A clinicopathologic series of 22 cases of tonsillar granulomas.

Kardon DE, Thompson LD.
Laryngoscope. 2000 Mar;110(3 Pt 1):476-81.
OBJECTIVES: Tonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation.
DESIGN: Retrospective clinicopathologic review.
METHODS: Twenty-two cases of tonsillar granulomas diagnosed between 1940 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. H&E slides and a series of histochemical stains were reviewed, and patient follow-up was obtained.
RESULTS: There were 11 males and 11 females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nonspecific infection, sarcoidosis, and a neoplasm. Histologically, the granulomas were focal and scattered, or diffuse, identified in the interfollicular zones (n = 16) and/or the germinal centers (n = 13), and occasionally associated with necrosis (n = 6). Based on histochemical and clinical follow-up information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin’s lymphoma (n = 2), toxoplasmosis (n = 1), squamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow-up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow-up or had died with disease (mean, 24.9 y). One patient was alive with unknown disease status (lost to follow-up after 13.3 y).
CONCLUSIONS: Although a cause for tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis. However, a careful work-up must be conducted to exclude specific causes and avoid clinical mismanagement.
PubMed ID: 10718441
Article Size: 1 MB

A clinicopathological study of 15 patients with neuroglial heterotopias and encephaloceles of the middle ear and mastoid region.

Gyure KA, Thompson LD, Morrison AL.
Laryngoscope. 2000 Oct;110(10 Pt 1):1731-5.
OBJECTIVES: Heterotopic masses of neuroglial tissue involving non-midline structures, specifically, the middle ear region, are exceptional. The pathogenesis of these lesions and, in particular, their relation to encephaloceles, is uncertain.
STUDY DESIGN AND METHODS: H&E-stained sections from 15 lesions diagnosed as neuroglial heterotopias or encephaloceles involving the middle ear region were reviewed. Radiographic or operative evidence of a central nervous system (CNS) relation and clinical factors possibly related to pathogenesis were analyzed.
RESULTS: All 15 lesions (from six men and nine women; mean age, 49 y; range, 16-67 y), regardless of their relation to the CNS, were composed of varying proportions of neurons and glia with associated chronic inflammatory cells and reactive gliosis. No significant ependymal or choroid plexus component was present. Operative findings revealed that two lesions had definite CNS connections and two were unrelated to the CNS; this relation could not be determined in the remaining cases. Seven of 10 patients for whom clinical information was available had a history of chronic otitis media or mastoiditis or both; four of these seven patients also had a history of previous trauma or surgery. Three patients, including both patients whose lesions had no demonstrable CNS attachment, had no predisposing factors.
CONCLUSIONS: Most neuroglial heterotopias of the middle ear are probably acquired encephaloceles. These lesions occur in older patients than do their midline counterparts. Determination of the relation of these lesions to adjacent CNS structures must be done radiographically or using operative findings, because histology alone cannot be reliably used to render an accurate diagnosis.
PubMed ID: 11037835
Article Size: 1 MB

Acute Necrotizing Herpetic Tonsillitis: A Report of Two Cases

Borhan WM, Dababo MA, Thompson LD, Saleem M, Pashley N.
Head Neck Pathol. 2015 Mar;9(1):119-22.
The finding of herpetic tonsillitis is rare. Tonsillectomies are usually done for children with recurrent chronic tonsillitis, while viral throat infections are generally self-limiting. We present two cases: A 5 yearold girl, with atypical hemolytic anemia managed with Eculizumab, who presented with a pharyngeal infection and tonsillar enlargement that did not respond to intravenous antibiotics or antifungal therapies; and a 30 yearold man who presented with upper airway obstruction and fever; bilateral tonsillectomies were performed. Histopathological examination showed a necrotizing tonsillitis with numerous ground-glass intranuclear inclusions, characteristic of herpes viral infection, further confirmed by Herpes simplex virus in situ hybridization. Both patients were managed by intravenous Acyclovir, with dramatic improvement.
PubMed ID: 24338612
Article Size: <1 MB

Adenoid cystic carcinoma of the head and neck — An update

Coca-Pelaz A, Rodrigo JP, Bradley PJ, Vander Poorten V, Triantafyllou A, Hunt JL, Strojan P, Rinaldo A, Haigentz M Jr, Takes RP, Mondin V, Teymoortash A, Thompson LDR, Ferlito A.
Oral Oncol. 2015 Jul;51(7):652-661.
This article provides an update on the current understanding of adenoid cystic carcinoma of the head and neck, including a review of its epidemiology, clinical behavior, pathology, molecular biology, diagnostic workup, treatment and prognosis. Adenoid cystic carcinoma is an uncommon salivary gland tumor that may arise in a wide variety of anatomical sites in the head and neck, often with an advanced stage at diagnosis. The clinical course is characterized by very late recurrences; consequently, clinical follow-up should extend at least >15 years. The optimal treatment is generally considered to be surgery with postoperative radiotherapy to optimize local disease control. Much effort has been invested into understanding the tumor’s molecular biological processes, aiming to identify patients at high risk of recurrence, in hopes that they could benefit from other, still unproven treatment modalities such as chemotherapy or biological therapy.
PubMed ID: 25943783
Article Size: 2.6 MB

Adenoma versus carcinoid tumor of the middle ear: a study of 48 cases and review of the literature.

Torske KR, Thompson LD.
Mod Pathol. 2002 May;15(5):543-55.
Carcinoid tumors and adenomas of the middle ear are rare neoplasms of indeterminate relationship to one another. Indeed, the literature is devoid of a large comprehensive series that evaluates the clinical, histologic, and immunophenotypic features of these tumors and their potential relationship. Forty-eight cases of middle ear adenoma between 1970 and 1995 were identified in the files of the Armed Forces Institute of Pathology. All cases were evaluated for cytomorphology and architectural pattern, in addition to their reactivity with various immunohistochemical reagents. Clinical follow-up was also obtained. A comprehensive review of the literature was performed with an eye toward correlating any distinct differences or similarities between carcinoid tumors and adenomas of the middle ear. The patients included 21 women and 27 men, aged 20 to 80 years (mean, 45.0 y). Patients experienced hearing loss, mass, and/or pain for a mean duration of 1.7 years. The mean tumor size was 0.8 cm, with six tumors extending beyond the middle ear. Histologically, the tumors were moderately cellular and unencapsulated, arranged in glandular, trabecular, and solid patterns composed of small cells with ‘salt and pepper’ nuclear chromatin distribution. The tumor cells were immunoreactive with keratin, keratin 7, chromogranin, and human pancreatic polypeptide. All patients had surgery. No patients died with their disease (mean follow-up, 15.7 y). Eight patients developed recurrences that were treated surgically and were without evidence of disease at last follow-up (mean, 15.1 y). Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors. Middle ear adenoma most correctly describes their morphologic features and clinical behavior, although neuroendocrine adenoma of the middle ear may be a more accurate designation.
PubMed ID: 12011260
Article Size: 3 MB

Allergic fungal sinusitis.

