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ENT Medicine > ENT Pathology > Flashcards

ENT Pathology Flashcards

1
Q

What lines the auditory meatus and external canal, and what glands are present?

A

Epidermis = contains sebaceous and ceruminous glands

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2
Q

What is the histology of the middle ear?

A

Columnar lined mucosa, contains ossicles (malleus, incus, stapes), opening of Eustachian tube and mastoid cavity

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3
Q

What structures are present in the inner ear?

A

Cochlea and vestibular apparatus

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4
Q

What cell type is present in the nasal vestibulae?

A

Squamous

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5
Q

What cell types are present in the nose and sinus (etc)?

A

Respiratory epithelium = pseudostratified ciliate columnar

Seromucinous glands

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6
Q

What cell types are present in the throat?

A

Respiratory and squamous epithelium depending on site

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7
Q

What are the features of the salivary glands?

A

Exocrine gland = major and minor, acinar component and ductular component

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8
Q

How do the serous cells of the salivary glands stain?

A

Darkly staining = contain digestive enzymes

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9
Q

How does the mucous component of the salivary glands stain?

A

Clear grey staining

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10
Q

How do the peripheral myoepithelial cells of the salivary glands appear?

A

Often flat or cuboidal with clear cytoplasm = may have some contractile properties

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11
Q

What is otitis media?

A

Inflammation of middle ear = usually viral, sometimes bacterial

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12
Q

What are some organisms that cause otitis media?

A

Strep. pneumoniae, h. influenzae, moxarella catarrhalis

If chronic = p. aeruginosa, s. aureus, fungal

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13
Q

What is a cholesteatoma?

A

Not a tumour and doesn’t contain cholesterol = common skin growth, may occur in any age group

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14
Q

Where do cholesteatomas normally arise?

A

Superior posterior middle ear or petrous apex

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15
Q

What may occur with cholesteatomas?

A

Chronic otitis media and acquired perforated tympanic membrane

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16
Q

What is the normal lining of the middle ear?

A

Cuboidal or columnar glandular epithelium

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17
Q

What is the lining of the middle ear when there is a cholesteatoma?

A

Abnormally situated squamous epithelium = high cell turnover and abundant keratin production, associated inflammation

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18
Q

What are vestibular schwannomas associated with?

A

Vestibular portion of vestibulocochlear nerve (VIII)

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19
Q

Where do vestibular schwannomas occur?

A

Within temporal bone = represent 80-90% of cerebellopontine angle tumours

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20
Q

How do vestibular schwannomas present?

A

95% are sporadic and unilateral, have equal gender distribution

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21
Q

What should be considered as the underlying cause of bilateral vestibular schwannomas in young patients?

A

Neurofibromatosis type 2

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22
Q

What is the gross appearance of vestibular schwannomas?

A

Circumscribed tan, white or yellow mass

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23
Q

What causes neurofibromatosis type 2?

A

May be autosomal dominant but usually sporadic mutation in NF-2 gene = encodes merlin protein at Ch22q12

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24
Q

What lesions occur in neurofibromatosis type 2?

A

Neurofibromas,, bilateral vestibular schwannomas, multiple meningiomas, gliomas, café au lait, cataracts

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25
Q

What are some causes of rhinitis and sinusitis?

A

Infection (common cold) or allergy (hay fever) = no requirement to biopsy

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26
Q

What are some features of nasal polyps?

A

Common (but not in children), equal gender distribution

Consider cystic fibrosis in young patients with polyps

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27
Q

What are some causes of nasal polyps?

A

Allergy, infection, asthma, aspirin sensitivity, nickel exposure

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28
Q

What is granulomatosis with polyangiitis?

A

Autoimmune disorder characterised by a small vessel vasculitis and necrosis

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29
Q

Where does granulomatosis with polyangiitis occur?

A

Usually limited to respiratory tract and kidneys = rare >40 years old

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30
Q

What does granulomatosis with polyangiitis present with?

A

Pulmonary/renal disease, nasal symptoms of congestion, septal perforation

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31
Q

What antibodies are present in high frequencies in granulomatosis with polyangiitis?

A

cANCA antibodies

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32
Q

Are tumours of the nose common?

A

No = relatively rare

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33
Q

What are some benign tumours of the nose?

A

Squamous papilloma, Schneiderian papilloma, angiofibroma

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34
Q

What are some malignant tumours of the nose?

A

Most commonly squamous cell carcinoma

Primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

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35
Q

What are the types of Schneiderian papillomas?

A

Inverted, exophytic or oncocytic

36
Q

Who gets Schneiderian papillomas?

A

More common in males, tends to be patients over 50 years old

37
Q

What are the risk factors for Schneiderian papillomas?

A

HPV (low risk), smoking, organic solvents, welding

38
Q

What do Schneiderian papillomas present with?

A

A blocked nose

39
Q

Where do Schneiderian papillomas occur?

A 
Inverted/oncocytic = lateral walls and paranasal sinuses
Exophytic = nasal septum
40
Q

Are nasopharyngeal carcinomas common?

A

No = low incidence in UK (but very high in Far East), more common in males

41
Q

What are nasopharyngeal carcinomas associated with?

A

Epstein Barr virus and volatile nitrosamines in food

42
Q

What kind of carcinomas are nasopharyngeal carcinomas?

A

Keratinising or non-keratinising squamous cell carcinomas

43
Q

What are some tumours associated with Epstein Barr virus?

A

Burkitt’s lymphoma, other B-cell lymphomas, Hodgkin’s lymphoma

44
Q

What does Epstein Barr virus infect?

A

Epithelial cells of oropharynx and B-cells

45
Q

What is Epstein Barr infection often described as being?

