Head and Neck Cancer: Hallmarks of the Inflammation Ecosystem

Norhafiza Mat Lazim

• Publisher: Bentham Science Publishers
• Year: 2021
• Print ISBN: 9789811803239
• eBook ISBN: 9789811803246
• Topic: Medicine
• Subtopic: Oncology

This reference comprehensively covers the clinical aspects of head and neck neoplasms while also highlighting the relationship that exists between inflammation and these cancers. This relationship is critical as it dictates the risks, assessment, treatment, and prognosis of head and neck cancer patients. The book starts with an introduction to the inflammation ecosystem in head and neck malignancy, followed by detailed discussions on the types of head and neck cancers and their histological classification. The book then provides information about specialized topics relevant to the specialty of head and neck oncology. Key Features: - Comprehensive coverage of head and neck cancers with topic-based chapters - Introductory text explaining the basics of inflammation
- Detailed information on the relationship between inflammation and head and neck neoplasms
- Information about classification of head and neck cancers
- Methods for diagnosis and treatment
- Special topics such as complications caused by HPV infections, chemoradiation, immune-targeted therapy and inflammatory biomarkers
- References for further reading The combination of basic and advanced topics makes this book an informative reference for medical students and professionals at all levels. Residents specializing in otolaryngology, oncology, and surgery as well as researchers studying inflammation will also gain an understanding of the subject in relation to oncogenesis.

Histological Classification of Head and Neck Tumors

Sharifah Emilia Tuan Sharif¹, Anani Aila Mat Zin^{1, *}

¹ Department of Pathology, School of Medical Science, Universiti Sains Malaysia, Health Campus 16150, Kubang Kerian, Kelantan, Malaysia

Abstract

Head and neck constituency tumor display many types of cell depending on the lineages, which can develop in a variety of tumor types. Nodaway, all these types and variants of tumor have been recognized based on histomorphological features and their molecular behavior. The most updated and receptive classification is provided by the World Health Organization (WHO) and the American Joint Committee on Cancer (AJCC). In the chapter, the discussion will include the common neoplasm, which can occur in oropharynx, nasopharynx, sinonasal region, salivary gland, thyroid gland and other adjacent structures. A brief overview, clinical presentation, histomorphology, genetic profile and outcome/prognosis will be highlighted.

Keywords: Genetic profiling, Head and neck tumor, Miscellaneous tumor, Molecular, Morphology, Predictive factor, Prognostic, Salivary gland tumor, Tumor with and without squamous differentiation, WHO and AJCC classification.

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^* Corresponding author Anani Aila Mat Zin: Department of Pathology, School of Medical Science, Universiti Sains Malaysia, Health Campus 16150, Kubang Kerian, Kelantan, Malaysia; Tel: [phone]; E-mail: [email protected]

INTRODUCTION

The head and neck areas have numerous specialized tissues giving rise to many types of malignancies. There are a few types and subtypes of lesions that will be described according to their histomorphology and molecular profiles, especially salivary gland, sinonasal tract, and oropharynx. Nasopharyngeal carcinoma had undergone a few classification changes. But, the most accepted classifications are from the World Health Organization (WHO). The same goes for the former in which the evolved classifications had been recognized by the WHO and American Joint Committee on Cancer (AJCC).

In this chapter, we focus on the most recent developments in the head and neck cancer classification. We will discuss the clinical features, pathological features, ancillary studies, prognostic and therapeutic considerations for each entity. These

cancers are further categorized by their histomorphological differentiation and the location of the head or neck in which they arise. These categories are described below, including the miscellaneous one.

HISTOPATHOLOGICAL CLASSIFICATION OF TUMOUR

Here, we discussed the histopathological classification based on histological features or differentiation (Fig. 1).

Fig. (1))
Classification of head and neck tumor.

