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MBBS II HNNS > L35 - NPC, Other Head and Neck Tumours > Flashcards

L35 - NPC, Other Head and Neck Tumours Flashcards

1
Q

What is the most common neoplasm in nasal cavity in paediatric population?

A

juvenile angiofibroma

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2
Q

Pathologenesis of juvenile angiofibroma? Presentation and onset age?

A

vascular + fibrous lesion (thickened vessels) causing malformation of nasal erectile tissue
» Benign but can infiltrate surrounding tissue and cause extensive destruction

nasal obstruction / intermittent epistaxis

Occurs in young boys (often develops around puberty, regresses afterwards)

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3
Q

Pathologenesis of inflammatory nasal polyps?

A

inflammation, allergy or mucoviscidosis (cystic fibrosis)

> > very oedematous fibrous tissue infiltrated by eosinophils and plasma cells

> > respiratory epithelium showing goblet cell hyperplasia

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4
Q

What are the 2 histological features of nasal polyp?

A

2 histological features (exam):

  1. Infiltrated by eosinophils, plasma cells (frequent)
  2. Respiratory epithelium often shows goblet cell hyperplasia
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5
Q

List 4 infections of the nose/ nasal sinuses from uncommon pathogens?

A

Tuberculosis (caseous necrosis)

Leprosy

Scleroma (granulomatous disease)

  • Fungal diseases: aspergillosis and candidiasis
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6
Q

Pathogenesis of scleroma?

A

chronic bacterial infection

> > Fungating polypoid mass begins in nose

> > progressively extends into nasopharynx, oropharynx, larynx

> > Presents as a granulomatous disease

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7
Q

List common congenital conditions that affect the nose/ nasal sinus? What physiological defect is caused?

A

cleft palate (unilateral / bilateral) / choanal atresia / stenosis

> > connection between the nasal canals and the pharynx is blocked completely or partially by a soft tissue membrane or bony plate

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8
Q

Name of a group of auto-immune conditions that affect the nose/ nasal sinuses/ upper respiratory tracts? Conditions included in this group?

A

Lethal midline granuloma

clinical syndrome = noninfective destructive lesion of the upper respiratory tract:
Wegener’s granulomatosis, conventional malignant lymphoma, and polymorphic reticulosis

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9
Q

Pathogenesis of wegener’s granulomatosis? Clinical sequalae? (think renal)

A
  • Necrotising giant cell granulomas*** from upper respiratory tract

> > spread to trachea and lungs

> > multinucleated giant cells, histiocytes infiltration + granulation tissue formation

Untreated = renal failure by renal arteritis, necrotizing glomerulitis or necrotizing vasculitis

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10
Q

List an example of traumatic/ toxic cause of nasal neoplasm?

A

Wood dust associated adenocarcinoma

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11
Q

List an example of endocrine/ environment cause of nasal neoplasm?

A

Allergic nasal polyp

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12
Q

List the 3 sites of origin of nasal neoplasms.

A
  • Epithelial
  • Lymphoid
  • Stromal
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13
Q

What is the most common benign and malignant epithelial** nasal neoplasm?

A

Most common benign = papilloma

Most common malignant = squamous cell carcinoma (followed by malignant melanoma)

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14
Q

Histology of nasal epithelial papilloma?

A

 Squamous or transitional

 Fungating mass: sometimes inverted, but not invasive

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15
Q

Pathogenesis of malignant lymphoma of the nose?

A

Mainly affect T cell lineage:

small number of lymphoma cells intermixed with reactive cells like plasma cells, histiocytes, immunoblasts, neutrophils, eosinophils

> > form polymorphous mixture&raquo_space; polymorphic reticulosis

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16
Q

What is the 1st and 2nd most common extra-nodal lymphoma?

A 
1st = gastrointestinal 
2nd = malignant lymphoma of the nose
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17
Q

Condition strongly associated with malignant lymphoma of the nose?

A

EBV infection

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18
Q

Which type of nasal neoplasm can be easily mistaken for benign lesions?

A

Malignant lymphoma

Because of the scattered lymphoma cells, the early biopsy is easily mistaken for a benign lesion

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19
Q

Most common epithelial nasopharyngeal neoplasm?

A 
Nasopharyngeal carcinoma (NPC): 
= commonest epithelial tumor (exam)
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20
Q

Epidemiology of NPC?

