Which of the following are true about leukoplakia of the vocal cords?
Leukoplakia of the vocal fold represents a white patch (which cannot be wiped off) on the mucosal surface, usually on the superior surface of the true vocal cord. Rather than a diagnosis per se, the term leukoplakia describes a finding on laryngoscopic examination. The significance of this finding is that it may represent squamous hyperplasia, dysplasia, and/or carcinoma. Lesions exhibiting hyperplasia have a 1 to 3% risk of progression to malignancy. In contrast, that risk is 10 to 30% for those demonstrating dysplasia. Furthermore, leukoplakia may be observed in association with inflammatory and reactive pathologies, including polyps, nodules, cysts, granulomas, and papillomas. Features of ulceration and erythroplasia are particularly suggestive of possible malignancy. A history of smoking and alcohol abuse should also prompt a malignancy workup. In the absence of suspected malignancy, conservative measures are used for 1 month. Any lesions that progress, persist, or recur should be considered for excisional biopsy specimen.
Factors associated with increased incidence of head and neck cancers include all of the following EXCEPT:
Human papilloma virus (HPV) is an epitheliotropic virus that has been detected to various degrees within samples of oral cavity squamous cell carcinoma. Infection alone is not considered sufficient for malignant conversion; however, results of multiple studies suggest a role of HPV in a subset of head and neck squamous cell carcinoma. Multiple reports reflect that up to 40 to 60% of current diagnoses of tonsillar carcinoma demonstrate evidence of HPV types 16 or 18. Environmental ultraviolet light exposure has been associated with the development of lip cancer. The projection of the lower lip, as it relates to this solar exposure, has been used to explain why the majority of squamous cell carcinomas arise along the vermilion border of the lower lip. In addition, pipe smoking also has been associated with the development of lip carcinoma. Factors such as mechanical irritation, thermal injury, and chemical exposure have been described as an explanation for this finding. Other entities associated with oral malignancy include Plummer-Vinson syndrome (achlorhydria, irondeficiency anemia, mucosal atrophy of mouth, pharynx, and esophagus), chronic infection with syphilis, and immunocompromised status (30-fold increase with renal transplant).
Features of oral tongue carcinoma include all of the following EXCEPT:
Tumors of the tongue begin in the stratified epithelium of the surface and eventually invade into the deeper muscular structures. The tumors may present as ulcerations or as exophytic masses. The regional lymphatics of the oral cavity are to the submandibular space and the upper cervical lymph nodes. The lingual nerve and the hypoglossal nerve may be directly invaded by locally extensive tumors. Involvement can result in ipsilateral paresthesias and deviation of the tongue on protrusion with fasciculations and eventual atrophy. Tumors on the tongue may occur on any surface, but are most commonly seen on the lateral and ventral surfaces. Primary tumors of the mesenchymal components of the tongue include leiomyomas, leiomyosarcomas, rhabdomyosarcomas, and neurofibromas. Surgical treatment of small (Tl -T2) primary tumors is wide local excision with either primary closure or healing by secondary intention. The CO2 laser may be used for excision.
Branchial cleft cysts, if enlarged, should be removed because of which of the following:
Congenital branchial cleft remnants are derived from the branchial cleft apparatus that persists after fetal development. There are several types, numbered according to their corresponding embryologic branchial cleft. First branchial cleft cysts and sinuses are associated intimately with the external auditory canal (EAC) and the parotid gland. Second and third branchial cleft cysts are found along the anterior border of the sternocleidomastoid (SCM) muscle and can produce drainage via a sinus tract to the neck skin. Secondary infections can occur, producing enlargement, cellulitis, and neck abscess that requires operative drainage.
All of the following are FALSE about salivary gland neoplasms EXCEPT:
Tumors of the salivary gland are relatively uncommon and represent less than 2% of all head and neck neoplasms. About 85% of salivary gland neoplasms arise within the parotid gland. The majority of these neoplasms are benign, with the most common histology being pleomorphic adenoma (benign mixed tumor). In contrast, approximately 50% of tumors arising in the submandibular and sublingual glands are malignant. Tumors arising from minor salivary gland tissue carry an even higher risk for malignancy (75%). Diagnostic imaging is standard for the evaluation of salivary gland tumors. Magnetic resonance imaging (MRI) is the most sensitive study to determine soft-tissue extension and involvement of adjacent structures. Benign epithelial tumors include pleomorphic adenoma (80%), monomorphic adenoma, Warthin tumor, oncocytoma, or sebaceous neoplasm.
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