1. Epithelial tumor with squamous differentiation.
2. Epithelial tumor without squamous differentiation.
3. Salivary gland tumors.
4. Miscellaneous – neuroendocrine carcinoma, hematolymphoid tumor, soft tissue and bone tumor, paraganglion tumors, thyroid neoplasm, etc.

EPITHELIAL TUMOUR WITH SQUAMOUS DIFFERENTIATION

Head and neck squamous cell carcinoma (HNSCC) and its variants are the most common types, usually developed in males of older age group. It develops from the lining of mucosa of the upper aerodigestive tract and is classified by its location; oral cavity/tongue, oropharynx, nasal cavity, and paranasal sinuses, nasopharynx, larynx or hypopharynx. Nasopharyngeal carcinoma (NPC) and other rarer tumor, such as NUT carcinoma, will also be discussed under this histopathological type.

Grossly, the tumor exhibits infiltrative exophytic or endophytic growth pattern with tan to white cut surface. The tumor can show variable degrees of ulceration, necrosis, and hemorrhage [1]. There are a few variants of HNSCC that depend on microscopic features and their associated etiologies will be discussed.

Keratinising Squamous Cell Carcinoma (KSCC)

It is the most common variant of HNSCC, which is most often described in head and neck malignancy.

Clinical Features

The presenting features vary depending on their location. Usually, they presented with non-specific symptoms, which include nasal obstruction and discharge, epistaxis, facial pain, a nasal mass, ulcer, or even eye-related symptoms [2].

Morphology

It is characterized by malignant squamous epithelial cell proliferation with evidence of keratinization and invasive growth pattern. Keratin pearl formation is common. Invasion into the stromal tissue is often accompanied by a desmoplastic changes, accompanied by chronic inflammatory cells (Fig. 2). In general, it is graded into well-, moderately-, and poorly differentiated. Well-differentiated SCC exhibits mild nuclear atypia with keratin pearls, whereas poorly differentiated SCC display highly pleomorphic and hyperchromatic cells, with numerous typical and atypical mitoses, minimal keratinization, and sometimes necrosis. In this case, the presence of intercellular bridges is an important diagnostic clue for squamous differentiation or origin. Most SCCs are moderately-differentiated, which exhibit features in between well-differentiated and poorly differentiated carcinoma. HNSCCs express most epithelial markers such as cytokeratin. However, in well-differentiated SCC, diagnosis can be made by H&E without additional stains. In poorly differentiated tumors, immunohistochemistry may play a role. HNSCCs are immunopositive for pan cytokeratin. CK5/CK6, p63 and p40 are excellent markers for squamous differentiation [3, 4].

Fig. (2))
Keratinizing squamous cell carcinoma (KSCC). Left (H&E 100X): Infiltrating tumours are seen arranged in large irregular sheets surrounded by desmoplastic stroma. Right (H&E 400X): The intercellular bridges (arrow) is present.

Non-keratinizing Squamous Cell Carcinoma (NKSCC)

SCC exhibited a distinctive ribbon-like growth pattern with minimal maturation. It accounts for about 10 to 27% of sinonasal SCC; the maxillary sinus and nasal cavity are the most frequently involv...

Table of contents

• Welcome
• Table of Content
• Title
• BENTHAM SCIENCE PUBLISHERS LTD.
• FOREWORD
• PREFACE
• List of Contributors
• Introduction to Inflammation Ecosystem in Head and Neck Cancer
• Types of Head and Neck Malignancy
• Histological Classification of Head and Neck Tumors
• Inflammation, Risk Factors and Etiopathogenesis of Head and Neck Cancer
• The Diagnostic Tools for Head and Neck Cancer
• The Emergence of New Inflammatory Markers of Head and Neck Cancer and their Potentials
• Inflammation and Current HPV Status in Head and Neck Malignancy
• Treatment of Head and Neck Cancer and Relation to Inflammation
• Behind the Screen: The Emergence of New Evidence
• Targeting Inflammation: Window for Therapeutic Strategy in Head and Neck Malignancy