ENT pathology Flashcards
describe the histology of the salivary gland
Acinar component and ductal component
Serous cells – darkly staining. Contain digestive enzymes including amylase
Mucinous component – clear grey staining. Contain glycoproteins
Ducts lined by columnar/cuboidal epithelium
Myoepithelial cells – often flat or cuboidal with clear cytoplasm. Have some contractile properties
what is cholesteatoma?
an abnormal collection of skin cells deep inside your ear
can be acquired or congenital
Superior posterior middle ear/ petrous apex or anterior superior
if left untreated can cause damage to inner ear- vestibuli and cochlea and cause problems with hearing and balance
what is the most common ENT tumour?
squamous cell carcinoma
ear - related to chronic inflammation or radiation
oropharynx - HPV
majority related to smoking and alcohol
describe vestibular schwannoma
- Associated with vestibular portion of vestibulocochlear nerve (VIII).
- Occur within temporal bone and are the most common cerebellopontine angle tumours
- most are sporadic and unilateral
- if seen bilaterally in a young patent consider neurofibromatosis type 2
what can cause nasal polyps?
hypersensitivity- allergy, infection, asthma, nickel exposure, aspirin sensitivity
if seen in young patient consider CF
who develops nasal polyps?
common in adults
very rare in children - seen in CF
describe the presentation of granulomatosis with polyangiitis (Wegner’s)
small vessel vasculitis and necrosis restricted to respiratory tract and kidneys
respiratory symptoms e.g. nasal congestion, septal perforation & renal disease
what tests are positive in GPA (wegner’s)?
PR3-ANCA
describe sinonasal papilloma
benign lesions however can undergo malignant change
can be inverted, exophytic or oncocytic
present with blocked nose
describe nasopharyngeal carcinoma
senn more in males
strong association with epstein-barr virus & nitrosamines in food
highly malignant, extensive local spread and early nodal metastasis
how does epstein-barr virus cause cancer?
EBV genes “hi-jack” normal signaling pathways. LMP-1 acts as an oncogene. EBNA-2 promotes transition from G0 to G1
basically prevents apoptosis and promotes blood vessel growth
describe laryngeal polyps
- Reactive change in laryngeal mucosa secondary to vocal abuse, infection and smoking. Rarely associated with hypothyroidism.
- Nodules and polyps are largely interchangeable terms.
- Nodules are usually seen in young women and are bilateral on middle 1/3 to posterior 1/3 on vocal cord.
- Polyps are unilateral and pedunculated
- no significant inflammatory component
describe contact ulcers of the throat
Benign response to injury
Posterior vocal cord
Chronic throat clearing, voice abuse, gastrooesophageal reflux (GORD), intubation
describe squamous cell papillomas of the throat
seen in <5s or between 20 & 40
related to HPV types 6 & 11
agressive disease in children
solitary lesion in adults
describe paragangliomas of the throat
- Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.
- Sympathetic – secrete catecholamines. Paravertebral (organ of Zuckerkandl, rarely bladder)
- Parasympathetic – related to great vessels of the head and neck and clusters around oral cavity, nose, nasopharynx, larynx and orbit).
- rare tumours, most commonly seen >50 year olds, related to MEN2
