Upper Airway tract

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Figure 4.1 Clinical Appearance of White Sponge Nevus. (Courtesy of Dr. James Sciubba, Long Island Jewish Medical Center, Long Island, New York.)

Figure 4.2 White Sponge Nevus. There is a marked pallor of the cytoplasm due to intracellular edema

Figure 4.3 Low-power (A) and high-power (B) views of juxtaoral organ of Chievitz. (From Tschen JA,

Fechner RE. The juxtaoral organ of Chievitz. Am J Surg Pathol. 1979;3:147-150.)

Figure 4.4 Clinical Appearance of Geographic Tongue. (Courtesy of Dr. James Sciubba, Long Island Jewish Medical Center, Long Island, New York.)

Figure 4.5 Lip Biopsy in a Patient With Melkersson-Rosenthal Syndrome. Numerous non-necrotizing granulomas are seen beneath a normal epithelium

Figure 4.6 Tongue Ulceration With Eosinophilia. A mixed inflammatory infiltrate rich in eosinophils is present

Figure 4.7 Extravasation Mucocele. The lining of the mucus-filled cyst is made up of histiocytes rather than epithelial cells

Figure 4.8 Necrotizing sialometaplasia. The retained lobular configuration is an important diagnostic clue

Figure 4.9 Amalgam Tattoo. The pigment is seen surrounding vessels and nerves as well as adhering to the connective stroma fibers

Figure 4.10 Keratosis Without Dysplasia

Figure 4.11 Mild Dysplasia

Figure 4.12 Moderate Dysplasia

Figure 4.13 Severe Dysplasia

Figure 4.14 Lichenoid Dysplasia. There is a bandlike lymphocytic infiltrate beneath the squamous epithelium, with some infiltration of lymphocytes in the lower third. This lesion is commonly underdiagnosed

Figure 4.15 Squamous Papilloma of the Oral Cavity

Figure 4.16 Infiltrative lobules composed of poorly differentiated basaloid cells with focal keratinization (so-called non-keratinizing squamous cell carcinoma) are typical of HPV-related oropharyngeal squamous cell carcinomas

Figure 4.17 A p16 immunohistochemical stain is strongly positive in the entire tumor including both nuclear and cytoplasmic staining. This pattern of staining, in conjunction with the morphology, supports that this is a high-risk HPV-related carcinoma

Figure 4.18 Hairy Leukoplakia. There is prominent ballooning of the squamous cells in the upper half of the epithelium, associated with mild inflammation in the underlying stroma

Figure 4.19 Scattergram indicating site of origin of over 200 asymptomatic early squamous cell carcinomas. Note concentration of lesions around papilla at exit of Wharton duct, ventrolateral aspect of tongue, lingual aspect of retromolar trigone, anterior pillar, and soft palate. (Adapted from Mashberg A, Meyers H. Anatomic site and size of 222 early asymptomatic oral squamous cell carcinomas. A continuing prospective study of oral cancer. II. Cancer. 1976;37:2149-2157.)

Figure 4.20 Gross Appearance of Verrucous Carcinoma With Extensive Involvement of the Tongue

Figure 4.21 Verrucous Carcinoma of Tongue. Extremely well-differ- entiated squamous rete pegs push into the underlying stroma

Figure 4.22 Basaloid Squamous Cell Carcinoma. Note the lobular configuration, pseudoglandular spaces, and the deposition of basement membrane material

Figure 4.23 Spindle Cell (Sarcomatoid) Carcinoma. The island in the bottom left is clearly identifiable as squamous cell carcinoma, whereas the remaining component has a pleomorphic sarcoma-like appearance

Figure 4.24 Canalicular Adenoma. This type of benign salivary gland tumor is particularly common in the lip

Figure 4.25 Myoepithelioma exclusively composed of so-called hyaline or plasmacytoid cells

