Tracheopathia osteoplastica.

Head & Neck, Larynx
Penner CR, Thompson LD.
Ear Nose Throat J. 2003 Jun;82(6):427.
FIRST PARAGRAPH: Tracheopathia osteoplastica (tracheobronchopathia osteochondroplastica) is a segmental degenerative disorder of the tracheobronchial tree. It is characterized by multiple submucosal cartilaginous and osseous nodules of various sizes that cause a narrowing of the upper respiratory tract. This disorder is most common in elderly men, and it is occasionally associated with chronic inflammation or with trauma. Tracheopathia osteoplastica can manifest clinically as nonspecific signs and symptoms, although stridor and dyspnea are common. Radiologic studies may suggest the diagnosis if scalloped nodular calcified opacities are seen in the submucosa. The diagnosis is confirmed after endoscopic and pathologic examination.
PubMed ID: 12861866
Article Size: <1 MB

Update on Nasopharyngeal Carcinoma.

Head & Neck, Sinonasal Tract
Thompson LDR.
Head Neck Pathol. 2007 Sep;1(1):81-6.
FIRST PARAGRAPH: The most common type of nasopharyngeal tumor is nasopharyngeal carcinoma. The etiology is multifactorial with race, genetics, environment and Epstein-Barr virus (EBV) all playing a role. While rare in Caucasian populations, it is one of the most frequent nasopharyngeal cancers in Chinese, and has endemic clusters in Alaskan Eskimos, Indians, and Aleuts. Interestingly, as native-born Chinese migrate, the incidence diminishes in successive generations, although still higher than the native population.
PubMed ID: 20614287
Article Size: <1 MB
 

Wegener granulomatosis.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2013 Jan;92(1):18-22.
FIRST PARAGRAPHS: Wegener granulomatosis presents clinically as ulcerative and crusted lesions with tissue destruction. Wegener granulomatosis (WG) is an idiopathic, nonneoplastic, aseptic, necrotizing disease characterized by vasculitis and destructive properties. In general, affected patients exhibit disease in the sinonasal tract, lungs, and kidney, in some cases metachronously. Patients may present with systemic or localized disease; patients with systemic disease are usually quite sick. Disease progression may be seen when localized disease becomes systemic, but many patients will remain with limited disease.
PubMed ID: 23354886
Article Size: <1 MB

Angioleiomyoma of the Sinonasal Tract: Analysis of 16 Cases and Review of the Literature

Head & Neck, Sinonasal Tract
Agaimy A, Michal M, Thompson LD, Michal M
Head Neck Pathol. 2015 Dec;9(4):463-73.
Angioleiomyoma (ALM; synonyms: angiomyoma, vascular leiomyoma) is an uncommon benign tumor of skin and subcutaneous tissue. Most arise in the extremities (90 %). Head and neck ALMs are uncommon (~10 % of all ALMs) and those arising beneath the sinonasal tract mucosa are very rare (<1 %) with 38 cases reported so far. We herein analyzed 16 cases identified from our routine and consultation files. Patients included seven females and nine males aged 25-82 years (mean 58; median 62). Symptoms were intermittent nasal obstruction, sinusitis, recurrent epistaxis, and a slow-growing mass. Fifteen lesions originated within different regions of the nasal cavity and one lesion was detected incidentally in an ethmoid sinus sample. Size range was 6-25 mm (mean 11). Histologically, all lesions were well circumscribed but non-encapsulated and most (12/16) were of the compact solid type superficially mimicking conventional leiomyoma but contained numerous compressed muscular veins. The remainder were of venous (2) and cavernous (2) type. Variable amounts of mature fat were observed in four cases (25 %). Atypia, necrosis, and mitotic activity were absent. Immunohistochemistry showed consistent expression of smooth muscle actin (12/12), h-caldesmon (9/9), muscle-specific actin (4/4), variable expression of desmin (11/14) and CD56 (4/6), and absence of HMB45 expression (0/11). The covering mucosa was ulcerated in 6 cases and showed squamous metaplasia in one case. There were no recurrences after local excision. Submucosal sinonasal ALMs are rare benign tumors similar to their reported cutaneous counterparts with frequent adipocytic differentiation. They should be distinguished from renal-type angiomyolipoma. Simple excision is curative.
PubMed ID: 26047608
Article Size: 3 MB
 

Salivary acinic cell carcinoma: reappraisal and update

Head & Neck, Salivary Gland
Vander Poorten V, Triantafyllou A, Thompson LD, Bishop J, Hauben E, Hunt J, Skalova A, Stenman G, Takes RP, Gnepp DR, Hellquist H, Wenig B, Bell D, Rinaldo A, Ferlito A.
Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3511-3531.
Epidemiologic and clinicopathologic features, therapeutic strategies, and prognosis for acinic cell carcinoma of the major and minor salivary glands are critically reviewed. We explore histopathologic, histochemical, electron microscopic and immunohistochemical aspects and discuss histologic grading, histogenesis, animal models, and genetic events. In the context of possible diagnostic difficulties, the relationship to mammary analog secretory carcinoma is probed and a classification is suggested. Areas of controversy or uncertainty, which may benefit from further investigations, are also highlighted.
PubMed ID: 26685679
Article Size: 5.22 MB
 

Pleomorphic sarcoma of the neck.

Head & Neck, Neck
Thompson LD.
Ear Nose Throat J. 2015 Sep;94(9):376-7.
Pleomorphic sarcoma is an uncommon neoplasm in the head and neck now that refinements in diagnostic techniques have more accurately classified tumors that used to be placed in this category.

FIRST PARAGRAPH: ‘Pleomorphic sarcoma’ is the World Health Organization’s preferred term for malignant fibrous histiocytoma. This high-grade pleomorphic malignant mesenchymal neoplasm is a diagnosis of exclusion after other sarcomas and pleomorphic neoplasms have been excluded by histochemistry, immunohistochemistry, electron microscopy, and/or molecular evaluation. Most of these tumors arise de novo, but postradiation tumors are not uncommon. To be considered as a postradiation tumor, the tumor must be located in the radiation field and it must develop at least 3 years after radiation in an area that was free of tumor before radiation.

PubMed ID: 26401667
Article Size: <1 MB

Angiolymphoid hyperplasia with eosinophilia.

Ear & Temporal Bone, Head & Neck
Thompson LD.
Ear Nose Throat J. 2015 Oct-Nov;94(10-11):443-4.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular tumor that features immature blood vessels lined by epithelioid endothelial cells with a prominent inflammatory infiltrate, frequently showing a conspicuous eosinophil component.

FIRST PARAGRAPH: Angiolymphoid hyperplasia with eosinophilia (ALHE), sometimes called epithelioid hemangioma, is a benign vascular tumor. It features immature blood vessels lined by epithelioid endothelial cells with a prominent inflammatory infiltrate, frequently showing a conspicuous eosinophil component. There is controversy about whether this lesion is a reactive or benign neoplastic condition.

