Head and Neck Pathology E-Book

A Volume in the Series: Foundations in Diagnostic Pathology

Lester D. R. Thompson, Justin A. Bishop

• Publisher: Elsevier
• Year: 2017
• Print ISBN:
  9780323479165
• eBook ISBN:
  9780323553506
• Edition: 3
• Topic: Medicina
• Subtopic: Patologia

An essential foundation text for residents and pathologists, the third edition of Head and Neck Pathology, a volume in the Foundations in Diagnostic Pathology series, has been fully revised to include recent advances in the field. Featuring a highly templated, easy-to-use format and new information throughout, this practical, affordable resource by Drs. Lester D. R. Thompson and Justin A. Bishop is ideal for study and review as well as everyday clinical practice.- Inclusion of a wide range of diagnoses in both head and neck and endocrine organ pathology.- A focus on the specific features of selected non-neoplastic and neoplastic entities, including broad and in-depth differential diagnoses.- Clinical and Pathologic Features summarized in quick-reference boxes for fast access to information.- A highly templated format that includes pertinent clinical, imaging, and management/prognostic features; pathologic features; ancillary studies; differential diagnosis; and meaningfully chosen bibliography.- Over a thousand full-color photographs illustrate important pathologic features, enabling you to form a differential diagnosis and compare your findings with actual cases.- Contributions from internationally recognized expert pathologists, keeping you up to date with the latest information in the field.- New criteria as established by the 2017 World Health Organization Classification of Head and Neck Tumours and the 2017 World Health Organization Classification of Endocrine Organ Tumours.- A new oropharynx section, separated from the oral cavity.- Inclusion of unique newly identified molecular information in many tumor entities.- Coverage of NUT carcinoma, HPV-associated adenoid cystic-like carcinoma, sinonasal renal cell-like adenocarcinoma, SMARCB1 (INI-1) deficient sinonasal carcinoma, biphenotypic sinonasal sarcoma, neuroendocrine carcinomas, oropharyngeal carcinoma, polycystic disease and sclerosing polycystic adenosis, secretory carcinoma, cribriform adenocarcinoma of the minor salivary glands, variants of myoepithelioma, clear cell carcinoma, and changes in gnathic cysts classification.- Expert Consult™ eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.

1

Non-Neoplastic Lesions of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx

Austin McCuiston, Justin A. Bishop

■ Rhinosinusitis

Rhinosinusitis is defined simply as inflammation of the nasal cavity (rhinitis), paranasal sinuses (sinusitis), or both (rhinosinusitis).

Clinical Features

Rhinosinusitis is a common condition that can be caused by myriad etiologies, including allergies (most common), infections, aspirin intolerance, exposures to toxins or medications, pregnancy, systemic diseases, among others. Rhinosinusitis can also be idiopathic, with no known cause. Regardless of etiology, patients share the symptoms of nasal obstruction and discharge.

Acute rhinosinusitis is typically infectious, either viral (e.g., rhinovirus, adenovirus, respiratory syncytial virus, among others) or bacterial (Streptococcus pneumoniae, Haemophilus influenzae, among others). Viral rhinosinusitis results in a watery nasal discharge, whereas bacterial disease results in a mucopurulent discharge, headache, and fever. Bacterial rhinosinusitis can occasionally be superimposed on viral disease.

Chronic rhinosinusitis (i.e., symptoms lasting longer than 12 weeks) is most often allergic in etiology as a result of an IgE-mediated reaction. Patients with allergic rhinosinusitis complain of a clear nasal discharge, sneezing, and itching after exposure to the offending allergen. Clinical examination reveals sinonasal mucosa that is edematous, pale, and sometimes bluish in color. Inflammatory polyps, as described later, are often seen in this setting.

By imaging, inflamed sinuses demonstrate opacification and mucosal thickening (Fig. 1.1A). Air-fluid levels are classically identified in acute disease (see Fig. 1.1B).

FIGURE 1.1 This computed tomography scan demonstrates radiographic features of both acute and chronic sinusitis. The left maxillary sinus demonstrates near complete opacification (A), and air-fluid levels are noted (arrow) in the left ethmoid sinus (B).

Pathologic Features

Gross Findings

In general, the gross findings consist of fragments of soft tissue and bone with no specific changes. Inflammatory polyps (as described later) may be encountered.