Thompson LD.
Ear Nose Throat J. 2011 March;90(3):106-107.
FIRST PARAGRAPH: Allergic fungal sinusitis, also known as allergic mucin and eosinophilic fungal rhinosinusitis, is an allergic response in the sinonasal tract mucosa to aerosolized fungal allergens, amplified and perpetuated by eosinophils. The class II genes in the major histocompatibility complex are involved in antigen presentation and immune response (modulation), and an allergic reaction develops to inhaled fungal elements in immunocompetent people. Aspergillus species are the most common agents (widespread in soil, wood, and decomposing plant material), but Alternaria, Bipolaris, Curvularia, Exserohilum, and Phialophora species have also been reported
PubMed ID: 21412738
Article Size: <1 MB


Thompson LD.
Ear Nose Throat J. 2003 Jan;82(1):19.
FIRST PARAGRAPH: Ameloblastomas are locally aggressive gnathic tumors that have a high propensity for recurrence. They are believed to arise from remnants of the odontogenic epithelium or the developing enamel organ. They occur in patients over a wide spectrum of ages and equally among the sexes, as a slow-growing, often asymptomatic, locally invasive tumor. Radiographic images usually demonstrate a multilocular, expansile radiolucency of bone, usually of the posterior mandible.
PubMed ID: 12610896
Article Size: <1 MB

Amyloidosis of the larynx: a clinicopathologic study of 11 cases.

Thompson LD, Derringer GA, Wenig BM.
Mod Pathol. 2000 May;13(5):528-35.
Laryngeal amyloidosis (LA) is uncommon and poorly understood, with limited long-term clinicopathologic and immunophenotypic studies in the literature. Eleven cases of LA were retrieved from the files of the Otorhinolaryngic-Head & Neck Tumor Registry from 1953 to 1990. The histology, histochemistry, immunohistochemistry, and follow-up were reviewed. All patients (three women and eight men) presented with hoarseness at an average age of 37.8 years. The lesions, polypoid or granular, measured an average of 1.6 cm and involved the true vocal cords only (n = 4), false vocal cord only (n = 1), or were transglottic (n = 6). An acellular, amorphous, eosinophilic material was present in the stroma, often accentuated around vessels and seromucous glands, which reacted positively with Congo red. A sparse lymphoplasmacytic infiltrate was present in all cases that demonstrated light chain restriction by immunohistochemistry in three cases (kappa = 2, lambda = 1). Serum and urine electrophoreses were negative in all patients. Treatment was limited to surgical excision, including a single laryngectomy. Six patients manifested either recurrent and/or multifocal/systemic disease: two patients with light chain restriction were dead with recurrent disease (mean, 11.1 years); two patients were dead with no evidence of disease (mean, 31.7 years); and two patients were alive, one with light chain restriction and recurrent and multifocal disease (41.6 years) and one with no evidence of disease after a single recurrence (43.4 years). The remaining five patients were either alive or had died with no evidence of disease an average of 32.4 years after diagnosis. No patient developed multiple myeloma or an overt B-cell lymphoma. LA is an uncommon indolent lesion that may be associated with multifocal disease (local or systemic). The presence of an associated monoclonal lymphoplasmacytic infiltrate and recurrent/multifocal disease in the respiratory or gastrointestinal tract of a few cases and the lack of development of a systemic plasma cell dyscrasia or overt systemic B-cell malignancy suggest that some LA may be the result of an immunocyte dyscrasia or tumor of mucosa-associated lymphoid tissue.
PubMed ID: 10824924
Article Size: 1.5 MB

Basaloid squamous cell carcinoma of the sinonasal tract.

Wieneke JA, Thompson LD, Wenig BM.
Cancer. 1999 Feb 15;85(4):841-54.
BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a high grade, aggressive variant of squamous cell carcinoma with a predilection for the larynx, hypopharynx, tonsils, and base of the tongue. To the authors’ knowledge, BSCC originating in the nasal cavity and paranasal sinuses rarely has been reported.
METHODS: Fourteen cases of BSCC involving the nasal cavity and paranasal sinuses were identified in the files of the Otolaryngic-Head and Neck Pathology Tumor Registry of the Armed Forces Institute of Pathology from 1975-1997. Clinical records and follow-up were available in all cases. Paraffin blocks were available for histochemical and immunohistochemical studies in all cases.
RESULTS: There were 7 females and 7 males, ages 32-86 years (median, 66.5 years; mean, 62 years). The patients presented primarily with a mass lesion and unilateral nasal obstruction. In nine patients the tumor was confined to the nasal cavity. In three patients the tumor involved the sinuses alone and in two patients the tumor involved the nasal cavity and paranasal sinuses. Histologically, the tumors were widely invasive with a variety of growth patterns, including lobular, solid, trabecular, cribriform, and fascicular. The neoplastic infiltrate included predominantly pleomorphic, basaloid-appearing cells with hyperchromatic nuclei, inconspicuous to prominent nucleoli, and a variable amount of eosinophilic to clear-appearing cytoplasm. Mitotic figures, including atypical forms, were readily apparent as was necrosis (individual cell and comedo-type). Foci of squamous differentiation were limited in extent but were found in all cases and included squamous whorls, individual cell keratinization, and intercellular bridges. Intraepithelial dysplasia, carcinoma in situ, or invasive squamous carcinoma was present in all cases. Other histologic features included intercellular stromal hyalinization and peripheral nuclear palisading. In two cases, neural-type rosettes were found. Immunoreactivity for a variety of epithelial markers including cytokeratin (AE1/AE3/LP34), CAM 5.2, 34betaE12, CK7, and epithelial membrane antigen was present in all cases. Variable reactivity was present with vimentin, actins (smooth muscle and muscle specific), neuron specific enolase, S-100 protein, glial fibrillary acidic protein, CK20, carcinoembryonic antigen, Leu7, and Ewing’s marker. Chromogranin, synaptophysin, neurofibrillary protein, leukocyte common antigen, HMB-45, desmin, and Epstein-Barr virus latent membrane protein were absent. Surgical resection was the treatment of choice. Eight patients had recurrent or persistent tumor and metastatic disease occurred in five patients. At last follow-up, 7 patients (50%) had died of disease with a median survival of 12 months from the time of diagnosis and 3 patients were alive with disease over periods ranging from 8 months-5 years. Of the 4 remaining patients, 2 were alive without disease at 1 month and 5 years, respectively, 1 patient was lost to follow-up with no evidence of tumor at 3 years, and 1 patient had died of unrelated causes with no evidence of disease.
CONCLUSIONS: Sinonasal BSCC is a histologically distinct variant of squamous cell carcinoma with pathologic features and aggressive biologic behavior similar to BSCC localized to more common mucosal sites of the upper aerodigestive tract.
PubMed ID: 10091761
Article Size: 2 MB

Biomarkers predicting malignant progression of laryngeal epithelial precursor lesions: a systematic review.

Rodrigo JP, García-Pedrero JM, Suárez C, Takes RP, Thompson LD, Slootweg PJ, Woolgar JA, Westra WH, Brakenhoff RH, Rinaldo A, Devaney KO, Williams MD, Gnepp DR, Ferlito A.
Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1073-83
Some laryngeal epithelial precursor lesions progress to invasive carcinoma and others do not. Routine light microscopic classification has limited value in predicting the evolution of these lesions. This article reviews the experience to date with the use of molecular markers for the prognostic evaluation of laryngeal epithelial precursor lesions. We conducted a thorough review of the published literature to identify those studies using biomarkers to predict malignant progression of laryngeal epithelial precursor lesions. Of the 336 studies identified in this systematic search, 15 met the inclusion criteria and form the basis of this review. Limited studies suggest that certain biomarkers are potentially reliable predictors of malignant progression including various regulators of cell adhesion and invasion (e.g. FAK, cortactin, osteopontin, and CD44v6) and proliferation-associated markers such as TGF-?RII and Kv3.4. The predictive value of these markers, however, has yet to be confirmed in large-scale prospective studies. Although the cell cycle-related proteins are the most frequently studied markers, none have been consistently reliable across multiple studies. The absence of standardization in methodologies, test interpretation, and other parameters may contribute to study inconsistencies. Various biomarkers have proved to have potential prognostic value and could be clinically relevant. The utility and prognostic power of these biomarkers should be confirmed in large, well-designed, standardized prospective studies.
PubMed ID: 22081098
Article Size: <1 MB

Branchial cleft cyst.