PubMed ID: 26535818
Article Size: <1 MB

Update on Select Benign Mesenchymal and Meningothelial Sinonasal Tract Lesions

Head & Neck, Sinonasal Tract
Thompson LD, Fanburg-Smith JC.
Head Neck Pathol. 2016 Mar;10(1):95-108.
Several benign and malignant mesenchymal and meningothelial lesions may preferentially affect or extend into the sinonasal tract. Glomangiopericytoma (GPC, formerly sinonasal-type hemangiopericytoma) is a specific tumor with a predilection to the sinonasal tract. Sinonasal tract polyps with stromal atypia (antrochoanal polyp) demonstrate unique histologic findings in the sinonasal tract. Juvenile nasopharyngeal angiofibroma (JNA) arises from specialized tissue in this location. Meningioma may develop as direct extension from its intracranial counterpart or as an ectopic tumor. Selected benign mesenchymal tumors may arise in the sinonasal tract and pose a unique differential diagnostic consideration, such as solitary fibrous tumor and GPC or lobular capillary hemangioma and JNA. Although benign and malignant vascular, fibrous, fatty, skeletal muscle, and nerve sheath tumors may occur in this location, this paper focuses on a highly select group of rare benign sinonasal tract tumors with their clinicopathological and molecular findings, and differential diagnosis.
PubMed ID: 26830398
Article Size: 4 MB
 
 
 
 

Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control

Head & Neck, Oral Cavity/Gnathic (Jaw)
Maxwell JH, Thompson LD, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, Prabhu AV, Lai C, Shuai Y, Carroll WR, Morlandt A, Duvvuri U, Kim S, Johnson JT, Ferris RL, Seethala R, Chiosea S.
JAMA Otolaryngol Head Neck Surg. 2015 Dec 1;141(12):1104-10.
IMPORTANCE: Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique.
OBJECTIVE: To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015.
INTERVENTIONS: In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR.
MAIN OUTCOMES AND MEASURES: Local recurrence.
RESULTS: Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin.
CONCLUSIONS AND RELEVANCE: The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen-based margin assessment is recommended.
PubMed ID: 26225798
Article Size: <1 MB
 
 
 
 

Hotspot activating PRKD1 somatic mutations in polymorphous low-grade adenocarcinomas of the salivary glands

Head & Neck, Salivary Gland
Weinreb I, Piscuoglio S, Martelotto LG, Waggott D, Ng CK, Perez-Ordonez B, Harding NJ, Alfaro J, Chu KC, Viale A, Fusco N, da Cruz Paula A, Marchio C, Sakr RA, Lim R, Thompson LD, Chiosea SI, Seethala RR, Skalova A, Stelow EB, Fonseca I, Assaad A, How C, Wang J, de Borja R, Chan-Seng-Yue M, Howlett CJ, Nichols AC, Wen YH, Katabi N, Buchner N, Mullen L, Kislinger T, Wouters BG, Liu FF, Norton L, McPherson JD, Rubin BP, Clarke BA, Weigelt B, Boutros PC, Reis-Filho JS.
Nat Genet. 2014;Nov;(46(11):1166-9.
Polymorphous low-grade adenocarcinoma (PLGA) is the second most frequent type of malignant tumor of the minor salivary glands. We identified PRKD1 hotspot mutations encoding p.Glu710Asp in 72.9% of PLGAs but not in other salivary gland tumors. Functional studies demonstrated that this kinase-activating alteration likely constitutes a driver of PLGA.
PubMed ID: 25240283
Article Size: 1 MB
 
 
 
 

Oral Traumatic Ulcer.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Thompson LD.
Ear Nose Throat J. 2011 Nov; 90(11):518-34.
FIRST PARAGRAPH: A traumatic ulcer is a chronic traumatic ulceration of the oral mucosa that shows unique histopathologic features. Also known as traumatic granuloma, eosinophilic granuloma, and Riga-Fede disease, this lesion is usually caused by some sort of mechanical injury. The most common causes include accidental trauma from biting, malposed teeth, and even sharp foodstuffs. However, self inflicted wounds caused by nocturnal clenching or tongue and lip biting, electrical and thermal injuries, hot foods or beverages, and even factitial injuries yield a similar finding. Ulceration of the ventral tongue as a result of tongue thrusting in infants with natal or neonatal teeth is referred to as Riga-Fede disease.
PubMed ID: 22109918
Article Size: <1 MB

Chondrodermatitis nodularis helicis.

Ear & Temporal Bone, Head & Neck
Thompson LDR.
Ear Nose Throat J. 2007 Dec;86(12):734-5.
FIRST PARAGRAPH: Chondrodermatitis nodularis helicis (CDNH) is a non-neoplastic inflammatory and degenerative process of the external ear. It is characterized by necrobiotic changes in the dermis that extend down to the perichondrium; associated alterations are seen in the cartilaginous plate. The dermal injury is thought to be attributable to a combination of factors: local trauma, actinic damage, and the relatively tenuous vascularity of the auricle. The necrobiotic dermal collagen—and in some cases the cartilaginous matrix—is extruded through a crater-like defect in the epidermis; thus, CDNH is considered to be one of the transepidermal elimination disorders.
PubMed ID: 18217375
Article Size: <1 MB

Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review

Head & Neck, Oral Cavity/Gnathic (Jaw)
Suárez C, Barnes L, Silver CE, Rodrigo JP , Shah JP, Triantafyllou A, Rinaldo A, Cardesa A, Pitman KT, Kowalski LP, Robbins KT , Hellquist H, Medina JE, de Bree R, Takes RP, Coca-Pelaz A , Bradley PJ, Gnepp DR, Teymoortash A, Strojan P, Mendenhall WM, Anderson Eloy J, Bishop JA, Devaney KO, Thompson LDR, Hamoir M, Slootweg PJ, Vander Poorten VV, Williams MD, Wenig BM, Skálová A, Ferlito A.
Auris Nasus Larynx. 2016 Oct;43(5):477-484.
The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0–14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.
PubMed ID: 27017314
Article Size: <1 MB
 

Cervical Lymph Node Metastasis in High-Grade Transformation of Head and Neck Adenoid Cystic Carcinoma: A Collective International Review.

Head & Neck, Salivary Gland
Hellquist H, Skálová A, Barnes L, Cardesa A, Thompson LD, Triantafyllou A, Williams MD, Devaney KO, Gnepp DR,, Bishop JA, Wenig BM, Suárez C,, Rodrigo JP,, Coca-Pelaz A, Strojan P, Shah JP, Hamoir M, Bradley PJ,, Silver CE, Slootweg PJ, Vander Poorten V,, Teymoortash A, Medina JE, Robbins KT, Pitman KT, Kowalski LP, de Bree R, Mendenhall WM, Eloy JA, Takes RP, Rinaldo A, Ferlito A.
Adv Ther. 2016 Mar;33(3):357-68.
Adenoid cystic carcinoma (AdCC) is among the most common malignant tumors of the salivary glands. It is characterized by a prolonged clinical course, with frequent local recurrences, late onset of metastases and fatal outcome. High-grade transformation (HGT) is an uncommon phenomenon among salivary carcinomas and is associated with increased tumor aggressiveness. In AdCC with high-grade transformation (AdCC-HGT), the clinical course deviates from the natural history of AdCC. It tends to be accelerated, with a high propensity for lymph node metastasis. In order to shed light on this rare event and, in particular, on treatment implications, we undertook this review: searching for all published cases of AdCC-HGT. We conclude that it is mandatory to perform elective neck dissection in patients with AdCC-HGT, due to the high risk of lymph node metastases associated with transformation.
PubMed ID: 26895332
Article Size: 3 MB
 

Rhinosporidiosis.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2016 Mar;95(3):101..
FIRST PARAGRAPH: Rhinosporidium seeberi is the etiologic agent of a chronic, and usually painless, localized granulomatous infection of the mucous membranes of the sinonasal tract, conjunctiva, and urethra. Endemic in India and Sri Lanka, the disease is becoming more significant as a result of migration. R seeberi has not been definitively cultured but is thought to be a blue-green algae, with the infectious agent being a thick-walled sporangium containing endospores. It is passed to humans from animals (cats, free-grazing horses) or possibly fomites, identified in water or soil contaminated by waste.
PubMed ID: 26991216
Article Size: <1 MB

Ear and temporal bone meningioma

Ear & Temporal Bone, Head & Neck
Thompson, LD.
Ear Nose Throat J. 2016 Apr-May;95(4-5):146.
FIRST PARAGRAPH: Meningiomas account for 30% of all intracranial neoplasms, but primary extracranial (ectopic) meningiomas of the ear and temporal bone are less common, accounting for about 10% of all ear and temporal bone tumors. Meningiomas are derived from the arachnoid cap cells, also called pacchionian bodies.
PubMed ID: 27140011
Article Size: <1 MB

Cervical Lymph Node Metastasis in Adenoid Cystic Carcinoma of the Larynx: A Collective International Review

