors:

Adenoid cystic carcinoma

Histological hallmarks

Back 26

The tumor is composed of uniform basaloid cells with dark nuclei and scant cytoplasm.

The hallmark of the tumor is perineural and intraneural invasion.