ALL WGs (743)
BREAST (47)CARD (27)
CYTO (47)DERM (48)
DIGE (45)EM (19)
GYNE (49)H&N (75)
HAEMA (48)HEPAT (15)
INFE (17)NEPH (43)
NEUR (13)OPHT (14)
PEDI (42)PULMO (38)
SO-TI (31)THY (5)
URO (49)VARIOUS (16)

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Criteria: H&N Found: 75 cases
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Case 1 - ecp25, Head and Neck Pathology
Presented by: Jelena Sopta, Serbia

78 year old female patient with pain in cervical spine during 1,5 year. Difficulties during swallowing. Laboratory analysis of the proper. Radiological solitary osteolytic lesion on the cervical vertebral body C2. Lesion has a lobular appearance with propagation in soft tissue. The slight compression of the spinal cord without neurological changes.
F 2 HE, 10xF 3 HE, 4xF 4 HE, 20xF 5 HE, 20xF 6 HE, 40xF 7 HE, 40xF 8 vimentin, 20x
F 9 CK pan , 20xF 10 brachyury, 20x
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Case 2 - ecp25, Head and Neck Pathology
Presented by: Odile Casiraghi, 94805 VILLEJUIF Cedex, France

A 57-year-old patient, native of Mauritania but living in Senegal, smoker in the past, otherwise without significant previous pathology, consulted in our Institute for therapeutic advice about an ethmoidal tumor.

He complained since six months of a left nasal obstruction with anosmia. A complete filling of the ethmoidal area and an obstructive aspect of the sphenoidal and maxillary sinuses were observed on CT scan. An endonasal surgery with a wide meatotomy and resection of the inferior and middle turbinate was performed, and biopsies were taken from the ethmoidal sinus. This surgery improved the nasal obstruction, but not the anosmia. He was seen for the first time in our Institute two months after this first surgery. On nasofibroscopic examination, a soft strawberry-like tumor was observed, extruding out of the anterior area of the ethmoidal sinus. On CT scan and MR Imaging, a 4 cm mass filling the entire ethmoidal left sinus, with bone erosion of the cribriform plate, slight extension into the anterior base of the skull, slight meningeal invasion but without cerebral invasion was observed. There were no metastases on cervical and chest CT as well on TEP scan. This tumor was classified T4a N0 M0.

The patient was treated by chemotherapy, but without significant efficacity. A large surgery was then performed, including naso-ethmoidectomy, resection of the anterior base of the skull and adjacent meninges, resection of the internal orbital wall, sphenoidectomy and bilateral meatotomy. This surgery was followed by Intensity-Modulated Radiation Therapy (IMRT). He is free of disease 2 months after the end of the radiotherapy.
Slide 1HES x2,5HES x5HES x10HES x40AE1-AE3 x5CHG x20
SYN x20PS100 x10Ki67 x5Ki67 x20
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Case 3 - ecp25, Head and Neck Pathology
Presented by: Sulen Sarioglu, Izmir, Turkey

Forty-five year old woman presented with a mass at her lower jaw, with a history of five years. She described bleeding from this region two years ago. A biopsy was performed from the inner mucosa overlying the mandible.
Slide 1X4X10X40X40
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Case 4 - ecp25, Head and Neck Pathology
Presented by: Adriana Handra-Luca, Bobigny, France

A 23-years old woman presented for a right sublingual mass, clinically diagnosed as vascular malformation. A pleomorphic adenoma was suggested on cytology. The treatment consisted in surgical resection. The tumor, measuring 4.1 cm, consisted in a spindle cell proliferation, showing several zones of palissading. Several angioma-like vessel agglomerates and macrophage thickening of intratumor vascular walls were observed. On immunohistochemistry, tumor cells expressed diffusely S100 protein, as well as CD56 and podoplanin.
Slide 1
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Case 5 - ecp25, Head and Neck Pathology
Presented by: Marina Vozmitel, Minsk, Belarus

Clinical History
A 46-year-old man presented with a painful rapidly growing tumor of the left parotid. The tumor was surgically removed by the parotid resection with postoperative adjuvant radiation therapy in summary dose 4Gr; regardless, numerous ribs, vertebral and lung metastases were detected ten months later. Metastatic disease was cured with radiation therapy (summary dose 24Gr) and chemotherapy (carboplatin and 5-FUDR, doxorubicin, cyclophosphamide and vincristine). Nevertheless metastatic lesions progressed with time; the patient had died of dissemination of carcinoma 3 years after tumor was diagnosed.

Histological and immunohistochemical Features
The neoplasm consisted of two carcinomatous components. One of them was represented by uniform neoplastic cells with slightly basophilic granular cytoplasm and cells featuring cellular vacuolization arranged in the solid and microcystic growth patterns, somewhere with lymphoid stroma. The other part of the tumor was typified by the small cells with scant cytoplasm and angulated nuclei that were devoid of any evidence of specific differentiation. Small tumor cells were arranged in the nests and sheets also into the organoid and trabecular patterns with fine vascular stroma. Mitotic figures, individual cells necrosis and comedonecrosis, as well as invasion of the residual salivary gland tissue, were well recognized.