Head & Neck, Larynx
Coca-Pelaz A, Barnes L, Rinaldo A, Cardesa A, Shah JP, Rodrigo JP,, Suárez C,, Eloy JA, Bishop JA, Devaney KO, Thompson LD, Wenig BM, Strojan P, Hamoir M, Bradley PJ,, Gnepp DR,, Silver CE, Slootweg PJ, Triantafyllou A, Vander Poorten V,, Williams MD, Skálová A, Hellquist H, Teymoortash A, Medina JE, Robbins KT, Pitman KT, Kowalski LP, de Bree R, Mendenhall WM, Takes RP, Ferlito A.
Adv Ther. 2016 Apr;33(4):553-79.
Adenoid cystic carcinoma (AdCC) of the head and neck is a well-recognized pathologic entity that rarely occurs in the larynx. Although the 5-year locoregional control rates are high, distant metastasis has a tendency to appear more than 5 years post treatment. Because AdCC of the larynx is uncommon, it is difficult to standardize a treatment protocol. One of the controversial points is the decision whether or not to perform an elective neck dissection on these patients. Because there is contradictory information about this issue, we have critically reviewed the literature from 1912 to 2015 on all reported cases of AdCC of the larynx in order to clarify this issue. During the most recent period of our review (1991-2015) with a more exact diagnosis of the tumor histology, 142 cases were observed of AdCC of the larynx, of which 91 patients had data pertaining to lymph node status. Eleven of the 91 patients (12.1%) had nodal metastasis and, based on this low proportion of patients, routine elective neck dissection is therefore not recommended.
PubMed ID: 27084720
Article Size: <1 MB
 

Subsets of Salivary Duct Carcinoma Defined by Morphologic Evidence of Pleomorphic Adenoma, PLAG1 or HMGA2 Rearrangements, and Common Genetic Alterations

Head & Neck, Salivary Gland
Chiosea SI, Thompson LD, Weinreb I, Bauman JE, Mahaffey AM, Miller C, Ferris RL, Gooding WE.
Cancer. 2016 Oct 15;122(20):3136-3144. doi: 10.1002/cncr.30179. Epub 2016 Jul 5.
BACKGROUND: The authors hypothesized that histogenetic classification of salivary duct carcinoma (SDC) could account for de novo tumors and those with morphologic or molecular evidence (pleomorphic adenoma gene 1 [PLAG1], high-mobility group AT hook 2 [HMGA2] rearrangement, amplification) of pleomorphic adenoma (PA).
METHODS: SDCs (n = 66) were reviewed for morphologic evidence of PA. PLAG1 and HMGA2 alterations were detected by fluorescence in situ hybridization (FISH). PLAG1-positive tumors were tested by FISH for fibroblast growth factor receptor 1 (FGFR1) rearrangement. Thirty-nine tumors were analyzed using a commercial panel for mutations and copy number variations in 50 cancer-related genes.
RESULTS: On the basis of combined morphologic and molecular evidence of PA, 4 subsets of SDC emerged: 1) carcinomas with morphologic evidence of PA but intact PLAG1 and HMGA2 (n = 22); 2) carcinomas with PLAG1 alteration (n = 18) or 3) HMGA2 alteration (n = 12); and 4) de novo carcinomas, without morphologic or molecular evidence of PA (n = 14). The median disease-free survival was 37 months (95% confidence interval, 28.4-45.6 months). Disease-free survival and other clinicopathologic parameters did not differ for the subsets defined above. Combined Harvey rat sarcoma viral oncogene homolog/phosphatidylinositol-4,5-biphosphate 3-kinase, catalytic subunit α (HRAS/PIK3CA) mutations were observed predominantly in de novo carcinomas (5 of 8 vs 2 of 31 tumors; P = .035). Erb-B2 receptor tyrosine kinase 2 (ERBB2) copy number gain was not observed in de novo carcinomas (0 of 8 vs 12 of 31 tumors; P = .08). Tumor protein 53 (TP53) mutations were more common in SDC ex pleomorphic adenomas than in de novo carcinomas (17 of 31 vs 1 of 8 tumors; P = .033).
CONCLUSIONS: The genetic profile of SDC varies with the absence or presence of pre-existing PA and its cytogenetic signature. Most de novo SDCs harbor combined HRAS/PIK3CA mutations and no ERBB2 amplification.
PubMed ID: 27379604
Article Size: <1 MB
 
 
 
 

Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach.

Head & Neck, Sinonasal Tract
Thompson LD.
Mod Pathol. 2017 Jan;30(s1):S1-S26. doi: 10.1038/modpathol.2016.119.
One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic ‘MR SLEEP’ helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.
PubMed ID: 28060373
Article Size: 4 MB
 

Laryngeal Dysplasia, Squamous Cell Carcinoma, and Variants

Head & Neck, Larynx
Thompson, LDR.
Surg Pathol Clin. 2017 Mar;10(1):15-33.
Squamous cell carcinoma (SCC) is a malignant epithelial tumor showing evidence of squamous differentiation. It is the most common malignancy of the larynx, with several variants (verrucous, exophytic or papillary, spindle-cell, basaloid, acantholytic, adenosquamous) recognized, with well-established precursor lesions. Dysplasia is now separated into only low-grade and high-grade categories. Each SCC variant has unique cytomorphologic features and histologic differential diagnoses that are important to consider, as management and outcomes are different.
PubMed ID: 28153131
Article Size: 13 MB
 
 
 
 

Update From the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Tumours of the Ear.

Ear & Temporal Bone, Head & Neck
Thompson LD.
Head Neck Pathol. 2017 Mar;11(1):78-87. doi: 10.1007/s12105-017-0790-5. Epub 2017 Feb 28.
The 2017 fourth edition of the World Health Organization Classification of Tumours, specifically as it relates to the ear (Chap. 9), has several changes. Importantly, the number of entities has been significantly reduced by omitting tumors or lesions if they do not occur exclusively or predominantly at this site or if they are discussed in detail elsewhere in the book. These entities include: embryonal rhabdomyosarcoma, osteoma, exostosis, angiolymphoid hyperplasia with eosinophilia, Schneiderian papilloma, inverted papilloma, lipoma of the internal auditory canal, hemangioma, hematolymphoid tumors, and secondary tumors. Paraganglioma was included in the neck chapter. New entries include otosclerosis and cholesteatoma, while refinements to nomenclature, classification and criteria were incorporated into the ceruminous gland tumors and epithelial tumors of the middle and inner ear. Specifically, the middle and inner ear were combined, as practical limitations of origin and imaging make a definitive separation artificial. The classification reflects the state of current understanding for these uncommon entities, with this update only highlighting selected entities that were the most significantly changed.
PubMed ID: 28247225
Article Size: 4.6 MB
 
 
 
 

Ectopic Hamartomatous Thymoma: A Review Of The Literature With Report Of New Cases And Proposal Of A New Name: Biphenotypic Branchioma.