Thompson LD.
Ear Nose Throat J. 2004 Nov;83(11):740.
FIRST PARAGRAPH: A developmental alteration of the branchial clefts or pouches can result in cysts, sinuses, and/or fistulas. A branchial cleft cyst is a congenital abnormality usually located in the lateral neck along the anterior portion of the sternocleidomastoid muscle; it can also involve the ear and parotid salivary gland. There is no sex preference, and although the lesion usually presents clinically in young patients, older patients are occasionally affected as well. The cysts are typically nontender masses that may become secondarily inflamed or infected, which often brings them to clinical attention. Bilateral masses are associated with an increased likelihood of a syndrome.
PubMed ID: 15628626
Article Size: <1 MB

Canalicular adenoma.

Penner CR, Thompson L.
Ear Nose Throat J. 2005 Mar;84(3):132.
FIRST PARAGRAPH: Canalicular adenomas are benign neoplasms with a unique predilection for the upper lip (~80% of cases). They account for 1% of all salivary gland neoplasms. Their incidence peaks during the seventh decade of life; they are distinctly uncommon in patients younger than 50 years of age. The female-to-male predominance is approximately 2:1.
PubMed ID: 15871577
Article Size: <1 MB

Canalicular Adenoma: A Clinicopathologic and Immunohistochemical Analysis of 67 Cases with a Review of the Literature

Thompson LD, Bauer JL, Chiosea S, McHugh JB, Seethala RR, Miettinen M, Müller S.
Head Neck Pathol. 2015 Jun;9(2):181-95.
There is a lack of a comprehensive immunohistochemical (IHC) analysis of canalicular adenoma (CanAd), especially when combined with a description of the unique histologic features. Given the usual small biopsies, IHC may be useful in distinguishing CanAd from other tumors in the differential diagnosis. Retrospective. The patients included 54 females and 13 males (4.2:1), aged 43-90 years, with a mean age at presentation of 69.9 years. Clinical presentation was generally a mass (n = 61) slowly increasing in size (mean 38.5 months), affecting the upper lip (n = 46), buccal mucosa (n = 17) or palate (n = 4), involving the right (n = 29), left (n = 24) or midline (n = 9), without any major salivary gland tumors. The tumors ranged in size from 0.2 to 3 cm (mean 1.2 cm). Most tumors were multilobular or bosselated (76 %), often surrounded by a capsule. Histologically, the tumors were characterized by cystic spaces, tumor cords with beading, tubule formation, and by the presence of luminal squamous balls (n = 41). The cells were cuboidal to columnar with stippled chromatin. Mitoses were inconspicuous. A myxoid stroma (n = 64), sclerosis (n = 42), luminal hemorrhage (n = 51), and luminal microliths (calcifications) (n = 33) were characteristic. Nine (13.4 %) were multifocal. CanAd showed the following characteristic immunohistochemistry findings: CK-pan and S100 protein (strong, diffuse reaction); peripheral or luminal GFAP reaction; CK5/6 and p16 luminal squamous ball reaction; SOX10 nuclear reaction; cytoplasmic p63 reaction. CanAd are unique minor salivary gland tumors showing a distinct architecture and phenotype. They predilect to older women, with the majority multilobulated and affecting the upper lip, multifocal in 13 %; no major salivary gland tumors were identified. S100 protein, CK-pan, GFAP and SOX10 are positive, with luminal squamous balls highlighted by CK5/6 or p16.
PubMed ID: 25141970
Article Size: 4.5 MB

Carcinoma Ex-Schneiderian Papilloma (Malignant Transformation): A Clinicopathologic and Immunophenotypic Study of 20 Cases Combined with a Comprehensive Review of the Literature.

Nudell J, Chiosea S, Thompson LD.
Head Neck Pathol. 2014 Sep;8(3):269-286.
Schneiderian papilloma (SP) are uncommon tumors with malignant transformation even less common. The histologic criteria to define malignant transformation are not well developed nor is the immunohistochemical profile reported in a large series of carcinomas. 20 cases of malignant transformation of SP included 7 females and 13 males, aged 38-86 years (mean 60.7 years). Patients presented most frequently with a mass (n = 11) and obstructive symptoms (n = 7), present for 38.7 months (mean). Most patients had no previous history of SP (n = 13); metachronous carcinoma was identified in 7 patients an average of 34.4 months after the first diagnosis of SP, with 1-4 recurrences of SP. With a mean size of 4.1 cm, the majority of tumors involved a combination of more than one anatomic site (n = 10), followed by the maxillary sinus only (n = 5) or nasal cavity only (n = 3). Histologically, 17 were inverted and 3 exophytic type SP. There were 17 squamous cell carcinomas, 2 mucoepidermoid carcinomas and 1 sinonasal undifferentiated carcinoma, comprising from 10 to 95 % of the tumor volume. Malignant histologic features included atypical mitoses, necrosis, bone invasion, lymphovascular invasion, decreased transmigrating neutrophils, paradoxical maturation, dyskeratosis and/or perineural invasion (n = 3). Patients tended to present with advanced stage (n = 14, Stage III and IV). Immunohistochemical studies showed positive reactions in the malignancies for CK5/6 (86 %), p63 (86 %), CK7 (luminal, 50 %), p53 (83 %), and p16 (25 %). In situ hybridization detected human papillomavirus in 26 %. Surgery was often accompanied by radiation therapy (n = 13), with a mean of 2.4 years of follow-up. Five patients developed a recurrence between 0.8 and 3.3 years. Carcinomas ex-SP are less common and are associated with better outcome than previously reported. Patients tend to present with a synchronous carcinoma, developing in an inverted type SP, with squamous cell carcinoma the most common malignancy. Development of metachronous carcinomas ex-SP was always preceded by SP recurrence in this series.
PubMed ID: 24519376
Article Size: 1.7 MB

Causes of death of patients with laryngeal cancer.

Ferlito A, Haigentz M Jr, Bradley PJ, Suárez C, Strojan P, Wolf GT, Olsen KD, Mendenhall WM, Mondin V, Rodrigo JP, Boedeker CC, Hamoir M, Hartl DM, Hunt JL, Devaney KO, Thompson LD, Rinaldo A, Takes RP.
Eur Arch Otorhinolaryngol. 2014 Mar;271(3):425-34.
Despite remarkable advances in the care of patients with laryngeal cancer over the past several decades, including a growing awareness of therapeutic complications and attention to quality of life, little is known about the causes of mortality in this population. In addition to the laryngeal malignancy itself, acute and late or chronic treatment-associated causes, second primary cancers, intercurrent disease and psychosocial factors are all responsible for patient morbidity and mortality. We examine the current literature related to the causes of death in patients with laryngeal cancer, in the hope of guiding future interventions to improve the longevity and quality of life of individuals with this cancer.
PubMed ID: 23591796
Article Size: <1 MB

Ceruminous adenomas: a clinicopathologic study of 41 cases with a review of the literature.

