Henrik B. Hellquist MD, PhD, SAPath(Stockh), FCAP's research while affiliated with Haukeland University Hospital and other places
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Publications (43)
The temporal bone is affected in the majority of fractures of the base of the skull. Although such lesions are frequent at autopsy, there has hardly been any study of fractures of the temporal bone in pathological material and what knowledge there is has largely been derived from clinical and radiological observations.
In this chapter an account of the histopathology of cervical lymph nodes is provided in respect of the role of the pathologist in the examination of neck dissection specimens from patients with cancer of the head and neck. The diagnostic pathology of other lymph node lesions such as malignant lymphoma is beyond the scope of this work.
Squamous cell carcinoma, although rare, is the commonest malignant neoplasm of the nasal vestibule, which is a region covered by modified hair-bearing skin. The other two important malignant neoplasms of the skin, malignant melanoma and basal cell carcinoma, also occur here, but with less frequency.
It is doubtful whether a lesion composed entirely of adult fibrous tissue with collagen and sparse fibrocytes is ever neoplastic; it is usually the endresult of an inflammatory process. Occasionally a fibroblastic form of meningioma may be so poorly cellular as to resemble a fibrous tumour. In such cases the concentrically laminated arrangement of...
Ménière’s disease is an affection of both the hearing and balance organs of the inner ear, characterised by episodes of vertigo, hearing loss and tinnitus. Its pathological basis has become firmly established as “hydrops”, i.e. distention of the endolymphatic spaces of the labyrinth by fluid. The cause of the hydrops in Ménière’s disease is unknown...
Swelling and polyposis of the mucosa of the nose and paranasal sinuses are produced in many different pathological conditions, both benign and malignant. Histological investigation is essential for accurate diagnosis.
Squamous cell papillomas are frequent in the larynx of adults. They also found in children where, because of the much narrower diameter of the airway, the more widespread involvement in the larynx and the greater tendency to recurrence, the symptoms are more serious, and treatment is more urgent and difficult. It is thus customary to divide the con...
Most cases of carcinoma of the nasal cavity and paranasal sinuses — a rare entity — are of epidermoid type so that the numbers of non-epidermoid carcinomas are very small indeed. Sinonasal adenocarcinomas are primarily of two types, one originating from the surface epithelium and the other from mucosal seromucinous glands (most of the latter being...
Reinke’s space is a potential space of the true vocal cord bounded above and below by the junctions of squamous with respiratory epithelium, anteriorly by the anterior commissure, and posteriorly by the tip of the vocal process of the arytenoid. The squamous epithelium of the vocal cord and the elastic tissue of the vocal ligament represent the sup...
Deposits of cerebral tissue are occasionally seen in the nose. If they are not in direct communication with the brain they are called gliomas. It must be stressed, however, that these lesions are not actually neoplasms of glial tissue, but rather heterotopic brain tissue.
The majority of squamous carcinomas of the larynx are composed of epidermoid elements with definite cytological changes of malignancy. In a few cases a major portion of the neoplasm shows a mesenchymal appearance without squamous cell differentiation — the spindle cell carcinoma. At the other extreme of the spectrum of malignancy is a highly differ...
The TNM system of staging of laryngeal carcinoma divides laryngeal tumours into supraglottic, glottic and subglottic.1 The terms are not used purely as anatomical descriptions, but, more than this, to designate three embryologically distinct regions, each of which gives rise to its own type of neoplasm. Origin of a carcinoma from two adjacent regio...
Congenital anomalies of the larynx are uncom mon. The reason for this may in part be that the patency of the laryngeal airway is necessary for life. This is not the whole explanation, because serious laryngeal anomalies are rare in autopsies performed on neonatal deaths and stillborn infants.
Benign cartilaginous neoplasms of the nose are surprisingly infrequent although hyaline cartilage constitutes the whole anterior part of its framework. Ringertz1 found only two examples in his series of 391 tumours of the nose and paranasal sinuses. Seven chondromas were found in another review of 256 nasal neoplasms,2 three being in the nasal sept...
Vascular neoplasms arise from either lymphatic or blood vessels. Lymphangiomas are rare and usually arise from extension of cystic hygroma of the neck into the larynx (see Chapter 45). In a series of 160 cystic hygromas, ten (6%) extended into the larynx.1 Lymphangioma confined to the larynx is very rare. Reported cases have presented in young chil...