Head & Neck, Neck
Sato K, Thompson LDR, Miyai K, Kono T, Tsuda H.
Head Neck Pathol. 2018 Jun;12(2):202-209.
Ectopic hamartomatous thymoma (EHT) is a rare benign neoplasm of the lower neck suggesting branchial origin. Despite use of the term thymoma in the nomenclature, there is no evidence of thymic origin or differentiation. It affects middle-aged adults with a remarkable male predominance. To date less than 80 cases have been reported in the English literature. We present here two additional cases of EHT. The first is a benign case in a 31-year-old man, showing typical histological features. The second is a malignant case in a 70-year-old woman, showing intraductal carcinoma arising in intimate association with an EHT. These cases are presented in the context of a review of cases reported in the English literature. The exact origin has not been identified, but is considered to be of branchial apparatus, creating a quandary about the best terminology. Recently, the designation “branchial anlage mixed tumor” or “thymic anlage tumor” were proposed, but do not quite reflect the true nature of the neoplasm. To avoid taxonomic confusion, international consensus on terminology is desired. As this entity is a neoplasm that shows dual mesoderm and endoderm derivation/differentiation, we propose a new name “biphenotypic branchioma.”
PubMed ID: 28879635
Article Size: 2 MB
 
 
 
 

Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Berdugo J, Thompson LDR, Purgina B, Sturgis CD, Tuluc M, Seethala R, Chiosea SI.
Head Neck Pathol. 2019 Jun;13(2):154-161.
doi: 10.1007/s12105-018-0925-3. Epub 2018 Apr 26.
The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a “plumb line” to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.
PubMed ID: 29700721
Article Size: 3 MB

Improving margin revision: Characterization of tumor bed margins in early oral tongue cancer.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Prabhu AV, Sturgis CD, Lai C, Maxwell JH, Merzianu M, Hernandez-Prera JC, Purgina B, Thompson LDR, Tuluc M, Yang X, Seethala RR, Ferris RL, Chiosea SI.
Oral Oncol. 2017 Dec;75:184-188.
OBJECTIVES: To improve margin revision, this study characterizes the number, fragmentation, and orientation of tumor bed margins (TBM) in patients with pT1-2 pN0 squamous cell carcinoma (SCC) of the oral tongue.
MATERIALS AND METHODS: Pathology reports (n=346) were reviewed. TBM parameters were indexed. In Group 1 patients all margins were obtained from the glossectomy specimen and there were no TBM. In Revision Group/Group 2 (n=103), tumor bed was sampled to revise suboptimal margins identified by examination of the glossectomy specimen. In Group 3 (n=124), TBM were obtained before examination of the glossectomy specimen.
RESULTS AND CONCLUSIONS: Fewer TBMs were obtained per patient in Group 2 compared to Group 3 (57/103, 55% of patients with <3 vs. 117/124, 94%, ≥3 TBMs, respectively). The new margin surface was more frequently indicated in Group 2 compared to Group 3 (59/103, 57%, vs. 19/124, 15%, p<.001). If glossectomy specimen margins are accepted as the reference standard, then the TBM was 15% sensitive in Group 2 (95% confidence interval [CI], 7-29) and 32% sensitive in Group 3 (95% CI, 15-55). TBM fragmentation (23/103, 22% vs. 42/124, 34%) and frozen vs. permanent discrepancies (8/103, 3% vs. 3/124, 2%) were similar between Groups 2 and 3. The new margin surface was not indicated in 6 of 11 cases with discrepant frozen vs. permanent pathology findings, precluding judgment on final margin status. To facilitate the assessment of final margins, TBM should be represented by one tissue fragment with a marked new margin surface.
PubMed ID: 29074194
Article Size: <1 MB
 
 
 
 

Head and Neck Kaposi Sarcoma: Clinicopathological Analysis of 11 Cases.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Agaimy A, Mueller SK, Harrer T, Bauer S, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):511-516.
Kaposi sarcoma (KS) of the head and neck area is uncommon with limited published case series. Our routine and consultation files were reviewed for histologically and immunohistochemically proven KS affecting any cutaneous or mucosal head and neck site. Ten males and one female aged 42-78 years (median, 51 years; mean, 52 years) were retrieved. Eight patients were HIV-positive and three were HIV-negative. The affected sites were skin (n = 5), oral/oropharyngeal mucosa (n = 5), and lymph nodes (n = 3) in variable combination. The ear (pinna and external auditory canal) was affected in two cases; both were HIV-negative. Multifocal non-head and neck KS was reported in 50% of patients. At last follow-up (12-94 months; median, 46 months), most of patients were either KS-free (n = 8) or had ongoing remission under systemic maintenance therapy (n = 2). One patient was alive with KS (poor compliance). Histopathological evaluation showed classical features of KS. One case was predominantly sarcomatoid with prominent inflammation mimicking undifferentiated sarcoma. Immunohistochemistry showed consistent expression of CD31, CD34, ERG, D2-40 and HHV8 in all cases. This is one of the few series devoted to head and neck KS showing high prevalence of HIV-positivity, but also unusual presentations in HIV-negative patients with primary origin in the skin of the ear and the auditory canal. KS should be included in the differential diagnosis of difficult-to-classify spindle cell lesions at this uncommon location.
PubMed ID: 29508130
Article Size: 1.6 MB
 
 
 
 

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Head & Neck, Salivary Gland
Pantanowitz L , Thompson LDR, Rossi ED.
Head Neck Pathol. 2018 Dec;12(4):548-561.
Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.
PubMed ID: 29524082
Article Size: 3.5 MB
 
 
 

Sinonasal Tract Alveolar Rhabdomyosarcoma in Adults: A Clinicopathologic and Immunophenotypic Study of Fifty-Two Cases with Emphasis on Epithelial Immunoreactivity.

Head & Neck, Sinonasal Tract
Thompson LDR, Jo VY, Agaimy A, Llombart-Bosch A, Morales GN, Machado I, Flucke U, Wakely PE Jr, Miettinen M, Bishop JA.
Head Neck Pathol. 2018 Jun;12(2):181-192.
Sinonasal tract (SNT) alveolar rhabdomyosarcoma (ARMS) are frequently misdiagnosed, especially in adults. Fifty-two adult (≥18 years) patients with SNT ARMS were reviewed and characterized by immunohistochemistry and molecular studies. Twenty-six females and 26 males (18-72 years; mean 43.2 years), presented after a short duration (mean 2.6 months) with a large (mean 5.5 cm) destructive nasal cavity mass, involving multiple contiguous paranasal sites (n = 46) and with cervical adenopathy (n = 41). The tumors showed an alveolar, nested to solid growth pattern below an intact, but often involved (n = 9) epithelium with frequent necrosis (n = 37), destructive bone invasion (n = 30), and lymphovascular invasion (n = 25). The neoplastic cells were dyshesive and dilapidated, with crush artifacts. Rhabdoid features (n = 36) and tumor cell multinucleation (n = 28) were common. Mitotic counts were high (mean 17/10 HPFs). The neoplastic cells showed the following immunohistochemical positive findings: desmin (100%), myogenin (100%), MYOD1 (100%), MSA (96%), SMA (52%), CAM5.2 (50%), AE1/AE3 (36%); other positive markers included S100 protein (27%), CD56 (100%), synaptophysin (35%), and chromogranin (13%). Overall, 54% show epithelial marker reactivity. Molecular studies showed FOXO1 translocations (81%) with PCR demonstrating PAX3 in 72.7% tested. Patients presented with high stage (IV 24; III 26) and metastatic disease (lymph nodes n = 41; distant metastases n = 25) (IRSG grouping). Surgery (n = 16), radiation (n = 41) and chemotherapy (n = 45) yielded an overall survival of 36.1 months (mean; range 2.4-286); 18 alive without disease (mean 69.6 months); 7 alive with disease (mean 11.0 months); 1 dead without disease (63.7 months); and 26 dead with disease (mean 18.5 months). SNT ARMS frequently present in adults as a large, destructive midline mass of short symptom duration, with high stage disease. The alveolar to solid pattern of growth of cells with rhabdoid-plasmacytoid features suggests the diagnosis, but epithelial immunohistochemistry markers are present in 54% of cases, leading to misdiagnosis as carcinomas if muscle markers are not also performed. Overall survival of 36.1 months is achieved with multimodality therapy, but 64% have incurable disease (16.9 months). Mixed anatomic site (p = 0.02) was a significant adverse prognostic indicator, while stage (0.06) and tumor size >5 cm (0.06) approached marginal significance.
PubMed ID: 28875443
Article Size: 4 MB
 
 
 
 

Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features.

Head & Neck, Sinonasal Tract
Sánchez-Romero C, Carlos R, Díaz Molina JP, Thompson LDR, de Almeida OP, Rumayor Piña A.
Head Neck Pathol. 2018 Mar;12(1):52-61.
Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.
PubMed ID: 28508272
Article Size: 3 MB
 
 
 
 

Sinonasal Leiomyosarcoma: Clinicopathological Analysis of Nine Cases with Emphasis on Common Association with Other Malignancies and Late Distant Metastasis.

