Head and Neck

Pathology
Department of Pathology
Emilio Aguinaldo College of Medicine
Objectives
• To understand:
• 1. Common conditions of the head and neck.
• 2. The normal structures of the head and neck and how this
relates to disease.
• 3. The pathology and aetiology of head and neck infectious
diseases.
• 5. The main types of head and neck tumors, including
presentation and spread.
UPPER RESPIRATORY TRACT
• INFLAMMATION
• Infections of the nose, nasal sinuses, pharynx and larynx are
common.
• They are usually mild and self-limiting.
• Most cases are due to viral infection, but this is often followed
by bacterial superinfection
UPPER RESPIRATORY TRACT
• 1. VIRAL INFECTION
• This phase is characterised by features of acute inflammation
but without the exudation of neutrophils.
UPPER RESPIRATORY TRACT
• Viruses involved
• A wide variety, of which the major types are:
• Rhinoviruses and Coronaviruses
• Responsible for more than half of cases of the common cold.
• Adenovirus, influenza, parainfluenza and respiratory syncytial
viruses can also invade the lower respiratory tract.
UPPER RESPIRATORY TRACT
• 2. BACTERIAL PHASE
• Many bacteria are commensal in the respiratory tract (e.g.
Streptococcus mutans, Haemophilus influenzae) and can
superinfect the damaged tissue, which then exhibits the
typical features of acute inflammation including exudation of
neutrophils.
UPPER RESPIRATORY TRACT
• INFECTIVE
• Acute coryza
(common cold)
usually involves the
nose and adjacent
structures.
• The two phases, viral
and bacterial, are
typically seen in this
disease.
UPPER RESPIRATORY TRACT
• ALLERGIC
• Allergic rhinitis (hay
fever) is a Type I
hypersensitivity
reaction to inhaled
materials
ACUTE PHARYNGITIS,
TRACHEITIS AND LARYNGITIS
• ACUTE PHARYNGITIS AND TRACHEITIS
• Most sore throats are caused by viruses – including
adenovirus and Epstein–Barr virus.
• Bacteria include Streptococcus pyogenes, Haemophilus
parainfluenzae and Corynbacterium diphtheriae.
• Tonsillitis is a common acute inflammation caused by viral
infection in the majority of cases. Streptococcal infection is the
cause in around 10% of cases.
ACUTE PHARYNGITIS, TRACHEITIS AND
LARYNGITIS
ACUTE PHARYNGITIS,
TRACHEITIS AND LARYNGITIS
• Diphtheria, now uncommon due to vaccination, is a serious
infection.

• This pseudomembrane may spread to block the larynx, causing

respiratory obstruction.
• Acute epiglottitis
• historically caused by H. influenzae. With vaccination it is now
more often caused by other bacteria (e.g. Staphylococcus
aureus).
• Acute laryngitis
• caused by viruses (e.g. rhinoviruses), bacteria (e.g. group A
streptococcus) and irritants (e.g. cigarette smoke).
ACUTE PHARYNGITIS,
TRACHEITIS AND LARYNGITIS
• CHRONIC LARYNGITIS
ACUTE PHARYNGITIS,
TRACHEITIS AND LARYNGITIS
• Tuberculosis – this can cause severe ulceration of the larynx
and is usually secondary to pulmonary tuberculosis.
• Vocal cord polyps and singer’s nodules
• They consist of squamous epithelium overlying fibrin-rich and
myxoid stroma.
TUMOURS OF THE UPPER
RESPIRATORY TRACT
TUMOURS OF THE UPPER
RESPIRATORY TRACT
• BENIGN TUMOURS
• (a) Epithelial
• Papillomas may be single but are often multiple and due to
infection by papilloma virus (HPV 11 and 16). The epithelium
may be one of two types:
TUMOURS OF THE UPPER
RESPIRATORY TRACT
• (b) Connective tissue
• Haemangiomas, especially
of the nasal septum, are a
rare cause of persistent
nose bleeds.
• A special form,
angiofibroma,
• typically located in the nasal
septum, affects male
children.
• It is locally aggressive and
grows throughout childhood
but typically regresses.
TUMOURS OF THE UPPER
RESPIRATORY TRACT
• MALIGNANT TUMOURS
• Nasopharyngeal carcinoma is common in certain regions of
East Asia and Africa and is associated with Epstein–Barr virus
infection, which can usually be detected in tumour cells by
PCR on in-situ hybridisation techniques.
• Adenocarcinoma of the nose is a rare tumour, sometimes seen
in woodworkers.
MOUTH
MOUTH
• VIRAL INFECTIONS
• Herpes simplex virus (usually Type I)
infects the mouth in young children.
• The virus can become latent in the
trigeminal ganglion and repeated ‘cold
sores’ occur on the lip in later life.
• Coxsackie viruses
• can cause oral blistering (e.g.
herpangina; hand, foot and mouth
disease).
• Koplik spots are a feature of
measles.

