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ENT Patrick Stenhouse > ENT Pathology > Flashcards

ENT Pathology Flashcards

1
Q

What lines the auditory meatus and external canal?

What does the dermis contain?

A

Epidermis

(containing sebaceous and ceruminous glands)

Hair follicles, sebaceous and ceruminous glands

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2
Q

What lines the middle ear?

A

Columnar lined epithelium

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3
Q

Which type of epithelium lines the nasal vestibule?

A

Squamous epithelium

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4
Q

Which type of epithelium lines the nose and sinus?

A

Respiratory epithelium

(pseudostratified ciliated columnar, seromucinous glands)

It is also called Schneiderian epithelium

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5
Q

Which two components comprise a salivary gland?

what are the 3 major salivary glands?

what do serous cell contain?

what are the ducts lined by?

A
  1. Acinar
  2. Ductular

Parotid

submandibular and sublingual

digestive enzymes like amylase and stain darkly

columnar/cuboidal epithelium

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6
Q

Why are peripheral myoepithelial cells useful in salivary glands?

A

They have contractile properties

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7
Q

What is otitis media?

A

Inflammation of the middle ear

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8
Q

What can cause otitis media?

A

Viral infections mostly

Occasionally bacterial (most common is strep pneumoniae)

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9
Q

Chronic otitis media may be as a result of which bacteria?

A

Pseudomonas aeruginosa

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10
Q

What is cholesteatoma?

A

Keratinised squamous epithelium in middle ear

(it is NOT a tumour)

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11
Q

Which age group is affected by cholesteatoma?

A

Any

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12
Q

Despite not being a tumour, which neoplastic property does cholesteatoma possess?

A

High cell turnover

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13
Q

What is the pathogenesis for cholesteatoma?

A

Chronic otitis media

Perforation of tympanic membrane

(full description on DP)

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14
Q

Which tumour is associated with the vestibular portion of the vestibulocochlear nerve?

A

Vestibular schwannoma

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15
Q

In which bone do vestibular schwannomas associate?

A

Temporal

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16
Q

What is the classic microscopic appearance of a schwannoma?

A

Verocay bodies

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17
Q

How do most vestibular scwannoma cases present?

A

Sporadic and unilateral

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18
Q

If a vestibular scwannoma presents bilaterally in a young patient, what should be suspected?

A

Neurofibromatosis Type 2

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19
Q

Which type of neurofibromatosis is more common?

A

Type 1

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20
Q

For which reasons may an individual develop neurofibromatosis type 2?

A
  1. AD inheritance
  2. Sporadic mutation in NF2 gene
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21
Q

Which clinical features will be seen in a patient with neurofibromatosis type 2?

A
  1. Multiple meningiomas
  2. Gliomas
  3. Bilateral vestibular schwannomas
  4. Posterior subcapsular cataracts
  5. Pigmentary retinopathy
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22
Q

Which common benign swelling is often found in the nasal cavity?

A

Nasal polyps

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23
Q

What can induce nasal polyps?

A
  1. Allergy
  2. Infection
  3. Aspirin sensitivity
  4. Cystic fibrosis (young)
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24
Q

What must be ruled out if a child presents with nasal polyps?

A

Cystic fibrosis

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25
Q

What are the identifying features of nasal polyps microscopically?

A

Highly oedematous

Eosinophils prominent

26
Q

How may a patient with GPA present?

A
  1. Pulmonary or renal disease
  2. Symptoms of nasal congestion

commonly affects the nose causing epistaxis and crusty nasal secretions

can cuase hearing loss

classic sign is Saddle shaped nose due to a perforated nasal septum = causes a dip halfway down the nose

also another big clue is glomerulonephritis

has a high cANCA

27
Q

How is GPA identified?

A

cANCA +ve

28
Q

What is the most common cause of septal ulceration?

A

Cocaine use

(GPA can also cause)

29
Q

What are the identifying features of GPA on microscopy?

A
  1. Liquefactive or coagulative necrosis
  2. Profuse eosinophils and multinucleated giant cells
  3. Pallisading histiocytes and giant cells with central necrosis
  4. Few lymphocytes and plasma cells
30
Q

Which benign tumours may be found in the nasal cavity?

A
  1. Squamous papilloma
  2. Angiofibroma
  3. sinonasal papiloma - usually in males over 50, blocked nose
31
Q

Which malignant tumours may be found in the nasal cavity?

