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Pathology > Chapter 16-upper Airways, Ears, And Neck > Flashcards

Chapter 16-upper Airways, Ears, And Neck Flashcards

1
Q

What is another name for infectious rhinitis

A

Common cold

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2
Q

What causes infectious rhinitis

A

Adenovirus, echovirus, and rhinovirus

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3
Q

Exam signs of infectious rhinitis

A

Thick, edematous , red nasal mucosa with catarrhal discharge (runny nose from goblet cells)

Narrowed nasal cavities

Enlarged turbinates

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4
Q

Infectious rhinitis can lead to ____

A

Pharyngotonsillites

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5
Q

If have infectious rhinitis A ___ ___ __ enhances inflammatory reaction leading to mucopurulent/suppurative exudate

A

Secondary bacterial infection

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6
Q

“In a week if treated, or seven days if ignored” with common cold

A

Treating doesn’t really help

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7
Q

What is another name for allergic rhinitis

A

Hay fever

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8
Q

What is allergic rhinitis

A

IfE mediated hypersensitivity reaction

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9
Q

Early phase allergic rhinitis

A

Marked mucosal edema, redness, and mucus secretion

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10
Q

Late phase allergic rhinitis

A

Leukocytic infiltration with prominent eosinophils

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11
Q

What percentage of Americans are effected by allergic rhinitis

A

20

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12
Q

What are some common allergens that cause hay fever

A

Plant pollen, fungi, animal allergens, dust mites

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13
Q

What causes nasal polyps

A

Occur with recurrent rhinitis (either type)

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14
Q

Histology of nasal polyps

A

Edematous mucosa with loose stroke, hyperplastic mucus glands and infiltrated by neutrophils, eosinophils and plasma cells

Likely to ave goblet cells inthe outer respiratory mucosal layer

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15
Q

Most people with nasal polyps are not ___; only .5% of __ patients develop polyps

A

Atopic

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16
Q

What if polyps are large or multiple

A

Can obstruct airway impairing sinus drainage

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17
Q

Chronic polyps

A

The costal covering of the polyps may become ulcerated or infected

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18
Q

Chronic rhinitis

A

Sequela to acute microbial or allergic rhinitis with the eventual development of superimposed bacterial infection

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19
Q

Histology chronic rhinitis

A

Superficial mucosal desquamation or ulceration with inflammatory infiltrates extending into the air sinuses

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20
Q

What can predispose someone to microbial invasion/chronic rhinitis

A

Deviated septum or nasal polyps

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21
Q

What is acute sinusitis preceded by

A

Acute or chronic rhinitis (edema impairs sinus drainage)

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22
Q

What causes acute sinusitis

A

Oral commensals (almost always bacterial

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23
Q

How treat acute sinusitis

A

Amoxicillin

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24
Q

What causes acute sinusitis in diabetics

A

Fungal

Mucormycosis

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25
Q

If there is a complete sinus drainage block with acute sinusitis it may lead to what

A

Epyema of the sinus where the suppurative exudate becomes impounded

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26
Q

With acute sinusitis, obstruction of outflow is most common from the ___ ___ leading to accumulation of the mucous secretions, called ____

A

Frontal sinus (not anterior ethmoid sinuses)

Mucocele

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27
Q

Is acute sinusitis serious

A

Uncomfortable nut not serious unless the infection spreads into the orbit or cranial vault (septic thrombophlebitis of a dural venous sinus) or penetrates the bone causing ostemyelitis

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28
Q

What bad things can happen from an acute sinusitis

A

Septic thrombophlebitis of a dural venous sinus or penetrates the bone causing osteomyelitis

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29
Q

Maxillary sinusitis why get

A

An extension of a periapical tooth infection

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30
Q

Kartagener syndrome triad

A

Sinusitis, bronchiectasis and situs inversus

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31
Q

What causes kartagener syndrome

A

Congenitally defective ciliary action

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32
Q

Necrotizing lesions of the nose/upper airway causes

A

Acute fungal infections, espicially mucormycosis in diabetic and immunocompromised patients

Granulomatosis with polyangiitis (wegener granulomatosis)*

Extranodal NK/T cell lymphoma-nasal type, harboring EBV

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33
Q

Who gets extranodal NK.T cell lymphoma-nasal type, harboring EBV

A

Asian/Latin American males in 5-6 decade

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34
Q

What is extranodal NK.T cell lymphoma complicated by

A

Ulceration and bacterial superinfection

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35
Q

How treat extranodal NK.T cell Lymphoms

A

Radiotherapy controls localized disease

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36
Q

How can extranodal NK/T cell lymphoma be fatal

A

Spread to cranial vault or necrosis with infection and sepsis

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37
Q

Relapse and recurrences of extranodal NK/T cell lymphoma is associated with a __ outcome

