Dr.

Villanueva Reviewer Pathology Head and Neck

Justine S. Villanueva MD2

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Herpes Simplex Virus Type 1 (HSV1)- causes common sores or in children a severe form of inflammation.
Acute Herpetic Gingivostomatitis- severe form of inflammatiom in children caused by HSV1
lesions of HSV1 consists of
1. Vesicles
2. Bullae (larger)
3. Shallowed ulceration
Histologically in HSV 1
1. Intracellular edema
2. Intercellular edema (acantholysis)
3. Eosinophilic intranuclear inclusions
4. Giant cells
3-4 weeks- vesicles heal completely
Oral candidiasis- manifested by superficial gray to white inflammatory membrane. Composed of organisms
enmeshed in its fibrino suppurative exudate, occurs in immune suppression (AIDS, diabetes, neutropenia)
Reactive lesions
1. Irritation fibroma- occurs at the gingivodental margin and consists of a mass of fibrous tissue covered by
squamous mucosa
2. Pyogenic granuloma- form of capillary hemangioma commonly seen in pregnant women (pregnancy tumor)
3. Peripheral giant cell granuloma- giant cell epulis, made of a striking aggregation of multi-nucleated foreign
body like giant cell made up of fibroangiomatous stroma.
Oral manifestation of systemic disease
1. Scarlet fever
2. Measles
3. Infectious mononucleosis
4. Dermatologic conditions- lichen planus, erythema multiforme
5. Hematologic disorder- pancytopenia, leukemia, monocytic leukemia, addison's disease, chronic phenytoin
(Dilantin), telangiectasia of Rendu-Osler Weber syndrome
Hairy leukoplakia- oral lesion of patients with AIDS, present as a white, confluent,
Epstein Barr Virus- causes hairy leukoplakia, may also be due to HIV or HPV
Ballooned or ground glass cytoplasm- hairy leukoplakia in histological finding
Tumors and precancerous lesions
1. Leukoplakia- defined as a white plaque on the oral mucous membrane that cannot be removed by scraping.
1. Benign epithelial thickening to a dysplastic change- lesion range of leukoplakia
2. Erythroplakia- less common, atypical, increased risk of malignancy
Tobacco- associated with leukoplakia and erythroplakia
Risk factor of tumors and pre cancerous lesions
1. Alcohol
2. Bad teeth
3. Ill fitting dentures
HPV type 16- tobacco related lesions
5-6%- cancer may occur in leukoplakia
50%- cancer may occur in erythroplakia
50-70 yrs old- usual diagnosis of squamous cell carcinoma
Alcohol and tobacco use- 6-15 fold freater rosk of cancer
Chewing betel buts and using pan- increased risk
Deletions in some cases of squamous cell carcinoma
1. 18p
2. 10p
3. 8p
4. 3p
Favored location of squamous cell carcinoma
1. Floor of the mouth
2. Tongue
3. Hard palate
4. Base of the tongue
Typical squamous carcinoma- Lesions of squamous cell carcinoma
Sites of local infiltration of squamous cell carcinoma:
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Dr. Villanueva Reviewer Pathology Head and Neck

Justine S. Villanueva MD2

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1. Mediastinal lymph nodes

2. Lungs
3. Liver
4. Bones
Lip lesions- best prognosis
Poorest prognosis with tumors in these area (20-30% 5 year survival)
1. Floor of the mouth
2. Base of the tongue
Infectious rhinitis or common colds are caused by
1. Adenovirus
2. Echovirus
3. Rhinovirus
Allergic rhinitis
1. IgE mediated
2. Immune reaction
Inflammatory nasal polyps- occurs after recurrent attacks of rhinitis
Sinusitis- is commonly preceded by acute or chronic rhinitis
Maxillary sinusitis- may arise by extension of a periapical tooth infection through the bony floor of the sinus
Mucormycosis- severe sinusitis caused by fungi (especially in diabetics)
Kartagener syndrome- sinusitis is accompanied by bronchiectasis and situ inversus all secondary to defective
ciliary action
Necrotizing lesions include:
1. Spreading fungal infections
2. Wegener granulomatosis
3. Lethal midline granuloma
Neoplasm of natural killer cells
1. Angiocentric
2. Non hodgkins lymphoma
Tumors of the nose, sinuses and nasopharynx
1. Nasopharyngeal angiofibroma- highly vascularized tumors that occurs in adolescent boys and may cause
serious bleeding during surgery
2. Inverted papillomas- benign but locally aggressive neoplasm of squamous epithelium
3. Isolated plasma cytomas- are made of mature and immature plasma cells
Nasopharyngeal carcinomas- can be non keratinizing or keratinizing squamous cell carcinoma
Epstein Barr virus- nasopharyngeal carcinoma is closely directed
Two types of nasopharyngeal cancer
1. Regaud's type
2. Schminke's
Laryngitis- may occur as a manifestation of allergic, viral, bacterial or chemical injury
H. Influenza- may cause laryngitis in kids
Croup- inspiratory stridor in laryngitis
Reactive nodules or vocal cord polyps- occur often in smokers and singers
Squamous papillomas- benign lesions, on the true focal cords
Juvenile laryngeal papillomatosis- squamous papillomas in children which are multiple
HPV 6 and 11- cause lesions, but do not become malignant
Spectrum of epithelial alterations seen in larynx
1. Hyperplasia
2. Atypical hyperplasia
3. Dysplasia
4. Carcinoma in situ
5. Invasive carcinoma
Level of atypia- the likelihood of development of an overt carcinoma is directly proportionate to this.
Risk factors
1. Smoke
2. Alcohol
Typical squamous cell lesion- 95% of laryngeal cancer, usually in the vocal cords
Cancer in the larynx manifested as
1. Persistent hoarseness
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Dr. Villanueva Reviewer Pathology Head and Neck

