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Head and Neck Pathology

Kerry B Baumann, Sasha J Betz
Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is a rare entity. Patients often present with complaints of nasal fullness, obstruction, and epistaxis. It may be confused with metastatic papillary thyroid carcinoma due to its histologic similarity and overlapping immunohistochemical studies, but it is important to distinguish between the two because of differing treatment modalities and prognosis. A significant difference between the two is that despite both entities demonstrating TTF-1 positivity, TL-LGNPPA usually does not stain for thyroglobulin...
July 11, 2018: Head and Neck Pathology
Ranran Zhang, Alain Cagaanan, Gholam-Reza Hafez, Rong Hu
Sclerosing microcystic adenocarcinoma is an exceedingly rare entity occurring in the mucosal surfaces of the head and neck that closely resembles cutaneous microcystic adnexal carcinoma. Here, we report a case of sclerosing microcystic adenocarcinoma that presented as a vague mass at the floor of the mouth in a 55-year-old woman. The pathology features and the diagnostic challenges, especially in the biopsy and margin evaluation are discussed here. Similar cases published in the English literatures are reviewed...
July 10, 2018: Head and Neck Pathology
Rehan Rais, Samir K El-Mofty
Ameloblastomas are the most common odontogenic tumors, excluding odontomas. Several morphologic variants have been described including follicular, plexiform, acanthomatous, granular cell, basaloid and desmoplastic. Desmoplastic ameloblastoma differs from other conventional ameloblastomas microscopically, clinically, and radiographically. Ameloblastic carcinoma, the malignant counterpart of ameloblastoma is characterized by cytologic features of malignancy combined within the overall histologic features of conventional ameloblastoma...
July 4, 2018: Head and Neck Pathology
Faraj M Alotaiby, Sarah Fitzpatrick, Jasbir Upadhyaya, Mohammad N Islam, Donald Cohen, Indraneel Bhattacharyya
Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spanning from 1994 to 2015 was performed. Extraoral cases as well as cases with insufficient patient information were excluded. A total of 340 out of 164,578 submitted specimens in a 22 year period (0...
June 21, 2018: Head and Neck Pathology
Aanchal Kakkar, Pirabu Sakthivel, Swati Mahajan, Alok Thakar
Nasopharyngeal adenocarcinomas are rare tumours, and include neoplasms arising from the nasopharyngeal surface epithelium as well as those of minor salivary gland origin, each of which is distinct from the other. The former encompasses nasopharyngeal papillary adenocarcinoma (NPAC), also known as low grade NPAC and thyroid-like NPAC, an extremely unusual malignancy bearing histomorphological similarity to papillary thyroid carcinoma, and displaying indolent clinical behaviour. We report the case of a 41-year-old lady who developed NPAC as a second malignancy five-and-a-half years after being diagnosed and treated for a diffuse astrocytoma in the frontal lobe...
June 19, 2018: Head and Neck Pathology
B Sivapathasundharam, B Kavitha, V M Padmapriya
Carcinoma cuniculatum is one of the variants of squamous cell carcinoma. It is significantly rare with an incidence rate < 1% compared to other histological variants of squamous cell carcinoma. Various etiologic factors implicated are trauma, HPV, chronic inflammation and alcohol consumption but real causative agent still remains unclear. Initially it resembles plantar wart which slowly progress to bulky exophytic mass in the sole of the foot, where cases have been reported first. In the oral cavity it presents clinically as an exophytic growth and slowly invades the jaw and destroys the underlying bone...
June 8, 2018: Head and Neck Pathology
C Mossinelli, C Pigni, F Sovardi, A Occhini, L Preda, M Benazzo, P Morbini, F Pagella
Mammary analogue secretory carcinoma (MASC) is a recently described low-grade salivary gland malignancy with histologic, immunohistochemical and molecular similarities to secretory carcinoma of the breast, including a specific t(12;15)(p13;q25) resulting in an ETV6-NTRK3 gene fusion. Ultrasound and magnetic resonance imaging frequently document a macrocystic structure. The main differential diagnosis of secretory carcinoma is with low grade acinic cell carcinoma (AciCC). The two can be differentiated with immunohistochemical stains for S100, mammaglobin, carbonic anhydrase VI and DOG-1; the identification of the specific translocation can help to characterize non-typical cases...
