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Atlas of
HEAD AND NECK
PATHOLOGY
THIRD EDITION
Bruce M. Wenig, MD
Chairman
Department of Diagnostic Pathology and Laboratory Medicine
Mt. Sinai Beth Israel, Mt. Sinai St. Luke’s and Mt. Sinai Roosevelt
Vice Chairman for Anatomic Pathology
Department of Pathology
Mt. Sinai Health System
Professor of Pathology
Icahn School of Medicine at Mount Sinai
New York, New York
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ATLAS OF HEAD AND NECK PATHOLOGY, THIRD EDITION ISBN: 978-1-4557-3382-8
Copyright © 2016 by Elsevier, Inc. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the
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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
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
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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 Schmidt
Content Development Specialist: Katie DeFrancesco
Publishing Services Manager: Jeff Patterson
Project Manager: Carol O’Connell
Design Direction: Maggie Reid
Printed in China
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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 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 greatgrandmother whose strong will and opinions are sorely
missed by everyone who knew her.
To my uncle-in-law, Juan José Urrutia, MD (19322014), the standard-bearer of his family who lived an
exemplary life; his quiet and confident demeanor served
as example for all of his family.
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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 committed 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 families in treating diseases that previously were considered
to be untreatable/incurable. For pathologists, advances
in molecular biology have provided a better understanding 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 spectrum 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 accessible 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 illustrations are a key component of any atlas. To this end,
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 Otorhinolaryngic 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 divisions 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 Pathology and Laboratory Medicine at Continuum Health
Partners in New York City that included Beth Israel
Medical Center, St. Luke’s Hospital, and Roosevelt Hospital 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 surgical 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 providing 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 Culliney, and Jean-Marc Cohen, creating one of the strongest 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
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vi
Preface to the Third Edition
create the Mount Sinai Health System. The Department
of Pathology under the leadership of Carlos CordonCardo, 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 Siegfried 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 grueling 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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Contents
SECTION 1 Nasal Cavity and
Paranasal Sinuses
SECTION 6 Major and Minor
Salivary Glands
1 Embryology, Anatomy, and Histology of the
Sinonasal Tract, 3
2 Non-Neoplastic Lesions of the Sinonasal
Tract, 9
3 Neoplasms of the Sinonasal Tract, 81
18 Embryology, Anatomy, and Histology of the
Salivary Glands, 805
19 Non-Neoplastic Diseases of Salivary
Glands, 816
20 Neoplasms of the Salivary Glands, 861
21 Intraoperative Consultation in Salivary Glands
and Biopsy Diagnosis of Salivary Gland
Neoplasms, 1050
SECTION 2 Oral Cavity
4 Embryology, Anatomy, and Histology of the
Oral Cavity, 221
5 Non-Neoplastic Lesions of the Oral
Cavity, 230
6 Neoplasms of the Oral Cavity, 273
7 Intraoperative Consultation in Oral Cavity
Mucosal Lesions, 384
SECTION 3 Pharynx, Including
Nasopharynx, Oropharynx, and
Hypopharynx
8 Embryology, Anatomy, and Histology of the
Pharynx, 399
9 Non-Neoplastic Lesions of the Pharynx, 407
10 Neoplasms of the Pharynx, 442
SECTION 4 The Neck
11 Anatomy of the Neck, 537
12 Non-Neoplastic Lesions of the Neck, 538
13 Neoplasms of the Neck, 563
SECTION 5 Larynx and Trachea
14 Embryology, Anatomy, and Histology of the
Larynx and Trachea, 651
15 Non-Neoplastic Lesions of the Larynx and
Trachea, 659
16 Neoplasms of the Larynx and Trachea, 694
17 Intraoperative Consultation of Laryngeal
Lesions, 801
SECTION 7 External, Middle, and
Inner Ear
22 Embryology, Anatomy, and Histology of the
Ear, 1075
23 Non-Neoplastic Diseases of the Ear, 1082
24 Neoplasms of the Ear, 1129
25 Immunohistochemistry of Middle Ear
Neoplasms, 1189
SECTION 8 Thyroid Gland
26 Embryology, Anatomy, Histology,
and Physiology of the Thyroid Gland, 1193
27 Non-Neoplastic Diseases of the Thyroid
Gland, 1202
28 Neoplasms of the Thyroid Gland, 1293
29 Thyroid Gland Post Fine Needle
Aspiration Biopsy (FNAB)-Related Histologic Changes and Intraoperative
Consultation, 1454
SECTION 9 Parathyroid Glands
30 Embryology, Anatomy, and Histology of the
Parathyroid Glands, 1471
31 Parathyroid Glands: General
Considerations, 1477
32 Non-Neoplastic Lesions of the Parathyroid
Glands, 1482
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viii
Contents
33 Neoplasms of the Parathyroid
Glands, 1494
34 Intraoperative Consultation (Frozen Section)
in Parathyroid Gland and Parathyroid
Proliferative Disease (PPD)/
Hyperparathyroidism, 1518
SECTION 10 Multiple Endocrine
Neoplasia (MEN) Syndromes
35 Multiple Endocrine Neoplasia (MEN)
Syndromes, 1531
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