Thompson LD, Nelson BL, Barnes EL.
Am J Surg Pathol. 2004 Mar;28(3):308-18.
BACKGROUND: Ceruminous gland neoplasms are rare neoplasms. To date, a large clinicopathologic study of benign ceruminous gland neoplasms has not been reported.
DESIGN: Forty-one cases of ceruminous gland adenomas diagnosed between 1970 and 2000 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemical analysis was performed (n = 21), and patient follow-up was obtained (n = 40).
RESULTS: The patients included 22 men and 19 women, 24 to 85 years of age (mean, 54.2 years). Patients presented clinically with a painless mass of the outer half of the external auditory canal (n = 33) or with hearing changes (n = 11). Symptoms were present for an average of 16.3 months. The polypoid masses affected the external auditory canal only and ranged in size from 0.4 to 2 cm in greatest dimension (mean, 1.1 cm). Histologically, the tumors demonstrated glands and small cysts lined by a tubuloglandular proliferation of inner ceruminous cells (cerumen-secreting epithelium with decapitation secretion) subtended by a spindled to cuboidal myoepithelial layer. A hyalinized stroma created an infiltrative pattern of growth; surface involvement (n = 8) was seen. Tumors were divided into ceruminous adenoma (n = 36), ceruminous pleomorphic adenoma (n = 4), and syringocystadenoma papilliferum (n = 1) types. The luminal cells were strongly and diffusely immunoreactive with CK7, while the basal cells were highlighted with CK5/6, S-100 protein, and p63. CD117 highlighted the luminal cells preferentially. The proliferation markers revealed a low index. Adenocarcinoma and middle ear adenoma are the principal differential consideration. Surgical excision was used in all patients. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28, mean 16.3 years) or dead (n = 12, mean 11.8 years).
CONCLUSION: Ceruminous gland adenomas are the most common external auditory canal tumors. They demonstrate a dual cell population of basal myoepithelial-type cells and luminal ceruminous (ceruminal) cells. Cerumen pigment, CK7, and p63 can help to distinguish this tumor from other neoplasms that occur in the region. Complete surgical excision results in an excellent long-term clinical outcome.
PubMed ID: 15104293
Article Size: 2 MB

Ceruminous Gland Carcinomas: A Clinicopathologic and Immunophenotypic Study of 17 Cases.

Crain N, Nelson BL, Barnes EL and Thompson LDR.
Head Neck Pathol. 2009 Mar;3(1):1-17.
BACKGROUND: Ceruminal gland carcinomas are rare neoplasms confined to the skin lining the cartilaginous part of the external auditory canal.
STUDY DESIGN:Retrospective.
RESULTS: The patients included 11 men and 6 women, aged 33-82 years (mean, 59.5 years). Patients presented clinically with a mass of the outer half of the external auditory canal (n = 14), hearing changes (n = 5), drainage (n = 4), or paralysis of the facial nerve (n = 3). The polypoid masses ranged in size from 0.5 to 3 cm in greatest dimension (mean, 1.8 cm). Histologically, the tumors demonstrated a solid to cystic pattern, composed of an infiltrating glandular to cribriform arrangement of epithelial cells. Histologic features included a dual cell population (although not the dominant histology), increased cellularity, moderate to severe nuclear pleomorphism, irregular nucleoli, increased mitotic figures (mean, 3/10 HPF), including atypical forms, and tumor necrosis (n = 2). Tumors were divided into three types of adenocarcinoma based on pattern of growth and cell type (ceruminous, NOS [n = 12], adenoid cystic [n = 4], mucoepidermoid [n = 1]). CK7 and CD117 highlighted the luminal cells, while S1-00 protein showed a predilection for the basal cells of ceruminous and adenoid cystic carcinomas. Metastatic adenocarcinoma or direct extension from salivary gland neoplasms are the principle differential considerations. Surgical resection was used in all patients with radiation used in four patients. Eleven patients were alive or had died of unrelated causes without evidence of disease (mean, 11.2 years); six patients had died with disease (mean, 4.9 years), all of whom had developed local recurrence.
CONCLUSION: Ceruminous-type carcinomas, with the exception of ceruminous mucoepidermoid carcinoma, all demonstrated a dual cell population of basal myoepithelial-type cells and luminal apocrine cells. The specific histologic sub-type does not influence the long-term patient outcome.
PubMed ID: 20596983
Article Size: 1 MB


Thompson LD.
Ear Nose Throat J. 2015 Jan;94(1):22-4.
FIRST PARAGRAPH: Cherubism is an autosomal-dominant inherited disease with variable expression. It is characterized by a progressive, painless, and symmetric expansion of the jaws. The disease is caused by a point mutation in the SH3BP2 gene (chromosome 4p16.3), which leads to dysregulation of the Msx-1 gene; this gene is involved in regulating mesenchymal interaction in craniofacial morphogenesis.
PubMed ID: 25606831
Article Size: <1 MB


Caponetti G, Thompson LD, Pantanowitz L.
Ear Nose Throat J. 2009 Nov;88(11):1196-8.
FIRST PARAGRAPH: Cholesteatoma is a lesion formed from keratinizing stratified squamous epithelium. It may present intradurally (an epidermoid) or extradurally. Extradural lesions most commonly involve the middle ear cleft; involvement of the mastoid or external auditory canal is less common. The term cholesteatoma is actually a misnomer as these masses rarely contain cholesterol. Although they are not true neoplasms either, clinically they can mimic malignant neoplasms because of their propensity to destroy surrounding tissue and recur after excision.
PubMed ID: 19924660
Article Size: <1 MB

Chondrosarcoma of the larynx.

Thompson LD.
Ear Nose Throat J. 2004 Sep;83(9):609.
FIRST PARAGRAPH: Chondrosarcoma of the larynx accounts for approximately 0.2% of all head and neck malignancies and approximately 1% of all laryngeal malignant tumors, although it is the most common nonepithelial neoplasm of the larynx. Men are affected more frequently than women (3:1 ratio), usually during the middle to later decades of life. Patients present with a variety of symptoms as a result of tumor growth, including dyspnea, dysphagia, hoarseness, airway obstruction, and/or pain.
PubMed ID: 15529643
Article Size: <1 MB

Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature.

Thompson LD, Gannon FH.
Am J Surg Pathol. 2002 Jul;26(7):836-51.
Chondrosarcomas of the larynx are rare tumors accounting for about 0.5% of all laryngeal primary tumors. A total of 111 laryngeal chondrosarcoma cases, diagnosed between 1970 and 1997, were retrieved from the Otorhinolaryngic-Head & Neck Tumor Registry of the Armed Forces Institute of Pathology. There was a 3.6:1 male/female ratio of patients 25-91 years of age (mean, 64.4 years). Patients presented most frequently with hoarseness (n = 72 patients) present for a mean of 28.2 months. The majority of tumors involved the cricoid cartilage (n = 77) with a mean size of 3.5 cm. All tumors were invasive and malignant by radiology and/or histology (into bone within the ossified laryngeal cartilages in 52 tumors). Most tumors were low-grade lesions: grade 1 (n = 51), grade 2 (n = 54); there were six grade 3 tumors. An associated benign chondroma with (n = 41 tumors) or without ischemia (n = 24 tumors) was noted. All patients had surgery and five had radiation therapy. Wide excision or voice-sparing surgery was used in 73 patients, whereas 37 patients had a laryngectomy. Recurrences occurred in 20 (18%) patients, 10 of whom underwent salvage laryngectomy. At the last follow-up, 102 patients had no evidence of disease (alive or dead, mean 11.2 years) and five patients had evidence of disease (alive, one patient, 6.5 years; dead, four patients, mean 6.4 years). The six patients with high-grade chondrosarcoma were all without disease at the last follow-up (mean, 15.1 years). There was no difference in clinical outcome based on grade (p = 0.210), location (p = 0.078), or treatment (p = 0.607) but was worse for patients with a myxoid-type chondrosarcoma (p = 0.044). Primary laryngeal chondrosarcomas are typically low- to moderate-grade lesions involving the cricoid cartilage, frequently associated with a chondroma. They usually portend an excellent overall long-term prognosis with initial conservative voice-sparing surgery.
PubMed ID: 12131151
Article Size: 1 MB


