22. Pulmonary Path 4 Flashcards
Nose, nasopharyxn and the paranasal sinuses are all similarly lined by respiratory type eptihelium and subjected to the same environmental exposures. Normally they will have resp. epi (ciliated and goblet cells), mucous glands and what *** unique aggregates?
Lymphoid aggregates
Rhinitis and sinusitis= rhinosiniusitis is an inflammatory condition caused by infection or allergic route. Infectious can be d/t viral such as rhinovirus, coronavirus, adenovirus, echovirus and have a runny nose called?
CLEAR- rhinorrhea
If someone has bacterial rhinosinusitis (cold) it is usually due to a superimposed infection, meaning initially had a viral infection which gave opportunity to bacterial infection, usually what two?
S. pneumoniae
Haemophilus influenzae
Bacterial sinusistis will present with what type of secretions as opposed to viral which is clear?
thick purulent (green/yellow) nasal secretions
Allergic rhinosinutsitis is a type 1 HS reaction as seen with allergies to pollens, mold, danger and will see inflam infiltrate with eosinophils and what in the airwyas?
edema and rhinorrea
Chronic rhinitis/sinusitis via chronic viral or allergis sinusitis can lead to inflammatory?
sinonasal polyps
Infammatory sinonasal polyps has an epithelial lining that is not thickened, it is a swollen polyp allergic in nature showing esoinophilic infilatrates, and is basically edema in the?
stroma
Obstruction can occur with sinusitis leading to empyema which is a purulent exudate or can lead to what, which is a cyst lined with resp epithelium with mucus fluid?
Mucocele
The pathway of infection can enter the maxillary sinus by tracking along periapical tissues (from the oral flora up to the inf. maxillary sinus), advanced sinusitis can secondarily do what?
spread infection
Sinusitis in the ethmoid sinus (hugs the medial aspect of our face) can spread to septum as well as WHAT common area?
Periorbital region = cellulitis
Sinusitis in the frontal sinus usually or can extend posteriorly to the brain, causing brain abcess, subdural abscess, and more commonly?
meningitis
epidural abscess
Fungal sinusitis occurs as a results of HS to fungal organisms (aspergillus) that colonized in the sinus tract, histologically can see thick compact allergic mucus with eosinophils and their break down product (charcot leyden crystals) as well as? 2
fungal hyphae
and SOMETIMES mycetoma (fungal ball)
What is a aspergillus mycetoma?
a fungal ball of aspergillus hyphae
What is another type of fungal sinusitis which occurs in diabetics or IC patients, due to Zygomycosis (Mucor) leading to emergent situation requiring IV antifungal therapy to prevent extension into brain or SEPSIS?
Acute invasive sinusitis **worst type
can involve orbit and brain=poor prognosis
What is sen in middle aged adults and can affect nasal passages and sinuses causing ulceration, necrosis, perforation of the septum-usually first time the disease is recognized in the nose?
granulomatosis with polyangitis (GPA) or Wegener granulomatosis
Granulomatosis with polyangitis can also affect the lungs and kidneys and histologically can see granulomatous inflammation with vasculitis with what classic phenomon seen on bx which is due to vaporized nuclei?
Necrobiotic necrosis
What benign tumor of the nasopharynx is a polypoid mass that occurs in young men which may recur and bleed and histologically has vascular fibrous core lined by benign epithelium?
Nasopharyngeal angiofibroma (looks like PP tissue)
Nasopharyngeal angiofibroma is highly associated with what familial disease, and is usually the first appearance of the dz?
Familial adenomatous polyposis FAP
Familial adenomatous polyposis FAP caused by a mutation in the APC gene, usually inherited- numerous colon polyps develop in childhood and adolescence, with invariable progression to?
invasive carcinoma by their 50s
*nasal polyp can be first sign of APC/FAP
What benign tumor occurs in middle aged men>women and has 3 types, exophytic, endophytic (10% become malignant) and oncocytic?
Sinonasal “Schneiderian” papilloma
What malignant tumor is denoted as small round blue cell tumor arising from neuroectoderm in the superior nasal passage with a bimodal distribution occuring in adolescence and middle age?