Head & Neck, Sinonasal Tract
Agaimy A, Semrau S, Koch M, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):463-470.
Sinonasal tract (SNT) leiomyosarcoma (LMS) is exceedingly rare with < 100 cases reported. Their relationship to retinoblastoma and other malignancies, along with previous irradiation has not been clarified. Routine and consultation cases were reviewed for histologically and immunohistochemically proven SNT LMS. The tumors were tested with antibodies against α-smooth muscle actin, desmin, h-caldesmon, HMB45, S100 protein, Rb1, MDM2, CDK4 and EBV (EBER-ISH). Nine tumors affecting 5 males and 4 females aged 26 to 77 years (median: 48 years) were identified in the maxillary sinus (n = 4), nasal cavity (n = 3) and combined SNT (n = 2). Three patients had previous irradiation (2 for retinoblastoma, 1 for fibrous dysplasia) and 1 patient had chemotherapy and stem cell transplantation for Hodgkin lymphoma. One patient had prostatic adenocarcinoma (prior) and rectal adenocarcinoma (post) to the LMS. All patients with follow-up developed either local recurrences and/or metastases, principally to lung (time to metastasis: 16-156 months, mean 62 months). Histologically, 6 tumors were conventional high-grade LMS, two had glycogen-rich clear cell (PEComa-like) morphology and one was spindle cell low-grade. The latter showed grade 2 in the recurrence and grade 3 in the lung metastases. Two cases showed dedifferentiation to anaplastic pleomorphic (inflammatory MFH-like) phenotype. Immunohistochemistry revealed diffuse expression of at least 2 smooth muscle markers in 8 and only actin in one case/s. All other markers were negative. RB1 loss was observed in 6/8 cases tested. Sinonasal tract leiomyosarcomas are rare aggressive sarcomas that frequently develop in a background of previous cancer therapy (4/9), most frequently irradiation. Their varied morphology underlines the wide differential diagnostic considerations. Long-term survival may be achieved with aggressive multimodal therapy.
PubMed ID: 29270859
Article Size: 2.2 MB
 
 
 
 

Sinonasal Tract Solitary Fibrous Tumor: A Clinicopathologic Study of Six Cases with a Comprehensive Review of the Literature.

Head & Neck, Sinonasal Tract
Thompson LDR, Lau SK.
Head Neck Pathol. 2018 Dec;12(4):471-480.
Solitary fibrous tumors (SFTs) are well recognized in the head and neck region, but rarely arise in the sinonasal tract (SNT). Six primary SNT SFTs were identified in the files of Southern California Permanente Medical Group between 2006 and 2017. The patients included five males and one female ranging in age from 33 to 72 years (mean 52 years), most of whom presented clinically with nasal obstruction. Three tumors involved the nasal cavity alone, one involved the paranasal sinuses, and two involved both the nasal cavity and paranasal sinuses. Histologically, the tumors were characterized by a variably cellular proliferation of cytologically bland spindle cells within a collagenous stroma with prominent interspersed branching vessels. Mitotic activity was low (range 0–2 per 10 high power fields) and there was no evidence of pleomorphism or tumor necrosis. Surface ulceration was noted. By immunohistochemistry, the lesional cells were positive for CD34, STAT6 and bcl-2. Clinical follow up information was available for all patients (range 32–102 months; mean 72 months). There were no recurrences or metastases and all were alive with no evidence of disease at last follow-up. SFTs rarely affect the SNT, but should be considered in the differential diagnosis of SNT mesenchymal lesions. Immunohistochemical expression of STAT6 can aid in diagnosis and separation of SFT from other spindle cell lesions occurring at this anatomic site. In combination with cases reported in the literature, primary SNT SFT behave in an indolent manner with conservative treatment.
PubMed ID: 29282671
Article Size: 4 MB

Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging

Head & Neck, Oropharynx
Bhattasali O, Thompson LDR, Abdalla IA, Chen J, Iganej S.
Rep Pract Oncol Radiother 23 (2018) 451-457.
Aim: To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngealsquamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging.
Background: Previous reports comparing these agents in head and neck cancer haveincluded heterogenous disease and p16-status.
Materials and methods: A retrospective review was conducted from 2006 to 2016 ofpatients with p16-positive OPSCC who underwent definitive radiotherapy concurrent witheither triweekly Cisplatin (n = 251) or Cetuximab (n = 40). AJCC 8th Edition staging wasadapted.
Results: Median follow-up for surviving patients was 40 months. On multivariate analysisfor all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR):6% vs. 16% (p = 0.07), 3-year distant metastasis (DM): 8% vs. 21% (p = 0.04), 3-year overallrecurrence rate (ORR): 11% vs. 29% (p = 0.01), and 3-year cause-specific survival (CSS): 94%vs. 79% (p = 0.06), respectively. On stage-based subgroup analysis, for stage I II disease, 3-year LRR: 5% vs. 10% (p = 0.51), 3-year DM: 7% vs. 16% (p = 0.32), 3-year ORR: 10% vs. 23%(p = 0.15), and 3-year CSS: 95% vs. 82% (p = 0.38). For stage III disease, 3-year LRR: 10% vs. 40%(p = 0.07), 3-year DM: 9% vs. 43% (p = 0.07), 3-year ORR: 15% vs. 55% (p = 0.04), and 3-year CSS:94% vs. 57% (p = 0.048).
Conclusions: When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I–II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these
findings.
PubMed ID: n/a
Article Size: <1 MB
 

Nodal Excisions and Neck Dissection Specimens for Head & Neck Tumours (TNM8)

Head & Neck, Staging
Bullock M, Beitler JJ, Carlson DL, Fonseca I, Hunt J, Katabi N, Sloan P, Taylor SM, Williams MD, Thompson LDR.
(2018) Nodal Excisions and Neck Dissection Specimens for Head & Neck Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-24-8

SCOPE:

The dataset has been developed for the reporting of lymph node resections from patients with carcinomas and melanomas of the head and neck. This excludes nodal resections for lymphoma and sarcomas. It is not intended for use in reporting lymph node core biopsy or fine needle aspirations. Carcinomas covered by the dataset include squamous cell carcinomas, sinonasal carcinomas, salivary and non-salivary type adenocarcinomas and neuroendocrine tumours. Pathologists may also apply the dataset to metastatic non-Merkel cutaneous squamous cell carcinomas and other cutaneous carcinomas. This dataset is to be used in conjunction with other datasets in the Head and Neck Series.

EXPERT COMMITTEE:
* Chair – Martin Bullock, Canada
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Jonathan Beitler, USA
* Diane L. Carlson, USA
* Isabel Fonseca, Portugal
* Jennifer Hunt, USA
* Nora Katabi, USA
* Philip Sloan, UK
* S. Mark Taylor, Canada
* Michelle Williams, USA
ISBN: 978-1-925687-24-8
Article Size: 2 MB
 
Bullock M, Beitler JJ, Carlson DL, Fonseca I, Hunt J, Katabi N, Sloan P, Taylor SM, Williams MD, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):452-462. doi: 10.5858/arpa.2018-0421-SA. Epub 2018 Nov 30.
PubMed ID: 30500291
Article Size: 4.8 MB

Malignant Odontogenic Tumours (TNM8)

Head & Neck, Staging
Odell E, Baumhoer D, Carlos R, Hunter KD, Mosqueda-Taylor A, Richardson M, Slater L, Slootweg PJ, Speight P, Wright J, Thompson LDR.
(2018) Malignant Odontogenic Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-23-1

SCOPE:

The dataset has been developed for the reporting of biopsy and resection specimens for malignant primary odontogenic tumours. Malignant neoplasms arising in the nasal cavity and paranasal sinuses, oral cavity, salivary glands, trachea, pharynx and larynx are dealt with in separate datasets. Bone, soft tissue and lymphoma protocols will be separately listed. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – Edward Odell, UK
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Daniel Baumhoer, Switzerland
* Roman Carlos, Guatemala
* Keith Hunter, UK
* Adalberto Mosqueda-Taylor, Mexico
* Mary Richardson, USA
* Lee Slater, USA
* Pieter Slootweg, Netherlands
* Paul Speight, UK
* John Wright, USA
ISBN: 978-1-925687-23-1
Article Size: 1.3 MB
 
Slootweg PJ, Odell EW, Baumhoer D, Carlos R, Hunter KD, Taylor AM, Richardson MS, Slater L, Speight PM, Wright J, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):587-592. doi: 10.5858/arpa.2018-0417-SA.
PubMed ID: 30500289
Article Size: 2.9 MB

Ear and Temporal Bone Tumours (TNM8)

Head & Neck, Staging
Thompson LDR, Gupta R, Sandison A, Wenig BM.
(2018) Ear and Temporal Bone Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-22-4

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of the ear and temporal bone. It includes ONLY primary tumours of the external auditory canal, middle and inner ear, including both benign and malignant entities (specifically due to anatomic confines and management alternatives which may require significant, destructive or disfiguring surgery).

