Diseases of the Upper Aerodigestive Tract Flashcards
A child comes in with a superficial, painful ulceration of the oral mucosa. What is the likely diagnosis and when should it resolve?
Aphthous ulcer (canker sore)
Resolves in 1-2 weeks spontaneously
What is an irritation fibroma and what causes it?
In response to persistent trauma or local irritation, fibroblasts proliferate and cause formation of a nodule of fibrous connective tissue
Where is an irritation fibroma normally found, and how is it cured?
Normally on the buccal mucosa, i.e. gets caught during chewing
Will only get worse if you keep irritating it, so it often must be excised
What is a pyogenic granuloma?
A misnomer -> red-purple soft, painless, polyploid mass which may grow rapidly and commonly arrises on buccal gingiva between teeth
-> made of excessive granulation tissue, very vascular
What typically causes the development of pyogenic granuloma and how is it treated?
Typically related to irritation or hormonal (often during pregnancy)
Treated with excision (curative), but often regresses in pregnant women, or can even progress to ossify if untreated
What strain of herpes most often causes mucous membrane infections and who tends to get it?
HSV-1, tends to occur in young children, but it is very common overall
What is the common mouth infection caused by HSV-1 and what are the symptoms?
Acute herpetic gingivostomatitis
Symptoms:
Fever, lymphadenopathy, painful vesicles of oral mucosa
What is recurrent herpetic stomatitis? What precedes it?
Cold sores -> viral reactivation which tends to occur on lip / vermillion border (herpes labialis)
-often preceded by initial pain and tingling
What does HSV-1 look like under the microscope?
The vesicles in the mucosa will have multinucleated epithelial cells with ground-glass nuclei and often eosinophilic intranuclear inclusions
What is thrush also called and what are the risk factors?
Acute oral pseudomembranous candidiasis
Risk factors:
Immunosuppression
Corticosteroids / antibiotics
Xerostomia (reduced saliva)
What are the defining characteristics of thrush?
Creamy white plaque, composed of pseudomembrane which is adherent to mucosa. However, it CAN be scraped off to show budding yeast and pseudohyphae
Who typically gets hairy leukoplakia and what causes it?
Caused by EBV infection of the mucosa along the tongue. Typically happens in immunosuppressed (especially HIV) patients who are smokers
What the features of hairy leukoplakia and why?
White plaque with folds and tiny hair-like protrusions usually on lateral surface of the tongue which CANNOT be scraped off
Thickening of the mucosa due to proliferation in squamous epithelial cells, keratin is very white.
How does hair leukoplakia appear under the microscope?
Will cause hyperkeratosis, or parakeratosis if the nuclei are still present
Balloon cells -> present in stratum spinosum, cells appear inflated and pale
What infection is associated with a swollen, erythematous tongue with prominent papillae and sometimes a white coating?
Strawberry tongue -> Scarlet fever -> S. pyogenes
When, where, and in what infection do Koplik spots appear?
In the prodrome of Measles (rubeola)
-> small, blue-white specks on an erythematous buccal mucosa opposite the upper molars
Why can diphtheria cause an emergency state?
Dense, gray, mucosal pseudomembrane can overly the tonsils and pharynx and obstruct breathing
What cancer is associated with gingival infiltration and enlargement?
Acute monocytic leukemia
What syndrome is associated with development of melanosis inside the mouth and hamartomatous polyps of the GI tract?
Peutz-Jeghers syndrome
What is the main risk factor for Leukoplakia and Erythroplakia?
Tobacco use of any kind
What is leukoplakia and how does it look under the microscope?
A white patch of the oral mucosa which cannot be scraped off and cannot be attributed to another condition (i.e. hairy leukoplakia)
Has a wide spectrum under the microscope -> hyperkeratotic and benign to carcinoma in situ
MUST be biopsied to tell -> potentially premalignant
What does erythroplakia look like and is it more or less worrying than leukoplakia?
Smooth, soft, flat, or slightly eroded red patch which is not otherwise accounted for (looks like a pizza burn)
More worrying -> often highly dysplastic or representing squamous cell carincoma with subjacent inflammation
What accounts for most malignancies of the head and neck?
Squamous cell carcinoma
What are the risk factors for squamous cell carcinoma in the oral cavity?
Tobacco smoking and alcohol
Chewing betel nut (Asian cultures it’s like chewing tobacco)
What are the risk factors for squamous cell carcinoma in the lower lip and the oropharynx?