Justine S. Villanueva MD2

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2. Pain
3. Dysphagia
4. Hemoptysis
Otitis media- mostly in infants and children
Causes otitis media
1. S. Pneumonia
2. H. Influenza
3. Beta hemolytic streptococci
Causes chronic otitis media
1. Pseudomonas
2. Staphylococcus
Cholestomas- associated with chronic otitis media. Cystic lesions 1-4cm in diameter
Keratinizing squamous epithelium- filled the amorphous debris and have spicules of cholesterol
Otosclerosis- abnormal bone deposition in the middle ear about the oval window, hampering the mobility of the
footplate of the stapes.
Thyroglossal duct cysts- arise from residua of the embryonic origins of the thyroid gland
Paragangliomas- are tumors arising in extraadrenal paraganglia either in the paravertebral areas or more
commonly in the paraganglia around the great vessels of the head and neck, including the carotid bodies
Paragangliomas pathology:
1. red, pink, or brown and consist of nests (zellballen) of polygonal chief cells enclosed by trabeculae of
fibrous and sustentacular elongated cells
2. The cells have neuroendocrine granules by electron microscopy and stain positively for neuroendocrine
markers
Paraganglioma (Carotid body tumor)
1. They occur singly and sporadically but may be familial , as part of the multiple endocrine neoplasia II
syndrome, where they are multiple and bilateral.
2. They may recur after excision in about 50% of cases and ultimately prove fatal due to infiltrative growth
Paraganglioma (Carotid body tumor) pathology
1. organoid pattern
2. cellularity
3. lack of mitosis
Sialoadenitis- may be viral, bacterial, or autoimmune in origin, the last-mentioned usually associated with Sjogren
syndrome
Bacterial sialoadenitis- is usually ductal obstructions by stones, sialolithiasis
salivary glands- give rise to a variety of benign and malignant tumor
65 to 80%- salivary glands tumors arise within the parotid
10%- in the submandibular, and the remainder in the minor salivary glands
15-30%- of parotid tumors are malignant
40%- of submandibular tumors- malignant
70-90%-of minor salivary gland tumors- malignant
Pleomorphic adenomas (Benign mixed tumor) - are mixed tumors that are the most common of salivary gland
neoplasms, represent 60% of parotid tumors and show both epithelial and mesenchymal differentiation
Pleomorphic adenoma pathology:
1. composed of epithelial nests, cords, or glands dispersed through a matrix showing varying degrees of myxoid,
hyaline, chondroid, and even osseous tissue
tumors of pleomorphic adenomas present as
1. painless masses
2. slow-growing masses
3. mobile masses
4. discrete masses (within the parotid or submandibular areas or in the buccal cavity.)
5. They may recur if not well excised, with recurrence approaching 25% in some series
10% of pleomorphic adenomas- Malignant transformation occurs in more than 15 years duration, usually in the
form of adenocarcinoma or undifferentiated carcinoma
Warthin tumor (Papillary Cystadenoma)
1. almost always arises in the parotid gland
2. 10% are multifocal and bilateral

