Henrik B. Hellquist MD, PhD, SAPath(Stockh), FCAP’s research while affiliated with Haukeland University Hospital and other places

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.

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.

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 mandibular (the latter of which soon fuse to form the lower jaw) being arranged around a primordial mouth cleft. Medial to each olfactory placode a swelling is formed, the medial nasal fold. The fusion of the two medial nasal folds gives rise to the frontonasal process, a precursor of the external nose and nasal septum. Lateral to each olfactory placode, a lateral nasal process on each side forms the groove between the nose and the eye. The groove between the maxillary process and the lateral nasal fold on each side gives rise to the nasolacrimal duct. The olfactory placode forms a pit, which sinks deeper and eventually joins posteriorly with the oral cavity. The pit of the nasal cavity produces ledges on its lateral wall, which are each eventually supported by a bony skeleton to produce the turbinates. Paranasal sinuses bud off the main nasal cavity (Fig. 12.1).

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.

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. There are, however, other diseases of known aetiology in which hydrops may be present as a complication. The common feature of these conditions is presence of inflammatory or neoplastic involvement of the perilymphatic spaces. Thus otitis media complicated by perilymphatic labyrinthitis (see Chapter 3), syphilitic involvement of the labyrinth (see Chapter 8), leukaemic deposits in the perilymph spaces or vestibular schwannoma (see Chapter 11) may be associated with hydrops.

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 predilection for that region and those that pose special diagnostic histological and clinical problems.

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 superficial and deep boundaries of Reinke’s space, respectively. It is suggested that, because Reinke’s space does not possess an adequate lymph drainage, blood products may accumulate in it without resolution and give rise to tissue reactions; together the blood products and their tissue reactions in Reinke’s space constitute the vocal cord polyp and some other lesions of the true vocal cord.

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 salivary gland adenocarcinomas of different types). The exact incidence of each of these types of sinonasal adenocarcinomas is extremely difficult to access as almost every report on the subject has made no distinction between adenocarcinoma from surface epithelium and seromucinous gland adenocarcinomas (apart from adenoid cystic carcinoma). However, one can estimate sinonasal adenocarcinomas to represent from 6% to 13% of sinonasal malignancies.1, 2

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 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 regions is held to indicate “invasion” or “extension” from one of these regions to the other and hence to necessitate a higher, i.e. more serious, grading. The concept of the separate embryological development of the three parts of the larynx is unproven, however. The most frequent site for the localisation of carcinoma is the anterior part of the vocal cords and the diameter of the tumour is usually small. It may be that a similarly small neoplasm happens to arise across the arbitrarily designated boundary of glottis and supraglottis or glottis and subglottis. The behaviour of such a neoplasm is not necessarily more aggressive. Laryngeal neoplasms, however, do possess different innate biological properties of growth activity and aggressiveness, which may be related to original size but cannot be predicted from involvement of more than one region.