(18.1) Pulmonary Path IV (Singh) Flashcards
Why do we include the nose, nasopharynx and paranasal sinuses in pulmonary path?
All these structures are lined by respiratory epithelium
They are vulnerable to the same enviornmental factors
What are the normal histologic features of the nose, nasopharynx and paranasal sinuses?
Respiratory epithelium
Mucous glands
Lymphoid aggregates
What are the common causes of viral rhinitis/sinusitis?
Rhinovirus
Coronavirus
Adenovirus
Echovirus
Symptom of viral rhinitis/sinusitis?
Clear rhinorrhea
What typically causes bacterial rhinitis/sinusitis?
Superimposed infection of streptococcus pneumoniae or haemophilus influenzae
Symptom of bacterial rhinitis/sinusitis?
Thick, purulent nasal secretions
What is a common manifestation of chronic rhinitis/sinusitis?
Inflammatory sinonasal polyps
What are the histologic hallmarks of inflammatory sinonasal polyps?
Edema in the stroma
w/ Eosinophilic infiltrates
What is an example of a consequence from chronic obstruction of a sinus?
Mucocele
What is a dental consideration with sinusitis?
The pathway of infection to the sinuses!
Normal oral flora may enter the maxillary sinus by tracking along periapical tissues (oral flora)
What are the 4 major sinuses, and where are they located anatomically?
Frontal sinus
Ethmoidal sinus
Maxillary sinus
Sphenoidal sinus
What causes allergic fungal sinusitis?
Occurs as a result of hypersensitivity of fungal organisms (eg aspergillus) that have colonized the sinus tract
What are the histologic features of allergic fungal sinusitis?
Allergic mucin
May see fungal hyphae
+/- mycetoma (fungal ball)
What typically causes acute invasive sinusitis?
Zygomycosis species (mucor)
What population does acute invasive sinusitis target?
Diabetic
or
Immunosuppressed
What is the severity of acute invasive sinusitis?
VERY emergent situation
Requires IV antifungal therapy to prevent extension into brain or sepsis
Granulomatosis with polyangiitis (GPA) typically affects?
Middle aged adults
Where can GPA affect anatomically?
Nasal passages/sinuses
Lungs
Kidney
What is the unique histology associated with GPA?
Granulomatous inflammation/vasculitis
Classic “necrobiotic” necrosis
What are the benign tumors of the nose, sinuses and nasopharynx?
Nasopharyngeal angiofibroma
Sinonasal (Schneiderian) papilloma
What are the malignant tumors of the nose, sinuses and nasopharynx?
Olfactory neuroblastoma
NUT midline carcinomas
EBV related malignancies (nasopharyngeal carcinoma and extranodal NK/T cell lympoma)
Nasopharyngeal angiofibroma
What is it?
Demographic?
Nasopharyngeal polypoid mass
Young men
What are the unique histologic features of nasopharyngeal angiofibroma?
Vascular fibrous core lined by benign epithelium
SIMILAR TO spongiosum of erectile tissue
What is the MAJOR association of nasopharyngeal angiofibroma?
Familial adenomatous polyposis (FAP)
What is familial adenomatous polyposis (FAP)?
Caused by a mutation in APC gene
Typically inherited
Characterized as numerous colon polyps that develop in childhood and adolescence
***Inevitable progression to carcinoma by middle age
Why does it matter that familial adenomatous polyposis (FAP) is HIGHLY associated with nasopharyngeal angiofibroma?
Because patients that have NO family hx. of FAP may have had a sporadic mutation in APC gene that would predispose them to colon cancer
If the physician observes nasopharyngeal angiofibroma, should look into genetic testing and performing a colon biopsy to evaluate risk of colon cancer
What are the three types of sinonasal (Schneiderian) papillomas?
Exophytic
Endophytic
Oncocytic
What is a common name for olfactory neuroblastoma?
Is it benign or malignant?
“Small round blue cell tumor”
Malignant
What is the origin of olfactory neuroblastoma?
Neuroectoderm in the superior nasal passage
(Neuroendocrine tumor)
What are the 2 age peaks for olfactory neuroblastoma?
Adolescence
Middle age
What is the classic radiographic presentation of olfactory neuroblastoma?
“Dumb-bell” shaped tumor
(penetrates through cribiform plate)
What is the most important clinical presentation of nasopharyngeal carcinoma?
Majority of cases present in the neck as cervical lymph node metastasis
*This is stange because the origin of nasopharyngeal carcinomas occur in the nasopharynx
(Double arrow=cervical lymph node metastasis, Single arrow=origin of nasopharyngeal carcinoma)
What are the risk factors for nasopharyngeal carcinoma?
Age
EBV
Chinese/Southeast asian adults
Young african children