Figure 4.26 Clear Cell Carcinoma of Minor Salivary Glands. These typically arise in intraoral minor salivary gland and are composed of irregular islands composed of large clear cells associated with a hyalinized to spindled stroma

Figure 4.27 Polymorphous Low-Grade Adenocarcinoma. At low power, multiple architectural patterns can be seen including solid, tubular and papillary in this example

Figure 4.28 Polymorphous Low-Grade Adenocarcinoma. The cells are monotonous with oval nuclei containing pale chromatin, somewhat resembling the nuclei seen in papillary thyroid carcinoma

Figure 4.29 Peripheral Ameloblastoma. This tumor connected with the lining epithelium of the gingival mucosa and did not involve the jawbones but is otherwise identical to intraosseous ameloblastomas

Figure 4.30 Spitz nevus of tongue accompanied by intense pseudo- epitheliomatous hyperplasia of the overlying squamous epithelium

Figure 4.31 Peripheral giant cell granuloma beneath a slightly hyperplastic squamous epithelium

Figure 4.32 Granular Cell Tumor. The lesion shows an infiltrative pattern with growth along muscle fibers. The cells are large and polygonal with abundant granular eosinophilic cytoplasm

Figure 4.33 Clinical Appearance of Congenital Granular Cell Epulis. (Courtesy of Dr. R.A. Cooke, Brisbane, Australia; From Cooke RA, Stewart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.)

Figure 4.34 Verruciform Xanthoma. Clusters of foamy macrophages are seen expanding the stroma beneath a hyperkeratotic epithelium

Figure 4.35 Pyogenic Granuloma. Numerous neoformed vessels are separated from each other by an inflamed and edematous stroma. The overlying mucosa is partially ulcerated

Figure 4.36 Intravascular Papillary Endothelial Hyperplasia. Remnants of the original thrombus can be seen in the more superficial portion of the nodule

Figure 4.37 Intravascular Papillary Endothelial Hyperplasia. Papillary projections lined by endothelial cells are seen within the vascular lumen

Figure 4.38 Epithelioid Hemangioma of Soft Tissues of Oral Cavity. This lesion tends to be overdiagnosed as a malignant vascular neoplasm and sometimes is confused with carcinoma

Figure 4.39 Kaposi Sarcoma of Oral Cavity. Atypical spindle cells form slit-like vascular channels containing red blood cells

Figure 4.40 Adult Rhabdomyoma of Oral Cavity. Large eosinophilic cells contain cytoplasmic vacuoles, some of which resemble "spider cells." Cross striations can be seen focally in many cases

Figure 4.41 Clinical appearance of embryonal rhabdomyosarcoma of oral cavity in an infant

Figure 4.42 Low-Power Appearance of Embryonal Rhabdomyosar- coma of Oral Cavity. A prominent cambium layer is present

Figure 4.43 Ectomesenchymal Chondromyxoid Tumor of Tongue. (Slide courtesy of Dr. D. Heffner, Washington, DC.)

Figure 4.44 Synovial Sarcoma of Pharynx. Note the hemangioperi- cytoma-like areas and the foci of calcification/ossification

 Figure 4.45 Clinical appearance of primary fibrosarcoma of the oral cavity, presenting as a sessile polypoid mass in the gingiva

Figure 4.46 Allergic nasal polyp showing a large number of eosinophils and associated chronic inflammation

Figure 4.47 Bizarre stromal cells in a nasal polyp, set against an edematous and inflammatory background

Figure 4.48 Allergic mucin with aggregates of eosinophils and sloughed epithelial cells. Within the acellular mucin, numerous Charcot-Leyden crystals are seen

Figure 4.49 Rhinosporidiosis. Large globular cysts are present surrounded by a heavy inflammatory reaction

Figure 4.50 Rhinoscleroma. The infiltrate is mainly of histiocytic character, some of the cells having foamy features. The main differential diagnosis is with nasal involvement by Rosai-Dorfman disease