A

Poor

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38
Q

URI

A

Pharyngitis and tonsillitis

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39
Q

Common causes of pharyngitis and tonsillitis

A

Rhinovirus, echovirus, adenovirus> influenza, respiratory syncytial virus

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40
Q

Histology pharyngitis and tonsillitis

A

Mucosal edema+erythema+reactive lymphoid hyperplasia in lymph nodes and tonsils

Exudative membrane may cover nasopharyngeal mucosa and tonsils (pseudomembrane)

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41
Q

Secondary ____ or ____ bacteria infections exacerbate pharyngitis and tonsillitis

A

B hemolytic strep or staph aureus (beware or sequelae_

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42
Q

Rheumatic fever is associated with what

A

Mitral valve prolapse

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43
Q

Post streptococcal glomerulonephritis is associated with what

A

Tea colored using

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44
Q

Follicular tonsillitis

A

Redden, enlarged tonsils (due to reactive lymphoid hyperplasia) with pinpoints of exudate emanating fromt he tonsillar crypts

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45
Q

What is a nasopharyngeal angiofibroma

A

Highly vascularized benign tumor that has a very bland look

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46
Q

Who gets nasopharyngeal angiofibroma

A

Red head, fair skinned adolescent males

Or/and

Associated with familial adematous polyps (FAP)-Germaine APC mutation

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47
Q

Where are nasopharyngeal angiofibroma

A

In stroma of posterolateral wall oft he roof of the nasal cavity

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48
Q

Treat nasopharyngeal angiofibroma

A

Surgery

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49
Q

Prognosis nasopharyngeal angiofibroma

A

Locally aggressive and intracranial extension =20% recurrence

9% fatal due to hemorrhage or intracranial extension

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50
Q

Sinonasal (scheiderian_ papilloma benign or malignant

A

Benign

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51
Q

Where are sinonasal (scheiderian_ papilloma

A

From the respiratory or schneiderian mucosa lining the nasal cavity and paranasal sinuses

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52
Q

What are the three forms of sinonasal papilloma

A

Exophytic (most common)

Endophytic (inverted, most biologically important)

Cylindrical

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53
Q

What is the only form of sinonasal papilloma that is aggressive

A

Endophytic

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54
Q

Who gets sinonasal papilloma

A

Males thirty to sixty

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55
Q

What virus is sinonasal papilloma associated with

A

HPV 6, 11

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56
Q

Sinonasal papilloma have ___ ___ cores

A

Fibrovascular

Stromal

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57
Q

Endophytic sinonasal papilloma

A

Benign, but locally aggressive neoplasm of the squamous epithelium of the nasal cavity or paranasal sinuses

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58
Q

How does an endophytic sinonasal papilloma grow

A

Papillary way but invaginates into the underlying stroma

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59
Q

Malignant transformation fo endophytic sinonasal papilloma is seen in what percent of cases

A

Ten

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60
Q

Complete excision fo an endophytic sinonasal papilloma may prevent recurrence with potential invasion into the orbit or cranial vault. What is not all excised?

A

High change of return

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61
Q

Olfactory neuroblastoma (esthesioneuroblastoma) is benign or malignant

A

HIGHLY MALIGNANT

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62
Q

Describe an olfactory neuroblastoma

A

Uncommon, highly malignant tumor arising from the neuroectodermal olfactory cells present within the mucosa within the superior aspect of the nasal cavity

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63
Q

What is the bio deal distribution of olfactory neuroblastoma

A

Peak incidence at 15 and 50 years

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64
Q

How do patients with olfactory neuroblastoma present

A

Nasal obstruction and epistaxis

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65
Q

Histology olfactory neuroblastoma

A

Small, BLUE, round cell neoplasm

Nests and lobules of well circumscribed cells separated with fibrovascular stroma

*memrane bound secretory granules and neuron specific markers neoplasm, synaptophysin, CD56 and chromogranin

66
Q

What are the other small blu round cell neoplasms

A

Lymphoma, small cell carcinoma, Ewing sarcoma/peripheral neuroectodermal tumor, rhabomyosarcoma, melanoma, and sinonasal undifferentiated carcinoma