By definition, all malignancies of the external ear (pinna, concha, scaphoid, lobe, etc., such as squamous cell carcinoma, basal cell carcinoma, atypical fibroxanthoma, Merkel cell carcinoma and melanoma) are separately covered by the dermatopathology datasets.

Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For bilateral tumours, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair and Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Ruta Gupta, Australia
* Ann Sandison, UK
* Bruce Wenig, USA
ISBN: 978-1-925687-22-4
Article Size: 1.4 MB
 
Gupta R, Sandison A, Wenig BM, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):593 602. doi: 10.5858/arpa.2018-0415-SA.
PubMed ID: 30500288
Article Size: 4.7 MB

Carcinomas of the Nasopharynx and Oropharynx (TNM8)

Head & Neck, Oropharynx, Staging
Lewis JS Jr, Adelstein DJ, Agaimy A, Diane Carlson D, Faquin WC, Helliwell T, Hille J, Nicholls JM, Ng T, O’Sullivan B, Thompson LDR.
(2018) Carcinomas of the Nasopharynx and Oropharynx, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-18-7

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of the nasopharynx and oropharynx. The protocol applies to all invasive carcinomas of the nasopharynx and oropharynx including the base of tongue, tonsils, soft palate, posterior wall, and uvula. Lymphomas and sarcomas are not included. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – James S Lewis Jr, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* David Adelstein, USA
* Abbas Agaimy, Germany
* Diane Carlson, USA
* William Faquin, USA
* Tim Helliwell, UK
* Jos Hille, South Africa
* John Nicholls, Hong Kong
* Tony Ng, Canada
* Brian O’Sullivan, Canada
ISBN: 978-1-925687-18-7
Article Size: 1.5 MB
 
Lewis JS Jr, Adelstein DJ, Agaimy A, Diane Carlson D, Faquin WC, Helliwell T, Hille J, Nicholls JM, Ng T, O’Sullivan B, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):447-451. doi: 10.5858/arpa.2018-0405-SA. Epub 2018 Nov 30.
PubMed ID: 30500294
Article Size: 2 MB

Mucosal Melanomas of the Head and Neck (TNM8)

Head & Neck, Staging
Thompson LDR, Franchi A, Helliwell T, Müller S, Williams MD.
(2018) Mucosal Melanomas of the Head and Neck, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-25-5

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal melanoma arising in the nasopharynx, oropharynx, larynx, hypopharynx, oral cavity, nasal cavity and paranasal sinuses. All other malignancies and tumour categories are dealt with in separate datasets, specifically cutaneous melanoma is separately reported. Direct extension of a cutaneous primary into a mucosal site should be excluded, and would not be reported in this dataset. Metastasis to a head and neck mucosal site is also excluded. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair and Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Alessandro Franchi, Italy
* Tim Helliwell, UK
* Susan Müller, USA
* Michelle Williams, USA
ISBN: 978-1-925687-25-5
Article Size: 1.2 MB
 
Williams MD, Franchi A, Helliwell T, Müller S, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):603-609 doi: 10.5858/arpa.2018-0412-SA.
PubMed ID: 30500297
Article Size: 4.8 MB

Carcinomas of the Major Salivary Glands (TNM8)

Head & Neck, Staging
Seethala RR, Altemani A, Ferris RL, Fonseca I, Gnepp DR, Ha P, Nagao T, Skalova A, Stenman G, Thompson LDR.
(2018) Carcinomas of the Major Salivary Glands, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-21-7

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of malignant neoplasms and associated carcinoma in situ arising from the major salivary glands. The protocol applies to all carcinomas of the parotid, submandibular and sublingual glands. Melanomas, lymphomas, and sarcomas are dealt with in separate datasets. Minor salivary gland malignancies arising in the oral cavity, nasal cavity and paranasal sinuses, trachea, nasopharynx, oropharynx and hypopharynx and odontogenic specimens are staged according to their anatomical sub-site and are dealt with in separate datasets. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For bilateral tumours, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair – Raja Seethala, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Albina Altemani, Brazil
* Robert L Ferris, USA
* Isabel Fonseca, Portugal
* Douglas Gnepp, USA
* Patrick Ha, USA
* Toshitaka Nagao, Japan
* Alena Skalova, Czech Republic
* Göran Stenman, Sweden
ISBN: 978-1-925687-21-7
Article Size: 1.3 MB
 
Seethala RR, Altemani A, Ferris RL, Fonseca I, Gnepp DR, Ha P, Nagao T, Skalova A, Stenman G, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):578-586. doi: 10.5858/arpa.2018-0422-SA.
PubMed ID: 30500293
Article Size: 3.4 MB

Carcinomas of the Hypopharynx, Larynx and Trachea (TNM8)

Head & Neck, Staging
Helliwell T, Chernock R, Dahlstrom JE, Gale N, McHugh J, Perez-Ordonez B, Roland N, Zidar N, Thompson LDR.
(2018) Carcinomas of the Hypopharynx, Larynx and Trachea, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-17-0

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal malignancies of the larynx, hypopharynx and trachea. The protocol applies to all invasive carcinomas of the larynx, hypopharynx and trachea (including the supraglottis, glottis, and subglottis). Salivary-type malignancies arising from mucosal glands of the hypopharynx and larynx should be recorded in this dataset. Mucosal melanoma is presented in a separate dataset. Lymphomas and sarcomas are not included. Malignancies arising at other sites in the head and neck region, and neck dissections and nodal excisions are dealt with in separate datasets which may be used, as appropriate, in conjunction with this dataset. Where more than one anatomically or histologically distinct primary tumours occur, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair – Tim Helliwell, UK
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Rebecca Chernock, USA
* Jane Dahlstrom, Australia
* Nina Gale, Slovenia
* Jonathan McHugh, USA
* Bayardo Perez-Ordonez, Canada
* Nick Roland, UK
* Nina Zidar, Slovenia
ISBN: 978-1-925687-17-0
Article Size: 1.5 MB
 
Helliwell T, Chernock R, Dahlstrom JE, Gale N, McHugh J, Perez-Ordonez B, Roland N, Zidar N, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):432-438. doi: 10.5858/arpa.2018-0419-SA. Epub 2018 Nov 30.
PubMed ID: 30500292
Article Size: 2 MB

Carcinomas of the Nasal Cavity and Paranasal Sinuses (TNM8)

Head & Neck, Staging
Franchi A, Bishop JA, Coleman H, Flucke U, Licitra L, Llorente JL, Stelow E, Toner M, Weinreb I, Thompson LDR.
(2018) Carcinomas of the Nasal Cavity and Paranasal Sinuses, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-20-0

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal malignancies originating in the nasal cavities and paranasal sinuses. Neuroectodermal neoplasms (including melanoma) and sarcomas are not included. Bone, soft tissue and lymphoma protocols are separately listed. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For additional independent tumours, complete a separate dataset for each.

