Transcript TUMORS OF THE HEAD AND NECK

TUMORS OF THE HEAD
AND NECK
Areas of Concern
1. Skin of the head and neck
2. Oral cavity
3. Nasopharynx
4. Oropharynx
5. Hypopharynx
6. Lrynx
7. Soft tissue and bony structures
I. Diagnosis
A. History and P.E.
1. Manifestations affecting
respiration and alimentation.
2. Palpable or visible
masses and cervical
lymphadenopathies.
3. Bimanual examination
B. Ancillary procedures
1. Endoscopy
a. nasopharynx
b. upper GI
c. bronchoscopy
2. Biopsy procedures
a. fine needle
b. incision or punch biopsy
3. Imaging studies
a. X-rays
b. CT scans or MRI
II. Pathologies
A. Thyroglossl duct cyst
1. Congenital anomaly in
thyroid gland development
2. Tx. – excision also caled
Sistrunk procedure
B. Brachial cleft anomalies
- cysts, sinuses, or cartilaginous
remnants
- incomplete fusion of the clefts
1. 2nd branchial cleft anomaly
a. most common
b. opens at the anterior border of the
sternocleido m. an passes
through the bifurcation of the
carotid a.and exits through the
posterolateral pharynx just
below the tonsillar fossa.
c. clear fluid seen draining anterio to
SCM
d. associated with biliary
and congenital cardiac
anomalies.
atresia
e. Tx – removal of the cyst and
dissection of the tract
2. First branchial cleft anomaly
3. 3rd branchial cleft anomaly
C. Hemangiomas and vascular malformations
D. Lip
1. Usually due to chronic irritation or
ultraviolet radiation.
2. Clinical manifestations
a. visible or palpable lesion
b. thickening of the lip
c. scaling
d. Tx – wide excision and reconstruction
E. Oral Cavity
1. Mucous retention cyst
a. submucosal accumulation
of mucus
b. common in labial mucosa
and lower lip
c. 1 cm with bluish hue
d. Tx. – excision or
marsupialization
2. Ranula
a. mucus retention cyst of
the major salivary glands
b. most commonly in the
sublingual gland
c. Tx. - excision
3. Epulis
a. granulomatous lesion of
the gingiva
b. exaggerated inflammatory
response
c. two types
i. congenital
ii. Gravidarum
d. Tx. – excision for
symptomatic epulides
4. Peripheral giant cell reparative granuloma
a. common in the gingiva
b. “giant” cell resembles
osteoclasts
c. polypoid, submucosal and
fibrous, ulcerating which
causes bleeding
d. radiographs may reveal
underlying bone erosion
e. complete excision to prevent
recurrence
5. Central giant cell reparative
granuloma
a. of bony origin typically
within the mandible
b. may also arise in the
paranasal sinuses, orbit
cranial vault, temporal bone
c. true giant cell tumor with
malignant potential
d. Brown tumors of
hyperparathyroidism
e. traumatic bone cyst
f. fibrous dysplasia
g. Tx. - curretage
6. Papillomas
a. common in tongue and
larynx
b. associated with Human
Papilloma Virus
c. soft, irregular, pedunculated
tumors
d. Tx. – excision or cautery
7. Granular cell myoblastoma
a. described by Abrikossof in 1926
b. rare benign tongue tumor
c. firm, submucosal swelling in
the middle third of the tongue and
may mimic scc
d. wedge excision is usually
curative
F. Ulcerative lesions of the oral cavity
1. Idiopathic aphthous ulcer
a. most common lesion of the oral
lining
b. cycle of painful ulceration and
healing
c. Etiology: herpes simplex infection,
nutritional deficiencies, emotional
stress
d. Tx - steroids
2. Pemphigus vulgaris
a. multiple painful oral lesions
b. severe, generalized toxicity
c. 5th – 7th decade, Mediterranean
descent
d. intraepitheleal bullae which
ruptures and ulcerates, overlying
epithelium rubs off easily
(Nikolsky’s sign)
e. Tx – steroids and antimetabolites
3. Necrotizing sialometeplasia
a. benign inflammatory disease of
the minor salivary glands usually in
the hard palate
b. discrete painful ulcers
c. local trauma with progressive
ischemia and ulceration
d. spontaneous healing in 6-10
weeks
e. biopsy done to differentiate from
malignancy
4. White sponge nevus, Lichen planus,
Oral hairy leukoplakia
a. white plaque lesions in the oral
cavity
b. parakeratosis histologically
c. self-limiting, immune related
(HIV or AIDS patient)
d. associated with scc, especially
lichen planus
G. Nose
1. Polyps
a. nasal and paranasal
cavities; multiple and
bilateral
b. male = female ratio
c. nasal obstruction,
anosmia, nasal discharge
d. allergic or inflammatory
