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Head And Neck > Nose, Paranasal Sinuses, Nasopharynx > Flashcards

Nose, Paranasal Sinuses, Nasopharynx Flashcards

1
Q

What is the anterior portion of each nasal cavity called?

A

Vestibule

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2
Q

What forms the posterior border of the nasal cavity and separates it from the nasopharynx?

A

Choana

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3
Q

What is the lower portion of the vestibule lined by?

A

Skin containing adnexal structures, including hair

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4
Q

What is the nasal cavity lined by?

A

Thick, highly vascular, ciliated columnar epithelium

Goblet cells may be present

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5
Q

What are paranasal sinuses?

A

Diverticula of the nasal cavity

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6
Q

Which paranasal sinus is developed at birth?

A

Ethmoid sinus

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7
Q

What is the lining of the nasopharynx?

A

60% is stratified squamous the rest is ciliated columnar
Squamous is found on the inferior half of the anterior and posterior walls as well as anterior half of the lateral walls
Columnar ciliated is found on the nasal Choana and over the roof of the posterior wall
The rest is a mixture

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8
Q

What does mucor look like and how does it spread?

A

Nonseptate, and broad

Spreads along nerves, across tissue planes and into blood vessels

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9
Q

What does aspergillus look like?

A

Septate that branches at 45 degrees

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10
Q

Bone erosion due to aspergillus is caused by what?

A

Pressure remodeling rather than destructive fungal invasion

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11
Q

What does the allergic mucin due to aspergillus look like?

A

It is very adherent

Has eosinophils, Charcot-Leyden crystals, and hyphae

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12
Q

What does leprosy look like histologically in the nasal cavity?

A

Foamy histiocytes with a background of chronic inflammatory infiltrate
Acid fast stain is positive

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13
Q

What can be confused for leprosy and what causes it?

A

Rhinoscleroma
Foamy histiocytes - mikulitz cells
Klebsiella rhinoscleroma - GNR
Do the Steiner stain

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14
Q

What 3 entities are a diagnostic challenge but differ in prognosis and therapies and what sampling is needed?

A

Wegener, NK/T cell lymphoma, idiopathic midline destructive disease
Need deep incisional biopsies

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15
Q

What is myospherulosis and what causes it?

A

It is an inflammatory and fibrous reaction that surrounds encysted, degenerating erythrocytes
Due to surgical procedures when an oil-based hemostatic packing is used

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16
Q

What are the most common nasal polyps and what is the patient population?

A

Inflammatory polyps
Most are older than 30 with history of asthma or chronic rhinitis
About 14% have aspirin intolerance that is manifested as bronchospasm due to prostaglandin metabolism defect

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17
Q

What is associated with nasal polyps?

A

Cystic fibrosis

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18
Q

How do inflammatory nasal polyps in CF differ from regular inflammatory nasal polyps?

A

Lack BM thickening and sub mucosal hyalinization
Usually contain few stromatolites eosinophils
The mucous glands, cysts, and blanket contain acid mucin which will stain blue/purple with AB/PAS
Regular inflammatory polyps are neutral mucin which stains pink

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19
Q

How do antrochoanal polyps differ from inflammatory?

A 
Usually single and unilateral
Patients are younger
Lacks a thickened BM
Stroma is less edematous and more fibrotic
Storms inflammation is patchy
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20
Q

What can be found in nasal polyps that can confuse you for sarcoma?

A

Atypical stromal cells
These are associated with younger individuals and prominent fibrosis
There is no increased cellularity and mitosis figures are rare

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21
Q

How does fungi form papilloma and inverted papilloma differ?

A

Fungiform arises from the nasal septum and is not associated with carcinoma
Inverted arises from lateral wall or paranasal sinuses and is associated with carcinoma, may have symptom of proptosis

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22
Q

What is the histologic characteristic of oncocytic papilloma?

A

Finely granular eosinophilic cytoplasm

Have inspissated mucin droplets

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23
Q

What is respiratory epithelial adenomatoid hamartoma? And where does it mostly occur?

A

Proliferation of glandular spaces lined by ciliated epithelium, sometimes has goblet cells
The posterior nasal septum

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24
Q

What is SCC of the nasal cavity related to?

A

Smoking and exposure to nickel ore

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25
Q

Where do many of the nasopharynx carcinomas arise from?

A

Eustachian tube opening

26
Q

What is NUT midline carcinoma?