• FUNGAL INFECTION
• Candida albicans is an oral
commensal in 40% of the
population.
MOUTH
• BACTERIAL INFECTIONS
• Syphilis
• can occur as a primary chancre or as irregular lines of ulceration,
i.e. snail track ulcers of the secondary stage.
• can also occur as small gummas (tertiary syphilis).
• Oral tuberculosis (TB
• Aphthous ulcers
• Dermatoses, e.g. lichen planus – can affect the oral mucosa.
MOUTH
• Oral cancer accounts for 2% of cancers in the United Kingdom.
There is wide geographical variation.
• It is much commoner in South-East Asia.
• Men are at least twice as commonly affected as women.
• It is a disease of the elderly.
• Aetiology
• The major causes are:
• 1. Tobacco
• 2. Alcohol, especially spirits.
• 3. Exposure to ultraviolet light (cancer of the lip).
• 4. Human papilloma virus (type 16) may be involved.
MOUTH
• Almost all cases are squamous cell carcinomas. The lip,
tongue, floor of mouth and tonsil are affected in that order of
frequency.
MOUTH
• ERYTHROPLAKIA AND LEUKOPLAKIA
• These terms describe velvety-red patches and white patches in the oral
mucosa.

• Not all examples of leukoplakia are premalignant. They may be due to:
• – Chronic irritation (e.g. dentures)
• – Pipe smoking
• – Candida
• A distinctive form – ‘hairy leukoplakia’ – occurs on the lateral border of the
tongue in patients with AIDS. It is due to Epstein–Barr virus infection, often
with superimposed candida.
MOUTH
• Pigmentations
• Melanotic pigmentation of the mouth is seen in Addison disease,
haemochromatosis and the Peutz–Jeghers syndrome.
• Benign tumours
• A variety of benign tumours are seen, e.g. squamous papillomas
and haemangiomas (often on the lips or tongue).
• Granular cell tumour
• This is a rare tumour and its importance lies in the fact that it may
be mistaken for carcinoma of the tongue.
• Epulis is a clinical term applied to swellings at the gum margin.
• Most of them are granulomas associated with chronic gingivitis.
LARYNX
REACTIVE NODULES
Polyps
• develop on the vocal cords,
• heavy smokers
• Unilateral

Singers' nodules
• in individuals who impose great strain on their vocal cords
• Bilateral lesions

• Adult men

• These nodules are smooth, rounded, sessile or pedunculated excrescences, generally

only a few millimeters in the greatest dimension, located usually on the true vocal cords.

• They are typically covered by squamous epithelium that may become keratotic,
hyperplastic, or even slightly dysplastic. The core of the nodule is a loose myxoid
connective tissue that may be variably fibrotic or punctuated by numerous vascular
channels.

• When nodules on opposing vocal cords impinge on each other, the mucosa may
undergo ulceration.
REACTIVE NODULES

Diagrammatic comparison of a benign papilloma and an exophytic

carcinoma of the larynx to highlight their quite different appearances.
REACTIVE NODULES

• Myxoid, edematous stroma is prominent in this example

SQUAMOUS PAPILLOMA
• Laryngeal squamous papillomas
are benign neoplasms, usually
located on the true vocal cords,
that form soft, raspberry-like
excrescences rarely more than 1
cm in diameter.

• On histologic examination, the

papillomas are made up of
multiple slender, finger-like
projections supported by central
fibrovascular cores and covered
by an orderly stratified squamous
epithelium.
PAPILLOMATOSIS
Juvenile laryngeal
papillomatosis

• Multiple papillomas in
children

• HPV types 6 and 11.

• Frequently recur.

• Cancerous transformation is
rare.
 CARCINOMA OF THE LARYNX
• Macroscopically, the epithelial changes vary from smooth, white or reddened focal
thickenings, sometimes roughened by keratosis, to irregular verrucous or ulcerated

• Orderly hyperplasias have almost no potential for malignant transformation, but the
risk rises to 1% to 2% during the span of 5 to 10 years with mild dysplasia and 5% to
10% with severe dysplasia.

