Gomez - Head and Neck Pathology Flashcards by Kash Kaul

What are squamous papillomas of the nasal vestibule?

Essentially, warts

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What are the three different subtypes of Schneiderian papillomas?

Exophytic

Inverted

Oncocytic

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What are Schneiderian papillomas?

Benign neoplasms that are locally destructive

Found in sinonasal tract

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Describe the exophytic papilloma

Septal, squamous, fungiform

Least aggressive

Rarely becomes invasive

Associated with HPV

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Describe the inverted sinonasal papilloma

Rounded mass

On lateral wall of nasal cavity

Covered by mucosa

Projections of squamous epithelium growing inward

Can become aggressive

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Describe the oncocytic papilloma

Occurs on lateral nasal wall

Originates from cylindrical or columnar epithelium

Abundant pink cytoplasm from lots of mitochondria

Not associated with HPV

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What is an olfactory neuroblastoma?

Arises from neural tissue at roof of nose

Average age of onset around either 15 or 50 yrs

Often large and can cause obstruction

5 yr survival 40-90%

“Small blue cell tumor”

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What is Waldeyer’s ring?

Ring of lymphoid tissue around naso/oropharynx

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What type of epithelium covers the palatine and lingual tonsils?

Squamous epithelium

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What type of epithelium covers the adenoid (pharyngeal tonsil)?

Ciliated columnar respiratory epithelium

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Hypertrophic adenoidal tissue can obstruct the internal auditory canal. What can this lead to?

Recurrent otitis media

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What organism causes whooping cough?

Bordetella pertussis

Small Gram-negative coccobacillus

Spreads via droplets

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What is Stage 1 of pertussis?

Catarrhal phase

Indistinguishable from URI (congestion, rhinorrhea, sneezing)

Most infectious in this stage

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What is Stage 2 of pertussis?

Paroxysmal phase

Characterized by paroxysms (violent attack) of intense coughing

Cough followed by a loud whoop upon inspiration

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What is Stage 3 of pertussis?

Convalescent phase

Chronic cough may last for weeks

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Describe the nasopharyngeal angiofibroma

Occurs in the upper pharynx

Occurs almost exclusively in young males, often redheads

Typically benign, but 10-20% can be locally aggressive, 9% fatal

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What are the three subtypes of nasopharyngeal carcinoma?

Keratinizing

Nonkeratinizing

Undifferentiated/basaloid

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What is undifferentiated nasopharyngeal carcinoma associated with?

Epstein-Barr virus

What are the environmental associations of nasopharyngeal carcinoma?

Associated with certain food preservatives like nitrosamine

Associated with smoking (common tumor in Chineese adults)

What is a NUT midline carcinoma?

Used to be called undifferentiated nasopharyngeal carcinoma

Mostly occur in mediastinum, but can be in head/neck

Associated with BDR4/BDR3-NUT fusion gene

Very aggressive tumor - median survival 7 months

Describe the presentation of Group A Streptococcus

Common cause of pharyngitis in 5-15 yr olds

Incidence peaks in winter or early spring

Presents with ST+fever without cough

PE will show tender ant. cervical lymph nodes and enlarged, erythematous tonsils with patchy exudate

Fusobacterium necrophorum leads to which condition?

Can cause tonsillar abscesses, which can lead to thrombophlebitis of the jugular vein

What is Lemierre syndrome?

Peritonsillar abscess with jugular vein thrombophlebitis

Describe Corynebacterium diptheriae

Club-shaped Gram-positive rod

tox gene causes sloughing of epithelium, leading to formation of a pseudomembrane containing dead cells, inflammatory cells, and some bacteria

What condition are rhinoviruses associated with?

Indirect pharyngitis

What is pharyngoconjunctival fever caused by?

Adenoviruses

What does Epstein-Barr virus cause?

Infectious mononucleosis Detected by Monospot test

What can acute laryngitis lead to in children?

laryngoepiglottitis CAN BE LIFE THREATENING

Describe the pathophys of croup

Caused by parainfluenza (paramyxovirus) Results in a seal-like barking cough

What is Reinke edema?

Edema and swelling of the mucosa overlying the vocal cords

Describe vocal cord papillomas

Benign neoplasms of the true vocal folds Usually single in adults, but can be recurrent Often multiple in children Caused by HPV types 6 and 11

Describe squamous cell carcinoma of the larynx

Associated with heavy smoking (more so than other types of tobacco) Often also an associaton with EtOH abuse Typically present with prolonged hoarseness, sometimes can affect breathing

What is the most common form of laryngeal carcinoma?

Glottic carcinoma

What are the types of laryngeal carcinoma?

Glottic (most common, best survival) Supraglottic (2nd most common, worse prognosis) Subglottic

What is "intrinsic" laryngeal carcinoma?

Cancer that is confined to larynx

What is extrinsic laryngeal carcinoma?

Cancer that extends beyond the larynx

Describe otitis externa

Marked tenderness upon gentle traction of pinna Caused by traumatized ear canal or contaminated water (swimmer's ear) Can be bacterial in nature Any neoplasms will be skin tumors

What is a cholesteatoma?

Cyst lined by squamous epithelium found in the middle ear Has lots of inflammation and keratin debris Can cause local destruction of tissue, so they are typically resected

What is otosclerosis?

Calcification and fusion of the stapes footplate to the oval window Leads to conductive hearing loss Familial

What does the thyroid gland arise from?

Base of the tongue Foramen cecum formed during descent of thyroid gland

Where can thyroglossal duct cysts be found?

Anywere along the midline of the neck along the course of thyroid gland descent Will see thyroid follicles in these cysts

What is a carotid body tumor?

Neuroendocrine parasympathetic tumor Similar to pheochromocytoma Most benign, but if infiltrative, 50% fatality rate Can't tell from histology which will be aggressive and which won't, so treated as malignant

What tumor syndromes are associated with carotid body tumors?

Familial forms MEN types 2a & 2b von Hippel-Lindau syndrome Neurofibromatosis type 1