67
Q

How treat olfactory neuroblastoma

A

Surgery, radio/chemotherapy

68
Q

Prognosis olfactory neuroblastoma

A

5 year survival rate of 40-90%

69
Q

NUT midline carcinoma

A

Uncommon, extremely aggresssive and resistant to therapy

70
Q

Where do we get NUT midline carcinoma

A

Nasopharyngeal, salivary gland or other midline structures of thorax/abdomen

71
Q

Genetics of NUT midline carcinoma

A

Translocation in fusion gene of NUT and BRD4

72
Q

NUT

A

Chromatin regulator

73
Q

BRD4

A

Chromatin reader

74
Q

What happens if take drug that displace NUT-BRD4 from chromatin

A

Induce NUT midline carcinoma cells to terminally differentiate (no cure)

Unusual in epithelial cancers, although common ina cute Leukemias

75
Q

Prognosis of NUT midline carcinoma

A

Survival less than a year -high mortality very lethal

76
Q

Who gets NUT midline carcinoma

A

Any age group

77
Q

Morphology NUT midline carcinoma

A

Like squamous cell carcinoma

78
Q

Nasopharyngeal carcinoma who gets it

A

African kids and Chinese adults (south china)

79
Q

Where are nasopharyngeal carcinoma

A

Close anatomic relationship to lymphoid tissue

80
Q

What are nasopharyngeal carcinomas associated with

A

EBV infection, diets high in nitrosamines (fermented food, salted fish), smoking

81
Q

What are the three types of nasopharyngeal carcinoma

A

Keratinize got squamous cell carcinoma

Non keratinize go squamous cell carcinoma

Undifferentiated/basaloid carcinomas (lymphoepithelioma)-may have abundant non neoplastic, lymphocytic infiltrate

82
Q

Risk factors for nasopharyngeal carcinoma

A

Hereditary, age, EBV infection , diets high in nitrosamines (fermented foods and salted fish), smoking, chemical fumes

83
Q

Squamous nasopharyngeal carcinoma morphology

A

Look like other squamous cell carcinomas in body

84
Q

Undifferentiated/basaloid nasopharyngeal carcinoma morphology

A

Large epithelial cells with oval or round vesicular nuclei, prominent nucleoli and indistinct cell borders disposed in a syncytial like array

Mixed with lymphocytes, espicially mature T cells

May also detect EBR1 or LMP1

85
Q

Clinical presentation nasopharyngeal carcinoma

A

Found secondary to nasal obstruction, epistaxis and metastasis to cervical lymph nodes

86
Q

Treat nasopharyngeal carcinoma

A

Radiotherapy

87
Q

What nasopharyngeal nasocarcinoma is most radiosensitive

A

Undifferentiated carcinoma

88
Q

Prognosis nasopharyngeal carcinoma

A

Five year survival overall 60%

Non keratinize go 70-98%

Keratinize go 20% least radiosensitive

89
Q

What are common laryngeal pathologies and uncommon

A

Common-inflammatory

Uncommon-tumors

90
Q

What happens if remove laryngeal tumour

A

Loss of normal voice, larynx is the voice box

91
Q

Laryngitis causes

A

Allergic, viral, bacterial, or chemical injury (GERD)

92
Q

Treatment of laryngitis

A

Self limited

93
Q

Why can laryngitis be serious in kids/infants

A

SMAll airway

94
Q

Laryngoepiglottitis

A

Caused by haemophilus influenza (there is a vaccine), respiratory syncytial of B hemolytic strep may induce sudden swelling of the epiglottis and vocal cords that the airway is compromised (medical emergency

95
Q

Laryngotracheobronchitis in kids

A

Croup

Inflammatory narrowing of the airway produces inspiration stridor

96
Q

What is the msot common form of laryngitis and what are the problems associated with it

A

In heavy smokers

Predisposes to squamous epithelial metaplasia and sometimes overt carcinoma

97
Q

Reactive nodules (polyps) of the vocal cords are __ in heavy smokers and __ in singers

A

Unilateral

Bilateral

98
Q

Morphology reactive nodules

A

Small, smooth, round, sessile or pedunculated excrescences (bumps) on the true vocal cords