Thompson LD.
Ear Nose Throat J. 2011 January;90(1):16-18.
FIRST PARAGRAPH: Chordomas are low- to intermediate-grade malignant tumors that recapitulate the notochord. They are divided into three broad categories: sacrococcygeal (60% of cases), spheno-occipital (25%), and vertebral (15%). About 10% of all tumors are cervical. Vertebral or neck chordomas typically develop in the fifth and sixth decades of life; they have no predilection for either sex. Nerve impingement, progressive pain, and headaches are common. When a chordoma arises within the parapharyngeal space, the mass may be detected clinically. Radiographically, chordomas are usually solitary, lytic lesions; they are associated with matrix calcification in as many as 70% of cases.
PubMed ID: 21229504
Article Size: <1 MB

Clinicopathologic and Immunophenotypic Characterization of 25 Cases of Acinic Cell Carcinoma with High-Grade Transformation

Thompson LD, Aslam MN, Stall JN, Udager AM, Chiosea S, McHugh JB
Head Neck Pathol. 2016 Jun;10(2):152-60.
Acinic cell carcinoma (AiCC) with high-grade transformation is a rare variant of AiCC composed of both a conventional low-grade (LG) AiCC and a separate highgrade (HG) component. We describe here, the clinicopathologic and immunohistochemical features of 25 cases diagnosed between 1990 and 2015. Available tissue was analyzed and compared with a cohort of pure LG AiCC for the morphologic and immunophenotypic profile. Incidence was higher in females (1.8:1) than males with an overall mean age at presentation of 63.2 years. All tumors occurred in the parotid gland including 76 % with facial nerve trunk and branches involvement. Most patients were treated with extensive resection and adjuvant therapy. Local recurrence or distant metastasis occurred in most patients, with 72.7 % dead with disease (mean 2.9 years) and 3 patients alive with disease (mean 2.4 years). The majority of the tumors were composed of a LG microcystic AiCC and a HG component consisting of invasive lobules of undifferentiated cells with predominantly solid, cribriform, and glandular patterns. Acinic differentiation was still present in HG areas but aggressive features such as perineural invasion (76 %), lymphovascular invasion (62 %), positive margins (72 %), high mitotic rate, atypical mitoses and/or comedonecrosis (86 %) were easily identified. Compared to the pure LG AiCC, the cases with HG transformation showed significantly increased expression of cyclin-D1, p53 and Ki-67. Most HG areas of AiCC expressed membranous b-catenin (92 %) and were negative for p63 (three cases were focally positive), S100, SMA, androgen, and estrogen receptors. DOG1 expression was present in all LG AiCC tested with retained expression in 91 % of cases with HG transformation, supporting acinic differentiation in the HG foci. Recognition of AiCC with high-grade transformation is imperative as more aggressive clinical management is warranted.
PubMed ID: 26245749
Article Size: 6 MB

Cystic chondromalacia of the ear.

Nelson BL, Thompson LD.
Ear Nose Throat J. 2003 Feb;82(2):104-5.
FIRST PARAGRAPH: Idiopathic cystic chondromalacia (endochondral pseudocyst of the auricle) is a benign cystic degenerative lesion of the auricular cartilage. The lesion appears as a painless unilateral swelling along the upper half of the ear, usually in the area of the scaphoid or triangular fossae adjacent to the helix. The disorder affects young and middle-aged men more often than it does women. Trauma is an associated, although not proven, etiologic factor.
PubMed ID: 12619465
Article Size: <1 MB

Dedifferentiated chondrosarcomas of the larynx: a report of two cases and review of the literature.

Garcia RE, Gannon FH, Thompson LD.
Laryngoscope. 2002 Jun;112(6):1015-8.
OBJECTIVES: To analyze the long-term clinical outcome of dedifferentiated chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component (CAMMC) of the larynx and compare the results with those of axial chondrosarcomas.
STUDY DESIGN/METHODS: Two patients with CAMMC of the larynx (0.03%) were retrospectively identified within the archives of the Armed Forces Institute of Pathology between 1970 and 2001. We compared the clinical and histologic features of these two cases with those reported in the English literature (Medline 1966-2001) (Table I).
RESULTS: Patient no. 1 was a 67-year-old man who presented with a 12-month history of hoarseness and was found to have a 4-cm mass involving the cricoid cartilage. Enucleation was performed and histologically demonstrated a dedifferentiated chondrosarcoma. Without additional intervention, the patient died after 136 months without evidence of disease. Patient no. 2 was a 41-year-old man who also presented with a 12-month history of hoarseness and dysphagia and was found to have a 5-cm mass involving the cricoid cartilage. A total laryngectomy was performed for the dedifferentiated chondrosarcoma. He is alive without evidence of disease at last contact (91 mo).
CONCLUSION: CAMMC of the larynx are rare tumors but have a better prognosis than their axial counterparts (mean, 6 mo). Initial voice-sparing surgery can be followed with more aggressive surgery if recurrences develop.
PubMed ID: 12160266
Article Size: <1 MB

Definitive treatment of androgen receptor–positive salivary duct carcinoma with androgen deprivation therapy and external beam radiotherapy.

Soper MS, Iganej S, Thompson LD.
Head Neck. 2014 Jan;36(1):E4-7.
BACKGROUND: Salivary duct carcinoma (SDC) is an aggressive malignancy with high recurrence rates. Standard management includes surgical resection followed by adjuvant radiation. Androgen receptor positivity has been described to be present in 40% to 90% of SDCs, and a recent case series showed a benefit to androgen deprivation therapy (ADT) in recurrent or metastatic disease.
METHODS AND RESULTS: We present the case of an 87-year-old woman with a locally advanced androgen receptor-positive parotid SDC treated definitively with ADT and external beam radiotherapy, a regimen modeled after the treatment of prostate cancer. She had a complete response on positron emission tomography (PET)/CT scan and had no evidence of disease 24 months after the completion of treatment.
CONCLUSION: To our knowledge, this case report is the first to describe the use of ADT plus radiation to definitively treat SDC. This regimen could be considered in patients with androgen receptor-positive SDCs who are considered unresectable or who refuse surgery.
PubMed ID: 23720164
Article Size: <1 MB

Diagnostically challenging lesions in head and neck pathology.

