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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
Q

What are the types of sinonasal papillomas?

A

Exoophytic (growing outwards)

Endophytic/inverted and growing inwards without invading.

Mixed

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26
Q

Who most commonly gets sinonasal papillomas?

A

Males

people aged 30 - 60

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27
Q

What infection causes papillomas?

A

HPV (esp types 6 and 11)

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28
Q

Which SNPs can recur?

A

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)

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29
Q

What is the chance of SNP becoming cancerous?

A

Small risk; endophytic has a small chance (~10%) of transforming into squamous cell carcinoma if not excised.

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30
Q

Why must endophytic SNPs be operated on?

A

They can erode bone and grow into cranial vault or orbit.

They can also change into squamous cell carcinomas.

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31
Q

What is the eyeliner sign?

A

If you track along the base of the epithelium it looks darker

32
Q

What does the exophytic papilloma look like on histology?

A

Papilloma with branching, epithelial projections and a fibrovascular core lined by well-differentiated stratified squamous epithelium.

33
Q

What does the endophytic papilloma look like on histology?

A

Similar features to exophytic papilloma but gorws down into stroma without invading underlying basement membrane

34
Q

What are the common patterns of nasopharngeal carcinomas?

A

Keratinising squamous cell carcinoma (WHO type I)

Non-keratinising squamous cell carcinoma (WHO type II)

Undifferentiated carcinoma [lymphoepithelial carcinoma] (WHO type III)

35
Q

Which of the 3 patterns of nasopharyngeal carcinoma are associated with EBV? What are the others associated with?

A

Non-keratinising (type II)

Undifferentiated (Type III)

The keratinising carcinoma (Type I) is HPV associated

36
Q

How are nasopharyngeal carcinomas treated?

A

Radiotherapy +/- surgery

37
Q

How are nasopharyngeal carcinomas distributed?

A

They are geographically distributed:

In Africa they are common in children

In China they are common in adults

38
Q

Which of the 3 nasopharyngeal carcinomas have good prognosis?

A

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
Q

Where do olfactory neuroblastomas arise from?

A

Neuroectoderm (it is a neuroendocrine tumour)

40
Q

How common is olfactory neuroblastoma?

A

Very rare.

41
Q

What is the prognosis of olfactory neuroblastoma like?

A

It is locally destructive but has a good prognosis.

42
Q

How does olfactory neuroblastoma present?

A

Nasal obstruction and epistaxis

43
Q

How is olfactory neuroblastoma detected?

A

Neuroendocrine markers including synaptophysin and CD56

44
Q

At what age is olfactory neuroblastoma most common?

A

15 and 50

45
Q

What kind of organisms cause infections of the larynx?

A

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
Q

What chemical insult commonly causes laryngitis?

A

Smoking (in kids from parents that smoke)

47
Q

What causes vocal cord polyps?

A

Smoking

Repetitive strain on vocal cords

48
Q

What causes benign squamous papillomas of the larynx?

A

HPV type 6 and 11

Similar to oral cavity

49
Q

What is another name for vocal cord polyps?

A

Singer nodules

50
Q

What causes malignant squamous cell carcinoma of the larynx?

A

Not associated with HPV and is associated with smoking

51
Q

What are the sequence of events leading to malignant squamous cell carcinoma of the larynx?

A

Hyperplasia -> Dysplasia -> Carcinoma in situ -> Invasive carcinoma

52
Q

What are the most proceses of disease in salivary glands?

A

Inflammatory and neoplastic

53
Q

Which structures are the minor salivary glands similar to?

A

Lacrimal glands of eyes and other seromucinous glands.

54
Q

What is sialolithitis?

A

Stones can develop in the ducts of salivary glands and this can cause inflammation or blockage.

55
Q

What causes sialadenitis?

A

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
Q

What are the trauma/obstruction causes of sialadenitis?

A

Can be idiopathic

Secondary to infection

Dehydration

Medications (antihistamines, beta blockers, antipsychotics, and amphetamines)

57
Q

What are the infectious causes of sialadenitis?

A

Viral (mumps, influenza A, parainfluenza, HIV, others)

Secondary bacterial infection following sialolithiasis (S.aureus)

58
Q

What are the autoimmune causes of sialadenitis?

A

Sjogren syndrome

IgG4 sclerosing disease

59
Q

How are mucocoele’s produced from sialadenitis?

A

Blockage/inflammation -> dilatation of ducts -> mucocoele/retention of cyst

60
Q

What do normal salivary glands have?

A

Acini

Ducts (epithelial and myoepithelial cells)

Other tissues in the background (fat, nerves, vessels, MALT)

61
Q

What are the types of neoplasms that can affect the salivary glands?

A

Epithelial

Lymphoma

Others

62
Q

What are the most common benign tumours of the salivary glands?

A

Pleomorphic adenoma (50%)

Warthin tumour (5 - 10%)

63
Q

What are the most common malignant tumours of the salivary glands?

A

Mucoepidermoid carcinoma (15%)

Adenoid cystic carcinoma (5%)

64
Q

Why are pleomorphic adenomas called pleomorphic?

A

They are mixed tumours with epithelial and myoepithelial components in background of a chondromyxoid stroma

They are very highly variable

65
Q

Where are pleomorphic adenomas most common?

A

Parotid

66
Q

What are the possible complications of pleomorphic adenomas?

A

Can recur if not completely removed

Small risk of malignant transformation

67
Q

Who and where are warthin tumours most commonly found?

A

Nearly all are in parotid and nearly all are in smokers.

68
Q

How can warthin tumours be identified?

A

They have distinctive histology. They have finger like epithelial projections surrounding a fibrovascular stroma

69
Q

What is the most common malignant salivary gland tumour?

A

Mucoepidermoid carcinoma

70
Q

Which glands are mucoepidermoid carcinomas most commonly located?

A

Predominantly in parotid but also common in minor salivary glands.

71
Q

What cell types are characteristic of mucoepidermoid carcinomas?

A

Mucinous/ductal cells

Squamoid cells

Intermediate cells

72
Q

What kind of cancers are mucoepidermoid carcinomas causative of?

A

High grade is aggressive (5 year survival rate is 50%)

Low grade which rarely metastasises (5 year survival rate >90%)

73
Q

General rule regarding neoplasms of salivary glands:

A

Tumours in minor salivary glands are more likely to be malignant.

Tumours in major salivary glands are more likely to be benign.

74
Q

What does histology of mucoepidermal carcinoma look like?

A

3 cell types (mucinous/ductal cells, squamoid cells, and intermediate cells)

Circumscribed but histologically infiltrative

75
Q

What kind of cells make up adenoid cystic carcinomas?

A

Epithelial and myoepithelial cells

76
Q

What kind of pathology do adenoid cystic carcinomas cause?

A

They are slow growing, frequent, with perineural invasion and a relentless course.

77
Q

What are the 5 year and 10 year survival rates of adenoid cystic carcinomas?

A

5 year: 60 - 70%

10 year: <30%

It often metastasizes late (5+ years)

IMED3001 (46 decks)

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