ENT Pathology

Question 1

What is a cholesteatoma?

Answer 1

Abnormal non-cancerous skin growth in middle ear behind tympanic membrane

Question 2

What causes cholesteatoma?

Answer 2

Birth Defect

Repeated middle ear infections

Question 3

What happens in cholesteatoma?

Answer 3

Squamous epithelium evades and forms abnormal adhesions

Question 4

Describe a vestibular schwannoma

Answer 4

Tumour from schwann cells of the vestibular portion of CNVIII

Question 5

Where does a vestibular schwannoma occur?

Answer 5

Temporal Bone

Question 6

How does a vestibular schwannoma present?

Answer 6

Deafness

Question 7

What causes vestibular schwannoma?

Answer 7

Bilateral - neurofibromatosis type 2

Question 8

What will a vestibular schwannoma look like pathologically?

Answer 8

Cerebelopontine angle

Circumscribed tan/white/yellow mas

Question 9

Describe neurofibromatosis type 2

Answer 9

Autosomal dominant but often a sporadic mutation in gene that codes for the merlin protein (tumour suppressor)
Meningiomas, gliomas, café au lait patches and cataracts

Question 10

What disease is aggressive papillary adenocarcinoma associated with?

Answer 10

Hippel-Lindau

Question 11

Describe the pathology of nasal polyps

Answer 11

Grey masses of pedunculate tissue which look like a bunch of grapes - oedematous mucosa, respiratory epithelium with goblet cell hyperplasia

Question 12

What causes nasal polyps?

Answer 12

Allergy, infection, asthma, aspirin sensitivity, nickel exposure

Question 13

If nasal polyps present in young kids what should be considered?

Answer 13

Cystic Fibrosis

Question 14

Name five tumours that can present in the nose

Answer 14

Squamous Papilloma 
Angiofibroma 
Schneiderian Papilloma 
SCC 
Nasopharyngeal Carcinoma

Question 15

What causes schneiderian papilloma?

Answer 15

Unknown

Associated with HPV, smoking, organic solvents, welding

Question 16

Who usually gets schneiderian papilloma?

Answer 16

Men >50 years old

Question 17

What is an angiofibroma?

Answer 17

Rare, tumour of angromatous tissue and fibrous stroma - benign and expands locally may involve adjacent cranial bones

Question 18

What is the typical presentation of an angiofibroma?

Answer 18

Young male with nasal obstruction and bleeding

Question 19

What virus is nasopharyngeal carcinoma associated with?

Answer 19

EBV

Question 20

How will nasopharyngeal carcinoma present?

Answer 20

Enlarged painless lymph nodes, nasal obstruction, epistaxis, hearing problems

Question 21

What does EBV mimic?

Answer 21

Helper T cell response to cause proliferation

Question 22

Where do vocal nodules occur?

Answer 22

Area of maximum vibration of vocal cords - anterior third and posterior two thirds

Question 23

Define vocal nodules

Answer 23

Bilateral, localised hard thickenings on the edge of each cord

Question 24

What causes vocal nodules?

Answer 24

Misuse of voice

Question 25

Define vocal polyp

Answer 25

Unilateral pedunculated smooth glistening body attached to one cord

Question 26

How does a vocal polyp present?

Answer 26

Hoarseness

Question 27

What is a contact ulcer?

Answer 27

Thickening and heaping of the mucous membrane

Question 28

What causes a contact ulcer?

Answer 28

Chronic throat clearing, voice abuse, GORD, intubation

Question 29

Where do contact ulcers usually occur?

Answer 29

Posterior vocal cord

Question 30

State the two peak incidences of squamous papillomatosis

Answer 30

< 5 years old | 20-40 years old

Question 31

What is the key risk factor for squamous papillomatosis?

Answer 31

HPV type 6 and 11

Question 32

Describe squamous papillomatosis

Answer 32

Non-keratinised squamous papilloma - presents gradually with increasing hoarseness/stridor but may affect the entire respiratory tract

Question 33

What is a paroganglioma?

Answer 33

Tumours arising in clusters of neuroendocrine cells throughout the body

Question 34

SCC tumours in the oropharynx are related to what?

Answer 34

HPV type 16

Question 35

Describe the classification of SCC in the oropharynx

Answer 35

T1a - one cord T1b - both cords T2 - extension into supra/subglottis T3 - vocal cord fixation/extension into paraglottic space, thyroid cartilage T4a - thyroid cartilage, trachea, tongue, strap, oesophagus T4b - prevertebral space, mediastinal structures, carotid artery

Question 36

What is the name for a stone in the salivary gland?

Answer 36

Sialolithiasis

Question 37

What is the most common site of tumour in the salivary glands?

Answer 37

Parotid gland

Question 38

What tumours can present in salivary glands?

Answer 38

Pleomorphic adenoma Warthin's tumour Mucoepidermoid carcinoma Adenoid cystic carcinoma

Question 39

Describe Warthin's Tumour

Answer 39

Adenolymphoma, males >50 years old, rare outwit parotid. Often bilateral and multicentric - strongly associated with smoking

Question 40

Describe a mucoepidermoid carcinoma

Answer 40

Most common worldwide - majority in parotid galen | High/low risk, high survival

Question 41

Describe a adenoid cystic carcinoma

Answer 41

Most common in UK, wide age range and range of sites. Usually >40 years old and parotid/palate Perineural invasion associated with pain/loss of function