Lymphomas have two general forms: Hodgkin’s and non-Hodgkin’s. We are not aware of a case of Hodgkin’s lymphoma having occurred in the nose and paranasal sinuses. In the upper air and food passages the neoplasms considered under the generic term of non-Hodgkin’s lymphoma are most commonly seen in the palatine tonsils. Surprisingly, in view of the a...
The lymphoid tissue of the entire Waldeyer’s ring, the tonsils included, has no afferent lymphatic channels leading to it. This anatomical feature explains the rarity of metastatic carcinoma in the tonsils (see below). Any carcinoma in the tonsils should be considered primary until proven otherwise. Before the age of immunohistochemistry it was fre...
This is often called Rendu-Osler-Weber disease and even sometimes Weber-Rendu-Osler disease.
The development of the inner structure of the nose and paranasal sinuses is initiated by the formation in the second month of an ectodermal thickening, the olfactory placode, on each side. These are each placed above and medial to a maxillary swelling, which has been formed above a mandibular swelling, the four swellings, two maxillary and two mand...
Angiofibroma, or juvenile nasopharyngeal angiofibroma, is a fibrous and vascular tumour-like swelling of the nasopharynx, which occurs only in young males.
Most of the benign and malignant epithelial neoplasms of the larynx are epidermoid, but a small proportion are not. The latter may arise from the respiratory epithelium, which covers most of the larynx, or from the cells lining the subepithelial glands, which are abundant in the larynx, particularly in the false cord and adjacent to the saccule.
The external ear is a specialised appendage of the skin, so that its neoplasms are most frequently those derived from skin. Bony neoplasms also occur, as would be expected from the presence of bone nearby, but the cartilage of the ear seems to have no neoplastic propensity. The following account will deal only with those tumours that have a predile...
Benign epidermoid neoplasms of the nasopharynx, i.e. everted and inverted papillomas, are rare. There has been an occasional report of inverted papilloma arising in that situation, but, since the boundary between nose proper and nasopharynx is not clear-cut, it seems possible that these may be posteriorly situated nasal lesions.
Infection of the middle ear causes not only generally known inflammatory changes but also others peculiar to the site. Otitis media is one of the most common of all diseases, particularly in young children. The clinical forms of the acute and chronic conditions correspond to the pathological changes, but intermediate or mixed states are frequent. P...
The basic outlines of development of the larynx are clear and uncontroversial. It is accepted that the epithelium of the larynx arises from the upper end of an outgrowth from the endoderm of the ventral wall of the pharynx. In growing caudally this outgrowth eventually produces the trachea, and bifurcates to produce the bronchi and lungs.
The ear is not a single organ, but two, being the peripheral receptor site both for stimuli derived from sound waves and for changes of posture. The structures subserving both of those functions are developed from an invagination of ectoderm early in embryonic life — the otocyst — to produce the epithelia of the membranous labyrinth of the inner ea...
The vast majority of malignant epithelial neoplasms of salivary glands can be allocated to the categories of acinic cell carcinoma, mucoepidermoid carcinoma or adenoid cystic carcinoma. All of the other neoplasms described in this chapter are rare.
A large number of infectious agents have been identified in the nose, including bacteria, viruses, fungi and protozoa. The relationship of the infecting agents to pathological changes may be summarised under three headings:
1.
Colonisation.
2.
Transmission.
3.
Association with local inflammatory change.
Pagef’s disease (osteitis deformans) is a common condition affecting particularly the skull, pelvis, vertebral column and femur in people over 40 years of age. The cause is not yet certain, but the presence in many cases of paramyxovirus-like structures seen within osteoclasts has prompted the suggestion that Pagefs disease may be of viral aetiolog...
The hypopharynx extends from the level of the hyoid bone above to that of the lower border of the cricoid cartilage below. For purposes of classification of the position and extent of carcinoma, the hypopharynx is divided into three areas:
1.
Pharyngo-oesophageal junction (postcricoid area).
2.
Piriform sinus.
3.
Posterior pharyngeal wall.1
The nasopharynx (nasal part of the pharynx, epipharynx, post-nasal space) lies behind the nose, with which its lining and cavities are continuous. It has an arbitrary lower level at the posterior edge of the soft palate. The bony superior and posterior walls make a concavity composed of the body of the sphenoid above and the atlas and axis cervical...