June 6, 2018: Head and Neck Pathology
Deepak Pandiar, Sangeetha K Nayanar, Basavaraj Ankalkoti, Sajith Babu
Basaloid squamous cell carcinoma with spindle cell component is an uncommon aggressive variety of squamous cell carcinoma with only a few reported cases in literature. Histologically a combination of basaloid squamous cell carcinoma and spindle cell squamous cell carcinoma is appreciated and immunohistochemistry serves a role in differentiation from malignant neoplasms of salivary gland or neuro-endocrine origin. Prime treatment modality is combination of surgery and external beam radiotherapy. A case of basaloid squamous cell carcinoma with proliferation of bizarre mesenchymal component is being reported here with an updated literature review...
June 5, 2018: Head and Neck Pathology
Shiraz S Fidai, Nicole A Cipriani, Daniel T Ginat
Histiocytic necrotizing lymphadenitis is an uncommon autoimmune condition characterized by fever, leukopenia, and neck swelling. Diagnostic imaging, including ultrasound and CT, typically demonstrates conglomerates of enlarged cervical lymph nodes with hypervascular cortices and areas of necrosis. Ultimately, the diagnosis is confirmed with the histopathologic findings of paracortical coagulative necrosis with karyorrhectic debris, abundant histiocytes, and absence of neutrophils. Other potential etiologies, such as other causes of infectious lymphadenitis, tuberculosis, lymphoma, and systemic lupus erythematosus, must be excluded...
June 1, 2018: Head and Neck Pathology
Vincent Cracolici, Sandeep Gurbuxani, Daniel T Ginat
Sinus histiocytosis with massive lymphadenopathy, or Rosai-Dorfman disease, is a rare, benign type of non-Langerhans cell histiocytosis. The radiological findings are often nonspecific, potentially mimicking malignancies. The diagnosis is ultimately made based on pathology, in which the lymph nodes are characterized by a dilated subcapsular sinus filled with histiocytes that can exhibit emperipolesis. Immunohistochemically, the histiocytes are variably CD68 positive and reliably negative for CD1a. The features of head and neck sinus histiocytosis with massive lymphadenopathy are exemplified in this radiology-pathology correlation sine qua non article...
May 31, 2018: Head and Neck Pathology
Zitong Zhao, Yu Jin Lee, Shuwei Zheng, Li Yan Khor, Kok Hing Lim
IgG4-related disease of the thyroid gland is a recently recognized subtype of thyroiditis, often with rapid progression requiring surgical treatment. It is considered as a spectrum of disease varying from early IgG4-related Hashimoto's thyroiditis (HT) pattern to late fibrosing HT or Riedel's thyroiditis patterns. Here, we report a 47-year-old Malay woman presenting with progressively painless neck swelling over 3 years and subclinical hypothyroidism. Computed tomography (CT) scan revealed diffuse thyroid enlargement (up to 13 cm) with retrosternal extension and without regional lymphadenopathy...
May 31, 2018: Head and Neck Pathology
Masaru Miyazaki, Mikiko Aoki, Yasuko Okado, Kaori Koga, Makoto Hamasaki, Fumiaki Kiyomi, Toshifumi Sakata, Takashi Nakagawa, Kazuki Nabeshima
Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is rare and offers a poor prognosis; more accurate prognostic biomarkers are required. Our laboratory recently demonstrated that tumor budding, characterized by tumor cell clusters (< 5 cells), and laminin 5-γ2 staining of SCC of the EAC are associated with shorter survival. However, clusters composed of ≥ 5 tumor cells are also found in the stroma. Previous reports of colorectal cancer suggest that poorly differentiated clusters (PDCs) are a negative prognostic indicator...
May 30, 2018: Head and Neck Pathology
Athiva Shankar, Dorothy H Crouch, Michaelina Macluskey
High-risk human papilloma virus (HR-HPV) has increasingly been associated with head and neck squamous cell carcinoma (HNSCC), in particular oropharyngeal cancers. Ezrin-Radixin-Moesin Binding Phosphoprotein 50 (EBP50), a putative tumour suppressor, localises to the plasma membrane in suprabasal epithelium and to the cytoplasm in proliferative basal layers, and is a target for degradation by the HR-HPV E6 oncoprotein. The aim of this study was to investigate EBP50 protein expression patterns in HNSCC in a large Scottish cohort to determine if there was a correlation with HPV status and clinical outcomes...
