The pathology of head and neck tumors: Squamous and mucous-gland carcinomas of the nasal cavity,paranasal sinuses,and larynx,part 6

Carcinomas of the nasal cavity and paranasal sinuses are statistically dominated by squamous-cell lesions, which account for between 85% and 90% of the epithelial malignancies in these sites. Neoplasms of glandular derivation are far less frequent, accounting for between 4% and 8% of carcinomas in this region. Both classes of malignancy, however, indicate an ominous prognosis for their hosts, and for both, it is the extent of the cancer, and hence the clinical stage, that is the major determinant. The clinicopathologic characteristics of squamous-cell and glandular carcinomas of the nasal cavity and paranasal sinuses are presented, and for the latter, a review of their presentation in the larynx is also offered.     

The pathology of head and neck tumors: vasoformative tumors, part 9B

There are three principal malignant vasoformative tumors that can be found in the head and neck--hemangiopericytoma, angiosarcoma, and Kaposi's sarcoma. All are uncommon and provide challenges for the pathologist and the therapist both. The histogenesis of each tumor is different. Kaposi's sarcoma has many features which suggest that it is an altered immune-response disease. Angiosarcoma is a malignancy of endothelium. Hemangiopericytoma is a tumor whose cell of origin is considered to be the perithelial pericyte. The general prognosis for patients with Kaposi's sarcoma is good. The biologic course of a hemangiopericytoma is variable and unpredictable, but there appears to be a site dependency. Angiosarcomas, particularly high grade lesions, are resistant to therapy.     

The pathology of head and neck tumors: Vasoformative tumors,part 9A

Tumors originating from components of the vascular system vary widely in the degree of morbidity and mortality that they incur. They all have endothelial cells as integral components of their histologic appearance. Vasoformative tumors include hemangiomas, lymphangiomas, and pyogenic granulomas, which are relatively common, and hemangiopericytomas, glomus tumors, and angiosarcomas, which are relatively uncommon. For many vasoformative tumors, including lymphogenous lesions, the head and neck is an area of predilection, and, in some instances, location in the head and neck appears to modify biologic activity.     

The pathology of head and neck tumors: Salivary glands,part 3

The term adenoma is applied to a rather wide variety of histopathologic entities in the salivary glands. These include tumors derived from the ductal epithelium and/or from myoepithelial cells and other salivarygland elements, such as the sebaceous glands. Within the categories of mixed tumor (pleomorphic adenoma), monomorphic adenoma, clear-cell tumor, and sebaceous lesions, there are also several subtypes, each of which lends further credence to the germinative potential of the salivary tissues. Presented in this report is a clinicopathologic and histogenetic analysis of these lesions. Specifically discussed are mixed tumor, monomorphic adenoma, carcinoma ex-pleomorphic adenoma, clear-cell tumor, sebaceous lymphadenoma, and sebaceous carcinoma.     

The pathology of head and neck tumors: Salivary glands,part 4

Adenoid cystic carcinomas and adenocarcinomas of salivary tissues are more plentiful in minor than in major salivary glands. In the latter, they comprise no more than 10% of tumors. In both sites, however, their clinical course is characterized by local aggressiveness, recurrences, and a relatively torpid and protracted course, eventually leading to death. The clinicopathologic aspects of these two lesions form the major part of this report. Their behavior is contrasted with that of the two other lesions presented: heterotopic salivary tissue, which is seldom the site of neoplasia; and necrotizing sialometaplasia, a self-limited disorder that simulates malignancy both clinically and histopathologically.     

The pathology of head and neck tumors: Salivary glands,part 1

The surgical pathology of the head and neck is perhaps the most demanding of all subdivisions of pathology. It is demanding both for the pathologist and for the head and neck surgeon–who, as a team, must provide optimal patient care. Beginning with this issue of HEAD & NECK SURGERY, a series will be presented dealing with the clinicopathologic aspects of head and neck tumors. The authors have chosen to begin with the salivary glands, and in this report they present a concept of histogenesis and classification as well as an analysis of (1) salivarygland tumors in children, (2) the relationship between breast carcinoma and salivary-gland carcinoma, (3) the status of radiation induction of salivary-gland tumors, and (4) the clinicopathologic aspects of tumors of the salivary oncocyte.     

The pathology of head and neck tumors: Mucosal melanomas,part 13

Pigmented lesions, including melanomas, of the mucous membranes of the head and neck are far outnumbered by their counterparts in the skin. This relative dearth is partially responsible for the fact that scientific inquiry into mucosal melanomas has not kept pace with the advances in knowledge of the pathogenesis of cutaneous melanomas and their diagnosis and treatment. Integral to these latter advances have been the refinements in clinical and histologic classification and clinicopathologic correlations with quantitative evaluation of melanomas of skin—enhancements that up to now have been singularly lacking for mucosal melanomas. This report acknowledges this slowness in progress, presents recommendations for purifying the nomenclature of pigmented lesions of the mucosae, and at the same time, also notes the poorer prognosis for melanomas of the upper aerodigestive tracts, as a group, when compared with cutaneous melanomas. Only prospective studies will answer the question of whether the poor prognosis is intrinsic to these mucosal melanomas or whether delay in detection and removal are responsible.     

