B40, Tumors of the nasal passages, nasopharyns, and larynx

Question 1

What are the primary tumors of the nasal cavity

Answer 1

1. Nasopharyngeal carcinoma
2. Nasopharyngeal angiofibroma
3. Nasal polyps

Nasopharyngeal carcinomas: with 3 subtypes ALL of them are associated with EBV infection, and are endemic to Asia. All of them also feature prominent invasion by mature, non-neoplastic lymphocytes, and they are sometimes called by the misnomer lymphoepitheliomas. Are also associated with Smoking.

1. Well differentiated, keratinizing, squamous cell carcinoma
2. Moderately differentiated non-keratinizing squamous cell carcinoma
3. Undifferentiated
   
   • is the most common type
   • has large syncytial epithelial cells with lots of pale cytoplasm.
   • Strongest EBV link.
   • Rare in the US and europe
   • Endemic to African Children
   • Endemic to Asian Adults, 70% of them are males.

It is locally invasive to the ocular or cranial cavities, and also spreads to cervial lymph nodes then metastasizes

50% 5yrS

Nasopharyngeal angiofibromas: rare, found in young males. Causes bleeding and typically unilateral obstruction of the nasal passage. neoplastic fibroblasts and capillaries make up the tumor.

• arise at the posterior nasopharynx
• benign but can locally invade orbits, sinuses, cranium.

Nasal polyps

• caused by recurrent or chronic rhinitis
• edmatous respiratory mucosa and inflammatory cell infiltrate
• eosinophils in the infiltrate
• usually seen in people over 30yrs.

Question 2

Bnign tumors of the larynx

Answer 2

Non-malignant tumors: Most frequently form on the true vocal cords - site of chronic irritation/vibration and cell renewal. They can become ulcerated and cause bloody coughing.

1. Vocal cord polyps/nodules​
   
   • ​​Smooth nodules covered by stratified squamous epithelium
   • Found in smokers and singers
2. Vocal cord papilloma
   
   • ​Benign neoplasia
   • finger-like projections of epithelium on a fibrovascular core/stalk
3. Laryngeal Papillomatosis, aka Recurrent Respiratory Papillomatosis
   
   • ​​Caused by HPV 6 and 11, low risk subtypes.
   • is benign and does not transform.
   • Usually in children and often regresses at puberty.

Question 3

Malignant tumors of the larynx.

Answer 3

Just one. Is rare but not exceedingly rare. ~2% of all cancers. Predominantly in Males over 40. 7:1 ratio

Laryngeal Carcinoma

• 95% are squamous cell carcinoma
• Smoking and Alcohol associated
• Asbestos possibly also
• Local invasion is limited by tough membranes or ligaments
• Is either Supraglottis, subglottic, or glottic - meaning on the vocal cords
• 60-75% are glottic which presents with the first obvious symptoms - hoarseness.
• 20-40% are supraglottic - Is rich in lymphatics and 1/3rd of these tumors will metastasize to the cervical lymph nodes.
• 5% are sublgottic - this has poor lymph drainage, and these rarely metastasize even when the local tumor is very malignant looking.
• Spreads to local cervical lymph nodes and then metastasizes, especially to lung and thyroid gland.

Symptoms:

• hoarseness
• persistent non-infectious cough
• dysphagia
• ulceration and hemoptysis

Treatment:

Surgery or radiation and/or chemo. Is frequently curative, ~1/3 die form metastases and cachexia or concurrent respiratory infections.