e. Tx – medical, steroids,
polypectomy
2. Squamous papillomas
a. caused by papilloma
virus
b. in the skin of nasal
sills, columella or allae
c. nasal obstruction
d. Tx - excision
3. Juvenile nasopharyngeal
angiofibromas
a. benign but highly
expansible and
fibrovascular neoplasm
b. adolescent males (1020 y/o)
c. starts as superior nasal
cavityand erodes into the
paranasal sinuses, orbit,
middle cranial and
pteryogomaxillary fossa
d. s/s:
Early
- nasal obstruction and
epistaxis
Late
- anosmia, proptosis,
cranial nerve
dysfunction
e. Tx. Angiographic
embolization followed by
surgical dextirpation;
radiation for residual disease
H. Paranasal sinuses
1. Mucus retention cysts
a. blockage of secretions
of mucus glands within the
lining of the paranasal sinuses,
usually a sequelae of sinusitis
b. fluid containing mass that
remains separate from the bony
wall of the sinus
c. most common in the maxillary sinus
d. Tx – rarely necessary
2. Mucocoeles
a. benign, highly
expansile lesions
b. microscopic blockage of a
sinus ostium by epithelial or
osseus neoplasms,
inflammatory process or as a
result of trauma
c. thinning and destruction of the
sinus wall, invades adjacent vital
structures
d. CT scan or MR
e. Tx – evacuation and removal of entire
mucosal lining of the sinus
I. Larynx
1. Papilloma (laryngeal)
a. most common benign
neoplasm, true vocal chords
b. associated with human
papilloma virus
c. presents with hoarseness
d. adults – solitary and rarely
recurs
juvenile – multiple and usually
recurs
e. Tx – excision/laser obliteration
2. Laryngocoele
a. herniation of the
laryngeal ventricles
b. 3 forms categorized by
site of presentation
i. internal - confined
to larynx
ii. external –
protrudes through
thyrohyoid membrane
iii. mixed
c. seen in singers, musicians
d. Tx – ligation of the stalk and
repair of ventricular
weakness
J. Malignant Head and Neck
Tumors
- exhibit same behavior and
characteristics as most solid
tumors
1. local growth
2. loco-regional spread
3. distant metastasis
- effects on human life mainly due to
disruption of function
1. alimentation
2. respiration
- Histopathology – 90% squamous
cell carcinoma
- difference in natural history
depends on the location, blood
supply, aand lymphatics of the tumor
- clinical manifestations – nonspecific
- treatment – multidisciplinary
considerations:
1. complete extirpation
2. functional end result
1. Etiology of Head and Neck
Cancers
a. ultraviolet rays
b. tobacco
c. alcohol
d. occupational related
e. race
f. radiation exposure
2. Diagnosis
a. history
i. pain
ii. bleeding
iii. obstruction
iv. mass
b. physical examination
i. inspection and
palpation
ii. neurologic
examination
c. biopsy
1. punch biopsy
2. incisional biopsy
3. fine needle
aspiration biopsy
(except small lesions
and parotid tumors)
d. additional studies
1. radiologic studies
2. CT scan
3. MRI
4. contrast studies
3. Cancer of the oral cavity
a. boundaries
i. anterior: lips
pappilae
tongue
ii. posterior: anterior
tonsillar pillars,
posterior aspect of the
hard palate, and the
circumvallate
of the
b. pathology
i. 90% scc
ii. preceded by
erythroplakia or
leukoplakia
iii. Usually moderate
or well- differentiated
iv. 30% have clinical or
subclinical lymph node
involvement
c. clinical features
i. ulcerated tumors
ii. 50-70 y/o, males
iii. heavy smoker,
alcohol drinker, poor
dental hygiene
iv. Painless unless
deeply invasive
v. submandibular or jugular
nodes are palpable in 30% of
cases
d. treatment
i. resection –
commando) with
ipsilateral neck
dissection (even in
the absence of
clinically absent
nodes)
ii. Staged bilateral
neck dissection if
lesion crosses the
midline
iii. Radiation for smaller
lesions and recurrece
4. unknown primary cancers
head
and neck
a. 5-10% of metastatic
tumors in the neck
of the
b. rule of 80’s
i. 80% of non-thyroidal
masses are neoplastic
ii. 80% of neoplastic
masses are malignant
iii. 80% of malignant masses
are metastatic
iv. 80% of primary tumors
above the clavicle
c. history
d. physical examination
i. nasopharyngoscopy
ii. Laryngoscopy
iii. Bronchoscopy
iv. Esophagoscopy
e. additional diagnostic
examinations
i. open biopsy
ii. fine needle biopsy
f. Tx
i. neck dissection
ii. radiation