The pathology of head and neck tumors: Salivary glands,part 2

Acinic-cell carcinomas and mucoepidermoid carcinomas remain somewhat controversial salivarygland lesions. Because of an ambiguity in the literature conceming their malignant potential and a lack of sufficient follow-up periods, these carcinomas have been underestimated with respect to their morbidity and lethality. The failure of histopathologic evaluation to successfully predict the subsequent biologic course of these neoplasms should not mitigate treatment. Aciniccell carcinomas are usually isomorphic neoplasms having their genesis in the neoplastic reserve cells of the terminal portions of the duct system. Mucoepidermoid carcinomas, on the other hand, may be described as forming a histologic spectrum or continuum from the most highly differentiated to the most poorly differentiated malignancy. They arise from the interlobular and intralobular ducts. The histopathologic features of these two neoplasms are presented, along with a review of their biologic activity in humans.     

The pathology of head and neck tumors: verrucous carcinoma,part 15

Verrucous squamous cell carcinoma is a distinctive clinicopathologic entity. The lesion's biologic activity places it between conventional (nonverrucous) carcinomas and nonautochthonous hyperplasias of squamous epithelium. The diagnosis of the lesion requires full communication and cooperation between surgeon and pathologist. Once the diagnosis is confirmed, the selection of surgery over radiotherapy should be based on the recorded effectiveness of each modality and not on the phenomenon of anaplastic transformation reported to follow radiotherapy.     

The pathology of head and neck tumors: The occult primary and metastases to the head and neck,part 10

Metastases from carcinomas to the head and neck, either to lymph nodes or to extranodal sites, arise most often from known primary neoplasms. However, some are from a clinically inapparent neoplasm—the so-called occult primary. If the metastasis is an epidermoid carcinoma in a lymph node, the odds clearly favor the primary being in the upper aerodigestive tract. The success rate of discovery is variable, however, and a significant number of primaries remain undetected. Metastatic adenocarcinomas, to either nodal or extranodal sites, are most often from infraclavicular neoplasms. In general, the incidence of metastases to the head and neck from visceral primaries below the clavicle follows the general incidence of the primary cancer itself. Renal-cell carcinoma is the exception since its frequency of metastases to the head and neck exceeds the expected incidence in the general population. Branchiogenic carcinoma is more a conceptual than a literal clinicopathologic entity. The diagnosis should be made with reluctance and only after fulfillment of several rather stringent criteria.     

The pathology of head and neck tumors: Carcinoma of the nasopharynx,part 11

The past decade has witnessed extraordinary advances in the epidemiology, virology, and immunology of carcinomas of the nasopharynx. There has not been a parallel growth in the study of morphologic expressions of the neoplasms. In great part, this has been due to a lack of a universally accepted histologic classification. As a consequence, correlation between histology and other factors relating to the pathogenesis of these neoplasms has been impeded. The World Health Organization (WHO) has proposed a histologic classification of nasopharyngeal carcinomas as squamous-cell, nonkeratinizing, and undifferentiated. This report presents an argument in favor of using the WHO classification and a hypothesis relating to the histogenesis of the 3 types of nasopharyngeal carcinoma.     

The pathology of head and neck tumors: Cysts of the jaws,part 12

The jaws are unique bones of the skeleton because of their intimate involvement with tooth and facial development. Abnormal sequelae of these developmental processes may give rise to cystic lesions later in life. This paper reviews the pathogenesis, clinical features, and behavior of these odontogenic and nonodontogenic cysts. Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification. Emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.     