In the vestibule and nostril, papillomas are usually stratified squamous arising on the skin surface. Rarely do they recur after simple removal, and malignant transformation is seldom a problem. Abnormal hyperplastic changes of the epithelium are frequent, but if similar criteria of assessment for possible cancerous or precancerous change are used...
The important action of the larynx is that of opening and closing the vocal cords. Any disturbance of this process is observed clinically as a voice disorder and, on laryngoscopy, as a failure of movement of the vocal cord. Inability to abduct the vocal cord is a frequent manifestation of such paresis.
Although many modern laboratory techniques such as cytopathology, immunohisto chemistry, electron microscopy, frozen sections, chromosomal analysis and various molecular biological methods are available for the diagnosis of salivary gland neoplasms, routine haematoxylin and eosin-stained sections are still the most important and will in the majorit...
The palatine tonsil is derived from the second pharyngeal pouch endoderm, which, like that of all the pharyngeal grooves, except the first, disappears early in development. A small recess, the tonsillar fossa, develops and the endodermal cells at its fundus proliferate. They are soon invaded by mesodermal cells and the closely associated cells of t...
The middle ear is only occasionally the site of a new growth. Because of its deep-seated position, primary malignant tumours of the middle ear do not usually manifest themselves until they are well advanced. Table 5.1 lists the developmental tumourlike anomalies and neoplasms that have been located there.
Infection of the inner ear may be produced by viruses, bacteria, treponemes or fungi.
The major salivary glands arise by budding from oral ectoderm, with the possible exception of the submandibular glands, which may be of endodermal derivation. The anlage for the parotid and submandibular glands appears in the sixth/seventh week; the sublingual gland appears in the ninth. The glands migrate and have reached their final position by a...
The cellular constituents of the inner ear, apart JL from bone are, for the most part, fully differentiated non-mitotic structures — nerve cells and sensory epithelia — so that neoplasms would not be expected to arise in them. Primary neoplasms are indeed rare except for vestibular schwannoma.
Angioma, including haemangioma and lymphangioma, is the most common benign mesenchymal salivary gland tumour (45%), and represents about 50% of all salivary gland tumours in children, but less than 5% in adults. The age peak for angiomas is in the first and second decades of life. Only 10% of mesenchymal salivary gland tumours are sarcomas (see bel...
In this chapter a variety of non-neoplastic conditions will be considered. Inflammation of the middle ear is dealt with separately (see Chapter 3). with those occurring elsewhere on the skin. Others are specific to or most common in the region of the external ear and only these will be considered here.
The larynx is subject to infections caused by a wide variety of organisms. Table 30.1 lists the bacterial, viral and fungal infections that a review of the literature shows the larynx to have endured from time to time. Those infections that are represented by only a very small number of case reports in the literature have not been listed. In spite...
Most of the clinically important malformations affecting the ear involve the inner ear. For convenience a short section here describes the malformations of the middle ear.
Citations
... At the pyriform fossa, lymphocytes located immediately beneath the epithelium occasionally form lymphoid follicles with rich lymphatic vessel plexus. The submucosa contains glands made up of both mucous and serous acini that open on the surface by occasional ducts [1]. ...
... Exostosis are multiple, bilateral, appear as wide based and smooth lesions of the EAC and are usually considered to be a reactive condition secondary to multiple cold-water immersions or recurrent otitis externa. 9,10 There are limited histopathological studies done for osteoma and exostosis as these lesions are drilled during surgical removal. Exostosis are concentric, dense layers of subperiosteal bone with abundant osteocytes, lacking fibrovascular channels covered with periosteum and squamous epithelium. 1 Studies by Fenton et al suggested that fibrovascular pathway is a characteristic feature of osteoma, and could also be found in exostosis also and so it could not be differentiated histopathologically. 2 In some cases they might also occur together. ...
... The subepithelial tissue in both the NAM and PSM consisted of loose connective tissue containing blood vessels and glands of varying sizes and numbers. Different authors describe an increased vascularization of the nasal mucosa compared to the paranasal sinuses mucosa in general [40,[44][45][46]. Large veins in the nasal cavity have a high capacity for blood accumulation, which can lead to a severe swelling of the nasal mucosa [45,46]. ...
