ENT Pathology Flashcards
what is contained within the external auditory meatus?
sebaceous glands
ceruminous glands
hair follicle
lined with skin
what is contained within the middle ear?
columnar lined mucosa
ossicles
opening of eustachian tube
mastoid cavity
what is contained within the inner ear?
the cochlea
vestibular apparatus
what lines the nasal vestibule?
stratified squamous
what lines the nose and sinuses etc?
resp epithelium
sero-mucinous glands
what lines the throat?
resp and squamous epithelium depending on site
describe the salivary gland
exocrine
major and minor
acinar and ductular component
serous cells (contain digestive enzymes including amylase)
mucinous component (clear grey staining)
peripheral myoepithelial cells (flat/cuboidal with clear cytoplasm, have contractile properties)
what is otitis media and what usually causes it?
inflammation of middle ear
usually viral, occasionally bacterial
if chronic - pseudomaonas aerginosa, stph aureus, fungal
what is cholesteatoma?
noncancerous, abnormal skin growth within the middle ear
not a tumour and doesn’t contain cholesterol
can arise as a result of chronic otitis media and perforated tympanic membrane
describe the underlying pathology in cholesteatoma
normal lining of the middle ear is cuboidal or columnar glandular epithelium
abnormally situated squamous epithelium high cell turnover and abundant keratin production
associated inflammation
what is a vestibular schwannoma?
benign primary intracranial tumour of the myelin-forming cells of the vestibulocochlear nerve(schwann cells)
associated with the vestibular portion of CN VIII
occur within temporal bone
how does vestibular schwannoma present?
95% are sporadic and unilateral
gross - circumscribed tan/white/yellow mass
what can cause bilateral vestibular schwannoma in young people?
neurofibromatosis type 2
give 7 features of neurofibromatosis type 2?
autosomal dominant neurofibromas bilateral vestibular schwannoma multiple meningiomas gliomas café au lait cataracts
causes of rhinitis and sinusitis?
infectious - common cold
allergic - hay fever, type 1 hypersensitivity
causes of nasal polyps?
allergy infection asthma aspirin sensitivity nickel exposure if young - consider CF
what is GPA and how will it present?
granulomatosis with polyangiitis
autoimmune disorder of small vessel vasculitis and necrosis usually limited to the resp tract and kidneys
presents with pulmonary, renal or nasal symptoms
- nose bleeds
- bridge collapse
- deafness
- etc
GPA antibodies?
cANCA
PR3
causes of benign nasal tumours?
squamous papillomas
Schneiderian papillomas
angiofibromas
causes of malignant nose tumours?
most commonly squamous cell carcinoma primary adenocarcinoma nasopharyngeal carcinoma neuroblastoma lymphoma
features of Schneiderian papilloma?
inverted and oncocytic on lateral walls and paranasal sinuses
exophytic on nasal septum
causes a blocked nose
Schneiderian papilloma risk factors?
over 50s males HPV smoking organic solvents welding
risk factors for nasopharyngeal carcinoma?
mals > females
associated with Epstein barr virus and volatile nitrosamines in food
histology of nasopharyngeal carcinoma?
keratinising SCC
or non-keratinising
how is EBV involved in carcinogenesis?
seen in lymphomas
infects epithelial cells of oropharynx and B cells
hijacks and mimics helper T cell responses leading to proliferation and survival of B cells
mediated largely by latent membrane protein 1
EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1 (in cell cycle?)
what causes laryngeal polyps?
reactive change in laryngeal mucosa secondary to vocal abuse, infection and smoking
(occasionally in hypothyroidism)
laryngeal polyps vs nodules?
nodules = young women, bilateral on middle 1/3rd to posterior 1/3rd of vocal cord polyps = unilateral and pedunculated
what causes a contact ulcer in the throat?
benign response to injury - chronic throat clearing - voice abuse - GORD - intubation usually occurs on posterior vocal cord
aeitiology of squamous papilloma/papillomatosis?
peaks in <5 y/o and 20-40 y/o
related to HPV - types 6 and 11
aggressive in children
often solitary and not related to HPV in adults
what is a paraganglioma?
tumour arising in culsters of neuroendocrine cells dispersed throughout the body
2 types of paraganglioma?
chromaffin +ve - sympathetic CNS - can secrete catecholamines - usually adrenal medulla or paravertebral - organ of Zuckerkandl non-chromaffin - carotid bodies - aortic bodies - jugulotympanic ganglia - ganglia nodosum of vagus - clusters around oral cavity, nose, nasopharynx, larynx and orbit
who does paraganglioma usually occur in?
usually >50
can be part of MEN2
- autosomal dominant
risk factors for squamous cell carcinoma in throat?
smoking
alcohol
HPV virus
where does SCC occur in the head and neck?
nose sinuses pharynx larynx oral cavity
how can HPC cause cancer?
usually due to type 16
produces proteins E6 and E7 which disrupt P53 and RB pathways leading to cellular immortality
staging of SCC in the larynx?
T1a = one vocal cord T1b = both vocal cords T2 = extension into supra/subglottis T3 = vocal cord fixation or extension into paraglottic space, minor thyroid cartilage involvement T4a = thyroid cartilage, trachea, tongue muscles, strap muscles, thyroid, oesophagus T4b = prevertebral space, mediastinal structures, carotid artery
what are the 4 salivary glands?
parotid
submandibular
sublingual
minor salivary glands
name 3 salivary gland pathologies
sialolithiasis - stones
infection - paramyxovirus (mumps, parotitis)
tumours
where do tumours present in salivary glands?
usually parotid
tumours in smaller glands more likely to be malignant
if young and a painful mass - think malignant
what is the most common salivary gland tumour?
pleomorphic adenoma
benign but risk of malignant transformation if longstanding (carcinoma ex pleomorphic adenoma)
who does pleomorphic adenoma usually occur in?
females
4th-6th decade
can occur at any age in any gland
second most common salivary gland tumour?
who does this occur in?
Warthin’s tumour
usually males >50
associated with smoking
presentation of Warthin’s tumour?
usually in parotid
often bilateral and multicentric
most common malignant salivary gland tumour?
worldwide = mucoepidermal carcinoma UK = adenoid cystic carcinoma
where does mucoepidermoid carcinoma usually occur?
majority in parotid but can be in any gland
wide age range
equal gender incidence
who/where does adenoid cystic carcinoma usually occur in?
wide age range
usually over 40
usually in parotid
most common malignant tumour of the palate
frequent perineural invasion causing pain and loss of function