A
  1. Squamous cell carcinoma
  2. Primary adenocarcinoma
  3. Nasopharyngeal carcinoma - low incidence in UK, strong association with EBV
  4. Neuroblastoma
  5. Lymphoma
32
Q

Which specific thing is primary adenocarcinoma of the nasal cavity particularly associated with?

A

Wood dust exposure

(this should be asked about in the history)

33
Q

Nasopharyngeal carcinoma has a high associated with what?

A

Epstein barr virus

Volatile nitrosamines in food

34
Q

Which type of patient will likely present with nasopharyngeal carcinoma?

A

Male

High incidence in far east

35
Q

What are the main problems with squamous “Schneiderian” papillomas?

A

Recur frequently

Can become malignant

36
Q

In which situations can laryngeal polyps develop?

A
  1. Vocal abuse (contact)
  2. Infection
  3. Smoking
  4. Hypothyroidism

Usually a reactive change in laryngeal mucosa secondary to the things above

37
Q

Squamous papillomas have which two peaks of incidence?

What is it sometimes related to?

A

< 5 years

20 - 40

HPV

38
Q

What are squamous papillomas associated with?

A

HPV exposure (types 6 and 11)

39
Q

What is koilocytosis?

A

Development of koilocytes

40
Q

What is a koilocyte?

A

A cell altered by the presence of HPV

Changes include:

  1. Nuclear enlargement (two to three times normal size).
  2. Irregularity of the nuclear membrane
  3. Hyperchromasia (dark nucleus)
  4. Perinuclear halo
41
Q

Which condition can be defined by “tumours arising in clusters of neuroendocrine cells dispersed throughout the body”?

A

Paraganglioma

42
Q

If a paraganglioma is chromaffin postitive what does this mean?

A

It contains chromaffin cells which, when stimulated by the sympathetic nervous system, secrete catechloamines such as adrenaline

43
Q

Which condition are paragangliomas associated?

what age does this usually appear?

A

MEN2

>50

44
Q

What do the majority of squamous cell carcinomas in the head/neck region relate to?

A

Smoking and alcohol

45
Q

Which virus is related to SCC?

A

HPV (type 16)

46
Q

Which other subtype of SCC is there besides type type associated with smoking/alcohol?

A

Affects young (30-50) healthy individuals

Lump in neck

47
Q

What is the prognosis for this type of SCC which affects young healthy people?

A

Good

(treated withchemoradiotherapy)

48
Q

What is the most common salivary gland to be affected by a pathology?

define sialolithiasis

the smaller the gland the —

A

Parotid

Stones

greater the chance of the tumour being malignant

49
Q

Tumours in smaller salivary glands tend to be _________

A

Tumours in smaller salivary glands tend to be malignant

50
Q

What is the most common salivary gland tumour?

when does it present?

A

Pleomorphic adenoma

females in the 3-6th decade

51
Q

What are the problems with a pleomorphic adenoma?

A
  1. Difficult to excise
  2. Associated with recurrence
  3. Longstanding cases may become malignant
52
Q

What is the second most common benign tumour associated with the salivary glands?

A

Warthin’s tumour

53
Q

Who does a Warthin’s tumour usually affect?

A

Males over 50

54
Q

Who and where does a pleomorphic adenoma affect?

A

Females over 60

Parotid

55
Q

A Warthin’s tumour is assciated with what?

A

Smoking

(tumours are often bilateral in the parotid glands and multicentric)

56
Q

What is the most common malignant tumour associated with the salivary glands?

A

Mucoepidermoid carcinoma (worldwide) - majority in parotid, wide age range

Adenoid cystic carcinoma (in UK)

57
Q

What is the most common malignant tumour of the palate and where else does it commonly affect?

A

Adenoid cystic carcinoma (usually in those over 40)

Parotid gland

(It is the most common tumour of the palate)

58
Q

What are the majoirty of tumours in the ear?

in this tumour, what is the sequential development?

A

squamous cell carcinomas - related to chronic inflammation or radiation

also the msot common tumour in the head and neck

hyperplasia - dysplasia and malignancy

59
Q

What conditions can epstein barr virus cause carcinogeneis?

A

burkitt’s lumphoma and hodgkin’s lymphoma

60
Q

What are contact ulcers associated with?

A

chronic throat clearing, voice abuse and GORD

ENT Patrick Stenhouse (27 decks)

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