Dr. Villanueva Reviewer Pathology Head and Neck

Justine S. Villanueva MD2

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The tumor is well-encapsulated and consists of glandular spaces lined by a double layer of epithelial cells
resting on a dense lymphoid stroma, sometimes bearing germinal center
4. The histogenesis is unknown
5. The tumors are benign
Mucoepidermoid carcinoma
1. represents about 15% of all salivary gland tumors
2. are the most common form of malignant tumor primary in the salivary gland
3. They may reach up to 8 cm in diameter and lack well-defined capsules
4. Histologically1. they consist of cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells with
small-to-large mucus-filled vacuoles highlighted with mucin stains
2. They can be low-grade, intermediate grade, or high-grade malignancies
3. Low-grade tumors invade locally and recur in 15% of cases
4. high-grade tumors recur in about 25% and have only a 50% 5-year survival rate
Adenoid cystic carcinoma - is a relatively uncommon tumor in the parotids but is the most common neoplasm in
the other salivary glands , particularly the minor salivary glands of the mouth
Similar neoplasms have been noted in the:
1. nose
2. sinuses
3. upper airways
4. elsewhere
Pathologically (adenoid cystic carcinoma)
1. Small, poorly encapsulated, infiltrative graypink lesions composed of small cells having dark, compact nuclei
and scant cytoplasm cribriform
2. These cells are arranged in a tubular, solid, or pattern; spaces between tumor cells are filled with hyaline
material to represent excess basement membrane
3. Tends to invade perineural spaces thought , making them very painful
4. Stubbornly recurrent
minor salivary glands- have a poorer prognosis than those primary in the parotids
Osteomyelitis of the jaws- usually represents an additional consequence and extension of dental or periodontal
infection, Acute, subacute, and chronic forms exist.
Hematogenous osteomyelitis- has been encountered rarely
Symptoms such as pain, fever, and soft-tissue swelling or redness in later stages are usually present
Smooth, regular, and atrophic loss of the covering mucosa- late finding in osteomyelitis, and the exposed bone
appears dull and devitalized
Roentgenographic features of osteomyelitis
1. subtle, irregular
2. ill-defined
3. predominantly radiolucent lesions
main microscopic findings inflammatory conditions
1. Acute suppurative inflammation
2. resorptive scalloping of margins of nonvital bone within a large portion of maxilla or mandible
Staphylococcus aureus- is the organism most commonly cultured in inflammatory conditions
Anaerobic bacteria- have also been demonstrated to be important in inflammatory conditions.
been causally identified in osteomyelitis of the jaw:
1. Tuberculosis
2. mucormycosis
3. aspergillosis
4. candidiasis
Odontogenic cysts- are derived from the tooth germ, degenerated epithelium around an impacted or unerupted
tooth, epithelial nests, or remnants of the dental lamina
Terminology depends on the location, eg, periapical, paradental, dentigerous
Most odontogenic cyst are lined by
1. hyperplastic stratified squamous epithelium with occasional focal keratinization, goblet cells, and hyaline
bodies
enucleation of the offending tooth to surgical excision of the cyst- Treatments of odontogenic cyst
Ameloblastoma- is the most common odontogenic tumor with aggressive growth potential
posterior mandible- 80% of ameloblastoma happens here
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Dr. Villanueva Reviewer Pathology Head and Neck

Justine S. Villanueva MD2

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posterior maxilla- 20% of ameloblastoma happens here

occurs both in men and women- ameloblastoma happens
30-50 years old- highest incidence of ameloblastoma
ameloblasts or dental lamina- ameloblastomas are from, the epithelium that either has produced or will produce
the crown of the tooth
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Impacted teeth- Ameloblastoma is often associated with this, is demonstrated to be derived from the wall of an
odontogenic cyst
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multilocular radiolucency- ameloblastoma appears radiologically as this.
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Ameloblastic reticulum like stellate cells- The islands of epithelium show columnar cells surrounding areas of
these.
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these epithelial cells are
1. columnar
2. show peripheral palisading and an inverted polarity
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Ameloblastic carcinoma- is a squamous cell carcinoma that resembles an ameloblastoma because of a prominent
peripheral palisade of columnar cells and a resemblance to stellate reticulum in the large islands of tumor
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the infiltrative tumor demonstrates:
1. the hallmarks of anaplasia such as pleomorphism
2. increased N:C ratio
3. increased and abnormal mitotic activity
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Ameloblastic Fibroma roentgenographically- often resembles a cyst In contrast to ameloblastoma, the tumor for
which it is most commonly mistaken,
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Young age group- ameloblastic fibroma usually occurs in a this age group , rarely being seen in individuals older
than 21 years of age.
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Microscopically, this tumor is composed of
1. strands and buds of epithelial cells in a cellular connective tissue stroma .
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mesenchymal component - The presence of this clearly distinguishes this lesion from ameloblastoma
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Fibrous dysplasia and Cemento-ossifying fibroma- two morphologically identical lesions that occur in the
pediatric age group;
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Cemento ossifying fibroma- is amenable to excision
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Fibrous dysplasia- reactive and related to Albrights syndrome (polyostotic multifocal)- a systemic disease.
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Differentiation is important due to differences in management
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Chinese character type of ossification - Both tumors are composed of a fibrous stroma characterized by this
type of ossification.
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the Ossifying fibroma is characterized by
1. osteoblastic rimming of the ossified islands- this is absent in fibrous dysplasia