Figure 4.51 Myospherulosis of paranasal sinus following an operation in the region for fibromatosis. A "bag" containing round structures is seen floating in a tissue cavity surrounded by fibrous tissue

Figure 4.52 Sinonasal Papilloma With Inverted Pattern of Growth

Figure 4.53 Stratified Lining by Cylindrical Cells in Sinonasal Papilloma. Note the transmigration of neutrophils and neutrophilic microabscesses

Figure 4.54 Sinonasal Papilloma Lined by Oncocytic Epithelium. Note the transmigration of neutrophils and neutrophilic microabscesses

Figure 4.55 Sinonasal Papilloma With Exophytic (Fungiform) Pattern of Growth

Figure 4.56 Low- (A) and high- (B) power views of sinonasal keratinizing squamous cell carcinoma

Figure 4.57 Nonkeratinizing squamous cellinonasal carcinoma of "transitional" type

Figure 4.58 Low-grade nonintestinal type sinonasal adenocarcinoma with complex arborizing tubular and papillary pattern and extremely well-differentiated cytologic appearance.

Figure 4.59 Nonintestinal Type Adenocarcinoma of the Nasal Cavity. The tumor is well differentiated and has a distinctly papillary configuration

Figure 4.60 Well-Differentiated Intestinal-Type Sinonasal Adeno- carcinoma (ITAC). The lesion resembles a villous adenoma of the colon. Note the bone invasion at the bottom

Figure 4.61 Moderately differentiated ITAC resembled conventional colorectal adenocarcinoma with "dirty" necrosis

Figure 4.62 Mucinous ITAC typically consist of pools of mucin with malignant cells either within the mucin or lining the mucous pools

Figure 4.63 Demonstration by in situ hybridization of EBER in nasopharyngeal undifferentiated carcinoma

Figure 4.64 Nasopharyngeal carcinoma of keratinizing squamous cell type

Figure 4.65 Differentiated nonkeratinizing nasopharyngeal carcinoma

Figure 4.66 Undifferentiated nonkeratinizing nasopharyngeal carcinoma with areas of necrosis

Figure 4.67 Undifferentiated nasopharyngeal carcinoma composed of tumor cells arranged in compact nests (so-called Regaud-type growth pattern)

Figure 4.68 Undifferentiated nasopharyngeal carcinoma composed of single carcinoma cells growing in the lymphoid stroma of the nasopha- ryngeal tonsil (so-called Schmincke-type growth pattern). This growth pattern of nasopharyngeal carcinoma imparts a lymphoma-like appearance

Figure 4.69 Undifferentiated nasopharyngeal carcinoma composed of oval and spindle tumor cells

Figure 4.70 A and B, Patterns of nasopharyngeal undifferentiated carcinoma metastatic to cervical lymph node: A, associated with granuloma formation; B, associated with xanthogranulomatous reaction

Figure 4.71 A and B, Cystic metastasis of nasopharyngeal undifferentiated carcinoma to cervical lymph node simulating the pattern of growth of branchial cleft cyst

Figure 4.72 Salivary Gland Anlage Tumor. A, The solid, multinodular growth with a focal cyst is the characteristic appearance of this polypoid growth. B, A solid focus is composed of stromal cells with interspersed small duct-like structures. Solid or duct-like structures adjacent to the nodules are typically present in the loose fibrous stroma between the solid nodules

Figure 4.73 Glial Heterotopia in Nasal Cavity

Figure 4.74 Olfactory Neuroblastoma. Both A and B show a lobular pattern of growth. The tumor depicted in C shows typical neurofibrillary background

Figure 4.75 Olfactory neuroblastoma associated with a striking lobular proliferation of blood vessels. This proliferation is a feature often seen in neuroepithelial and neuroendocrine neoplasms and may be mistaken for a vascular neoplasm. Note the small foci of residual olfactory neuroblastoma

Figure 4.76 Some high-grade olfactory neuroblastomas resemble small cell carcinoma of the nasal cavity. The lesion is extremely cellular and monotonous, with no obvious evidence of neural differentiation