Immunohistochemically, neoplastic cells of both parts were CK8 positive but did not express Chr, NSE, Syn, CD56, mammoglobin, S-100, p63 and p53. CK7-positivity was medium to strong in two components with weak in the areas with trabecular architecture. Strong nuclear cyclin D expression and membrane b-catenin expression was seen in small cells of undifferentiated carcinoma area, whereas it was weak or absent in the conventional acinic cell adenocarcinoma part; MIB-1 index in undifferentiated area was up to 75%.
Slide 1(H&E) - well recognizable comedo-necrosis(H&E) - trabecular growth pattern(H&E) – invasion of residual salivary gland (H&E) - mitotically active small cells(H&E) – small part of microcystic AcCC(b-catenin) - membrane b-catenin-positivity
(cyclin D) - nuclear cyclin D1 overexpression
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Case 6 - ecp25, Head and Neck Pathology
Presented by: Manju Prasad, New Haven, United States

A 53-year-old man presented with nasal obstruction, double vision (diplopia), proptosis and tearing of the right eye. Past medical history revealed frequent sinusitis and otitis media. He had sinonasal surgery for nasal obstruction 8-9 years ago when inflammatory tissue was removed. Since then he has had multiple head and neck surgeries that included septoplasty for nasal obstruction due to deviated septum, dacryocystorhinostomy for nasolacrimal duct obstruction and right tympanostomy for otitis media. On physical examination, the patient had right sided exophthalmos and nasal obstruction with widening of the nasal bridge. On CT scan, a soft tissue mass was seen in the right nasal cavity extending into the left side, the right orbit and retro-orbital tissue displacing the right eye. Patient underwent resection of the mass. An aggregate of tan-red firm tissue measuring 3 x 2.5 x 1 cm was received in Pathology. The tissue was serially sectioned to reveal a tan cut-surface.
Slide 1IgG4 positive plasma cells
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Case 7 - ecp25, Head and Neck Pathology
Presented by: Metka Volavšek, Ljubljana, Slovenia

A 54-year-old female patient was admitted to the Clinic of Neurosurgery with a one year history of mild paresthesia in her left arm and one month history of severe headache, disturbances of balance, and fatigue. CT scan showed a cystic tumor in the right parieto-occipital region. Gross total removal of the lesion was followed by irradiation. Control CT scan after RT was negative for tumor.

A year after surgery the patient noticed a lump on the right side of the neck. Despite the known history of previously treated CNS neoplasm, the exact nature of the lesion was not ascertained by repeated fine needle aspiration biopsies (FNABs). Treatment with chemo- and radiotherapy resulted in total remission. A year later, bilateral enlargement of the neck lymph nodes was noted and partial remission achieved by the same combination of drugs. Lymph nodes were excised to get the definite diagnosis (Slide 1, case 7).

A fixed inoperable lump, which reappeared on the right side of the neck after 6 months, was treated with a new combination of drugs. On last admission, the patient had multiple skeletal metastases. Additionally, metastases in retroperitoneal lymph nodes were suspected. No CNS recurrence was registered for the entire three year period after craniotomy. The patient died in a nursing home, four years after craniotomy. An autopsy was not performed.
Slide 1Lymph node metastasis, HE x10Lymph node metastasis, HE x10Lymph node metastasis, Olig2 x10Lymph node metastasis, GFAP x10Primary tumor, HE x40Primary tumor, IDH1 x20
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Case 8 - ecp25, Head and Neck Pathology
Presented by: Llucia Alós, Barcelona, Spain

A 72 year-old man complained of a painless, slowly growing tumour in the floor of the mouth. The MRI showed a multifocal tumoration involving sublingual gland, that measured from 0.8 to 5 cmts in diameter. 

The surgical excision of the lesions was performed. At gross examination all tumorations had similar appearance: were red-brown, lobulated and well circumscribed.
Slide 1
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Case 9 - ecp25, Head and Neck Pathology
Presented by: Rebecca Chernock, St Louis, United States

The patient is a 60 year old man who presented in 2009 with 'sore spots' on the right palate for two years irritated by spicy food. His clinical history was significant for tobacco chewing for 28 years, predominately on the right side. He is also status post tonsillectomy for chronic tonisillitis in 2005. Physical exam showed an extensive, well-demarcated area of erythroplakia involving predominately the right side of the oral cavity and oropharynx. Specifically, the posterior third of the right hard palate and right soft palate (extending to the left soft palate but sparing the uvula), the entire right retromolar trigone, right anterior tonsillar pilar and the resected tonsillar bed were affected. The erythroplakia also extended on to the posterior floor of mouth, lateral tongue and up onto the lingual surface of the mandible posteriorly, all on the right side. Laryngoscopy identified another area of erythroplakia in the supraglottic larynx centered on the right posterior arytenoid. Abnormal mucosa was additionally seen on the posterior oropharyngeal wall. No suspicious lymphadenopathy was identified on physical exam or on CT scan. Partial excision of the right hard and soft palate and biopsies from the right retromolar trigone, right arytenoid and posterior oropharyngeal wall were performed.
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Case 1 - ecp24, Head and Neck Pathology 1
Presented by: Michal Michal, Plzen, Czech Republic

22 years old man had a 9 mm large, round shaped lump on the left side within a minor salivary gland of the lip. Acini of the gland contained numerous signet-ring cells (Figure 1) with mucicarmine and PAS positive cytoplasm which sloughed into the acini within the basal membrane (Figure 2). No mitoses or atypias were observed in the lesion.
Slide 1Figure 1Figure 2
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