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Review
. 2023 Mar;17(1):119-131.
doi: 10.1007/s12105-023-01534-0. Epub 2023 Mar 16.

Top 10 Nested Pattern Head and Neck Lesions to Notice

Abberly Lott Limbach  1 , Deborah J Chute  2
Affiliations
Review

Top 10 Nested Pattern Head and Neck Lesions to Notice

Abberly Lott Limbach et al. Head Neck Pathol. 2023 Mar.

Abstract

Background: Nested is defined as "cellular clusters arranged in small groupings with intervening vascular or stromal networks, lacking lumens or glandular formation." Using this definition, multiple neoplastic and non-neoplastic lesions of the head and neck come into the differential. We have broadly organized the differential diagnosis of "nested" tumors into entities with neuroendocrine differentiation, squamous differentiation, thyroid follicular cell differentiation, and other lesions.

Methods: Review.

Results: Many different entities have a nested appearance and the morphologic, immunohistochemical, clinical, and radiographic features contribute to the differential diagnosis. The different tumors covered in this review include neuroendocrine neoplasms, paraganglioma, middle ear neuroendocrine tumor (formerly known as middle ear adenoma), medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, olfactory neuroblastoma, ectopic pituitary neuroendocrine tumor, hyalinizing trabecular tumor, solid subtype of papillary thyroid carcinoma, solid cell nests/C-cell hyperplasia, necrotizing sialometaplasia, and meningioma.

Conclusion: In this review, we discuss the morphologic and immunohistochemical features of the covered entities as a guide to differential diagnosis when nested-patterned head and neck lesions are encountered.

Keywords: Head and neck; Nested; Neuroendocrine; Thyroid.

PubMed Disclaimer

Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Differential diagnosis of nested entities in head and neck
Fig. 2
Fig. 2
Neuroendocrine neoplasms. A Neuroendocrine tumor (NET) underlying squamous mucosa, H&E, 40x. B NET with nested pattern and neuroendocrine nuclei, H&E 200x. C Neuroendocrine carcinoma (NEC), small cell carcinoma, H&E, 400x. D NEC, synaptophysin, 400x
Fig. 3
Fig. 3
A Paraganglioma (PGL), H&E, 100x. B PGL, sustentacular cells, S100, 400x. C Middle ear NET, H&E, 100x
Fig. 4
Fig. 4
A Medullary thyroid carcinoma (MTC), H&E, 100x. B MTC, Calcitonin, 100x. C Poorly differentiated thyroid carcinoma with mitoses, H&E, 400x
Fig. 5
Fig. 5
Olfactory neuroblastoma. A Nested pattern, H&E, 100x. B H&E, 400x. C Synaptophysin, 200x. D AE1/3, 200x
Fig. 6
Fig. 6
Ectopic pituitary adenoma (PitNET). A H&E, 100x. B H&E, 400x. C Synaptophysin, 100x. D CAM5.2, 100x
Fig. 7
Fig. 7
Hyalinizing trabecular tumor. A Well circumscribed nodule, H&E, 10x. B Nuclear features, H&E, 200x
Fig. 8
Fig. 8
Solid subtype of papillary thyroid carcinoma. A H&E, 100x. B H&E, 400x
Fig. 9
Fig. 9
A Solid cell nests, nested pattern, H&E 50x. B Solid cell nests, nuclear features, H&E, 400x. C C-cell hyperplasia, H&E, 50 × D C-cell hyperplasia, calcitonin, 200x
Fig. 10
Fig. 10
Necrotizing sialometaplasia. Necrosis of tissue with extensive sialometaplasia. H&E, 100x
Fig. 11
Fig. 11
Meningioma, meningothelial, whorled pattern, H&E, 200x
See this image and copyright information in PMC

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