 Figure 4.77 Olfactory Neuroblastoma. A, Chromogranin; B, neurofilament; C, synaptophysin; and D, S-100 protein

Figure 4.78 Malignant Melanoma of Nasal Cavity. The diffuse pattern of growth and lack of pigmentation often result in misdiagnoses

Figure 4.79 Extranodal NK/T-cell lymphoma demonstrating necrosis (left) and vessel involvement (upper center) with focal pseudoepithelio- matous hyperplasia (bottom left)

Figure 4.80 Most extranodal NK/T-cell lymphomas are composed of a heterogeneous proliferation of atypical lymphocytes

Figure 4.81 Immunohistochemical demonstration of NK marker expression such as TIA-1 help to confirm the diagnosis

Figure 4.82 The atypical lymphocytes are positive for EBER confirming the presence of Epstein-Barr virus. Note the EBER positive cells in the vessel on the left

Figure 4.83 A, A young female with a clinical diagnosis of lethal midline granuloma. B, Same patient a few years later. There was no evidence of systemic disease at the time. This unfortunate individual died a few weeks after this second photograph was taken

Figure 4.84 Nasopharyngeal Angiofibroma. The cut surface shows the characteristic spongy appearance and well-circumscribed outline

Figure 4.85 Nasopharyngeal Angiofibroma. The dense fibrous quality of the stroma and the numerous thin-walled vessels are characteristic of this entity

Figure 4.86 Respiratory Epithelial Adenomatoid Hamartoma. While these resemble inverted papillomas, the epithelial lining consists of normal surface respiratory mucosa with thickened basement membranes

Figure 4.87 Lobular Capillary Hemangioma of Nasal Cavity. Numerous capillary lobules are seen. This lesion should not be confused with nasopharyngeal angiofibroma

Figure 4.88 Glomangiopericytoma (Hemangiopericytoma-Like Tumor) of Nasal Cavity. Predominantly oval tumor cells arrange themselves around blood vessels forming small fascicles

Figure 4.89 Perivascular hyalinization is frequently seen

glomangiopericytomas

Figure 4.90 So-Called Masson Hemangioma (Papillary Endothelial Hyperplasia). The intraluminal papillary fronds have a fibrin core and are covered by endothelial cells

Figure 4.91 Solitary Fibrous Tumor of Paranasal sinus. The tumor is highly vascularized and shows an alternation of hypercellular and hypocellular foci

Figure 4.92 Solitary Fibrous Tumor of the Nasal Cavity. Bland spindle cells associated with ropey collagen bundles arranged in short fascicles are typical

Figure 4.93 Embryonal Rhabdomyosarcoma of Nasopharynx. The lesion is extremely cellular and mitotically active

Figure 4.94 Teratocarcinosarcoma of Sinonasal Region. This composite photomicrograph shows three different components: A, adenocarcinomatous with neural-type rosette formations; B, myosarcomatous areas; and C, cartilaginous foci. (Courtesy of Dr. Dennis K. Heffner, Washington, DC.)

Figure 4.95 Ewing Sarcoma/PNET of Sinonasal Region. This tumor type is distinct from olfactory neuroblastoma

Figure 4.96 So-Called Teflonoma of Larynx. A foreign body giant cell reaction is seen around Teflon fragments. These are polarizable using polarized light microscopy

Figure 4.97 Vocal Nodule. The lesion shown in A has a fibromyxoid quality, whereas that depicted in B has fibrinoid features

Figure 4.98 Contact Ulcer of Larynx. A polypoid mass is seen resulting from a heavily inflamed stroma covered by a partially ulcerated epithelium

Figure 4.99 Extensive Papillomatosis in an 18-Year-Old Boy. The patient had had almost 50 resections of this process, beginning at 7 years of age, and finally died of suffocation

Figure 4.100 Squamous papilloma of larynx with a typical arborizing papillary appearance

Figure 4.101 Squamous papillomas show an orderly pattern of maturation with koilocytes near the surface

Figure 4.102 Mild Dysplasia of Larynx. There is mild nuclear atypia with retained maturation and stratification of upper layers. (From Shan- mugaratnam K, Sobin H. Histological Typing of Tumours of the Upper Respiratory Tract and Ear. 2nd ed. New York, NY: Springer; 1991.)