EXPERT COMMITTEE:
* Chair – Alessandro Franchi, Italy
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Justin Bishop, USA
* Hedley Coleman, Australia
* Uta Flucke, Netherlands
* Lisa Licitra, Italy
* José L Llorente, Spain
* Edward Stelow, USA
* Mary Toner, UK
* Ilan Weinreb, Canada
ISBN: 978-1-925687-20-0
Article Size: 1.3 MB
 
Franchi A, Bishop JA, Coleman H, Flucke U, Licitra LF, Pendás JLL, Stelow EB, Toner M, Weinreb I, Wenig BM, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):424-431. doi: 10.5858/arpa.2018-0404-SA. Epub 2018 Nov 30
PubMed ID: 30500298
Article Size: 2 MB

Carcinomas of the Oral Cavity (TNM8)

Head & Neck, Staging
Müller S, Boy S, Day TA, Magliocca K, Richardson MS, Sloan P, Tilakaratne WM, Zain RB, Thompson LDR.
(2018) Carcinomas of the Oral Cavity, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-19-4

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of invasive carcinomas of the oral cavity, including lip and tongue. Mucosal melanoma, lymphomas and sarcomas are not included. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – Susan Müller, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Sonja Boy, South Africa
* Terrance Day, USA
* Kelly Magliocca, USA
* Mary Richardson, USA
* Philip Sloan, UK
* WM Tilakaratne, Sri Lanka
* Rosnah B Zain, USA
ISBN: 978-1-925687-19-4
Article Size: 1.6 MB
 
Müller S, Boy S, Day TA, Magliocca K, Richardson MS, Sloan P, Tilakaratne WM, Zain RB, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):439-446. doi: 10.5858/arpa.2018-0411-SA. Epub 2018 Nov 30.
PubMed ID: 30500296
Article Size: 3.3 MB

Sinonasal renal cell-like adenocarcinomas: robust carbonic anhydrase expression

Head & Neck, Sinonasal Tract
Shen T, Shi Q, Velosa CM, Bai S, Thompson LDR, Keen C, Patel A, Simpson R, Wei S, Brandwein-Gensler M. Sinonasal Renal Cell-Like Adenocarcinomas: Robust Carbonic Anhydrase Expression and the Renal-Like Function of Schneiderian Mucosa
Hum Pathol. 2015 Nov;46(11):1598-606.
We report 3 new patients with sinonasal renal cell-like adenocarcinoma (SNRCLA). One case submitted in consultation demonstrated robust carbonic anhydrase IX (CA-IX) expression, leading us to a broader inquiry of CA-IX and carbonic anhydrase II (CA-II) expression in other SNRCLA, Schneiderian tissues, and histologic mimickers. Robust cytoplasmic and membranous CA-IX expression is demonstrated in 6 of 7 SNRCLAs; CA-II expression was demonstrated in 2 of 5 cases. Robust, diffuse CA-II expression is demonstrated throughout sinonasal seromucinous glands in all 10 normal Schneiderian samples. CA-IX is also expressed in all normal sinonasal samples, albeit focally. The closest salivary mimic to SNRCLA is hyalinizing salivary clear cell carcinoma; only focal CA-IX expression was demonstrated in 1 of 2 cases studied. Carbonic anhydrase expression in Schneiderian tissue speaks to its role in regulating the ion concentration of sinonasal secretions and may also explain the origin of this rare tumor.
PubMed ID: 26299508
Article Size: 4.7 MB
 
 
 
 

CAIX and pax-8 Commonly Immunoreactive in Endolymphatic Sac Tumors: A Clinicopathologic Study of 26 Cases with Differential Considerations for Metastatic Renal Cell Carcinoma in von Hippel-Lindau Patients.

Ear & Temporal Bone, Head & Neck
Thompson LDR, Magliocca KR, Andreasen S, Kiss K, Rooper L, Stelow E, Wenig BM, Bishop JA.
Head Neck Pathol. 2019 Sep;13(3):355-363. doi: 10.1007/s12105-018-0973-8. Epub 2018 Oct 5.
Endolymphatic sac tumors (ELSTs) are rare, slowly growing temporal bone neoplasms which show a high association with von Hippel-Lindau (VHL) syndrome. The immunohistochemistry evaluation of these papillary-cystic neoplasms frequently raises the differential diagnosis with renal cell carcinoma, among other metastatic neoplasms, whether in VHL patients or not. A cohort of 26 patients with ELSTs were evaluated for histologic features, immunohistochemistry findings, and association with VHL. Standard immunohistochemistry evaluation was performed. Sixteen females and 10 males ranging in age from 10 to 69 years (mean 44; VHL mean: 32) at initial presentation, comprised the cohort of patients. Most (86%) experienced hearing changes or inner ear symptoms (vertigo, dizziness), with an average duration of symptoms for 39 months (range 2-240 months). The tumors were an average of 2.9 cm (range 0.4-8 cm), with 14 left, 11 right sided and one bilateral tumor. Nine patients had documented VHL, with 3 patients having a concurrent or subsequent clear cell renal cell carcinoma. Patients were followed an average of 6.2 years (available in 24 patients): 19 alive without disease, 7.5 years; 2 dead without disease, 1.2 years; and 3 alive with disease, 3.1 years. The neoplastic cells show the following immunohistochemistry findings: AE1/AE3, EMA, CK7, CAIX, GLUT1, VEGF: 100% of cases tested were positive; pax-8: 85% of cases positive; CD10 and RCC: 0% of cases reactive. Based on this cohort of 26 patients with ELST, 9 of whom had VHL, the strong pax-8 and CAIX should be used in conjunction with negative CD10 and RCC to help exclude a metastatic renal cell carcinoma. As CAIX is an enzyme overexpressed in hypoxia and hypoxia inducible factor is what VHL protein regulates, this is an expected, although previously unreported finding. Whether part of VHL or not, VHL mutations may be a somatic rather than germline finding in the tumors, a possible further explanation for the CAIX reaction.
PubMed ID: 30291511
Article Size: 2 MB

Molecular Profiling of Salivary Gland Intraductal Carcinoma Revealed a Subset of Tumors Harboring NCOA4-RET and Novel TRIM27-RET Fusions: A Report of 17 cases.

Head & Neck, Salivary Gland
Skálová A, Vanecek T, Uro-Coste E, Bishop JA, Weinreb I, Thompson LDR, de Sanctis S, Schiavo-Lena M, Laco J, Badoual C, Santana Conceiçao T, Ptáková N, Baněčkova M, Miesbauerová M, Michal M.
Am J Surg Pathol. 2018 Nov;42(11):1445-1455.
Intraductal carcinoma (IC) is the new World Health Organization designation for tumors previously called “low-grade cribriform cystadenocarcinoma” and “low-grade salivary duct carcinoma.” The relationship of IC to salivary duct carcinoma is controversial, but they now are considered to be distinct entities. IC is a rare low-grade malignant salivary gland neoplasm with features similar to mammary atypical ductal hyperplasia or ductal carcinoma in situ, that shows diffuse S100 protein and mammaglobin positivity and is only partially defined genetically. (Mammary analogue) secretory carcinoma harboring ETV6-NTRK3, and in rare cases ETV6-RET fusion, shares histomorphologic and immunophenotypical features with IC. Recently, RET rearrangements and NCOA4-RET have been described in IC, suggesting a partial genetic overlap with mammary analogue secretory carcinoma. Here, we genetically characterize the largest cohort of IC to date to further explore this relationship. Seventeen cases of IC were analyzed by next-generation sequencing using the FusionPlex Solid Tumor kit (ArcherDX). Identified fusions were confirmed using fluorescence in situ hybridization break apart and, in some cases, fusion probes, and a reverse transcription polymerase chain reaction designed specifically to the detected breakpoints. All analyzed cases were known to be negative for ETV6 rearrangement by fluorescence in situ hybridization and for ETV6-NTRK3 fusion by reverse transcription polymerase chain reaction. Next-generation sequencing analysis detected a NCOA4-RET fusion transcript joining exon 7 or 8 of NCOA4 gene and exon 12 of RET gene in 6 cases of intercalated duct type IC; and a novel TRIM27-RET fusion transcript between exons 3 and 12 in 2 cases of salivary gland tumors displaying histologic and immunohistochemical features typical of apocrine IC. A total of 47% of IC harbored a fusion involving RET. In conclusion, we have confirmed the presence of NCOA4-RET as the dominant fusion in intercalated duct type IC. A novel finding in our study has been a discovery of a subset of IC patients with apocrine variant IC harboring a novel TRIM27-RET.
PubMed ID: 30045065
Article Size: <1 MB
 

Epithelial-Myoepithelial Carcinoma: Frequent Morphologic and Molecular Evidence of Preexisting Pleomorphic Adenoma, Common HRAS Mutations in PLAG1-intact and HMGA2-intact Cases, and Occasional TP53, FBXW7, and SMARCB1 Alterations in High-grade Cases.