• RISK FACTORS:
• Smoking and alcohol
• Nutritional factors, exposure to asbestos, irradiation, and infection with HPV.

• CLINICAL FEATURES:
• Manifests itself clinically by persistent hoarseness.
• At presentation, about 60% of these cancers are confined to the larynx.
• The prognosis for these is better than for those tumors that have spread into adjacent structures.
• Later, laryngeal tumors may produce pain, dysphagia, and hemoptysis. Patients are also extremely
vulnerable to secondary infection of the ulcerating lesion.
• With surgery, irradiation, or combination therapy, many patients can be cured, but about one third die of
the disease. The usual causes of death are infection of the distal respiratory passages or widespread
metastases and cachexia.
CARCINOM OF THE LARYNX
Morphology

• 95% are typical squamous cell

tumors.
• The tumor usually develops directly
on the vocal cords, but it may arise
above or below the cords, on the
epiglottis or aryepiglottic folds, or in
the pyriform sinuses.

• Squamous cell carcinomas of the

larynx begin as in situ lesions that
later appear as pearly gray, wrinkled
plaques on the mucosal surface,
ultimately ulcerating and fungating..

Laryngeal carcinoma. Note the large,

ulcerated, fungating lesion involving
the vocal cord and pyriform sinus.
CARCINOMA OF THE LARYNX

Histologic appearance of laryngeal squamous cell carcinoma. Note the atypical

lining epithelium and invasive keratinizing cancer cells in the submucosa .
NECK
BRACHIAL CLEFT CYST
(Cervical Lymphoepithelial Cyst)
BRACHIAL CLEFT CYST
(Cervical Lymphoepithelial Cyst)
• Upper lateral aspect of the neck
along the sternocleidomastoid
muscle.
• young adults between the ages of 20
and 40.
• cysts are well circumscribed, 2 to 5
cm in diameter, with fibrous walls
usually lined by stratified squamous
or pseudostratified columnar
epithelium.
• The cyst wall typically contains
lymphoid tissue with prominent
germinal centers.

• The cystic contents may be clear,

watery to mucinous fluid or may
Branchial cyst lined by squamous epithelium and
contain desquamated, granular contains lymphoid tissue with germinal follicle
cellular debris.
resembling thyroglossal duct cyst.
THYROGLOSSAL DUCT CYST
• Embryologically, the thyroid anlage begins in the
region of the foramen cecum at the base of the
tongue; as the gland develops it descends to its
definitive location in the anterior neck.
• Remnants of this developmental tract may
persist, producing cysts, 1 to 4 cm in diameter
• Rare malignant transformation
THYROGLOSSAL DUCT CYST
PARAGANGLIOMA
(Carotid Body Tumor)
• Paraganglia are clusters of neuroendocrine cells
associated with the sympathetic and parasympathetic
nervous systems.
• Approximately 70% of extra-adrenal paragangliomas
occur in the head and neck
• Paragangliomas typically develop in two locations:

• Paravertebral paraganglia (e.g., organs of Zuckerkandl

and, rarely, bladder). Such tumors have sympathetic
connections and are chromaffin-positive, a stain that
detects catecholamines.
• Paraganglia related to the great vessels of the head
and neck
PARAGANGLIOMA
(Carotid Body Tumor)
Morphology

• The carotid body tumor is a prototype of a parasympathetic

paraganglioma. It rarely exceeds 6 cm in diameter and arises close to
or envelops the bifurcation of the common carotid artery. The tumor
tissue is red-pink to brown.

• The microscopic features of all paragangliomas, wherever they

arise, are remarkably uniform.

• They are chiefly composed of nests (Zellballen) of round to oval

chief cells (neuroectodermal in origin) that are surrounded by
delicate vascular septae.

• The tumor cells contain abundant, clear or granular, eosinophilic

cytoplasm and uniform, round to ovoid, sometimes vesicular, nuclei
PARAGANGLIOMA
(Carotid Body Tumor)

 Carotid body tumor. A, Low-power view showing tumor clusters separated by

septa (Zellballen). B, High-power view of large, eosinophilic, slightly vacuolated
tumor cells with elongated sustentacular cells in the septa.
PARAGANGLIOMA
(Carotid Body Tumor)
• Rare. They are slow-growing and painless masses that
usually arise in the fifth and sixth decades of life.