Loose myxoid core, covered with squamous epithelium

May become keratotic, hyperplastic, or even slightly dysplastic

99
Q

A polyp on the volca cord may __ if the nodules impinge each other

A

Ulcerate

100
Q

Clinical reactive nodules

A

Progressive hoarseness

101
Q

Malignant transformation of reactive nodules of the volca cords

A

Never gives rise to cancer

102
Q

Squamous papilloma of larynxbenign or malignant

A

Benign

103
Q

What is a squamous papilloma of the larynx

A

Small benign squamous epithelium lined lesions on the true vocal cords

104
Q

Morphology squamous papilloma of larynx

A

Soft raspberry like proliferation’s

Multiple slender finger like projections supported by a central fibrovascular core and covered by an orderly stratified squamous epithelium

105
Q

What happens if get trauma to squamous papilloma on the free edge of the true vocal cord

A

Ulceration and hemoptysis

106
Q

Who gets squamous papilloma of larynx

A

Single adults HPV6 or 11 (non oncogenic) in which case they can be multiple and recur

Do not become malignant

Multiple in children (juvenile laryngeal papillomatosis) that may spontaneously regress at puberty

107
Q

Squamous cell carcinoma 9malignant) of the larynx

A

Squamous cell carcinoma seen in male chronic smokers in 6th decade

108
Q

Sequence of squamous cell carcinoma

A

Epithelial changes range from hyperplasia, atypical hyperplasia, dysplasia, and carcinoma in situation to invasive carcinoma

109
Q

Likelihood of developing overt cancer from squamous cell carcinoma is proportional to __ seen at first diagnosis

A

Atypia

Orderly hyperplasia have almost no potential for malignant transformation

110
Q

Risk factors for squamous cell carcinoma

A

Tobacco smoke, alcohol, asbestos, irradiation, HPV

Risk proportional to level of exposure,

Smoking cessation will cause the changes to regress

111
Q

Morphology squamous cell carcinoma

A

Intrinsic if confined to the inside of the larynx, if extends outward then is called extrinsic

Begin as in situation lesion that later appear pearly grey wrinkled plaques on the mucosal surface that may ultimately become a funginating mass that ulcerated

Degree of anaplasia is variable

Sometimes massive tumor giant cells and bizarre mitosis figures are seen

Adjacent mucosa may be hyperplastic or dysplastic

112
Q

Clinical squamous cell carcinoma

A

Persistent hoarseness* PERsistENT

Dysphagia, dysphonia, and hemoptysis

113
Q

Treat squamous cell carcinoma

A

Surgery and radiation

Maybe even laryngectomy

114
Q

Prognosis squamous cell carcinoma

A

Depends on clinical staging

115
Q

Name the most common aural disorders (in descending order of frequency)

A
  1. Acute and chronic otitis (middle ear and mastid_ sometimes leading to cholesteatoma
  2. Symptomatic otosclerosis
  3. Aural polyps
  4. Labyrinthitis
  5. Carcinomas, largely of the external ear
  6. Paragangliomas
116
Q

Otitis media (acute of chronic) has viral etiology…meaning?

A

Serious exudate (so transudate)

117
Q

Otitis media may become ___ with superimposed bacterial infection

A

Suppurative

118
Q

What bacteria may superimpose otitis media

A

Strep p.

Non typeable haemophilus influenza and morazella catarrhalis

119
Q

Clinical acute otitis media

A

Bulging opaque and hyperemic tympanic membrane with decreased movement on pneumatic otoscopy and a fever==strep p.

120
Q

Causadative agents of suppurative otitis media

A

Pseudomonas aeruginosa and staph aureus

121
Q

Most common cause of URI is __ etiology

A

Viral

122
Q

Otitis media in diabetic

A

When caused by pseudomonas aeruginosa is espicially aggressive and spreads widely, causing destructive necrotizing otitis media

123
Q

Cholesteatoma

A

Non neoplastic, cystic lesion 1-4 cm in diameter lined by keratinize go squamous epithelium or metaplastic mucus-secreting epithelium and filled with amorphous debris derived largely form desquamated epithelium

Sometimes contain spicules of cholesterol

Associated with chronic otitis media

124
Q

Otosclerosis

A

Abnormal deposition of bone in the middle ear about the rim of the oval window into which the footplate of the stapes fits

