LG 17 Pathology of the upper airways

The tongue is lined by epithelium.

Buccal Mucosa and Gingiva is lined by epithelium.

The tongue is comprised of muscle.

Oral Squamous Cell Carcinoma Clinical Presentation.
Oral lesions:
Can be painful or painless
Neck mass: can be present at presentation
Weight loss

Oral Squamous Cell Carcinoma has Two Major Types: and Associated

70% of oral squamous cell carcinoma associated with HPV, usually

Classic carcinogen induced oral squamous cell carcinoma:
Is caused by
Location: Ventral surface of tongue, floor of mouth, lower lip, soft palate, gingiva

HPV Associated oral squamous cell carcinoma:
70% of oral squamous cell carcinoma associated with oncogenic HPV, usually HPV-16
Location: Usually
Note: HPV associated oral squamous cell carcinoma has a prognosis than classic tobacco and alcohol associated oral squamous cell carcinoma
Miscellaneous Note: Other common sites for Squamous Cell Carcinoma are Cervix, Skin, Lung, Esophagus, Anus

In Normal Squamous Epithelium to Dysplasia to Squamous Cell Carcinoma you go from:
Orderly maturation towards surface with Maturation: Means the cells are more plump at bottom and flatten out as they approach the surface.
TO
No .
Completely growth.
Invasive.
in all areas.

In Classic Oral Squamous Cell Carcinoma you have can have:
mutations
mutations
mutation

In HPV associated Oral Squamous Cell Carcinoma you can have:
over-expression
inactivation
pathway inactivation

Leukoplakia
lesion may represent benign (thicker keratinized layer) or pre-cancerous lesion
5-25% of leukoplakia lesions are

Erythroplakia
lesion, usually represents carcinoma in situ
Up to % can be carcinoma in situ

Oral Squamous Cell Carcinoma Prognosis:
Dependent on
Low stage: 65-75% 5 year survival
Metastatic disease: 35% 5 year survival
HPV associated cancer has prognosis than classic tobacco/alcohol associated oral cancer

Sjogren Syndrome: Autoimmune Disease with Dry Mouth and Dry Eyes Clinical Features:
Most common in
50-60 years old
(dry mouth): Difficulty swallowing, decreased taste, cracks and fissures in mouth
(dry eyes): Blurring of vision, burning, itching
enlargement secondary to inflammation; however, involves all major and minor salivary glands
Note: means dry

Sjogren Syndrome:
Auto-immune destruction of glands
90% of patients have antibodies directed against two ribonucleoprotein antigens, (Ro) and (La)
Pathogenesis: Aberrant activation against salivary gland tissue in genetically susceptible patients
Associations: Rheumatoid arthritis, synovitis, diffuse pulmonary fibrosis, peripheral neuropathy
Therapy:
Prognosis: Slowly progressive, evolves over decades, waxing and waning
About 5% of patients develop secondary to chronic B-cell activation

Sjogren Syndrome Pathology in Salivary Gland:
Large numbers of attacking acinar cells
Normal salivary gland has very few cells
The will cause cell death and tissues will no longer produce saliva

Mucocele of minor salivary gland:
Blockage of minor salivary gland duct causes leakage of into surrounding tissues, which causes response

Pleomorphic Adenoma:
Benign tumor that shows epithelial, myoepithelial and tissues
Most common location is gland, less common in submandibular gland
Wide age range, with two peaks one in childhood and one in 4th-6th decade
gene rearrangements: is a transcription factor that expression of genes involved in cell growth

Warthin Tumor (Papillary Cystadenoma Lymphomatosum):
Benign tumor composed of layer of oncocytic epithelioid cells forming and cystic structures, resting on reactive stroma
Occurs largely in gland
Risk factors:
10% are bilateral, 10% are multifocal; multiple tumors may be synchronous or metachronous

: Tumors occur at different points in time
: Tumors occur at same time

Mucoepidermoid Carcinoma:
Malignant tumor composed of cells and -secreting cells forming solid and cystic patterns
Occurs in both major and minor salivary glands
Approximately half of tumors associated with t(11;19)(q21;p13) that creates and fusion
Prognosis depends on histologic of tumor

Nasopharyngeal Carcinoma:
Malignant tumor associated with infection
Also associated with high diet (preserved meats), smoking, chemical fumes
Clinical presentation: Common in African children and southern Chinese adults (rare in US), may present with enlarged lymph node
3 histologic types:
Keratinizing Squamous Cell Carcinoma
Non-keratinizing Squamous Cell Carcinoma
Undifferentiated/Basaloid Carcinoma
Prognosis: Overall 5 year survival of 60%

Nasopharyngeal Carcinoma, Undifferentiated Type, Pathology:
Large cells with round to ovoid nuclei with prominent nucleoli and moderate amounts cytoplasm
like clusters of cells
Benign in background
positive by in situ hybridization

Nasopharyngeal Angiofibroma:
Benign, highly vascular tumor that occurs almost exclusively in adolescent males due to dependent puberty induced growth
Clinical presentation: (nose bleed)
Avoid biopsy due to risk

Nasopharyngeal Angiofibroma Pathology:
produce fibrous (collagenous) stroma

Nasal Polyps:
polyps of nasal mucosa
Many etiologies: Allergy, Infection, Cystic fibrosis, Aspirin Intolerance, Familial
Aspirin Intolerance: Tetrad of , nasal polyps, chronic hypertrophic sinusitis and aspirin intolerance

Nasal Polyp Pathology:
Histology: Surface lined by epithelium with underlying stroma showing fibrous stroma and edema and mixed inflammation with , plasma cells, , lymphocytes