Thompson LD.
Eur Arch Otorhinolaryngol. 1997;254(8):357-66.
There are a variety of diagnostically challenging lesions in the head and neck region. Contact ulcer usually occurs within specific clinical parameters (vocal abuse, post-intubation and gastro-esophageal reflux), which should be documented in correlation with the granulation tissue-like response affecting the posterior vocal cords. Spindle squamous cell carcinoma (carcinosarcoma) presents a variably cellular spindle cell proliferation, often with surface epithelial ulceration. The clinical presentation of a firm, polypoid mass in the larynx, combined with the histomorphologic features of a spindle cell tumor, can be confirmed to be of epithelial origin when a portion of the overlying epithelium is seen to blend with the spindle cell component, or when ancillary studies authenticate the epithelial origin of the tumor. The diagnosis of a verrucous squamous cell carcinoma can only be made accurately with an accurate clinical history. The very well differentiated histologic appearance, a broad pushing border of infiltration, a bland epithelial proliferation with scant mitotic activity and ‘church-spire’-type keratosis coupled with the clinical presentation of a large, locally destructive lesion, can confirm the diagnosis of verrucous carcinoma. A wide variety of disorders can result in midline destructive disease clinically, but a specific etiology must be sought to provide appropriate clinical management. Angiocentric T/NK-cell lymphoma of the sinonasal tract is one such disease. The atypical lymphoid cells are usually angiocentric and angiodestructive in their growth pattern. Identification of the atypical cells in the early stages of disease may be difficult, often requiring multiple biopsies over time with the application of immunohistochemical stains or molecular studies to accurately identify the nature of the infiltrate. Cystic squamous cell carcinoma in the neck is almost always a manifestation of metastatic tumor and not a brachiogenic carcinoma. When specific histomorphologic features are noted (a large, unfilled cyst lined by a ribbon-like or endophytic growth of a ‘transitional’-appearing squamous epithelium with a limited degree of anaplasia), most of these tumors demonstrate primaries in Waldeyer’s ring, often of a very small size. Adequate clinical work-up (pan-endoscopy, extensive radiographic imaging and random biopsies or prophylactic tonsillectomy) is mandatory in order to limit the radiation-therapy ports and to document the location of the primary, yielding an excellent long-term prognosis.
PubMed ID: 9332890
Article Size: <1 MB

Ear ceruminous adenoma.

Thompson LD.
Ear Nose Throat J. 2011 Jul;90(7):304-5.
FIRST PARAGRAPH: Ceruminous adenoma, also called ceruminoma, ceruminal adenoma, apocrine adenoma, or even cylindroma in the past (the latter three terms are discouraged) is a benign glandular neoplasm of ceruminous glands (modified apocrine sweat glands) that arises solely from the external auditory canal. By definition, this tumor type cannot involve the auricular cartilages, ear lobe, or other such external ear apparatus.
PubMed ID: 21792797
Article Size: <1 MB

Embryonal rhabdomyosarcoma of the ear.

Sautter NB, Thompson LD.
Ear Nose Throat J. 2004 May;83(5):316-7.
FIRST PARAGRAPH: Rhabdomyosarcoma is the most common soft-tissue malignancy in the pediatric population. It is generally classified into embryonal, alveolar, pleomorphic, and mixed histologic subtypes. Embryonal rhabdomyosarcoma is the most common histologic variant seen in childhood; a large proportion of them arise in the head and neck—most commonly in the orbit, the nasopharynx, and the ear.
PubMed ID: 15195874
Article Size: <1 MB

Endolymphatic sac tumor.

Thompson LD.
Ear Nose Throat J. 2013 Apr-May;92(4-5):184-8.
FIRST PARAGRAPH: Endolymphatic sac tumor (ELST) is a papillary epithelial neoplasm arising within the endolymphatic sac/duct that shows a high association with von Hippel-Lindau disease (VHL). There is usually a VHL tumor suppressor gene germline mutation with an autosomal dominant inheritance pattern. Approximately 1 in 35,000 to 40,000 people have VHL, of which approximately 10 to 15% have endolymphatic sac tumors. There is a wide age range at presentation, although most patients are between 30 and 40 years; there is no gender predilection.
PubMed ID: 23599098
Article Size: <1 MB

Endoscopic Management of Recurrent Anterior Skull Base Schwannoma

Lee J, Thompson L, Garg R, Keschner D, Shibuya T.
International Journal of Otolaryngology and Head & Neck Surgery, Vol. 2 No. 2, 2013, pp. 52-56.
Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection. Study Design: Case report and review of the literature. Methods: The clinical presentation, radiographic features, histopathologic characteristics, surgical approach, and patient outcome were examined in the context of a literature review. Results: A 43-year-old woman presented with a 9-month history of left facial pain and pressure. She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007. Magnetic resonance imaging (MRI) and nasal endoscopy revealed a left ethmoid mass measuring 2.2 cm × 2.7 cm × 2.4 cm abutting the anterior skull base. The tumor was completely removed using a transnasal endoscopic approach, and the anterior skull base reconstructed with tensor fascia lata graft. Histology of the specimen showed schwannoma, and there has been no evidence of tumor recurrence nor CSF leak after 24 months of follow-up. Conclusion: With continual advances in surgical technique and instrumentation, sinonasal schwannomas have become increasingly more amenable to endoscopic resection even in the case of recurrence and skull base involvement.
PubMed ID: n/a
Article Size: >1 MB

Epithelial-myoepithelial carcinoma.

Folk GS, Thompson LD.
Ear Nose Throat J. 2006 Apr;85(4):214, 216.
FIRST PARAGRAPH: Epithelial-myoepithelial carcinoma (EMC) is an uncommon salivary gland malignancy, representing 1% of all salivary gland tumors. Women are more frequently affected (2:1). The incidence of EMC peaks between the ages of 50 and 60 years, although the age range is broad. The parotid gland is most frequently affected (60%), but both major and minor salivary glands can be involved. Patients typically present with a painless, slowly growing mass; occasionally there is rapid growth, pain, or facial weakness.
PubMed ID: 16696350
Article Size: <1 MB

Epstein-Barr virus and human herpes virus-8 are not associated with juvenile nasopharyngeal angiofibroma.

Carlos R, Thompson LD, Netto AC, Pimenta LG, Correia-Silva Jde F, Gomes CC, Gomez RS.
Head Neck Pathol. 2008 Sep;2(3):145-9.
BACKGROUND: Nasopharyngeal angiofibroma (also known as juvenile nasopharyngeal angiofibroma) is a rare fibroblastic tumor with a vascular component that occurs in the nasopharynx and posterolateral nasal wall of adolescent boys. The etiology of nasopharyngeal angiofibroma remains elusive. This investigation was undertaken to determine if human herpes simplex virus-8 and Epstein-Barr virus are possible etiologic viruses and to determine if they have any association with the age of the patient and/or the proliferative state of the lesion.
MATERIALS AND METHODS: Formalin fixed, routinely processed, and paraffin embedded surgical specimens of 15 angiofibromas were submitted to PCR for EBV and HHV-8, while in situ hybridization was also employed for EBV. Immunohistochemical analysis for ki-67 was performed using MIB immunostaining.
RESULTS: None of the tumors were positive for HHV-8. The PCR technique produced a false positive reaction in five cases, with all cases non-reactive with EBV-ISH. The age of the patients did not show correlation with the Ki-67 labeling index.
CONCLUSION: Angiofibroma does not appear to be associated with either HHV-8 or EBV, thereby excluding these viruses as potential etiologic agents. The lack of a correlation between the proliferative index and the age of the patient suggests the proposed puberty induced, testosterone-dependent tumor growth may not play a significant role in tumor development.
PubMed ID: 20614308
Article Size: <1 MB

Evaluation of PAX2 and PAX8 Expression in Salivary Gland Neoplasms.