125
Q

Otosclerosis unilateral or bilateral

A

Bilateral wnd slowly progressive to marked hearing loss

126
Q

What causes otosclerosis

A

Familial AD with variable penetrate

127
Q

Epithelial and mesenchymal tumors that arise in the ear are ___. Except for what

A

Rare

Basal cell or squamous cell carcinoma of the pinna

128
Q

Who gets basal cell or squamous cell carcinoma of the pinna

A

Elderly men

129
Q

What are basal cell or squamous carcinomas of the pinna associated with

A

Sun exposure

130
Q

Spread of basal cell or squamous cell carcinoma of the pinna

A

Locally invasive but rarely spread/metasticize

131
Q

Who gets squamous cell carcinoma of the canal

A

Middle age to elderly women

132
Q

What are squamous cell carcinoma of canal associated with

A

Not sun

133
Q

Morphology squamous cell carcinoma of canal

A

Resemble counterparts in other skin locations, beginning as populates that extend and eventually erode and invade locally

134
Q

Spread squamous cell carcinoma of canal

A

Invade cranial cavity or metastisize to regional nodes

135
Q

Prognosis squamous cell carcinoma of the canal

A

5 year mortality 50%

136
Q

Branchial cyst (cervical lymphoepithelial cyst)

A

Remnant of the second arch

137
Q

Who do we see branchial cyst in

A

Young adults between 20 and 40

138
Q

Morphology branchial cyst

A

Benign, welll circumscribed 2-5 cm in diameter, with fibrous walls usually lined by stratified squamous or pseudostratified columnar epithelium
Cyst wall contains lymphoid tissue with prominent germinal centers

139
Q

Where is the branchial cyst

A

Upper lateral aspect of the neck along the sternocleidomastoid muscle

140
Q

Malignancy branchial cyst

A

Rare…readily excusable

141
Q

Thyroglossal duct cyst

A

Thyroid analogue begin in the region of the foramen cecum at the base of the tongue

142
Q

How get thyroglossal duct cyst

A

As thyroid develops it descende to its definitive midline location in the anterior neck
Remnants of this developing tract may persist and produce cysts 1-4 cm in diameter

143
Q

Morphology thyroglossal duct cyst

A

Lined by stratified squamous epithelium when located near the base of the tongue

Lined by pseudostratified columnar epithelium when located in lower locations

144
Q

Treat thyroglossal duct cyst

A

Excision

145
Q

Malignancy thyroglossal duct cyst

A

Rare

146
Q

Paraganglioma (carotid body tumor)

A

Paraganglia-clusters of neuroendocrine cells associated with the sympathetic and parasympathetic nervous systems

147
Q

Most common location of paraganglioma (carotid tumor)

A

Adrenal medulla (pheochromocytoma)

70% extra-adrenal paragangliomas occur in the head and neck region

148
Q

Genetics paraganglioma (carotid body tumor)

A

Loss of function mutations in genes encoding succinate dehydrogenasesubunits or cofactors, proteins, occur frequent in both hereditary and spontaneous paragangliomas

149
Q

Paravertebral paraganglioma

A 
Sympathetic connections 
Chromatin positive (stsainthat detects catecholamines)
150
Q

Aorticopulmonary chain paraganglioma (related to vessels of head and neck)

A

Carotid bodies (most common, prototype of a parasympathetic paraganglioma)
Aortic bodies
Jugulotympanic ganglia
Ganglion nodosum of the vagus nerve
Clusters located about the oral cavity, nose, nasopharyngeal, larynx and orbit
Parasympathetic connections
Chromaffin-negative bc they infrequently release catecholamines

151
Q

Morphology paraganglioma

A

Composed of nests (Zellballen) of round to oval chief cells (neuroectodermal derivatives) that are surrounded by delicate vascular septae

Secrete catecholamines

Tumor cells contain abundant clear or granular eosinophilic cytoplasm and uniform round to ovoid sometimes vesicular nuclei

152
Q

Chief cells stain strongly for what

A

Neuroendocrine markers (chromogranin, synaptophysin, neuron specific enclave, CD56, CD57)

153
Q

Substentacular cells

A

Supporting network of spindle shaped stroma cells positive for s-100

154
Q

Are paraganglioma common

A

No

155
Q

When do people get paraganglioma

A

5-6th decade

156
Q

Are paraganglioma single or multiple

A

Single

157
Q

Are paraganglioma sporadic

A

Yup

But may be familial (AD, MEN2, multiple and sometimes bilateral)

158
Q

Are paraganglioma Benign

A

Look benign but may metasticize to regional lymph nodes and instant sites

159
Q

Why are 50% of paraganglioma fatal

A

Infiltrating growth

160
Q

It is almost impossible to predict the clinical course of a carotid body tumor

A

Incomplete resection -> recurrence

Pathology (28 decks)

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