May 30, 2018: Head and Neck Pathology
Benjamin G Barrena, Billy J Phillips, Kenneth J Moran, Sasha J Betz
Ameloblastomas are benign but aggressive odontogenic tumors that most commonly affect the posterior mandible. Approximately 15% occur in the maxilla, with a subset thought to originate from the epithelial lining of the sinonasal cavities. Histologically, sinonasal ameloblastomas are identical to those of the oral cavity, with classical features of palisaded columnar basilar cells surrounding a central proliferation that resembles the stellate reticulum of a developing tooth. Unlike the gnathic variant, sinonasal ameloblastomas tend to affect males more than females, and the incidence of diagnosis peaks at a later age, approximately 60 years old...
May 30, 2018: Head and Neck Pathology
Jason K Wasserman, Doaa AlGhamdi, John R de Almeida, Tracy L Stockley, Bayardo Perez-Ordonez
Neuroendocrine carcinomas (NECs) are epithelial neoplasms showing morphologic, immunophenotypic or ultrastructural evidence of neuroendocrine differentiation. The 2017 WHO Classification of Head and Neck Tumours classifies NECs into well, moderately and poorly differentiated NECs according to light microscopic features, mitotic rate and presence of tumour necrosis. In this study, we performed next generation sequencing (NGS) using a targeted 161 cancer gene panel on a poorly differentiated NEC of the nasal cavity...
May 29, 2018: Head and Neck Pathology
Mohamed E Mostafa, Amrou Abdelkader, Mario Scarpinato, Michael E Stadler, Bryan C Hunt, Tamara Giorgadze
Stensen's duct carcinoma (StDC) is an extremely rare neoplasm, with fewer than 40 cases reported in the literature. We report a unique case of primary StDC with papillary features and intestinal differentiation of a 74-year-old male. We discuss the radiologic and pathologic correlation along with the differential diagnosis of this rare entity.
May 17, 2018: Head and Neck Pathology
Daniel Thomas Ginat, Nicole A Cipriani, Gregory Christoforidis
The goal of this study was to evaluate the benefits of resident and fellow-facilitated radiology-pathology head and neck conferences. A total of seven resident-facilitated and six fellow-facilitated head and neck radiology-pathology cases were presented as part of the radiology department conference series. The radiology residents were surveyed regarding the perceived quality and effectiveness of the fellow-facilitated sessions. The number of publications yielded from all the cases presented was tracked. Overall, the residents assessed the quality of the fellow-facilitated conferences with an average score of 3...
May 17, 2018: Head and Neck Pathology
Zhenjian Cai, Jaiyeola Thomas, Ibrahim Alava, Nfn Aakash, Karan Saluja, Hui Zhu
Rhabdomyoma is a rare benign tumor with skeletal muscle differentiation. Rhabdomyoma is further classified into cardiac, adult, fetal, and genital subtypes. Out of these, fetal type rhabdomyoma (FTR) is the rarest. Only a small number of cases have been recorded in the literature. FTR typically affects male infants and young children and occurs predominantly in the head and neck region. FTR is exceedingly rare in the adult, with less than 30 cases reported. The classic FTR is composed of primitive undifferentiated spindle cells with scant eosinophilic cytoplasm embedded in a myxoid stroma...
May 14, 2018: Head and Neck Pathology
Ivan J Stojanov, Adrian Mariño-Enriquez, Nacef Bahri, Vickie Y Jo, Sook-Bin Woo
Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU...
May 10, 2018: Head and Neck Pathology
Ramkishan Balakumar, Matthew R B Farr, Malee Fernando, Ala Jebreel, Jaydip Ray, Sara Sionis
The autosomal dominant Birt-Hogg-Dubé syndrome is known to be associated with skin, lung and kidney lesions. It is caused by heterozygous germline mutations in the folliculin gene and has a high penetrance. We report the case of a 51 year old woman with Birt-Hogg-Dubé syndrome who presented with a laryngeal mass. Imaging confirmed a mass centered on the piriform sinus and following excision histological examination confirmed the lesion was composed of polygonal cells with abundant eosinophilic cytoplasm consistent with a rhabdomyoma...
May 9, 2018: Head and Neck Pathology
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