Butler RT, Alderman MA, Thompson LD, McHugh JB.
Head Neck Pathol. 2015 Mar;9(1):47-50.
PAX2 and PAX8 are transcription factors involved in embryogenesis that have been utilized as immunohistochemical indicators of tumor origin. Specifically, PAX2 is a marker of neoplasms of renal and müllerian origin, while PAX8 is expressed by renal, müllerian, and thyroid tumors. While studies examining these transcription factors in a variety of tumors have been published, data regarding their expression in salivary gland neoplasms are limited. The goal of this study was to assess expression of PAX2 and PAX8 in a large cohort of salivary gland tumors. Utilizing tissue microarrays, samples of normal salivary glands (n = 68) and benign and malignant salivary gland neoplasms (n = 442) were evaluated for nuclear immunoreactivity with PAX2 and PAX8. No expression was observed with either marker in the normal salivary glands, and PAX8 was negative in all neoplasms. Focal expression of PAX2 was observed in one example each of oncocytoma and acinic cell carcinoma. These results indicate that evaluation of PAX2 and/or PAX8 expression would be valuable in differentiating primary salivary gland tumors from metastases known to express PAX2 and/or PAX8.
PubMed ID: 24771139
Article Size: <1 MB

Ewing sarcoma and primitive neuroectodermal tumor.

Thompson LDR.
Ear Nose Throat J. 2007 Feb;86(2):79-80.
FIRST PARAGRAPH: Ewing sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related, high-grade, round-cell tumors with a neuroectodermal phenotype. These tumors are histologically considered on a morphologic spectrum, and they express similar genetic alterations. ES usually develops in bone and is more undifferentiated, while PNET tends to involve soft tissue and demonstrates more pronounced neuroendocrine features.
PubMed ID: 17385610
Article Size: <1 MB

Exophytic and papillary squamous cell carcinoma of the larynx.

Kardon DE, Thompson LDR.
Pathol Case Rev 2000;5(4):196-199.
Conventional squamous cell carcinoma (SCC) of the larynx presents as a largely flat or ulcerated lesion and is usually categorized histologically as in situ, superficially invasive, or deeply invasive. Papillary and exophytic squamous cell carcinomas of the larynx represent uncommon but distinct subtypes of SCC. As implied by their designations, these tumor types show predominant papillary or exophytic growth in the form of finger-like or filiform and broad-based bulbous fronds, respectively. Both tumor types are composed of cytologically malignant squamous epithelium. The following case illustrates the clinical and pathologic features of papillary squamous cell carcinoma and emphasizes the importance of distinguishing this entity from conventional squamous cell carcinoma of the larynx.
PubMed ID: n/a
Article Size: 2.5 MB

Exophytic and papillary squamous cell carcinomas of the larynx: A clinicopathologic series of 104 cases.

Thompson LD, Wenig BM, Heffner DK, Gnepp DR.
Otolaryngol Head Neck Surg. 1999 May;120(5):718-24.
Exophytic and papillary squamous cell carcinomas (SCCs) are uncommon variants of SCC of the upper aerodigestive tract mucosa. The histomorphologic distinction between these variants has not been previously attempted or correlated with prognostic outcome. One hundred four cases of exophytic and papillary SCCs of the larynx were identified in the files of the Armed Forces Institute of Pathology from 1971 to 1991. The patients included 25 women and 79 men, aged 27 to 89 years (average 60.7 years). Patients had hoarseness at presentation, and many patients were using tobacco (n = 87) and/or alcohol (n = 49). Tumors measured up to 6 cm in greatest dimension. The larger tumors were associated with vocal cord impairment (n = 39). Histologically, the SCCs were divided into 2 growth patterns: papillary-frond (n = 12) or broad-based, exophytic (n = 92). Patients were treated with excisional biopsy, vocal cord stripping, and/or laryngectomy, in conjunction with radiation therapy (n = 70). Eighty-seven patients had no evidence of disease at last follow-up (average follow-up 8.6 years). Seventeen patients with an exophytic pattern died with disease (10 disseminated disease; 7 local disease). No patients with papillary patterns died of disease, although there had been 4 recurrences. In conclusion, patients with papillary and exophytic SCCs have a better prognosis than those with conventional SCCs, and the prognosis for those with papillary SCCs is even better.
PubMed ID: 10229599
Article Size: <1 MB

Extracranial sinonasal tract meningiomas: a clinicopathologic study of 30 cases with a review of the literature.

Thompson LD, Gyure KA.
Am J Surg Pathol. 2000 May;24(5):640-50.
Extracranial meningiomas of the sinonasal tract are rare tumors. These tumors are frequently misclassified, resulting in inappropriate clinical management. To date, there has been no comprehensive study to evaluate the clinicopathologic aspects of meningi
PubMed ID: 10800982
Article Size: 2 MB

Fibrous dysplasia of bone.

Nelson BL, Thompson LD.
Ear Nose Throat J. 2003 Apr;82(4):259.
FIRST PARAGRAPH: Fibrous dysplasia (fibro-osseous metaplasia) is one of a diverse group of diseases that are characterized by alterations in bone growth. It is a developmental, tumor-like process of unknown etiology. Its initial clinical sign is usually a painless enlargement of the affected bone. It occurs in equal proportions in males and females, most often during the first two decades of life.
PubMed ID: 12735156
Article Size: <1 MB

Follicular lymphoma.

Pantanowitz L, Thompson LD.
Ear Nose Throat J. 2006 Oct;85(10):636-7.
FIRST PARAGRAPH: Follicular lymphoma is defined as a neoplasm of follicle center B lymphocytes (centrocytes and centroblasts) that has at least a partially follicular growth pattern. It is a low-grade lymphoma, and its course is indolent. Most patients present during the sixth decade of life; the neoplasm is very rare in patients younger than 20 years of age. The female-to-male ratio is 1.7:1. Lymph node enlargement is the usual presentation; only about 20% of patients have B symptoms (i.e., fever, chills, night sweats, and weight loss). The disease is usually systemic at presentation (stage III or IV). In the head and neck region, follicular lymphoma may involve lymph nodes, Waldeyer’s ring, and/or skin.
PubMed ID: 17124929
Article Size: <1 MB

Functional Histology of Salivary Gland Pleomorphic Adenoma: An Appraisal.

Triantafyllou A, Thompson LD, Devaney KO, Bell D, Hunt JL, Rinaldo A, Vander Poorten V, Ferlito A.
Head Neck Pathol. 2015 Sep;9(3):387-404.
The complex microstructure of salivary gland pleomorphic adenoma is examined in relation to function. Events related to secretion of macromolecules and absorption, responses to the altered microenvironment and controversies concerning epithelial-mesenchymal transition versus modified myoepithelial differentiation are explored. Their effects on tumor cell phenotypes and arrangements are emphasized. Heterotopic differentiation and attempts at organogenesis are also considered. The approach allows interpreting microstructure independently of histogenetic perceptions, envisaging the tumor cells as a continuum, endorsing luminal structures as the principal components, and defining pleomorphic adenoma as a benign epithelial tumour characterized by variable epithelial-mesenchymal transition, secretion/differentiation and metaplasia.
PubMed ID: 25380577
Article Size: 10.5 MB

Giant cell tumor of the larynx: a clinicopathologic series of eight cases and a review of the literature.

