Head and Neck Tumor Question and Answers

Head and Neck

Question 1. Classify salivary gland tumors.
Answer:

Salivary gland tumors

1. Benign

• Pleomorphic adenoma, War thin tumor, oncocytoma, basal cell adenoma, ductal papilloma

2. Malignant

• Mucoepidermoid carcinoma, adenocarcinoma not otherwise specified (NOS), acidic cell carcinoma, adenoid cystic carcinoma, malignant mixed tumor, squamous cell carcinomas

Question 2. Write a note on the adamantine of the jaw.
Answer:

Ameloblastoma/Adamantine of jaw

• The most common epithelial odontogenic tumors
• Age group: 3–5 decades
• Most common site: Mandible
• X-ray demonstrates a lytic expansive lesion

Gross

Read and Learn More Preparatory Manual of Pathology Question and Answers

• Solid and cystic

Microscopy

• Follicular and plexiform subtypes are the most common
• Follicular type: Follicles containing basaltic cells lining the basement membrane and the central portion of the follicle resembles stellate reticulum
• Plexiform type: Irregular masses and cords of epithelial cells within the stoma

Question 3. Write a note on the pleomorphic adenoma of a salivary gland.
Answer:

Pleomorphic adenoma (mixed tumors)

• Benign tumors that consist of a mixture of ductal (epithelial) and epithelial cells
• The most common site is the parotid gland

Risk factors

• Radiation exposure increases the risk
• Chromosomal rearrangements involving PLAG1

Morphology

Gross

• Presents as a rounded, encapsulated, well-demarcated masses
• Cut surface: Gray-white with myeloid-like areas

Microscopy

• Epithelial elements are arranged in acini, tubules, strands, or sheets of cells
• Epithelial cells in the ducts are surrounded by a epithelial cell layer in a background of myeloid substance

Question 4. Write a note on War thin’s tumor of a salivary gland.
Answer:

War thin tumor (papillary cystadenoma lymphomatous)

• Arises from the parotid gland
• Occurs more commonly in males
• Age group: Fifth to seventh decades of life
• 10% are multifocal and 10% are bilateral
• Smokers are at increased risk of developing these tumors

Gross

• Round encapsulated mass
• Cut surface: It shows multiple cystic spaces containing serous or mutinous secretions

Microscopy

• Cystic spaces are lined by a double layer of neoplastic epithelial cells resting on a dense lymphoid stoma with prominent germinal centers
• Cystic space lumen often contains secretions

Question 5. Write a note on malignant salivary gland tumors.
Answer:

Mucoepidermoid carcinomas

• The most common primary malignant tumor of the salivary glands
• Most common site: Parotid gland followed by minor salivary glands

Morphology

Gross

• Circumscribed tumor, but lack well-defined capsule
• Cut surface—solid with small, much-containing cysts

Microscopy

• The tumor grows in nests, sheets, and cords
• Tumor cells are composed of mixtures of squamous cells, mucus-secreting cells, and intermediate cells

Adenoid Cystic Carcinoma

• The most common site—the minor salivary glands (palate)
• Can show perineal invasion

Gross

• Small, poorly encapsulated, infiltrated lesions

Microscopy

• Tumor cells are arranged in a cribriform pattern
• Tumor cells have dark, compact nuclei and scant cytoplasm
• Cribriform spaces are filled with hyaline material

Question 6. Write a short note on nasopharyngeal carcinoma.
Answer:

Nasopharyngeal carcinoma

• Bimodal age group (15–25 years and 60–69 years)
• Etiopathogenesis: ABV infection, diets rich in nitrosamines, and smoking
• ABV detection is done by: PCR or by FISH (which detects Re-encoded RNA, EBER-1, or proteins such as LMP-1 in malignant epithelial cells)

Three patterns

1. Keratinizing squamous cell carcinomas
2. Non-keratinizing squamous cell carcinomas
3. Undifferentiated carcinomas (lymphoepithelioma)

Treatment

• Radiotherapy is the standard modality of treatment
• Undifferentiated carcinoma is the most radio-sensitive
• Keratinizing squamous cell carcinoma is the least radio-sensitive

Question 7. Write a note on paragangliomas.
Answer:

Paragangliomas

• Arises from the clusters of neuroendocrine cells
• In adrenal glands, they are termed pheochromocytoma
• 70% of extra-adrenal paragangliomas occur in the head and neck region

Paragangliomas can develop at:

1.  Paravertebral paraganglia (example organs of Zuckerkandl)—innervated by the sympathetic nervous system and are chromatin-positive
2.  Paraganglia related to the great vessels of the head and neck (aorticopulmonary chain): For example, carotid bodies (most common); aortic bodies; jugulate ganglia—innervated by the parasympathetic nervous system

Carotid body tumor

• Arises at the bifurcation of the common carotid artery
• Slow-growing and painless masses
• Age group: 40–50 years
• Familial cases are associated with MEN-2 syndrome

Morphology

Microscopy

• Composed of nests (Zellballen) of round to oval chief cells, surrounded by delicate vascular septal
• Chief cells stain strongly for chromogenic, synaptophysin, neuron-specific enolate
• Surrounding the chief cells there occur spindle-shaped stromal cells (sustentacular cells), which are positive for S-100 protein