ENT pathology 2

Question 1

What nose cancer has a strong association with EBV?

Answer 1

Nasopharyngeal carcinoma

Question 2

Describe the pathogenesis to which EBV results in lymphomas

Answer 2

• Infects epithelial cells of oropharynx and B-cells
• EBV hi-jacks and mimicks helper T-cell responses leading to proliferation and survival of B-cells.
• EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1.

Question 3

What are laryngeal polyps

Answer 3

• Reactive change in laryngeal mucosa secondary to - vocal abuse, infection and smoking
• Think a bit like nasal polyps but on the vocal cords

Question 4

What is a contact ulcer and what is it due to ?

Answer 4

• Benign ulcer in response to injury
• Due to e.g. Chronic throat, voice abuse, GORD

Question 5

What is a Squamous papilloma/papillomatosis?

Answer 5

• A benign papilloma that arises from the stratified squamous epithelium
• Can affect the skin, lip, oral cavity, tongue, pharynx, larynx, esophagus etc

Question 6

What infection predisposes to development of squamous papillomas ?

Answer 6

HPV exposure – types 6 and 11

Question 7

What is a paraganglioma ?

Answer 7

Tumours arrising in clusters of neuroendocrine cells dispersed throughout the body.

Can be chromaffin positive or negative

• Chromaffin positive – sympathetic nervous system and can secrete catecholamines. Usually adrenal medulla or paravertebral
• Non-chromaffin – carotid bodies, aortic bodies, jugulotympanic ganglia, ganglia nodosum of vagus and clusters around oral cavity, nose, nasopharynx, larynx and orbit.

Question 8

What condition can paragangliomas be associated with ?

Answer 8

MEN2 (multiple endocrine neoplasia) - look back to endocrine if needed

Question 9

What is the most common malignant cancer in the head and neck – (this includes nose, sinuses, pharynx, larynx and oral cavity)

Answer 9

Squamous cell carcinoma

Question 10

What are the key risk factors for developing squamous cell carcinoma ?

Answer 10

• Smoking and alcohol
• HPV - esp type 16

Question 11

How does the HPV increases the chances of cancer development ?

Answer 11

Produces proteins E6 and E7 which disrupt p53 and RB pathways respectively, leading to cellular immortality

Question 12

What is the most common salivary gland affected by tumours ?

Answer 12

Parotid gland

Question 13

What is the most common benign salivary gland neoplasm ?

Answer 13

Pleomorphic adenoma

Question 14

What is the classic patient to have a pleomorphic adenoma ?

Answer 14

Usually females over 60 in parotid

Question 15

What is warthins tumour ?

Answer 15

• The 2nd most common benign tumour affecting the salivary glands
• Usually in males over 50
• Associated with smoking

Question 16

What is the most common malignant tumour of the salivary glands ?

Answer 16

Adenoid cystic carcinoma

Question 17

Who/where is usually affected by adenoid cystic carcinomas?

Answer 17

Usually over 40 and parotid but most common malignant tumour of the palate.