Wieneke JA, Gannon FH, Heffner DK, Thompson LD.
Mod Pathol. 2001 Dec;14(12):1209-15.
True giant cell tumors of the larynx (GCTL) are quite rare, and only individual case reports are documented in the literature. Eight cases of GCTL were identified in the Otorhinolaryngic Pathology Tumor Registry between 1966 and 2000. There were 2 women and 6 men, ages 26 to 62 years (mean, 44.5 yrs). Patients presented with a palpable neck mass (n = 5), airway obstruction (n = 3), hoarseness (n = 3), and dysphagia (n = 2). All tumors involved the thyroid cartilage, a few with local extension. The mean tumor size was 4.1 cm. Histologically, the tumors showed no connection to the surface epithelium and arose in sites of ossification. The tumors had an expansile, infiltrative growth and consisted of numerous multinucleated osteoclast-like giant cells within a cellular stroma composed of plump, oval mononuclear cells. Of interest was that the nuclei of the giant cells were similar to the nuclei of the stromal cells. Treatment included biopsy only with adjuvant therapy (n = 2), local resection (n = 3), and total laryngectomy (n = 3). Follow-up showed 5 patients were alive without evidence of disease (mean follow-up, 6.9 yrs); 2 died of unrelated causes (mean survival, 22.2 yrs). No patients developed recurrences. GCTL are rare tumors that can cause significant airway obstruction. Complete surgical resection yields an excellent outcome without adjuvant therapy.
PubMed ID: 11743042
Article Size: 2 MB


Hollowell M, Thompson LD, Pantanowitz L.
Ear Nose Throat J. 2008 Mar;87(3):132, 134
FIRST PARAGRAPH: Gout is caused by disordered purine metabolism resulting in hyperuricemia. Symptoms are related to the precipitation of monosodium urate (uric acid) crystals, typically in joint spaces or soft tissue. Primary gout is caused by an increase in uric acid production, while secondary gout is caused by either a decrease in urinary uric acid excretion or an overproduction of purine secondary to increased cell turnover (e.g., tumor lysis). Predisposing clinical factors include older age (fifth and older decade), male sex, obesity, heavy alcohol ingestion, a purine-rich diet, certain medications (e.g., thiazide diuretics), and genetic factors.
PubMed ID: 18404905
Article Size: <1 MB

Hemangioma of the parotid.

Thompson LD.
Ear Nose Throat J. 2002 Nov;81(11):769.
FIRST PARAGRAPH: Hemangiomas are benign tumors of endothelial cell origin (benign hemangioendotheliomas). They are the most common salivary gland tumor in children younger than 1 year of age, accounting for 90% of cases. Hemangiomas in adults are uncommon. The characteristic features of hemangiomas are the rapid enlargement of a unilateral (usually on the left), compressible, bluish mass shortly after birth, particularly in girls. Hemangiomas are not associated with any syndrome.
PubMed ID: 12472029
Article Size: <1 MB

Herpes simplex virus laryngitis.

Thompson L.
Ear Nose Throat J. 2006 May;85(5):304.
FIRST PARAGRAPH: Both infectious and inflammatory conditions can result in laryngitis, which is divided into acute and chronic forms. Some conditions are more frequent in adults, while others are more common in children. Laryngitis (‘croup,’ epiglottitis, and laryngotracheobronchitis) has many causes, including viral, bacterial, mycotic, or mycobacterial infections, trauma, neoplasms, vascular compromise during surgery, iatrogenic injury from feeding tubes or tracheostomy tubes, foreign-body impaction, and radiation therapy. A number of etiologies may be present synchronously, such that an infection may develop in association with radiation therapy, for example. Therefore, multiple etiologies may need to be addressed.
PubMed ID: 16771019
Article Size: <1 MB

HIV-associated Hodgkin lymphoma: a clinicopathologic and immunophenotypic study of 45 cases.

Thompson LD, Fisher SI, Chu WS, Nelson A, Abbondanzo SL.
Am J Clin Pathol. 2004 May;121(5):727-38.
We retrospectively analyzed 45 cases of HIV-associated Hodgkin lymphoma (HIV-HL). HIV-HL generally is a disease of young white men (mean age, 40.1 years) who acquired HIV infection by homosexual or bisexual behavior (68%), intravenous drug use (24%), and/or blood transfusion (8%). The mean interval between the diagnosis of HIV and HIV-HL was 5.2 years. Morphologic classification of nodal biopsy specimens (2001 World Health Organization criteria) included 15 mixed cellularity Hodgkin lymphomas (MCHLs), 14 nodular sclerosis Hodgkin lymphomas (NSHLs), 9 lymphocyte depleted Hodgkin lymphomas (LDHLs), and 7 classic Hodgkin lymphomas, type not further categorized. The Hodgkin-Reed-Sternberg (HRS) cells expressed positive immunoreactivity with fascin (30/30 [100%]), CD30 (35/37 [95%]), CD15 (32/36 [89%]), bcl-X(L) (25/31 [81%]), bcl-2 (15/29 [52%]), CD20 (4/34 [12%]), bcl-6 (3/28 [11%]), and Epstein-Barr virus latent membrane protein-1 (32/33 [97%]) and were nonreactive for CD138/syndecan-1. CD4 and CD8 immunostaining showed an inverted CD4/CD8 ratio (<1/20) in all cases. At diagnosis, most patients (n = 27) had high-stage disease (IV(E)) associated with an aggressive course (16% 5-year survival). LDHL behaved more aggressively than MCHL and NSHL (15% vs 40%, 5-year survival, respectively), as did disease with a sarcomatoid pattern (11% 5-year survival). Chemotherapy and radiotherapy proved efficacious in a minority of these patients.
PubMed ID: 15151213
Article Size: <1 MB

Hodgkin-like transformation of a marginal zone B-cell lymphoma of the larynx.

Fung EK, Neuhauser TS, Thompson LD.
Ann Diagn Pathol. 2002 Feb;6(1):61-6.
Primary larynx lymphomas, specifically of the mucosa-associated lymphoid tissue, are a rare but documented phenomenon. Transformation of any type of lymphoma that has the presence of Reed-Sternberg cells is unusual in lymph nodes and exceptional in extranodal sites. Herein, we report the first case (to the best of our knowledge in a review of the English literature [MEDLINE 1966-2001]) in which both of these unusual findings are present; that is, an extranodal marginal zone B-cell lymphoma of laryngeal mucosa-associated lymphoid tissue with Hodgkin-like transformation. The patient is a 78-year-old man who presented with intermittent shortness of breath, progressive dysphagia, and intermittent hoarseness. On examination, a large mass of the left supraglottic larynx was identified with a ‘ball-valve’ effect into the laryngeal inlet with inspiration. Examination of the neck showed no palpable masses. Histologic examination of the incisional biopsy showed replacement of the submucosa by sheets of atypical monocytoid B cells (CD20+, CD79a+, lambda+, CD3-) characterized by nuclear atypia, mitotic activity, plasmacytoid differentiation, and restricted for lambda light chains. Dutcher bodies were easily identified. Interspersed throughout the neoplastic lymphoid population were numerous Reed-Sternberg cells and variants immunoreactive for CD30 and CD15 and nonreactive for CD45RB. The patient was treated with 44 cGy to the neck and larynx and was alive and free of disease at last contact, 2.6 years after the original presentation.
PubMed ID: 11842381
Article Size: <1 MB

Incisional or core biopsies of salivary gland tumours: how far should we go?

Nelson BL, Thompson LDR.
Diagnostic Pathology Volume 18:9 September 2012 pages 358-365.
Trends in the evaluation of salivary gland masses have changed as imaging studies have improved and sampling techniques have evolved over the past several decades. Whether clinically palpable or detected by imaging studies, salivary gland masses have been readily evaluated by fine needle aspiration. More recently, imaging guided core-needle biopsy has been employed with mixed results. The literature on these techniques is reviewed and analyzed with particular attention to tissue adequacy and diagnostic accuracy. Comparison is made using selected case presentations to highlight the advantages and disadvantages of establishing a diagnosis when core-needle biopsy is utilized. Core-needle biopsy of salivary gland tumours may be a useful first diagnostic approach as long as the limitations of the procedure are well understood and managed.
PubMed ID: n/a
Article Size: <1 MB