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THIRD EDITION

Bruce M. Wenig, MDChairmanDepartment of Diagnostic Pathology and Laboratory MedicineMt. Sinai Beth Israel, Mt. Sinai St. Luke’s and Mt. Sinai RooseveltVice Chairman for Anatomic PathologyDepartment of PathologyMt. Sinai Health SystemProfessor of PathologyIcahn School of Medicine at Mount SinaiNew York, New York

Atlas of HEAD AND NECK PATHOLOGY

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ATLAS OF HEAD AND NECK PATHOLOGY, THIRD EDITION ISBN: 978-1-4557-3382-8Copyright © 2016 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted 2008, 1993.

Library of Congress Cataloging-in-Publication Data

Wenig, Bruce M., author. Atlas of head and neck pathology / Bruce M. Wenig.—Third edition. p. ; cm. Includes index. ISBN 978-1-4557-3382-8 (hardcover : alk. paper) I. Title. [DNLM: 1. Head—pathology—Atlases. 2. Neck—pathology—Atlases. WE 17] RC936 617.5′100222—dc23

2015015063

Content Strategist: Bill SchmidtContent Development Specialist: Katie DeFrancescoPublishing Services Manager: Jeff PattersonProject Manager: Carol O’ConnellDesign Direction: Maggie Reid

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

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To my love, my wife Ana Maria and our children Sarah, Eli, and Jake

for their unwavering love and support.

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In Memorium

To my uncle-in-law, Juan José Urrutia, MD (1932-2014), the standard-bearer of his family who lived an exemplary life; his quiet and confident demeanor served as example for all of his family.

To my father, Louis Wenig (1926-2014), devoted son, husband, father, grandfather, and great-grandfather, athlete, World War II veteran, good guy, and pillar of his community who so ably provided for his family and set a standard for all of us to follow. I love you Dad and miss you.

To my mother-in-law, Ursula Karin Klostermann Urrutia (1928-2014), loving mother, grandmother, and great-grandmother whose strong will and opinions are sorely missed by everyone who knew her.

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there are 3338 images in the third edition, including approximately 1570 new images.

Over the past nearly 30 years, I have been fortunate to have worked in three superb medical facilities. I began my pathology career in the Department of Oto-rhinolaryngic and Endocrine Pathology at the Armed Forces Institute of Pathology (AFIP) in Washington, DC, in 1986, mentored by Drs. Vincent Hyams and Dennis Heffner in the Division of Otorhinolaryngic Pathology, and Clara Heffess, MD, in the Division of Endocrine Pathology. Subsequent to my joining the staff at AFIP, our department added Drs. Carol Adair and Lester Thompson, creating one of the strongest diagnostic divi-sions in all of the AFIP. Close collaboration with the Oral and Maxillofacial Pathology Division at AFIP allowed me to learn and collaborate with their many outstanding oral pathologists. I am forever grateful for having been given the opportunity to work at the AFIP and honored to have served on active duty in the United States Navy.

In 1998 I joined the Department of Pathology at the Albert Einstein College of Medicine Bronx, New York. Under the leadership of Michael Prystowsky, MD, PhD, I was fortunate to work in an environment that fostered and valued diagnostics, research and education. In 2001, I moved to the Department of Diagnostic Pathol-ogy and Laboratory Medicine at Continuum Health Partners in New York City that included Beth Israel Medical Center, St. Luke’s Hospital, and Roosevelt Hos-pital thanks to the support of the Chairman, Neville Colman, MD, PhD, whose unfortunate death in 2003 was a blow to the entire Health System. Over the past 14 years spent at Continuum Health Partners, I have worked with an outstanding group of diagnostic surgi-cal pathologists and have appreciated their support of me, of the Department, and of the Health System. These past 14 years also brought together a unique core of high level and accomplished physicians focused on pro-viding care to patients with diseases of the head and neck. This multidisciplinary team of clinicians has included Drs. Louis Harrison, Roy Sessions, Mark Persky, Mark Urken, Ken Hu, Roy Holiday, Bruce Cul-liney, and Jean-Marc Cohen, creating one of the stron-gest groups of physicians focused on diseases of head and neck within New York and the United States. Change is inevitable, and in 2013 Continuum Health Partners merged with the Mount Sinai Hospital to

Preface to the Third Edition

It has been a daunting task to undertake revising this atlas not so much for the dedicated time and effort com-mitted to completing it but for keeping apprised of all the new information that appears in the literature on a near daily basis. Molecular diagnostics has reached the “prime time” in assisting physicians in managing their patients, specifically (but not solely) in the advances achieved in targeted therapy offering better outcomes and, more importantly, hope to patients and their fami-lies in treating diseases that previously were considered to be untreatable/incurable. For pathologists, advances in molecular biology have provided a better understand-ing of the diseases we diagnose. However, relative to compiling a book such as this one, the advances in molecular biology are akin to a moving target with near weekly publications that provide new information and/or information that render previous knowledge relative to a given disease essentially moot. I have to the best of my ability tried to provide the most current information relative to the diseases included in this atlas. I sincerely hope I have succeeded in this endeavor or to at least have made this atlas a valuable resource to a wide spec-trum of individuals with interest in diseases of the head and neck.

