The authors, editors and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of the book's production. However, the authors, editors and publisher are not responsible for errors or omissions or for any consequences arising from the application of the information in this book and make no warranties, express or implied, as to the contents of the publication. Added to the need for accurate histopathological diagnoses is the burden to provide our clinical colleagues with information that will allow them to assess disease prognosis and predict response to therapy.
As a result, diagnoses need to be more detailed and specific and the number of data elements required to generate a surgical pathology report has increased exponentially, making management of the information required for diagnosis cumbersome and sometimes difficult. For the most part, such texts provide in-depth and detailed coverage of the various areas of surgical pathology. The aim of this series is to bridge the gap between the major subspecialty texts and the large, double-volume textbooks of general surgical pathology, by providing compact, one-volume monographs that concisely cover the salient and important points needed for the diagnosis of the most common conditions.
Any errors of omission or commission are those of the author, for which I apologize in advance. Squamous metaplasia replaces a large portion of the normal glandular acini while preserving the glandular contour (Figure 1-1).
Necrotizing Sialometaplasia
Numerous foamy macrophages (muciphages) and variable numbers of lymphocytes, eosinophils, and plasma cells and occasional surrounding granulation tissue (Figure 1-2).
Irritation fibroma
Solid sheet of large acidophilic cells contains foci of cytoplasmic vacuolization
Numerous randomly arranged, ectatic branching vessels vary from those with a single layer of endothelium without a muscular layer in small capillaries to larger vessels with pad-like or partially circumferential smooth muscle coats; no elastic lamina (figure 1-6). Smooth muscle actin stain shows a complete absence of a smooth muscle wall surrounding many of these vessels.
Nasopharyngeal Angiofibroma
Some patients complain of a burning sensation or pain depending on the extent of the lesion, but most are asymptomatic.
Epithelial Precancerous Lesions
Squamous Cell Carcinoma, Conventional Type
Numerous keratinized nests of malignant squamous cells display a “drop-off”
Nasopharyngeal Carcinoma, Nonkeratinizing undifferentiated
Alveolar Soft Part Sarcoma
Plasmablastic Lymphoma
Numerous extravasated red blood cells are mixed with malignant spindle and polygonal cells; in the center of the field is a cluster of hyaline globules.
Kaposi Sarcoma
Chronic Nonspecific Sinusitis
Sinonasal Polyps
The combination of laminated layers of mucin with large numbers of eosinophils with or without Charcot-leyden crystals and cytoplasmic debris constitutes "allergic mucin".
Allergic fungal Sinusitis (AfS)
Schneiderian Papilloma
Lobular Capillary Hemangioma [Pyogenic granuloma]
The cells have soft, smooth-shaped elongated or rounded nuclei and a small amount of cytoplasm with indistinct borders.
Solitary fibrous Tumor
Widely patent anastomosing vessels create a “hemangiopericytomatous” vascular pattern
Sinonasal Adenocarcinoma (SNA), Intestinal Type
Olfactory Neuroblastoma (ONB)
Sinonasal undifferentiated Carcinoma [SNuC]
Extranodal NK/T-cell Lymphoma, Nasal Type
Cells near the center of these loose alveolar nests may show evidence of rhabdomyomatic differentiation with small amounts of eosinophilic cytoplasm; cytoplasmic transverse striations rare (figure 2-15).
Polypoid nodules of ulcerated granulation tissue that occur on one or both true vocal cords due to various lesions of the mucosa, including trauma after intubation, vocal abuse and gastroesophageal reflux. The ulcerated mucosa with a fibrinopurulent superficial layer overlies small capillaries oriented perpendicular to the mucosal surface and a dense inflammatory infiltrate and proliferating fibroblasts (Figure 3-1).
Vocal cord polyp/Nodules
Laryngeal cysts
Hyperplastic alterations of the mucosa
It can involve both true and false vocal cords, with possible extension to the subglottis and tracheobronchial tree.
Patterns include cribriform, solid, trabecular, and lobular forms populated by a relatively monotonous population of closely packed smaller cells with minimal cytoplasm, hyperchromatic nuclei—many with indistinct nucleoli, and numerous mitoses (figures 3-7). Conventional squamous cell carcinoma is a minor feature; may consist only of dysplasia of the surface epithelium or focal keratinization of individual cells.
Basaloid squamous cell carcinoma
Verrucous carcinoma
A predominantly biphasic neoplasm with foci of carcinoma closely associated with malignant spindle cell proliferation showing a variety of patterns, including storiform, fascicular, and herringbone; up to one-third of cases are monophasic spindle cell neoplasms. Positive iHC: vimentin, p63 (50%), pan-cytokeratin, eMa; negative staining for cytokeratin and other epithelial markers in up to one-third of cases.
Heterologous osteosarcomatous differentiation is present
High-grade chemosensitive carcinoma consisting of 'small' cells with minimal visible cytoplasm, high mitotic count, necrosis and immunohistochemical evidence of neuroendocrine differentiation.
High-grade chondrosarcoma: a conspicuous hypercellular neoplasm with single cells showing moderately marked pleomorphism in a myxoid rather than chondroid matrix, increased mitoses, and necrosis.
Laryngeal chondrosarcoma
Sialolithiasis
Wide age range (including children) peaking in decades 4 to 7; more likely to occur in women.
Cystic spaces may be empty but typically contain amorphous cellular debris, cholesterol crystals, foamy histiocytes, or calcifications.
Warthin tumor
Basal cell adenoma
Sites: A painless mass that appears on the soft or hard palate, followed by the buccal mucosa; rarely in large salivary glands.
Cuboidal luminal cells have isomorphic rounded nuclei; myoepithelial cells larger with coarse chromatin or small nucleoli.
Salivary Duct carcinoma
Fibrous Dysplasia, craniofacial
Juvenile type: woven bone trabeculae surrounded by enlarged osteoblasts, highly cellular fibroblastic stroma with mitoses; psammomatous ossicles of bone with variable stroma.
Follicular type: islands of uniformly neutral epithelial cells in a mature fibrous, focally hyalinized stroma surrounded by a stiff perpendicular palisade of hyperchromatic columnar cells; the latter exhibits 'reverse polarization', that is, the nuclei are located in the apical half of the cell, oriented away from the basement membrane (Figure 5-4).
Keratocystic odontogenic tumor (odontogenic Keratocyst)
Keloid
The cells have a moderate amount of granular eosinophilic cytoplasm with diffuse anisonucleosis characterized by nucleomegaly, pleomorphism, and hyperchromasia (figure 6-6).
Jugulotympanic paraganglioma
Vestibular schwannoma (acoustic Neuroma)
Endolymphatic sac papillary tumor (Heffner tumor)
Branchial cleft cyst
Well-demarcated nodule composed of uniform spindle cells in a focal storiform or tissue culture-like pattern with a stroma that varies from extremely myxoid to predominantly fibrous; spindle cells have oval-elliptical open nuclei with small nucleoli (Figure 7-2).
Nodular fasciitis
Teratoma
Benign lipomatous neoplasm characterized by the presence of a mixture of mature adipose tissue, soft spindle cells, multinucleated giant cells and variable amounts of collagen.