A

19/100,000

 Males affected 3-4 times more frequently than females

 Peak at age 44 (middle age)

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21
Q

Define the 3 aetiological risk factors of NPC (excluding smoking).

A

1) Genetic factor: HLA A2 + BW 46 combination increases relative risk by 3x; family history
2) Diet: Dimethylnitrosamines in salted fish, phorbol esters in plants, oils = mutagenic compounds

3) EBV: 2 oncogenic proteins to cause proliferation:
a) . Latent membrane protein 1 (LMP1)
b) . Bam ARightFragment1 (BARF1)

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22
Q

What is the serological marker for NPC patients with EBV infection?

A

IgA component of Viral Capsid Antigen (VCA)

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23
Q

Multistep pathogenesis model of NPC?

A
  1. Normal nasopharyngeal epithelium
  2. Reversible mild hyperplasia
  3. Early premalignant lesion
  4. Irreversible malignant transformation
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24
Q

Anatomical location of NPC? 3 Routes of spread and structures affected?

A

Fungating mass located in the fossa of Rosenmüller/ pharyngeal recess (clinically obscure area)

1) local spread to the parapharyngeal space&raquo_space; base of skull&raquo_space; foramina into the cranium
2) Local spread to blood vessels, cranial nerves, lymphatics and muscle
3) Distal spread by lymphatics or blood&raquo_space; first to the neck nodes in the head and neck

25
Q

List and explain 4 important symptoms of NPC?

A
  1. Deafness, tinnitus (due to blockage of Eustachian tube)
  2. Bleeding (blood in postnasal drip): very significant in early diagnosis
  3. Headache (frequently temporal), facial pains (caused by involvement of trigeminal nerve)
  4. Palpable upper jugular lymph nodes at the apex of posterior triangle
26
Q

Rank the 3 categories of NPC in terms of commonality?

A
  1. Undifferentiated carcinoma = most common, >95% exam
  2. Non- keratinizing carcinoma
  3. Squamous cell carcinoma = uncommon
27
Q

What does non-keratinizing carcinoma NPC resemble histologically?

A

transitional cell carcinoma

28
Q

Histological appearance of undifferentiated carcinoma NPC?

A

sheets of polygonal cells or spindle cells

> 50% have prominent lymphoid infiltrate&raquo_space; lymphoepithelioma

29
Q

Does lymphoid infiltration into NPC mean it is malignant?

A

NO

not malignant

> > represent a local tissue reaction to the tumour

30
Q

Treatment modalities for NPC?

A

external radiotherapy (Undifferentiated carcinoma responds best, Squamous cell carcinoma the least favourable)

Adjuvant chemotherapy

31
Q

Recurrence rate for NPC?

A

High recurrence:

Commonly within first 2 years following completion of radiotherapy

Shown to occur after a 10-year period

**Treated NPC patient should have routine follow up to detect early relapses **

32
Q

List 2 Non-epithelial neoplasms in the nasopharynx.

A

sarcomas - seen after radiation for NPC

Lymphomas - important in Hong Kong. Often T-cell and also associated with EBV

33
Q

Go through VINDICATE and outline oral cavity and tongue pathologies?

A

Inflammatory = Aphthous ulcers

Neoplastic = Squamous cell carcinoma – related to smoking+++

Auto-immune = Lichen planus

Traumatic/Toxic = Ulcers

34
Q

List some risk factors for squamous cell carcinoma in the oral cavity?

A 
 Smoking (tobacco = 6-fold risk) 
 Alcohol abuse 
 Poor dentition 
 Viral infection (HSV, HPV) 
 Sunlight exposure
35
Q

Go through VINDICATE and outline salivary gland pathologies/ neoplasms?

A

Inflammatory:

a) Sialadenitis – usually due to obstruction by stone
b) Mucocele (due to obstruction of minor salivary gland) exam

Infectious: Viral -mumps

Auto-immune: Sjogren’s syndrome

Neoplasm: benign and malignant

36
Q

List 2 benign salivary gland neoplasms. Which gland is most commonly affected?

A

Warthin’s tumour and Pleomorphic adenoma*

Both commonly affect parotid gland

37
Q

List 3 malignant salivary gland neoplasms?

A
  • Mucoepidermoid carcinoma
  • Adeonoid cystic
  • Lymphoepithelioma- like carcinoma
38
Q

What is the most common salivary gland tumour? Which gland most commonly affected? Histology?