The third edition of the Atlas of Head and Neck Pathology updates and revises the information detailed in the second edition. I have attempted to correct any/all mistakes that were present in the previous edition. As in the second edition, this third edition is an attempt to be as complete as possible relative to diseases of the head and neck within the context of the atlas format. The format of the atlas remains similar to that of the previous editions, with information provided in acces-sible bulleted statements rather than in a narrative style. The changes in this edition include separate sections on the pharynx and the neck previously subsumed within the section on the oral cavity in the second edition. Various sections have been expanded to include more disease-specific entities including but not limited to odonotgenic lesions/neoplasms in the Oral Cavity Section. Molecular diagnostics has become integral to diagnostic surgical pathology, and I have tried to include as much relevant molecular diagnostic information as it applies to the identification of new diseases/neoplasms, the understanding of disease/neoplastic pathogenesis, and the advances in treatment and prognosis. The illus-trations are a key component of any atlas. To this end,

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vi PrefacetotheThirdEdition

create the Mount Sinai Health System. The Department of Pathology under the leadership of Carlos Cordon-Cardo, MD, PhD, is among the largest in the United States. Once again I am fortunate to be in a department led by an individual who provides an environment that fosters academics, diagnostics, and education.

I would like to acknowledge my brother Barry L. Wenig, MD, my sister Hally Frist, and my uncle Sieg-fried Mayer, MD, as well as the entire extended Wenig and Urrutia families for their steadfast support and love.

I am indebted to the individuals at Elsevier, includ-ing William Schmitt, Kathryn DeFrancesco, Carol

O’Connell, and the entire Elsevier staff for their patience and understanding in awaiting completion of this atlas and for assistance in facilitating the publication of this edition. Thank you.

To Matt Townsend, my “drill sergeant,” for the gru-eling early morning workouts he put me through that allowed me to maintain my physical well-being as well as my sanity in the unique environment of living and working in New York City.

Bruce M. Wenig, MD

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SECTION 6  Major and Minor Salivary Glands

18 Embryology,Anatomy,andHistologyoftheSalivaryGlands,805

19 Non-NeoplasticDiseasesofSalivaryGlands,816

20 NeoplasmsoftheSalivaryGlands,86121 IntraoperativeConsultationinSalivaryGlands

andBiopsyDiagnosisofSalivaryGlandNeoplasms,1050

SECTION 7  External, Middle, and Inner Ear

22 Embryology,Anatomy,andHistologyoftheEar,1075

23 Non-NeoplasticDiseasesoftheEar,108224 NeoplasmsoftheEar,112925 ImmunohistochemistryofMiddleEar

Neoplasms,1189

SECTION 8  Thyroid Gland

26 Embryology,Anatomy,Histology,andPhysiologyoftheThyroidGland,1193

27 Non-NeoplasticDiseasesoftheThyroidGland,1202

28 NeoplasmsoftheThyroidGland,129329 ThyroidGlandPostFineNeedle

AspirationBiopsy(FNAB)-RelatedHistologicChangesandIntraoperativeConsultation,1454

SECTION 9  Parathyroid Glands

30 Embryology,Anatomy,andHistologyoftheParathyroidGlands,1471

31 ParathyroidGlands:GeneralConsiderations,1477

32 Non-NeoplasticLesionsoftheParathyroidGlands,1482

Contents

SECTION 1  Nasal Cavity and Paranasal Sinuses

  1 Embryology,Anatomy,andHistologyoftheSinonasalTract,3

  2 Non-NeoplasticLesionsoftheSinonasalTract,9

  3 NeoplasmsoftheSinonasalTract,81

SECTION 2  Oral Cavity

  4 Embryology,Anatomy,andHistologyoftheOralCavity,221

  5 Non-NeoplasticLesionsoftheOralCavity,230

  6 NeoplasmsoftheOralCavity,273  7 IntraoperativeConsultationinOralCavity

MucosalLesions,384

SECTION 3  Pharynx, Including Nasopharynx, Oropharynx, and Hypopharynx

  8 Embryology,Anatomy,andHistologyofthePharynx,399

  9 Non-NeoplasticLesionsofthePharynx,40710 NeoplasmsofthePharynx,442

SECTION 4  The Neck

11 AnatomyoftheNeck,53712 Non-NeoplasticLesionsoftheNeck,53813 NeoplasmsoftheNeck,563

SECTION 5  Larynx and Trachea

14 Embryology,Anatomy,andHistologyoftheLarynxandTrachea,651

15 Non-NeoplasticLesionsoftheLarynxandTrachea,659

16 NeoplasmsoftheLarynxandTrachea,69417 IntraoperativeConsultationofLaryngeal

Lesions,801

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viii Contents

33 NeoplasmsoftheParathyroidGlands,1494

34 IntraoperativeConsultation(FrozenSection)inParathyroidGlandandParathyroidProliferativeDisease(PPD)/Hyperparathyroidism,1518

SECTION 10  Multiple Endocrine Neoplasia (MEN) Syndromes

35 MultipleEndocrineNeoplasia(MEN)Syndromes,1531

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