Olfactory neuroblastoma
Olfactory neuroblastoma is in the superior nasal passage, so sometimes it will penetrate (since malignant) the cribriform plate, forming what characteristic shaped tumor?
dumbbell shaped tumor
What malignant tumor is essentially squamous carcinoma, but has a keratinizing and nonkeratinizing form, as well as basophilic lymphoid tissue (formerly lymphoepithelioma)?
Nasopharyngeal carcinoma
Nasopharyngeal carcinoma arises in the nasopharynx but the majority of cases present in the neck as?
cervical LN metastasis b/c the actually lesion is usually much smaller than the metastasis
Nasopharyngeal carcinoma may be hereditary, and due to age and EBV, seen in chinese/southeast asian adults (smoked fish ingestion) or young EBV related african children. What two commonalities is see on histo?
nonkeratinizing SCC
POSITIVE for EBER-1 (in situ hydridization)
what is another EBV related tumor increased incidence in asia and latin american at any age but peaks in middle age, and can cause necrotic destruction of paranasal sinuses?
Extranodal NK/T cell lymphoma
Extranodal NK/T cell lymphoma has systemic signs including fever, night sweats, and weight loss, however the prognosis depends on?
stage and symptoms
**biopsy showing necrosis **also EBER +
The three squamous lesions of the larynx include cancer on vocal cord, papilloma and?
singers node
What tumor is an expansion of soft tissue underlying the vocal fold (rienkes space) and is glrossly soft and translucent?
Vocal cord nodules/ Singer nodules
Singer nodules can damage the vocal cords either due to thelesion or due to the excision of the lesion- usually benign*, histologically you can see edema and loose stroma underlying ?
benign squamous epithelium
Laryngeal squamous papilloma is a benign squamous neoplasm with papillary appearance, grossly is friable papillary mass and has a strong association with what organism?
HPV types 6/11
Laryngeal squamous papilloma can be solitary or in association with recurrent respiratory papillomatosis, histologically benign or mild atypical squamous epithelium with multiple?
papillae
In recurrent respiratory papillomatosis, occuring in children and adolescents, it is also associated with HPV 6/11 but is thought to be acquired via?
first born vaginal delivery from a mother under 20
can diffusly involve lungs but malignant progression less than 1%
What carcinoma is a squamous carcinoma mostly seen in men over 60, with a strong association of smoking, alcohol and HPV infection? (see keratin pearls and crater/indentation showing invasion)
Laryngeal Carcinoma
Smoking and alcohol related to laryngeal carcinoma have a ?
synergistic influence (multiplicative)
Otitis media is typically due to bacterial and will see a cloudy, bulding tympanic membrane with no cone of light. What organisms for otitis media? (SMH)
Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae
Chronic otitis media occurs in older diabetics and is usually due to what organism?
pseudomonas aeruginosa
What is a cystic lesion that arises in chronic otitis media lined by benign squamous epithelium with trapped kertin debris?
cholesteatoma
cholesteatoma is a reactive process, not a neoplasm but can enlarge and erode adjacent bone, on histo you see reactive squamous reaction with loose?
keratin
What is abnormal bone deposition, typically at the stapedial footplate, causing conductive eharing loss usually due to AD inheritance pattern?
otoslcerosis
Branchial cysts are most often in young adults and most frequently arise from 2nd branchial arch next to SCM, histologically what can be seen?
simple cyst lined by squamous or resp. epi surrounding fibrous tissue +/- lymphoid tissue
MC neck tumors in children and adolescents are thyroglossal duct and branchial cleft cysts, however in adults what is the most common? Why is this important?
MC neck cyst in adults is metastatic cystic carcinoma
**age will determine whether neck cyst is cancer or not
What is a cyst that is remnant nests of tissue from thyroid migration with cystic change, can see thyroid follicles with pink colloid in middle?
Thyroglossal duct cyst
Carotid body tumor is a parasympathetic paraganglioma, tumors of neural crest origin arising from autonomic paraganglia: paravertebral and paraganlia related to vessels such as?
carotid body tumors
carotid body tumors may arise sporadically, or may be associated with MEN2, what type of ‘sign’ can be seen on imaging?
Lyre (instrument) sign
carotid body tumors have nests of cells (zellballen) which are demonstrated with what stain that highlights supporting sustentacular cells?