• They commonly occur singly and sporadically but may

be familial, with autosomal dominant transmission in the
multiple endocrine neoplasia 2 syndrome

• Carotid body tumors frequently recur after incomplete

resection and, despite their benign appearance, may
metastasize to regional lymph nodes and distant sites. .
DISEASES OF THE SALIVARY GLANDS
Diseases of the salivary glands
• INFLAMMATION
• The commonest acute inflammation is due to the mumps virus
• Chronic inflammation is rare. It may occur in sarcoidosis.
• Sjögren syndrome
• destruction of the salivary, lacrimal and conjunctival glands by an
infiltrate of lymphocytes (so-called ‘lympho-epithelial lesions’)
and plasma cells.
• Calculi
• Stones can form in the submandibular or, less often, the parotid
duct.
XEROSTOMIA
 dry mouth resulting from a
decrease in the production
of saliva.
 It is a major feature of the
autoimmune disorder
Sjögren syndrome, usually
accompanied by dry eyes.
 A lack of salivary secretions
is also a major
complication of radiation
therapy.
 Complications of
xerostomia include
increased rates of dental
caries, candidiasis, as well
as difficulty in swallowing
and speaking.
INFLAMMATIONS
• Sialadenitis may be of traumatic, viral, bacterial,
or autoimmune origin.
• Mucoceles are the most common type of
inflammatory salivary gland lesion.
• The most common form of viral sialadenitis is
mumps, in which the major salivary glands,
particularly the parotids, are affected. Other
glands (e.g., the pancreas and testes) may also
be involved.
INFLAMMATIONS
Mucocele

• This is the most common lesion of the salivary

glands.
• It results from either blockage or rupture of a
salivary gland duct, with consequent leakage
of saliva into the surrounding connective tissue
stroma.
• Mucoceles are most often found on the lower
lip and are the result of trauma
INFLAMMATIONS

• Mucocele. A, Fluctuant fluid-filled lesion on the lower lip subsequent to

trauma. B, Cystlike cavity filled with mucinous material and lined by
organizing granulation tissue.
Diseases of the salivary glands
• SALIVARY GLAND TUMOURS
• The majority (80%) of tumours arise in the parotid gland and are
usually benign.
• The remainder occur in the submandibular and minor salivary
glands where 30–40% are malignant.
INFLAMMATIONS
• A ranula is histologically
identical to a mucocele.
• However, this term is
reserved for mucoceles
that arise when the
duct of the sublingual
gland has been
damaged.
INFLAMMATIONS
Sialolithiasis and Nonspecific Sialadenitis
• Nonspecific bacterial sialadenitis, most often involving
the major salivary glands, particularly the
submandibular glands, is a common condition, usually
secondary to ductal obstruction produced by stones
(sialolithiasis).
• The common offenders are S. aureus and Streptococcus
viridans.
• The stone formation is sometimes related to
obstruction of the orifices of the salivary glands by
impacted food debris or by edema about the orifice
after some injury.
• Unilateral involvement of a single gland is the rule.
NEOPLASMS
• Overall, these neoplasms are
relatively uncommon and represent
less than 2% of all tumors in humans.

• About 65% to 80% arise within the

parotid, 10% in the submandibular
gland, and the remainder in the
minor salivary glands

• The likelihood of a salivary gland

tumor being malignant is more or less
inversely proportional to the size of
the gland.
PLEOMORPHIC ADENOMA
• PLEOMORPHIC
ADENOMA
• This is the most common
tumour of the salivary
glands and most often
occurs in the parotid.
• derived from the epithelial
and myoepithelial cells.
• Malignant change
• Under 5% of these
tumours become
malignant, often after
many years.
PLEOMORPHIC ADENOMA

• They represent about 60% of tumors in the parotid, are less

common in the submandibular glands, and are relatively rare in the
minor salivary glands.

• They are benign tumors that consist of a mixture of ductal

(epithelial) and myoepithelial cells, and therefore they show both
epithelial and mesenchymal differentiation.

• They reveal epithelial elements dispersed throughout the matrix

along with varying degrees of myxoid, hyaline, chondroid
(cartilaginous), and even osseous tissue. In some tumors the
epithelial elements predominate; in others they are present only in
widely dispersed foci.
 PLEOMORPHIC ADENOMA
Morphology.
• rounded, well-demarcated masses
rarely exceeding 6 cm in the
greatest dimension
• Although they are encapsulated, in
some locations the capsule is not
fully developed,
• The cut surface is gray-white with
myxoid and blue translucent areas
of chondroid (cartilage-like).

