Head And Neck Pathology

Front 1

patient with painless ulcer on hard palate secondary to injury/trauma

Micro:lobular necrosis with mucus extravasation and squamous metaplasia

Back 1

Necrotizing sialometaplasia

Front 2

patient with h/o smoking, has flocculant parotid lesion

Gross: solid/cystinc, "motor oil"

Micro: bilayered oncocytic epithelium with papillary growth and lymphoid stroma

Back 2

Warthin tumor

Front 3

patient with common neck mass

Gross: besselated, chondroid

Micro: mixed stromal and epithelioid components. Myoepithelial cells, tubules that blend in with stroma, chondroid/myxoid background.

Back 3

Pleomorphic adenoma

Front 4

biphasic tumor with small dark palisading cells, and ductal cells that are larger with lighter nuclei. Can have trabecular/solid/cribiform patterns. Inner/outer cell types; looks like islandsseparated by scant stroma

Back 4

basal cell adenoma

Front 5

fleshy tumor that presents as a mass lesion in the neck.

myoepithelial cells in hyalinized or myxoid matrix. cells can be clear, plasmacytoid, spindle cells

IHC: variable CK, positive for p63/p16, SMA, calponin, s100, vimentin

Back 5

myopithelioma

Front 6

oral cavity/palate mass lesion

Micro: nests of cells with syncitial growth, monomorphic nuclei that are round with clear/open vescicular chromatin. Open look is key to Dx

Back 6

polymorphous low grade adenocarcinoma

Front 7

patient with pain/nerve palsies and neck mass

Micro: tubular/cribiform/solid patterns of small dark nuclei that are dark and angulated, form small cystic looking spaces between cells- these lumens have blue or pink contents. Nests of cells separated by loose stroma and supported by myoepithelial cells


1. what pattern predicts outcome?

2. what feature is almost universal?

3. what weird IHCs are +?

Back 7

adenoid cystic carcinoma

1. solid

2. neural invasion

3. CKIT, BCL2

Front 8

MC malignancy of the salavay glands in adults and children.

Micro: 3 cell types: mucus cells, epidermoid, intermediate cells

1. what is the common translocation?

2. what is the grading scheme?

Back 8

mucoepidermoid Ca

1. t(11;19) (favorable)

2. cyst component, mitoses, anaplasia

Front 9

Ducts and tubules with epithelial cells surrounded by myoepithelial cells, with hyaline material in the center (and hyaline stroma)

Back 9

epithelial-myoepithelial carcinoma

Aunt minnie

Front 10

tumor of the salivary gland that resembles breast cancer- has comedo-type necrosis, grows in solid, micropapillary, and cribiform patterns. Can be ugly as hell

IHC:?

Back 10

salivary duct carcinoma

IHC: androgen receptor, her2/neu

Front 11

middle aged woman with painful salivary gland mass

Micro: "blue dot" tumor. Zymogen granules present, seen best with PAS stain. cells have basophilic/amphophilic granular cytoplasm.

Back 11

acinic cell Ca

Front 12

necrotozing granulomatous inflammation in the sinuses that invloves middle-sized blood vessels. may also have lung disease as well. Neutrophilic microabscesses are seen, as well as geographic necrosis.

IHC: elastin stain shows damage to vessels

Back 12

Wegner granulomatosus

Front 13

Papillary lesions

1. Which B9 lesion is most commonly found on the lateral nasal wall?

2. where are exophitic papillary lesions seen? How do you know it's not a squamous papilloma?

Back 13

Inverted Schiderian papilloma

2. Septum. goblet cells.

Front 14

What is respiratory epithelial adenomatoid hyperplasia?

Back 14

Normal respiratory epithelium trapped in deep glands

Front 15

Adolescent boy with nasal stuffiness

Micro: prominent vasculature, bland hypocellular stroma

Back 15

Angiofibroma

Front 16

Small round blue cell tumor with homer-wright rosettes and flexner-wintersteiner rosettes (true lumens). Grow in nested, lobular pattern. Nuceli are monomorphic. Lobules separated by thick stroma

Back 16

Olfactory neuroblastoma

Front 17

ugly as hell tumor with mitoses, necrosis, vascular invasion. stain + for CK. Cells have scant cytoplasm, hyperchromatic nuclei.

Back 17

sinonasal undifferentiated carcinoma (SNUC)

Front 18

Where do intestinal type primary adenocarcinomas of the sinonasal tract present?

2. what are the occupational exposures linked to this tumor?

3. IHC?

Back 18

1. ethmoid sinus

2. wood, leather, and formaldhyde

3. CK7,20, CDX2

Front 19

Papillary thyroid CA

1. Who gets it?

2. What variants have prognostic significance?

3. Which is more common in men?

4. which is more common in younger patients? What are the features?

5. which variant is associated with FAP?

6. what mutations are associated?

Back 19

1. Middle aged women, h/o radiation

2. Solid variant, tall cell variant (MC extrathyroid extension), columnar cell

3. tall cell variant

4. Diffuse sclerosing variant- squamus metaplasia and psammoma bodies

5. Cribiform-morular. These look like adenoid cystic CA

6. RET, RAS, BRAF

Front 20

Follicular CA of the thyroid

1. What is needed to DX follicular CA of the thyroid?

2.What is needed to call something vascular invasion?

3. what is the common translocation?

Back 20

Follicular CA

1. Capsular invasion (through/mushrooming)

2. Malignant cells must be attached to vessel wall

3. t(2;3), PAX8

Front 21

Elderly patient with a rapidly enlarging neck mass- mets may be present

Micro: undifferentiated cells with necrosis and vascular invasion, can have squamoid, pleomorphic giant cell, rhabdoid, or spindled appearance. May not stain with any keratin stains.

Back 21

Anaplasitc CA

Front 22

Elderly or young patient with thyroid mass, younger patients may have other endocrine tumors

1. What is the cell of origin?
2. What gene is mutated in younger patients?

3. what substance may be found in this tumor?
4. what immunos are positive?

Back 22

Medullary thyroid CA

1. C-cell
2. RET
3. Amyloid
4. CEA, calcitonin, chr, syn, TTF1

Front 23

Parathyroid:
1. How do you distinguish hyperplasia from adenoma clinically?
2. how about histologically

3. How do you distinguish CA?

Back 23

1. when adenoma is removed, patient's PTH levels drop. If hyperplasia, all glands are involved

2. No reliable way. Adenomas may be only once cell type (oxyphil, chief) or mixed. may be in a trabecular pattern. Both lack mitoses

3. Clinical criteria (very high Ca, PTH, palpable mass, histo:mets, LVS/neuro invasion, extension through capsile; these tend to have more atypia and mitoses

Front 24

Most common odontigenic cyst, in kids with inflammation and squamous lining

Back 24

Radicular cyst

Front 25

Teen with molar showing cyst (unerupted tooth). NON-keratinizing, squamous lining, no inflammation

Back 25

Dentigerous (follicular) cyst

Front 26

Associated with Gorlin's syn (BCC), cyst in jaw- lytic lesion can be multiple, assc. with unerupted tooth. Hist- keratinizing/parakeratotic lining.

Back 26

Odontogenic keratocyst