S100 stain
carotid body tumors have a prognosis of 15-40% will be malignant but cannot tell via histology, can only tell by?
time-see if they invade/metastasize
Pattern of bronchopneumonia is the MC, we will see it as viral, bacterial, atypical, etc. What is a characteristic finding on radiology?
Tree in bud (branch with buds coming off) - centered around airways ***multilobar
Lobar pneumonia, which is due to more aggressive bacteria like S. aureus and Klebsiella pneumoniae and gram negatives, can show agressive consolidation on radiography known as?
Bulging fissure sign *stays in single lobe
Abscess formation is seen in lobar pneumonia with an airfluid level = which is characteristic of ?
cystic space/asbcess
Normal lungs have airways distributed centrally with gas filled alveolar parenchyma occupying the peripheral lung fields (dark). In bronchiectasis there is an abnormal persistent widening of the airways often with extension?
into the peripheral lung fields (white in dark areas close to pleural surface)
Normally, airway markings are central, in bronchiectasis or situs inversus d/t kartagener syndrome with primary ciliary dyskinesis, CF, ABPA, tuberculosis or youngs syndrome, what can be seen
abnormal dilation and extension of airway spaces into peripheral fields
central Bat wing means white in the middle to out and peripheral bat wing means white around the outside, dark in the middle. Pulmonary edema, pneumoias (viral), HS pneumonitis, inhalation injury and anything favoring what vascular/airway involvement?
Proximal (batman is white)
Reverse bat wing infiltrates can be seen in fibrosis, idopathic pulmonary fibrosis, sarcoidosis, is more at the base and or periphery, and occurs in anything that favors?
peripheral involvement (batman is black)
hypersensitivity pneumonitis follows the airways (centrally white batwing) while sarcoidosis follows WHAT, which increases pleural involvement forming a reverse batwing (peripheral black in)?
Lymphatics
Pulmonary edema gives us batwing on radio because of the backup from site of occlusion (hydrostatic), backing up from left heart chambers (CHF), why does ARDS give us white out on imaging?
ARDS is associated with white out because it is permeative - all alveoli fill at the same time - occuring in the entire lung
What tumor is fibrous tissue with benign glandular epithelium around hyaline cartilage- coin lesion on CT, fine marble with smooth edges **POPCORN CALCIFICATION?
hamartoma
If you see a laminated, diffuse lesion on CT, you should think of old?
granulomas
Worrisome for Malignancy?
Larger size
rate of growth (increasing rapidly)
Solid nature of tumor (more solid =worse)
Irregular borders of tumor
If one sees calcification is it more likely benign or malig?
BENIGN mostly
Patient characteristics for malignancy?
Age of <35 less likely cancer
Smoker**
history of ?
malignancy - metastasis
What are the guidlines that basically determines if one should biopsy, have a follow up imaging or be left alone?
fleischner guidelines
Which tumor of the lungs willNOT follow pattern of suspected malignant features?
mucinous adenocarcinoma &adenocarcinoma in situ (can look like pneumonia/ be bilateral)
Adenocarcinoma in situ is know to have what tpye of appearance?
ground glass appearance
Invasive adenocarcinoma is a solid tumor that entraps the airway into the tumor, preserving them, what can be seen radiographically?
Bubble lucencies
SCC is a solid magnifying tumor that is commonly seen with what on imaging?
cavitation
Resorptive atelectasis reflects the radiating pattern of the airways, something is clogging the airway leading to the lungs collapse, what often occurs centrally due to its assocaition with damage airway epithelium?
Squamous carcinoma (white keratinized nodule occluding airway)
Endobronchial tumors like SCC in the airway are occlusive and cause extensive post - obstructive?
atelectasis/pneumonia
Along with mucus, a foreign body and SCC, what other type of tumor can cause airway obstruction, leading to WEDGE shapped atelectasis = resorption?
Carcinoid tumors
Why do we want an expiratory film during pneumothorax?
the thoracic cavity expands and reduces with normal breathing cycles, but air trapped in the thoracic cavity (pneumothorax) is a FIXED volume
Note: tension pneumothorax on expiratory decreases volume in the thoracic cavity which allows us to see tru damage
the end