• Pleomorphic adenoma. A, Slowly

enlarging neoplasm in the parotid
gland of many years duration. B,
The bisected, sharply
circumscribed, yellow-white tumor
can be seen surrounded by normal
salivary gland tissue.
PLEOMORPHIC ADENOMA

PLEOMORPHIC ADENOMA
A, Low-power view showing a well-demarcated tumor with adjacent normal salivary gland parenchyma. B,
High-power view showing epithelial cells as well as myoepithelial cells found within a chondroid matrix
material.
PLEOMORPHIC ADENOMA
Clinical Features

• These tumors present as painless, slow-growing, mobile discrete

masses within the parotid or submandibular areas or in the buccal
cavity.
• The recurrence rate (perhaps months to years later) with
parotidectomy is about 4% but, with simple enucleation, approaches
25%.
• The incidence of malignant transformation increases with the
duration of the tumor, being about 2% for tumors present less than
5 years and almost 10% for those of more than 15 years' duration.
• These cancers, when they appear, are among the most aggressive of
all salivary gland malignant neoplasms, producing mortality rates of
30% to 50% at 5 years.
WARTHIN TUMOR
• This is a benign lesion,
mainly in the parotid
of elderly men.
• It may be bilateral.
• It consists of tall
epithelial cells with
eosinophilic
cytoplasm (oncocytes)
and a reactive
lymphoid infiltrate.
WARTHIN TUMOR
• Second most common salivary gland neoplasm. It arises
almost exclusively in the parotid gland (the only tumor
virtually restricted to the parotid)
• occurs more commonly in males than in females,
• usually in the fifth to seventh decades of life.
• These neoplasms are benign, with recurrence rates of
only 2% after resection
• About 10% are multifocal and 10% bilateral.
• Smokers have eight times the risk of nonsmokers for
developing these tumors.
WARTHIN TUMOR
Morphology

• Most Warthin tumors are round to oval, encapsulated masses, 2 to 5 cm in

diameter, usually arising in the superficial parotid gland, where they are
readily palpable.

• Transection reveals a pale gray surface punctuated by narrow cystic or

cleftlike spaces filled with a mucinous or serous secretion.

• On microscopic examination these spaces are lined by a double layer of

neoplastic epithelial cells resting on a dense lymphoid stroma sometimes
bearing germinal centers.

• The spaces are frequently narrowed by polypoid projections of the

lymphoepithelial elements. The double layer of lining cells is distinctive; it
consists of a surface palisade of columnar cells having an abundant, finely
granular, eosinophilic cytoplasm, that imparts an oncocytic appearance,
which rests on a layer of cuboidal to polygonal cells.
WARTHIN TUMOR

• Warthin tumor. A, Low-power view showing epithelial and lymphoid elements. Note the
follicular germinal center beneath the epithelium. B, Cystic spaces separate lobules of
neoplastic epithelium consisting of a double layer of eosinophilic epithelial cells based on a
reactive lymphoid stroma.
MUCOEPIDERMOID
CARCINOMA
• These neoplasms are composed of variable mixtures of
squamous cells, mucus-secreting cells, and intermediate
cells.
• They represent about 15% of all salivary gland tumors,
and while they occur mainly (60% to 70%) in the
parotids, they account for a large fraction of salivary
gland neoplasms in the other glands, particularly the
minor salivary glands.
• associated with a balanced (11;19) (q21;p13)
chromosomal translocation that creates a fusion gene
composed of portions of the MECT1 and MAML2 genes.
• Overall, they are the most common form of primary
malignant tumor of the salivary glands.
MUCOEPIDERMOID
CARCINOMA
Morphology
• Mucoepidermoid carcinomas can grow as large
as 8 cm in diameter and although they are
apparently circumscribed, they lack well-defined
capsules and are often infiltrative at the margins.
• Pale and gray-white on transection, they
frequently contain small, mucin-containing cysts.
• The basic histologic pattern is that of cords,
sheets, or cystic configurations of squamous,
mucous, or intermediate cells.
MUCOEPIDERMOID
CARCINOMA