Lower lip - UV radiation, pipe smoking
Oropharynx - HPV, especially HPV16
Does tobacco-induced squamous cell carcinoma or HPV-induced have a better prognosis? What proteins does the latter affect?
HPV-induced does
p53 - inactivated by E6
Rb - inactivated by E7
p16 is a CDKI which is also overexpressed and becomes oncogenic
How does squamous cell carcinoma appear grossly, and where does it tend to spread?
Appears as a firm mass with central ulceration and raised, irregular borders
Tends to spread first to cervical lymph nodes (it is a carcinoma, not a sarcoma)
Who are infectious and allergic rhinitis told apart?
Infectious is due to a Type I hypersensitivity -> eosinophils will be present
What leads to formation of nasal polyps and what are they?
Repeated episodes of rhinitis leading to excessive mucosal enlargement
-> edema and lymphocytic infiltrate which can obstruct nasal passages or become infected themselves
What leads to acute sinusitis and what are some complications?
Rhinitis impairs drainage of sinus secretions
- > paranasal sinuses become inflamed
- > bacterial superinfection with normal nasal flora, i.e. S. pneumonia, H. influenzae, M. catarrhalis, S. aureus
Complications:
Empyema of sinus (suppurative exudate)
Mucocele (mucinous secretions)
What is chronic sinusitis and what are some complications?
Persistent sinusitis (>3 months)
Invasion into adjacent bone (osteomyelitis) and cranium (meningitis, abscess)
What are the most common causes of viral pharyngitis / tonsillitis, and how is bacterial pharyngitis / tonsillitis generally grossly identified?
Viral - rhinovirus / adenovirus
bacterial - will have suppurative exudate in addition to the mucosal edema, erythema, and reactive enlargement of tonsils
A patient comes in with a locally aggressive and destructive benign neoplasm of the nasopharynx causing epistaxis. Name and describe his condition, and what demographics he most likely is?
Nasopharyngeal angiofibroma (it is aggressive despite being benign)
Highly vascular neoplasm which causes profuse bleeding and has a high recurrence rate
Almost exclusively in adolescent males, especially with fair skin and red hair
What typically causes nasopharyngeal carcinoma and who is it seen in?
Seen in African children and Chinese adults
Associated with EBV infection classically, also nitrosamines and tobacco / fumes
What does nasopharyngeal carcinoma look like microscopically?
Appears like poorly differentiated squamous cell carcinoma (pleomorphic, keratin-positive), surrounded by lymphocytes (mostly T cells to fight EBV infection)
What additional metastatic finding is usually found with nasopharyngeal carcinoma, and what usually correlates with prognosis?
Cervical lymph node involvement
Nonkeratinizing carcinomas fare much better than keratinizing, as tumor must be susceptible to radiation therapy
What microbe is associated with laryngoepiglottitis in infants?
respiratory syncytial virus, also Beta-hemolytic strept
What infection does a steeple sign on X-ray indicate probably? What are its symptoms?
Subglottic tracheal narrowing seen in laryngotracheobronchitis (croup)
- > caused by parainfluenza virus
- > seal-like, barking cough and inspiratory stridor
What are reactive nodules on the vocal cords called? What are they composed of? What symptoms do they cause?
Usually bilateral -> called Singer’s nodules, from overuse
Composed of loose fibrovascular connective tissue covered by normal squamous epithelium
Will cause progressive hoarseness / voice changes
What is a benign neoplasm of the vocal cords called, and what causes it?
Squamous papilloma -> caused by HPV 6 and 11
How do squamous papillomas present different in adults vs children, and what do they look like?
Present as single in adults, but multiple in children
Look alot like genital warts but on vocal cords -> covered with stratified squamous epithelium. High recurrence rate.
What are the risk factors for squamous cell carcinoma of the larynx?
Smoking with concurrent alcohol use are most common causes, but can result from HPV infection
How does squamous cell carcinoma of the larynx differ from oral cavity in terms of course, and how does it present?
Larynx has a more linear progression from dysplasia -> carcinoma in situ
Oral cavity is more random
Presents with hoarseness, in middle-aged male smokers
Where in the larynx does squamous cell carcinoma occur?
Can be supraglottic (above vocal folds), subglottic, or glottic (on vocal folds)
If glottic -> picked up earliest (causes most hoarseness)
