ENT Pathology Flashcards
What lines the auditory meatus and external canal?
Epidermis
(containing sebaceous and ceruminous glands)
What lines the middle ear?
Columnar lined epithelium
Which type of epithelium lines the nasal vestibule?
Squamous epithelium
Which type of epithelium lines the nose and sinus?
Respiratory epithelium
(pseudostratified ciliated columnar, seromucinous glands)
It is also called Schneiderian epithelium
Which two components comprise a salivary gland?
- Acinar
- Ductular
Why are peripheral myoepithelial cells useful in salivary glands?
They have contractile properties
What is otitis media?
Inflammation of the inner ear
What can cause otitis media?
Viral infections mostly
Occasionally bacterial
Chronic otitis media may be as a result of which bacteria?
Pseudomonas aeruginosa
What is cholesteatoma?
Keratinised squamous epithelium in middle ear
(it is NOT a tumour)
Which age group is affected by cholesteatoma?
Any
Despite not being a tumour, which neoplastic property does cholesteatoma possess?
High cell turnover
What is the pathogenesis for cholesteatoma?
Chronic otitis media
Perforation of tympanic membrane
Which tumour is associated with the vestibular portion of the vestibulocochlear nerve?
Vestibular schwannoma
In which bone do vestibular schwannomas associate?
Temporal
What is the classic microscopic appearance of a schwannoma?
Verocay bodies
How do most vestibular scwannoma cases present?
Sporadic and unilateral
If a vestibular scwannoma presents bilaterally in a young patient, what should be suspected?
Neurofibromatosis Type 2
Which type of neurofibromatosis is more common?
Type 1
For which reasons may an individual develop neurofibromatosis type 2?
- AD inheritance
- Sporadic mutation in NF2 gene
Which clinical features will be seen in a patient with neurofibromatosis type 2?
- Multiple meningiomas
- Gliomas
- Bilateral vestibular schwannomas
- Posterior subcapsular cataracts
- Pigmentary retinopathy
Which common benign swelling is often found in the nasal cavity?
Nasal polyps
What can induce nasal polyps?
- Allergy
- Infection
- Aspirin sensitivity
- Cystic fibrosis (young)
What must be ruled out if a child presents with nasal polyps?
Cystic fibrosis
What are the identifying features of nasal polyps microscopically?
Highly oedematous
Eosinophils prominent
How may a patient with GPA present?
- Pulmonary or renal disease
- Symptoms of nasal congestion
How is GPA identified?
cANCA +ve
What is the most common cause of septal ulceration?
Cocaine use
(GPA can also cause)
What are the identifying features of GPA on microscopy?
- Liquefactive or coagulative necrosis
- Profuse eosinophils and multinucleated giant cells
- Pallisading histiocytes and giant cells with central necrosis
- Few lymphocytes and plasma cells
Which benign tumours may be found in the nasal cavity?
- Squamous papilloma
- Angiofibroma
Which malignant tumours may be found in the nasal cavity?
- Squamous cell carcinoma
- Primary adenocarcinoma
- Nasopharyngeal carcinoma
- Neuroblastoma
- Lymphoma
Which specific thing is primary adenocarcinoma of the nasal cavity particularly associated with?
Wood dust exposure
(this should be asked about in the history)
Nasopharyngeal carcinoma has a high associated with what?
Epstein barr virus
Volatile nitrosamines in food
Which type of patient will likely present with nasopharyngeal carcinoma?
Male
High incidence in far east
What are the main problems with squamous “Schneiderian” papillomas?
Recur frequently
Can become malignant
In which situations can laryngeal polyps develop?
- Vocal abuse (contact)
- Infection
- Smoking
- Hypothyroidism
Squamous papillomas have which two peaks of incidence?
< 5 years
20 - 40
What are squamous papillomas associated with?
HPV exposure (types 6 and 11)
What is koilocytosis?
Development of koilocytes
What is a koilocyte?
A cell altered by the presence of HPV
Changes include:
- Nuclear enlargement (two to three times normal size).
- Irregularity of the nuclear membrane
- Hyperchromasia (dark nucleus)
- Perinuclear halo
Which condition can be defined by “tumours arising in clusters of neuroendocrine cells dispersed throughout the body”?
Paraganglioma
If a paraganglioma is chromaffin postitive what does this mean?
It contains chromaffin cells which, when stimulated by the sympathetic nervous system, secrete catechloamines such as adrenaline
Which condition are paragangliomas associated?
MEN2
What doe the majority of squamous cell carcinomas in the head/neck region relate to?
Smoking and alcohol
Which virus is related to SCC?
HPV (type 16)
Which other subtype of SCC is there besides type type associated with smoking/alcohol?
Affects young (30-50) healthy individuals
Lump in neck
What is the prognosis for this type of SCC which affects young healthy people?
Good
(treated withchemoradiotherapy)
What is the most common salivary gland to be affected by a pathology?
Parotid
Tumours in smaller salivary glands tend to be _________
Tumours in smaller salivary glands tend to be malignant
What is the most common salivary gland tumour?
Pleomorphic adenoma
What are the problems with a pleomorphic adenoma?
- Difficult to excise
- Associated with recurrence
- Longstanding cases may become malignant
What is the second most common benign tumour associated with the salivary glands?
Warthin’s tumour
Who does a Warthin’s tumour usually affect?
Males over 50
Who and where does a pleomorphic adenoma affect?
Females over 60
Parotid
A Warthin’s tumour is assciated with what?
Smoking
(tumours are often bilateral in the parotid glands and multicentric)
What is the most common malignant tumour associated with the salivary glands?
Mucoepidermoid carcinoma (worldwide)
Adenoid cystic carcinoma (in UK)
What is the most common malignant tumour of the palate and where else does it commonly affect?
Adenoid cystic carcinoma (usually in those over 40)
Parotid gland
(It is the most common tumour of the palate)