• A, Mucoepidermoid carcinoma growing in nests composed of squamous

cells as well as clear vacuolated cells containing mucin. B, Mucicarmine
stains the mucin reddish pink.
MUCOEPIDERMOID
CARCINOMA
• The clinical course and prognosis depend on the grade of
the neoplasm.
• Low-grade tumors may invade locally and recur in about
15% of cases, but only rarely do they metastasize and so
yield a 5-year survival rate of more than 90%.
• By contrast, high-grade neoplasms and, to a lesser
extent, intermediate-grade tumors are invasive and
difficult to excise and so recur in about 25% to 30% of
cases and, in 30% of cases, metastasize to distant sites.
• The 5-year survival rate in patients with these tumors is
only 50%.
Adenoid cystic carcinoma
• relatively uncommon tumor, which in
approximately 50% of cases is found in the
minor salivary glands (in particular the
palate).
• Morphology.
• In gross appearance, they are generally
small, poorly encapsulated, infiltrative,
gray-pink lesions.
Adenoid cystic carcinoma

Adenoid cystic carcinoma in a salivary gland. A, Low-power view. The

tumor cells have created a cribriform pattern enclosing secretions. B,
Perineural invasion by tumor cells.
Adenoid cystic carcinoma
• Although slow growing, adenoid cystic carcinomas are
relentless and unpredictable tumors with a tendency to
invade perineural spaces , and they are stubbornly
recurrent.
• Eventually, 50% or more disseminate widely to distant
sites such as bone, liver, and brain, sometimes decades
after attempted removal.
• Although the 5-year survival rate is about 60% to 70%, it
drops to about 30% at 10 years and 15% at 15 years.
• Neoplasms arising in the minor salivary glands have, on
average, a poorer prognosis than those primary in the
parotids.
Acinic cell Carcinoma
• composed of cells resembling the normal serous acinar cells
of salivary glands.

• Uncommon, representing only 2% to 3% of salivary gland

tumors.
• Most arise in the parotids; the remainder arise in the
submandibular glands. They rarely involve the minor glands.
• They are generally small, discrete lesions that may appear
encapsulated.
• Overall, recurrence after resection is uncommon, but about
10% to 15% of these neoplasms metastasize to lymph nodes.
• The survival rate is in the range of 90% at 5 years and 60% at
20 years.
Acinic cell Carcinoma

• Acinic cell carcinoma. The cells have an abundant

cytoplasm filled with basophilic zymogen granules.
EARS
Middle ear and mastoid disease
• In untreated purulent otitis media, three serious complications
may arise from spread of the inflammation.
INFLAMMATORY LESIONS
Otitis Media
• occur mostly in infants and children
• Streptococcus pneumoniae, non-
typeable H. influenzae, and Moraxella
catarrhalis.
• Repeated bouts of acute otitis media
with failure of resolution lead to
chronic disease.
• Pseudomonas aeruginosa,
Staphylococcus aureus, or a
fungus; sometimes a mixed flora is
the cause.
• Chronic infection has the potential to
perforate the eardrum, encroach on
the ossicles or labyrinth, spread into
the mastoid spaces, and even
penetrate into the cranial vault to
produce a temporal cerebritis or
abscess.
INFLAMMATORY LESIONS
Cholesteatomas

• associated with chronic otitis media

• Chronic inflammation and perforation
of the eardrum with ingrowth of the
squamous epithelium
OTOSCLEROSIS
• Abnormal bone deposition in the
middle ear about the rim of the
oval window into which the
footplate of the stapes fits.

• At first there is fibrous ankylosis

of the footplate, followed in time
by bony overgrowth anchoring it
into the oval window.

• In most instances the process is

slowly progressive over the span
of decades, leading eventually to
marked hearing loss.
TUMORS
 A large variety of epithelial
and mesenchymal tumors
that arise in the ear—
external, middle, internal—
all are rare save for basal
cell or squamous cell
carcinomas of the pinna
(external ear).
 These carcinomas tend to
occur in elderly men and
are thought to be
associated with actinic
radiation.
TUMORS
• By contrast, those within the canal tend to be
squamous cell carcinomas, which occur in middle-
aged to elderly women and are not associated
with sun exposure.
• Basal cell and squamous cell lesions of the pinna
are locally invasive but they rarely spread.
• Squamous cell carcinomas arising in the external
canal may invade the cranial cavity or metastasize
to regional nodes accounting for a 5-year mortality
of about 50%.
Middle ear and mastoid disease
• Glomus Tumor
• arises from specialized structures behind the
eardrum, and is limited to the ear (glomus
tympanicum) or can spread into the neck
(glomus jugulare).
• Acoustic Neuroma
• a benign tumor of the balance nerve within
the bony canal between the ear and the brain,
and sometimes grows quite large toward the
brain.
• END