Malignant tumors of the nasal cavity and paranasal sinuses

PURPOSE: To evaluate the role of radiation therapy in patients with nasal cavity and paranasal sinus tumors. MATERIALS AND METHODS: Between October 1964 and July 1998, 78 patients with malignant tumors of the nasal cavity (48 patients), ethmoid sinus (24 patients), sphenoid sinus (5 patients), or frontal sinus (1 patient) were treated with curative intent by radiation therapy alone or in the adjuvant setting. There were 25 squamous cell carcinomas, 14 undifferentiated carcinomas, 31 minor salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), 8 esthesioneuroblastomas, and 1 transitional cell carcinoma. Forty-seven patients were treated with irradiation alone, 25 with surgery and postoperative irradiation, 2 with preoperative irradiation and surgery, and 4 with chemotherapy in combination with irradiation with or without surgery. RESULTS: The 5-year actuarial local control rate for stage I (limited to the site of origin; 22 patients) was 86%; for stage II (extension to adjacent sites (eg, adjacent sinuses, orbit, pterygomaxillary fossa, nasopharynx; 21 patients) was 65%; and for stage III (destruction of skull base or pterygoid plates, or intracranial extension; 35 patients) was 34%. The 5-year actuarial local control rate for patients receiving postoperative irradiation was 79% and for patients receiving irradiation alone was 49% (p =.05). The 5-, 10-, 15-, and 20-year ultimate local control rates for all 78 patients were 60%, 56%, 48%, and 48%, respectively. The 5-, 10-, 15-, and 20-year cause-specific survival rates for all 78 patients were 56%, 45%, 39%, and 39%, respectively. The 5-, 10-, 15-, and 20-year absolute survival rates for all 78 patients were 50%, 31%, 21%, and 16%, respectively. Of the 67 (86%) patients who were initially seen with node-negative disease, 39 (58%) received no elective neck treatment, and 28 (42%) received elective neck irradiation. Of the 39 patients who received no elective neck treatment, 33 (85%) did not experience recurrence in the neck compared with 25 (89%) of 28 patients who received elective neck irradiation. Most patients who received elective neck irradiation (57%) had stage III disease. Twenty-one (27%) of 78 patients had unilateral blindness develop secondary to radiation retinopathy or optic neuropathy; the complication was anticipated in most of these patients, because the ipsilateral eye was irradiated to a high dose. Four patients (5%) unexpectedly had bilateral blindness develop because of optic neuropathy. All four of these patients received irradiation alone. CONCLUSION: Surgery and postoperative radiation therapy may result in improved local control, absolute survival, and complications when compared with radiation therapy alone. Elective neck irradiation is probably unnecessary for patients with early-stage disease.     

The pathology of head and neck tumors: Fibroadipose tissue and skeletal muscle,part 8

Benign and malignant tumors originating from mesenchymal cells destined to become lipoblasts and myoblasts affect the head and neck with contrasting frequencies. Lipomas and especially liposarcomas are unusual lesions above the clavicles but when found there behave in a biologic manner identical to that of their counter-parts at other anatomic sites. Myogenic tumors, on the other hand, have a predilection for the head and neck, and for rhabdomyosarcomas this predilection is accentuated in childhood. Combination therapy of rhabdomyosarcomas has obviated radical surgery as a method of treatment, and many sites in the head and neck have benefited prognostically by this treatment. Success, however, is dependent on clinical stage of disease, and rhabdomyosarcomas of the nasopharynx, paranasal sinuses, and middle ear remain more resistant to short-term cures because of the extent of the neoplasm. A review of the clinicopathologic aspects of granular-cell tumors and alveolar soft-part sarcomas is also presented because it has been suggested that these tumors have a myogenous origin.     

The pathology of head and neck tumors: neoplasms of cartilage, bone, and the notochord, part 7

Neoplasms of the supporting tissues in the head and neck are outnumbered by their histologic counterparts in the trunk and extremities. This is especially true for tumors of bone, cartilage, and the remnants of the notochord. Malignancies occurring in all three tissues, however, are just as lethal as those sited elsewhere. Chondrosarcomas and osteogenic sarcomas of the facial bones are resistant to all conventional modes of therapy, manifest many recurrences, and have an often protracted morbidity. The craniocervical chordoma manifests a similar biologic course. For the tumors of cartilaginous origin and the osteogenic sarcomas, the initial surgical attempt at removal is of key importance. Neoplasms present at the margins of resection have a poor prognosis. Chorodomas are not likely to be cured by any modality.     

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses

The craniofacial approach for resection of tumors of the nose and paranasal sinuses is well established, as are its advantages over previous methods of treatment. The technique has been considerably modified, resulting in an operation that combines excellent access, a sound oncologic resection with excellent cosmesis, and low postoperative morbidity for conditions associated hitherto with an extremely poor prognosis. The 7-yr experience of 60 patients is presented. Results suggest improved survival in a group of patients who are potentially curable by this procedure, while in those with extensive disease good palliation is achieved. In addition, large benign tumors that would previously have been considered inaccessible can be resected. Its many advantages recommend it as the treatment of choice for tumors of the nose and paranasal sinuses.     

Transcranial resection of tumors of the paranasal sinuses and nasal cavity

Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.     

Metastases to nasal cavity and paranasal sinuses

The sinonasal cavities are rare locations for metastases. Metastases to these locations are usually solitary and produce similar symptoms to those of a primary sinonasal tumor. Nasal obstruction and epistaxis are the most frequent symptoms. The maxillary sinus is most frequently involved. The most common primary tumor sites to spread to this region originate in the kidney, breast, thyroid, and prostate, although any malignancy could potentially lead to a metastasis to the paranasal sinuses. The patient's prognosis is usually poor because of the fact that the sinonasal metastasis is usually associated with widespread disseminated disease. In the majority of patients, palliative therapy is the only possible treatment option. Nevertheless, whenever possible, surgical excision either alone or combined with radiotherapy may be useful for palliation of symptoms and, rarely, to achieve prolonged survival. This review considers the most interesting cases reported in the literature that presents metastases to the sinonasal cavities. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1847–1854, 2016