Robert A. Robinson, M.D., Ph.D., University of Iowa, Iowa City, IA
This course will present cases that focus on difficult challenges faced in cytology and surgical pathology of the head and neck. The focus points of the course will be to develop appropriate differential diagnoses based on conventional cytologic smears or histologic morphology and to narrow the differential to the correct choice. It is packed with useful tips to aid the practicing pathologist solve common problems in the diagnosis of head and neck tumors.
Directed at pathologists in practice as well as residents, the course is designed to help the course participant quickly and confidently master some of the most common problems encountered in head and neck pathology. The course will accomplish its goals by teaching and reviewing basic fundamental approaches in cytology and surgical pathology of the head and neck using key cases available for review to pre-registrants prior to the meeting as virtual slides on the USCAP website. The course director believes that by correlating the cytologic and surgical pathology findings of these cases and their differential, a better understanding of each discipline, cytology and surgical pathology, will be realized. An important part of the course will be the interaction between the participants and the course director. Ample time will be allotted to answer questions that arise.
Using a case-study approach, the emphasis of the course will be on the development of a practical differential diagnosis of 6 common categories of findings on fine needle aspirates. Following the presentation of the cytologic findings and differential diagnosis, the corresponding surgical pathology material will be discussed and correlated. Handouts will be provided at the meeting covering text material presented in the course along with a printed version of the text from the PowerPoint presentation that participants can follow along during the presentation.
The six common categories to be discussed are: 1) Minimally atypical squamous cells found in cystic neck masses. The differential diagnosis includes: metastatic squamous carcinoma, branchial cleft cyst and Warthin tumor. 2) Neuroendocrine tumors in aspirates of the head and neck of adults. The differential diagnosis includes: small cell carcinoma, Merkel cell carcinoma, primary neuroendocrine carcinoma of the parotid and other 'blue cell' tumors. 3) Hyaline and myxoid lesions with basaloid cells in salivary gland aspirates. The differential diagnosis includes: pleomorphic adenoma, adenoid cystic carcinoma and basal cell neoplasms of the salivary gland. 4) Mucinous lesions of the head and neck. The differential diagnosis includes: mucoepidermoid carcinoma and mucocele. 5) Oncocytic lesions of salivary gland. The differential diagnosis includes: oncocytoma, oncocytosis, oncocytic carcinoma and Warthin tumor. 6) Mixed basaloid and squamous cell neoplasms of the head and neck. The differential diagnosis includes: basaloid squamous carcinoma, pilomatrixoma and poorly differentiated squamous carcinoma.
Besides developing differential diagnoses in cytology, differentials will be developed and discussed in all six major categories for histologic findings as well. While in some specific lesions the histologic findings are straightforward and can quickly clarify the cytologic differential diagnosis, in many cases the corresponding surgical excision itself raises its own set of difficult problems in the differential diagnosis. In addition, where appropriate, the course director will update the participants with the newest information on the latest basic science apropos to the case, particularly when this information can be exploited for practical diagnostic use.
The course objectives for the participants are to: 1 ) explain to categorize fine needle aspirate and surgical pathology specimens from the head and neck into a diagnostic group that leads to the building of a differential diagnosis, 2 ) apply inclusionary and exclusionary rules based on morphologic findings that quickly narrow the differential diagnosis in head and neck tumors and 3) State the histologic and cytologic correlates of each of the lesions in the differential diagnosis.
At the end of the course the participant will be more comfortable with cytologic and histologic diagnosis in some of the most difficult areas of head and neck pathology. After the meeting, all participants will receive web access to the PowerPoint presentation given at the Annual Meeting along with the text portion of the syllabus.
(LAST SCHEDULED PRESENTATION) This course may be used for CME credits or SAM credits.