Head & Neck, Salivary Gland
El Hallani S, Udager AM, Bell D, Fonseca I, Thompson LDR, Assaad A, Agaimy A, Luvison AM, Miller C, Seethala RR, Chiosea S.
Am J Surg Pathol. 2018 Jan;42(1):18-27.
We hypothesized that there is a relationship between the preexisting pleomorphic adenoma [PA]), histologic grade of epithelial-myoepithelial carcinomas (EMCAs), and genetic alterations. EMCAs (n=39) were analyzed for morphologic and molecular evidence of preexisting PA (PLAG1, HMGA2 status by fluorescence in situ hybridization, FISH, and FGFR1-PLAG1 fusion by next-generation sequencing, NGS). Twenty-three EMCAs were further analyzed by NGS for mutations and copy number variation in 50 cancer-related genes. On the basis of combined morphologic and molecular evidence of PA, the following subsets of EMCA emerged: (a) EMCAs with morphologic evidence of preexisting PA, but intact PLAG1 and HMGA2 (12/39, 31%), (b) Carcinomas with PLAG1 alterations (9/39, 23%), or (c) HMGA2 alterations (10/39, 26%), and (d) de novo carcinomas, without morphologic or molecular evidence of PA (8/39, 21%). Twelve high-grade EMCAs (12/39, 31%) occurred across all subsets. The median disease-free survival was 80 months (95% confidence interval, 77-84 mo). Disease-free survival and other clinicopathologic parameters did not differ by the above defined subsets. HRAS mutations were more common in EMCAs with intact PLAG1 and HMGA2 (7/9 vs. 1/14, P<0.001). Other genetic abnormalities (TP53 [n=2], FBXW7 [n=1], SMARCB1 deletion [n=1]) were seen only in high-grade EMCAs with intact PLAG1 and HMGA2. We conclude that most EMCAs arose ex PA (31/39, 80%) and the genetic profile of EMCA varies with the absence or presence of preexisting PA and its cytogenetic signature. Progression to higher grade EMCA with intact PLAG1 and HMGA2 correlates with the presence of TP53, FBXW7 mutations, or SMARCB1 deletion.
PubMed ID: 29135520
Article Size: 1.2 MB
 

Ectomesenchymal Chondromyxoid Tumor: A Neoplasm Characterized by Recurrent RREB1-MKL2 Fusions.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Dickson BC, Antonescu CR, Argyris PP, Bilodeau EA, Bullock MJ, Freedman PD, Gnepp DR, Jordan RC, Koutlas IG, Lee CH, Leong I, Merzianu M, Purgina BM, Thompson LDR, Wehrli B, Wright JM, Swanson D, Zhang L, Bishop JA.
Am J Surg Pathol. 2018 Oct;42(10):1297-1305.
Ectomesenchymal chondromyxoid tumor is a rare and benign neoplasm with a predilection for the anterior dorsal tongue. Despite morphologic heterogeneity, most cases are characterized by a proliferation of bland spindle cells with a distinctive reticular growth pattern and myxoid stroma. The immunophenotype of these neoplasms is likewise variable; most cases express glial fibrillary acid protein and S100 protein, with inconsistent reports of keratin and myoid marker expression. The molecular pathogenesis is poorly understood; however, a subset of cases has been reported to harbor EWSR1 gene rearrangement. Following identification of an RREB1-MKL2 fusion gene by RNA Sequencing in an index patient, a retrospective review of additional cases of ectomesenchymal chondromyxoid tumors was performed to better characterize the clinical, immunohistochemical, and molecular attributes of this neoplasm. A total of 21 cases were included in this series. A marked predisposition for the dorsal tongue was confirmed. Most cases conformed to prior morphologic descriptions; however, hypercellularity, hyalinized stroma, and necrosis were rare attributes not previously emphasized. The neoplastic cells frequently coexpressed glial fibrillary acid protein, S100 protein, keratin, smooth muscle actin, and/or desmin; a single case was found to contain significant myogenin expression. An RREB1-MKL2 fusion product was identified in 19 tumors (90%), a single tumor (5%) had an EWSR1-CREM fusion product, and the remaining case lacked any known fusion gene by RNA Sequencing. The latter 2 cases subtly differed morphologically from many in the cohort. This series illustrates that recurrent RREB1-MKL2 fusions occur in most, perhaps all, cases of ectomesenchymal chondromyxoid tumor.
PubMed ID: 29912715
Article Size: 1 MB
 

Salivary gland lymphoepithelial cysts.

Head & Neck, Salivary Gland
Varnholt H, Thompson L, Pantanowitz L.
Ear Nose Throat J. 2007 May;86(5):265
FIRST PARAGRAPH: Lymphoepithelial cysts are benign, slowly growing unilocular or multilocular lesions that may appear in the head and neck. Among the reported head and neck sites are the salivary glands (typically the parotid gland) and the oral cavity (usually the floor of the mouth). These cysts are usually seen in adults and only occasionally in children. They range in size from 0.5 to 5.0 cm, and they can cause considerable cosmetic deformity and physical discomfort.
PubMed ID: 17580800
Article Size: <1 MB

Salivary gland adenoid cystic carcinoma.

Head & Neck, Salivary Gland
Thompson LD.
Ear Nose Throat J. 2015 Jul;94(7):262-4.

Tumors are poorly circumscribed with an infiltrative border, including extracapsular extension beyond the salivary gland.

FIRST PARAGRAPH: Adenoid cystic carcinoma (ACC) is a malignant epithelial salivary gland tumor with myoepithelial and ductal differentiation. Salivary gland tumors account for only about 5% of all head and neck carcinomas, with ACC the fourth most common salivary gland malignancy. ACC has a 3:2 female-to-male ratio. Patients tend to be adults, with a peak clinical presentation in the sixth decade. The tumors are found most frequently in the parotid gland but are also found in the palate, tongue, lip, and other sites in the upper aerodigestive tract and the rest of the body.

PubMed ID: 26214665
Article Size: <1 MB

Ear fetal rhabdomyoma.

Ear & Temporal Bone, Head & Neck
Thompson LD.
Ear Nose Throat J. 2017 Sep;96(9):358.
FIRST PARAGRAPH: Rhabdomyomas are a group of benign tumors that show skeletal muscle differentiation. They are divided into cardiac and extracardiac types with the extracardiac type divided into adult, fetal, and genital types. The fetal type is separated into myxoid and intermediate types. There is a predominance in the head and neck of both the fetal and adult types. The fetal type is commonly seen in newborns and early childhood, with a moderate male predominance (2:1).
PubMed ID: 28931187
Article Size: <1 MB

Dentigerous cyst

Head & Neck, Oral Cavity/Gnathic (Jaw)
Thompson, LD.
Ear Nose Throat J. 2018 Mar;97(3):57.
FIRST PARAGRAPH: A dentigerous cyst is a development cyst that surrounds and envelops the crown of an unerupted tooth, attached at the crown-root (cemento-enamel or cervical) junction. Dentigerous cysts account for about 20% of all odontogenic cysts, developing during a peak age of 10 to 30 years, with a male predilection (3:2). The lesion presents in the mandible (3rd molar region) about twice as often as the maxilla (near maxillary canines).
PubMed ID: 29554396
Article Size: <1 MB