Figure 4.103 Moderate Dysplasia of Larynx. There is moderate nuclear atypia with prominent nuclei, but the stratification of the upper layers is retained. (From Shanmugaratnam K, Sobin H. Histological Typing of Tumours of the Upper Respiratory Tract and Ear. 2nd ed. New York, NY: Springer; 1991.)

Figure 4.104 Severe Dysplasia of Larynx. There is severe nuclear atypia and increased mitotic activity, associated with some maturation and stratification of the most superficial layers. (From Shanmugaratnam K, Sobin H. Histological Typing of Tumours of the Upper Respiratory Tract and Ear. 2nd ed. New York, NY: Springer; 1991.)

Figure 4.105 Squamous Cell Carcinoma in situ of Larynx

Figure 4.106 Supraglottic carcinoma of the larynx replacing most of the epiglottis

Figure 4.107 Subglottic carcinoma appearing as multiple polypoid masses

Figure 4.108 Gross appearance of transglottic carcinoma

Figure 4.109 Superficial carcinoma of true vocal cord (glottic carcinoma), as seen in a sagittal section. This lesion is equally curable by resection or radiation therapy

Figure 4.110 True Subglottic Squamous Cell Carcinoma in a 42-Year- Old Man. Hemilaryngectomy was performed. All margins were free. This was the third infraglottic carcinoma out of 600 consecutive laryngectomies

Figure 4.111 Verrucous carcinoma of larynx with obliteration of right vocal cord and extension into subglottis. (From Kraus FT, Perez-Mesa C. Verrucous carcinoma. Clinical and pathologic study of 105 cases involving oral cavity, larynx, and genitalia. Cancer. 1966;19:26-28.)

Figure 4.112 Verrucous Carcinoma. Well-differentiated tongues of squamous epithelium impinge on the underlying stroma

Figure 4.113 Basaloid Squamous Cell Carcinoma of Larynx. The basophilic staining quality and the high-grade nature of the tumor are evident with central comedonecrosis

Figure 4.114 Whole mount of laryngeal sarcomatoid squamous cell carcinoma, showing typical polypoid shape

Figure 4.115 Sarcomatoid carcinoma of larynx with conventional squamous cell carcinoma at the bottom left

Figure 4.116 Carcinoid tumor of the larynx showing marked cytoplasmic clear change

Figure 4.117 Atypical Carcinoid Tumor (Moderately Differentiated Neuroendocrine Carcinoma) of Larynx. A, Low-power view; B, high- power view; and C, chromogranin stain

Figure 4.118 Well-Differentiated Angiosarcoma of Epiglottis. The tumor has a distinctly polypoid appearance and is partially ulcerated. (Courtesy of Dr. J. Costa, Lausanne, Switzerland.)

Figure 4.119 Gross appearance of well-differentiated chondrosarcoma of larynx arising in the posterior cricoid cartilage

Figure 4.120 Low-Power Microscopic View of Chondrosarcoma of Larynx. Most of these tumors are very well differentiated

Figure 4.121 Extensive Papillomatosis of Trachea and Bronchi

Figure 4.122 Squamous Cell Carcinoma of Trachea Growing as a Polypoid Mass. The tumor was treated by segmental resection

Figure 4.123 Adenoid cystic carcinoma of trachea growing beneath normal epithelium and showing typical cribriform pattern of growth

Figure 4.124 Glomus Tumor of Trachea. The microscopic appearance is identical to that of the homonymous tumor of the skin