A

Ubiquitous = often subclinical, occasional infectious mononucleosis

46
Q

How does Epstein Barr virus interfere with the immune system?

A

Hijacks and mimics T helper cell responses leading to proliferation and survival of B cells

47
Q

What mediates the action of Epstein Barr virus?

A

Latent membrane protein 1 (LMP-1) = encodes EBNA-2 activating cyclin D and promotes transition from G0 to G1

48
Q

Are laryngeal polyps common?

A

No = rare reactive change to laryngeal mucosa

49
Q

What may cause a laryngeal polyp?

A

Vocal abuse, infection, smoking and occasionally hypothyroidism

50
Q

How do laryngeal polys appear?

A

Unilateral and pedunculated

51
Q

Where do laryngeal nodules present?

A

Usually young women = bilateral on middle 1/3 to posterior 1/3 of vocal cord

52
Q

What is a contact ulcer of the throat?

A

Benign response to injury = usually posterior vocal cord

53
Q

What are some risk factors for developing a contact ulcer in the throat?

A

Chronic throat clearing, voice abuse, GORD, intubation

54
Q

What age groups are squamous papillomas of the throat common in?

A

In children <5 years old and adults aged between 20-40

55
Q

What is squamous papilloma of the throat associated with?

A

HPV exposure = types 6 and 11

56
Q

How does squamous papilloma of the throat present?

A

Aggressive in children

In adults often solitary and not related to HPV

57
Q

What are paragangliomas?

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body

58
Q

Where do chromaffin positive paragangliomas occur?

A

Sympathetic nervous system, usually adrenal medulla or paravertebral = can secrete catecholamines

59
Q

Where do non-chromaffin positive paragangliomas occur?

A

Carotid/aortic bodies, jugulotympanic ganglia, ganglia nodosum of vagus, clusters around oral cavity, nose, nasopharynx, larynx, orbit

60
Q

Are paragangliomas common?

A

No = rare, usually occur in patients over 50

61
Q

What condition can paragangliomas occur as part of?

A

MEN2 = autosomal dominant inheritance, usually multiple, higher incidence of malignant forms

62
Q

Where do squamous cell carcinomas of the head and neck occur?

A

Nose, sinuses, pharynx, larynx, oral cavity

63
Q

What are risk factors of squamous cell carcinomas of the head and neck?

A

Smoking and alcohol

64
Q

What site of squamous cell carcinoma of the neck is most associated with HPV?

A

The oropharynx

65
Q

What type of HPV is associated with squamous cell carcinomas of the oropharynx?

A

Majority HPV type 16

66
Q

What proteins does HPV type 16 produce which helps develop squamous cell carcinoma of the oropharynx?

A

Proteins E6 and E7 = disrupt p53 and RB pathways respectively, leading to cellular immortality

67
Q

Do squamous cell carcinomas associated with HPV type 16 have a good prognosis?

A

Yes = have greatly improved prognosis and sensitivity to treatment

68
Q

What is the staging of laryngeal squamous cell carcinomas?

A 
T1a = one vocal cord       T1b = both vocal cords
T2 = extension into supra/subglottis
T3 = vocal cord fixation/extension into paraglottic space, minor thyroid cartilage involvement 
T4a = thyroid cartilage, trachea, muscles of tongue, strap muscles, thyroid, oesophagus
T4b = prevertebral space, mediastinal structures, carotid artery
69
Q

What are some examples of salivary glands?

A

Parotid, submandibular, sublingual, minor salivary glands

70
Q

What is sialolithiasis?

A

Stones in the salivary glands

71
Q

What occurs in paramyxovirus (mumps) infection of the salivary glands?

A

Bilateral parotitis, associated orchitis and pancreatitis, risk of secondary meningitis

72
Q

What are some tumours of the salivary glands?

A

Pleomorphic adenoma, Warthin’s tumour, mucoepidermoid carcinoma, adenoid cystic carcinoma

73
Q

Where is the most common site for tumours of the salivary glands?

A

Parotid gland

74
Q

What are some signs that would make you consider a malignancy of the salivary glands?

A

Tumours in smaller glands, if patient is young, if tumour is painful

75
Q

What is the most common tumour of the salivary glands?

A

Pleomorphic adenoma = usually females aged 40-60 in parotid with a long history (can occur in any gland at any age)

76
Q

Why do pleomorphic adenomas of the salivary glands have a high rate of recurrence?

A

They are difficult to excise

77
Q

What is the risk associated with longstanding pleomorphic adenomas?

A

Risk of malignant transformation

78
Q

What is Warthin’s tumour of the salivary glands?

A

Second most common benign tumour = usually males >50, rare outwith parotid, often bilateral and multicentric

79
Q

What are Warthin’s tumours of the salivary glands associated with?

A

Strong link with smoking

80
Q

What is the most common malignant tumour of the salivary gland worldwide?

A

Mucoepidermoid carcinoma = wide age range, no gender predominance

81
Q

Where is the most common site for mucoepidermoid carcinomas of the salivary gland?

A

Parotid glands (can occur in any gland)

82
Q

How are mucoepidermoid tumours of the salivary glands classified?

A

High or low risk = low grade has 5 year survival of >90%, high grade has 5 year survival of <60%

83
Q

What is the most common malignant tumour of the salivary gland in the UK?

A

Adenoid cystic carcinoma

84
Q

What are some features of adenoid cystic carcinomas of the salivary glands?

A

Usually patients over 40 years old, most common malignant tumour of palate, 5 year survival of 35%

85
Q

Where do adenoid cystic carcinomas of the salivary gland frequently invade?

A

Frequent perineural invasion = associated pain or loss of function

ENT Medicine (22 decks)

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