Head-and-Neck-Diagnosis-OLD CASES

FRCPath Part 2 Surgical Course: Head and Neck Pathology Case No. HN1 HN2

Diagnosis  Mammary analogue secretory carcinoma  Acinic cell carcinoma •Mucoepidermoid carcinoma

HN3

•Pseudocyst lined by compressed rim of foamy macrophges •Extravasation mucocele

HN4

•Infiltrative tumour •Large polygonal cells with ++ granular cytoplasm •Eccentric bland nuclei •Granular cell tumour

HN5

•CYST ASSOCIATED WITH UNERUPTED LOWER WISDOM TOOTH, FEMALE 16 YRS

HN6

•Laminated mucin •Degenerate eosinophils •Charcot-Leyden crystals •Allergic fungal sinusitis

HN7

•SCC and Grade I follicular type non Hodgkin B cell lymphoma

HN8

•Necrotising granulomatous inflammation

HN9

•Basal cell palisading •Corrugated parakeratosis •Focal inflammation –loss of above and “non-specific” features •Odontogenic keratocyst •WHO 2005 Keratocystic odontogenic tumour •Consistent loss of PTCH tumour suppressor gene •Tendency for recurrence

HN10

•Bi-phasic spindle and keratinising epithelial tumour with features of malignancy •Dysplasia at edge •Spindle cell carcinoma •? Carcinosarcoma

FRCPath Part 2 Surgical Course: Head and Neck Pathology Case No.

Diagnosis •CK negative in up to 40% of cases

HN11

Deposition of hyalinised eosinophilic material in stroma •Congo red •+++ •Consider type •? Assoc with plasma cell dyscrasia –Kappa and lambda check plasma cells at edge of lesion •Systemic investigations for AL ? Myeloma •AA / hereditary •IHC

HN12

•Acinic cell carcinoma

HN13

•Warthin’s tumour •Multifocality and bilaterality sometimes a feature •Association with smoking

HN14

•Nests of cells •Vascular •Large vessels in background •Sustentacular cells •Paraganglionoma •“Carotid body tumour”

HN15

•Small blue round cell tumours nasal cavity •Cytokeratins (high and low mw) •CD56, synaptophysin, chomogranin •Melanoma markers •CD45 (CD20, CD56, T markers) •CD99 •Skeletal muscle (desmin, MyoD1) •CK ++ •SNUC

HN16

•Grade I (II elsewhere) chondrosarcoma •ALWAYS correlate radiological features with chondroid / bony tumours

FRCPath Part 2 Surgical Course: Head and Neck Pathology Case No.

Diagnosis

HN17

•Ameloblastoma

HN18

 Benign tumours  Malignant tumours •Lymphoid proliferation in SMG, diffuse •Epimyoepithelial islands •Largely small lymphocytes, some blasts •Lobular architecture lost and extension into periglandular fat

HN19

HN20

HN21

–Olfactory neuroblastoma –Sinonasal undiff carcinoma (SNUC) –Basaloid SCC –Neuroendocrine (small cell) –Rhabdo –ES/PNET –Lymphoma –Melanoma –Small cell osteosarcoma •Radicular cyst •Inflammation •Location •Epithelium

HN22

•Triad •Toxoplasmosis lymphadenitis

HN23

•Necrotising lymphadenitis •Karyorrhectic debris •Absence of neutrophils •Large blasts and histocytes at edge of necrotic areas •Kikuchi’s lymphadentitis

HN24

•Pleomorphic adenoma with ossification and atypia •In situ carcinoma ex pleomorphic adenoma •Warthin’s tumour and small lymphocytic lymphoma

HN25

FRCPath Part 2 Surgical Course: Head and Neck Pathology Case No.

Diagnosis

HN26

•Peripheral ameloblastoma •Diff diagnosis –BCC –Minor salivary gland tumour

HN27

•Carcinoma ex pleomorphic adenoma •Carcinoma often –High grade –Adenoca NOS –Can be any type of malignant sal gland tumour –hybrid

HN28

•“Interface” inflammatory pattern •Lichenoid mucositis –lichen planus or lichenoid reaction •Drugs / dental materials esp amalgam

HN29

•Chronic hyperplastic candidosis •Test tube shaped / psoriasiform epithelial hyperplasia •Neutrophilic subcorneal microabscesses

HN30

•Sinonasal polyps and inverted Schneiderian papilloma