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IMED3001 > Head and Neck pathology I: Salivary Glands and Upper Respiratory Tract > Flashcards

Head and Neck pathology I: Salivary Glands and Upper Respiratory Tract Flashcards

1
Q

What are the important aetiological processes in the upper airways?

A

Neoplasia (cancer caused by viruses and environmental agents)

Inflammation/infections

Autoimmune diseases

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2
Q

What tissue lines the upper airways?

A

Respiratory epithelium transitioning to squamous epithelium.

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3
Q

What are the upper airways important for?

A

Olfaction

Conditioning of inhaled air

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4
Q

What is acute infectious rhinitis?

A

The common cold

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5
Q

What can acute infectious rhinitis progress into?

A

pharyngitis/tonsillitis

chronic rhinitis (superimposed bacterial infection with pus)

Sinusitis

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6
Q

What anatomical abnormality increases chances of chronic rhinitis?

A

Deviated nasal septum

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7
Q

Which main viruses cause the common cold?

A

Adenovirus

Echovirus

Rhinovirus

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8
Q

How should a common cold be treated?

A

It is self limiting but unpleasant

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9
Q

What are the classes of sinusitis?

A

Acute

Chronic

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10
Q

What causes acute sinusitis?

A

Ascending infection from nose/nasopharynx/teeth. (usually bacterial)

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11
Q

What can acute sinusitis progress into?

A

Empyema/abscess

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12
Q

What causes chronic sinusitis?

A

Usually when there are problems with drainage.

Mixed flora, fungal/bacterial

Relapsing/remitting

Occasionally involves bone (osteomyelitis) or cranial vault

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13
Q

What are possible complications of pharyngitis/tonsilitis by streptococcus bacteria?

A

Post infectious GN

Rheumatic fever

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14
Q

What viruses cause pharyngitis/tonsillitis?

A

Adenoviruses, echoviruses, rhinoviruses

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15
Q

What is allergic fungal sinusitis?

A

Eosinophilic fungal infection.

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16
Q

What is allergic rhinitis?

A

Hayfever which is an allergic reaction to pollen, fungi, animals, dust mites, etc.

It is IgE mediated and is a type I hypersensitivity reaction. (both early and late phase response)

[nose equivalent of asthma]

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17
Q

What are the symptoms of allergic rhinitis?

A

Oedema

Leukocytic infiltrate with numerous eosinophils

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18
Q

What are nasal polyps?

A

A type of hyperplastic lesion which is characterized by repeated bouts of inflammation -> oedema and fibrosis -> polyp formation

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19
Q

What do nasal polyps cause?

A

Obstruction and further inflammation and recurrent infections

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20
Q

Hyperplastic lesions are referred to as allergic but are they?

A

Most people with nasal polyps don’t have signs of atopic disease

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21
Q

What is a polyp?

A

Derived from the word cuttlefish. Refers to an abnormal growth from a mucous membrane and has an epithelial lining over a stromal core.

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22
Q

What kind of diseases can cause polyp formation?

A

Neoplastic conditions

Hyperplastic conditions

Inflammatory conditions (pseudopolyps)

Hamartomatous (benign proliferation with disorganized growth)

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23
Q

What kind of base can polyps have?

A

Pedunculated (on a stalk)

Sessile (broad based)

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24
Q

What is a sinonasal papilloma?

A

Group of benign neoplasms arising from sinonasal epithelium.