A

Pleomorphic adenoma

parotid gland: epithelium forming small ducts, myoepithelial cells + Stroma may be myxoid / chondroid

39
Q

Treatment for the most common slivary gland tumour?

A

Pleomorphic adenoma

Local excision (if in parotid: ensure preserve facial nerve)

Local recurrence possible

40
Q

Which epithelium is affected in mucoepidermoid carcinoma?

A

glandular + squamous epithelium

41
Q

Salivary glands and cell types most commonly affected in adenoid cystic (malignant salivary neoplasm).

A

 More common in minor salivary glands (less so in parotid)

 Composed of a mixture of myoepithelial cells + glandular cells (form gland-like cysts)

42
Q

Histological appearance of lymphoepithelioma- like carcinoma, associated disease and sites of metastasis?

A

 Looks like NPC

 Can be associated with EBV

 Can metastasize to lungs, lymph nodes

43
Q

Most common cause of mass in larynx?

A

Inflammatory – vocal polyp (singers’ nodule)

44
Q

Pathogenesis of vocal polyps? Histological changes?

A

mechanical injury to vocal folds due to misuse

> > localised form of chronic laryngitis

Histological changes:

  • Squamous metaplasia
  • Localized stromal edema
  • Degeneration
  • Well-circumscribed polypoid mass
45
Q

List viral agents that cause laryngeal infection?

A

influenza, adenovirus, chickenpox

46
Q

List bacterial agents that cause acute laryngitis?

A

beta-haemolytic streptococci,

Haemophilus influenzae,

Corynecbacterium diphtheria

47
Q

Most common pathogen to cause epiglottitis?

A

Haemophilus influenzae

48
Q

Name a severe and rapidly progressive bacterial infection that cause severe laryngeal edema?

A

Epiglottitis by Haemophilus influenzae

49
Q

One congenital defect of the larynx?

A

laryngeal web (= thin, translucent membrane between vocal folds near anterior commissure)

50
Q

Go through VINDICATE and outline any neoplasms/ pathologies of the larynx.

A

Inflammatory = vocal polyp

Neoplasm: numerous

Infectious: viral, bacterial (acute laryngitis or epiglottitis)

Congenital = laryngeal web

Auto-immune – bee stings causing oedema

Traumatic/Toxic – burns causing oedema

51
Q

Name the commonest benign tumor in larynx?

A

Squamous papillomas of larynx

52
Q

Compare the onset and presentation of different forms of Squamous papillomas of larynx?

A
  1. Juvenile:
    - young age
    - soft and usually highly mobile due to a loose or long pedicle
    - Multiple lesions over wide area of laryngeal mucosa
  2. Adult:
    - Later age
    - Single lesion
    - Localized on vocal cords
53
Q

Compare the recurrence and malignant change between 2 forms of squamous papillomas of larynx?

A

Juvenile:

  • High recurrence rate following excision
  • usually disappear after puberty
  • May become malignant after repeated irradiations

Adult:

  • Rarely recur after excision
  • Malignant change even rarer
54
Q

List all the laryngeal neoplasms? (3)

A

Squamous papilloma (most common)

Carcinoma-in-situ

Invasive squamous cell carcinoma

55
Q

Common location of carcinoma- in - situ in the larynx?

A

Usually occurs on true vocal folds

May be multi-centric in origin

56
Q

Age, history and presentation of invasive squamous cell carcinoma in the larynx?

A

Commonest in 7th decade

history of chronic laryngitis or heavy smoking

hoarseness, pain, dysphagia, haemoptysis

57
Q

Define the anatomical classification of invasive squamous cell carcinoma in the larynx? Rank them by commonality.

A

classified anatomically into:

  • supraglottic
  • glottic (vocal folds, anterior and posterior commissures)
  • subglottic
Glottic = most common 
Supraglottic = intermediate 
Subglottic = rare
58
Q

Compare the rate of metastasis between the 3 classes of invasive SCC in the larynx? Rank them by prognosis?

A

Glottic = mostly local, confined = good prognosis

Supraglottic = rapid metastasis to regional LN, lungs

Subglottic = rapid metastasis to regional LN, lungs = Worst prognosis

59
Q

Morphological features of laryngeal invasive SCC?

A

May be papillary / ulcerative / infiltrative

Most = well-differentiated with varying degrees of keratin formation

Usually direct extension within mucosa, submucosa

MBBS II HNNS (57 decks)

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