Rhinosinusitis—Disease Fact Sheet

Definition

■ Inflammation of the nasal passages, most commonly as the result of allergies or infection

Incidence

■ Common

■ Nasal cavity and paranasal sinuses, often bilateral

Morbidity and Mortality

■ Usually minimal, although rarely untreated bacterial sinusitis can extend to the orbit or meninges

Sex and Age Distribution

■ Any age, no sex predilection

Clinical Features

■ Nasal discharge, watery in allergic and viral, mucopurulent in bacterial

■ Allergic disease accompanied by itching and sneezing

Treatment and Prognosis

■ Allergic rhinosinusitis treated with antihistamines, nasal steroids, allergic desensitization

■ Bacterial rhinosinusitis requires antibiotics, while viral infection is treated supportively

■ Surgery is reserved for refractory, chronic disease

Microscopic Findings

Rhinosinusitis exhibits sinonasal mucosa with a submucosal inflammatory infiltrate. The inflammatory cells are generally composed of lymphocytes, plasma cells, macrophages, and eosinophils, which predominate in allergic disease (Fig. 1.2). Acute rhinosinusitis is characterized by increased neutrophils, especially when associated with a bacterial etiology. There is often a component of stromal edema, which leads to the development of inflammatory polyps (described in detail in the next topic). The surface epithelium may also demonstrate changes, including inflammation, squamous metaplasia (Fig. 1.3A), or reactive papillary hyperplasia (so-called papillary sinusitis) (see Fig. 1.3B).

FIGURE 1.2 Chronic sinusitis is histologically characterized by a submucosal infiltrate of chronic inflammatory cells including lymphocytes, plasma cells, and eosinophils, which tend to predominate in allergic sinusitis.

FIGURE 1.3 Some cases of chronic sinusitis can demonstrate foci of surface epithelial squamous metaplasia (A). In addition, chronic sinusitis occasionally exhibits papillary surface epithelial hyperplasia as a reactive change. When prominent, this finding can be confused with other lesions such as respiratory epithelial adenomatoid hyperplasia or sinonasal papilloma (B).

Differential Diagnosis

The diagnosis of rhinosinusitis is usually not difficult. Many of the changes overlap with sinonasal inflammatory polyps, and the distinction between the two entities is not important. In cases with squamous metaplasia and/or reactive papillary hyperplasia of the surface epithelium, sinonasal papilloma can enter the differential diagnosis. Sinonasal papillomas have squamous or squamoid epithelium that is also thickened, proliferative with endophytic and/or exophytic growth, and infiltrated by neutrophils with microabscesses. Rarely, adenocarcinoma may enter the differential diagnosis when there is a reactive proliferation of seromucinous glands.

Prognosis and Therapy

Acute viral rhinosinusitis is treated symptomatically, whereas bacterial...

Table of contents

• Cover image
• Title Page
• Table of Contents
• Other books in this series
• Copyright
• Contributors
• Foreword
• Preface
• Acknowledgments
• 1 Non-Neoplastic Lesions of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx
• 2 Benign Neoplasms of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx
• 3 Malignant Neoplasms of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx
• 4 Non-Neoplastic Lesions of the Larynx, Hypopharynx, and Trachea
• 5 Benign Neoplasms of the Larynx, Hypopharynx, and Trachea
• 6 Malignant Neoplasms of the Larynx, Hypopharynx, and Trachea
• 7 Non-Neoplastic Lesions of the Oral Cavity
• 8 Benign Neoplasms of the Oral Cavity
• 9 Malignant Neoplasms of the Oral Cavity
• 10 Malignant Neoplasms of the Oropharynx
• 11 Non-Neoplastic Lesions of the Salivary Glands
• 12 Benign Neoplasms of the Salivary Glands
• 13 Malignant Neoplasms of the Salivary Glands
• 14 Non-Neoplastic Lesions of the Gnathic Bones
• 15 Benign Neoplasms of the Gnathic Bones
• 16 Malignant Neoplasms of the Gnathic Bones
• 17 Non-Neoplastic Lesions of the Ear and Temporal Bone
• 18 Benign Neoplasms of the Ear and Temporal Bone
• 19 Malignant Neoplasms of the Ear and Temporal Bone
• 20 Non-Neoplastic Lesions of the Neck (Soft Tissue, Bone, and Lymph Node)
• 21 Benign Neoplasms of the Neck (Soft Tissue, Bone, and Lymph Node)
• 22 Malignant Neoplasms of the Neck (Soft Tissue and Lymph Node)
• 23 Non-Neoplastic Lesions of the Thyroid Gland
• 24 Benign Neoplasms of the Thyroid Gland
• 25 Malignant Neoplasms of the Thyroid Gland
• 26 Non-Neoplastic Lesions of the Parathyroid Glands
• 27 Benign Neoplasms of the Parathyroid Gland
• 28 Malignant Neoplasms of the Parathyroid Gland
• 29 Diseases of the Paraganglia System
• Index