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25
What are the types of sinonasal papillomas?
Exoophytic (growing outwards) Endophytic/inverted and growing inwards without invading. Mixed
26
Who most commonly gets sinonasal papillomas?
Males people aged 30 - 60
27
What infection causes papillomas?
HPV (esp types 6 and 11)
28
Which SNPs can recur?
If not excised endophytic types can recur and can erode into orbit or cranial vault (erosion of bone can be an issue and can cause infection)
29
What is the chance of SNP becoming cancerous?
Small risk; endophytic has a small chance (~10%) of transforming into squamous cell carcinoma if not excised.
30
Why must endophytic SNPs be operated on?
They can erode bone and grow into cranial vault or orbit. They can also change into squamous cell carcinomas.
31
What is the eyeliner sign?
If you track along the base of the epithelium it looks darker
32
What does the exophytic papilloma look like on histology?
Papilloma with branching, epithelial projections and a fibrovascular core lined by well-differentiated stratified squamous epithelium.
33
What does the endophytic papilloma look like on histology?
Similar features to exophytic papilloma but gorws down into stroma without invading underlying basement membrane
34
What are the common patterns of nasopharngeal carcinomas?
Keratinising squamous cell carcinoma (WHO type I) Non-keratinising squamous cell carcinoma (WHO type II) Undifferentiated carcinoma [lymphoepithelial carcinoma] (WHO type III)
35
Which of the 3 patterns of nasopharyngeal carcinoma are associated with EBV? What are the others associated with?
Non-keratinising (type II) Undifferentiated (Type III) The keratinising carcinoma (Type I) is HPV associated
36
How are nasopharyngeal carcinomas treated?
Radiotherapy +/- surgery
37
How are nasopharyngeal carcinomas distributed?
They are geographically distributed: In Africa they are common in children In China they are common in adults
38
Which of the 3 nasopharyngeal carcinomas have good prognosis?
Keratinising is well differentiated and has a good prognosis Non-keratinising SCC is relatively less well differentiated and also has a decent prognosis (worse than keratinising) Undifferentiated SCC has a bad prognosis
39
Where do olfactory neuroblastomas arise from?
Neuroectoderm (it is a neuroendocrine tumour)
40
How common is olfactory neuroblastoma?
Very rare.
41
What is the prognosis of olfactory neuroblastoma like?
It is locally destructive but has a good prognosis.
42
How does olfactory neuroblastoma present?
Nasal obstruction and epistaxis
43
How is olfactory neuroblastoma detected?
Neuroendocrine markers including synaptophysin and CD56
44
At what age is olfactory neuroblastoma most common?
15 and 50
45
What kind of organisms cause infections of the larynx?
Usually viral and caused by same organisms as other URTIs. In children, Haemophilus influenzae type B, B-haemolytic streptococci and respiratory syncytial virus cause croup (laryngotracheobronchitis) Diptheria
46
What chemical insult commonly causes laryngitis?
Smoking (in kids from parents that smoke)
47
What causes vocal cord polyps?
Smoking Repetitive strain on vocal cords
48
What causes benign squamous papillomas of the larynx?
HPV type 6 and 11 Similar to oral cavity
49
What is another name for vocal cord polyps?
Singer nodules
50
What causes malignant squamous cell carcinoma of the larynx?
Not associated with HPV and is associated with smoking
51
What are the sequence of events leading to malignant squamous cell carcinoma of the larynx?
Hyperplasia -> Dysplasia -> Carcinoma in situ -> Invasive carcinoma
52
What are the most proceses of disease in salivary glands?
Inflammatory and neoplastic
53
Which structures are the minor salivary glands similar to?
Lacrimal glands of eyes and other seromucinous glands.
54
What is sialolithitis?
Stones can develop in the ducts of salivary glands and this can cause inflammation or blockage.
55
What causes sialadenitis?
Trauma/obstruction [Stones (Sialolithitis)] This can be idiopathic, secondary to infection, dehydration, and medications. Infection (viral or secondary bacterial infection) Autoimmune (Sjogren syndrome or IgG4 sclerosing disease)
56
What are the trauma/obstruction causes of sialadenitis?
Can be idiopathic Secondary to infection Dehydration Medications (antihistamines, beta blockers, antipsychotics, and amphetamines)
57
What are the infectious causes of sialadenitis?
Viral (mumps, influenza A, parainfluenza, HIV, others) Secondary bacterial infection following sialolithiasis (S.aureus)
58
What are the autoimmune causes of sialadenitis?
Sjogren syndrome IgG4 sclerosing disease
59
How are mucocoele's produced from sialadenitis?
Blockage/inflammation -> dilatation of ducts -> mucocoele/retention of cyst
60
What do normal salivary glands have?
Acini Ducts (epithelial and myoepithelial cells) Other tissues in the background (fat, nerves, vessels, MALT)
61
What are the types of neoplasms that can affect the salivary glands?
Epithelial Lymphoma Others
62
What are the most common benign tumours of the salivary glands?
Pleomorphic adenoma (50%) Warthin tumour (5 - 10%)
63
What are the most common malignant tumours of the salivary glands?
Mucoepidermoid carcinoma (15%) Adenoid cystic carcinoma (5%)
64
Why are pleomorphic adenomas called pleomorphic?
They are mixed tumours with epithelial and myoepithelial components in background of a chondromyxoid stroma They are very highly variable
65
Where are pleomorphic adenomas most common?
Parotid
66
What are the possible complications of pleomorphic adenomas?
Can recur if not completely removed Small risk of malignant transformation
67
Who and where are warthin tumours most commonly found?
Nearly all are in parotid and nearly all are in smokers.
68
How can warthin tumours be identified?
They have distinctive histology. They have finger like epithelial projections surrounding a fibrovascular stroma
69
What is the most common malignant salivary gland tumour?
Mucoepidermoid carcinoma
70
Which glands are mucoepidermoid carcinomas most commonly located?
Predominantly in parotid but also common in minor salivary glands.
71
What cell types are characteristic of mucoepidermoid carcinomas?
Mucinous/ductal cells Squamoid cells Intermediate cells
72
What kind of cancers are mucoepidermoid carcinomas causative of?
High grade is aggressive (5 year survival rate is 50%) Low grade which rarely metastasises (5 year survival rate >90%)
73
General rule regarding neoplasms of salivary glands:
Tumours in minor salivary glands are more likely to be malignant. Tumours in major salivary glands are more likely to be benign.
74
What does histology of mucoepidermal carcinoma look like?
3 cell types (mucinous/ductal cells, squamoid cells, and intermediate cells) Circumscribed but histologically infiltrative
75
What kind of cells make up adenoid cystic carcinomas?
Epithelial and myoepithelial cells
76
What kind of pathology do adenoid cystic carcinomas cause?
They are slow growing, frequent, with perineural invasion and a relentless course.
77
What are the 5 year and 10 year survival rates of adenoid cystic carcinomas?
5 year: 60 - 70% 10 year: <30% It often metastasizes late (5+ years)

IMED3001 (46 decks)

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