A

Highly aggressive variant of SCC

Chromosome 15 fusing with BRD4 or BRD3 genes on chromosomes 19 or 9 respectively

27
Q

What is the diagnostic criteria for wegener disease?

A

Must have at least 2 of the following: granulomatous inflammation, necrosis and vasculitis
And
Both the lungs and kidney show clinical signs of disease

28
Q

How do inflammatory polyps present?

A

They are usually multiple and bilateral in patients older than 30 with a history of asthma or allergies
Also is associated with aspirin intolerance that can lead to bronchospasm due to a defect in prostaglandin metabolism

29
Q

What do inflammatory nasal polyps look like histologically?

A

Outgrowths of lamina propria due to edema
Mucus glands are in the stroma
The BM of the surface may be thickened
Neuts, eos, lymphs

30
Q

If an inflammatory polyp occurs in a child what should you suspect?

A

CF

31
Q

What is the presentation of a schneiderian papilloma?

A

Men between the ages of 30 and 50 with unilateral nasal obstruction
Epistaxis, facial pain, purulent discharge and proptosis may occur

32
Q

What is the recurrence rate of a schneiderian papilloma treated by local excision?

A

50 to 70 % within 1 to 2 years

33
Q

Where are the organisms of rhinosporidiosis at?

A

In the epithelium and the underlying stroma

34
Q

Which nasal papilloma variant is most likely to undergo malignant transformation?

A

Oncocytic

35
Q

Where do most nasopharyngeal carcinomas arise from?

A

The eusthacian tube opening in the fossa of rosenmuller

36
Q

In patients with normal appear nasopharynx and suspected carcinoma, what should be done and why?

A

Random biopsies

Because 70% of the time it will yield something

37
Q

How is nasopharyngeal carcinoma treated? And which type has the poorest prognosis?

A

With radiation

Keratinizing is the least radio sensitive

38
Q

Is NUT-midline carcinoma associated with EBV or HPV?

A

No

So if positive in situ hybridization then not NUT

39
Q

What is the average survival time for NUT midline carcinoma?

A

9 to 10 months

40
Q

What does NUT midline carcinoma look like histologically?

A

Monotonous population of cells
Abrupt squamous differentiation
Tumor necrosis may be seen and brisk mitotic activity

41
Q

What is the grouping for adenocarcinomas in the sinonasal tract?

A

Salivary-type and non salivary-type (intestinal type and non intestinal type)

42
Q

What are some complications of untreated bacterial sinusitis?

A

Orbital cellulitis, meningitis, intracranial abscess, cavernous sinus thrombosis

43
Q

What is a nasal glial heterotopia?

A

Congenital malformation of displaced, mature glial tissue in which continuity with the intracranial meningeal component has become obliterated
In contrast to an encephalocele there will be a connection to the brain

44
Q

How do nasal glial heterotopia present?

A

Usually as a firm subcutaneous nodule on the bridge of the nose
Can also present intranasal as a polyp
Or both

Usually presents during infancy

45
Q

What is a histologic differential for a nasal glial heterotopia?

A

Fibrotic nasal polyp
Large astrometric cells may be misidentified as histiocytes
Do GFAP to stain glial cells

46
Q

How is allergic fungal sinusitis described histologically?

A

Alternating tides lines or ripples of mucin with degenerating cellular debris, most commonly eosinophils
Can form Charcot Leyden crystals which are composed of lysophospholipase

47
Q

What is in the differential for allergic fungal sinusitis?

A

Inflammatory polyps - do not have alternating ripples
Mycetoma - aggregation of fungal elements, does NOT invade, has fruiting heads
Invasive fungal infections - organisms within vessels or deep in the stroma

48
Q

How do you tell the difference in the cysts of rhinosporidiosis vs the cyst in oncocytic type of schneiderian polyp?

A

Scheiderian have small cysts of mucin with nuclear debris within the epithelium, these cysts are not birefringent

The wall of rhinosporidiosis is thick and birefringent

49
Q

What is a characteristic feature of wegener you see in the head and neck and what are you more likely to see in the lungs and kidneys?

A

Head and neck: there is a finely to coarsely granular granular, basophilic, geographic-type necrosis
The basophilic debris results from neutrophil karyorrhexis and death of the endothelial cells and collagen

Lung and kidney: small vessel vasculitis

Scattered giant cells in both

50
Q

How do respiratory epithelial adenomatoid hamartomas appear histologically?

A

Prominent glandular proliferation so lined with ciliated respiratory mucosa
Often in continuity with the surface
Usually surrounded by a thickened, dense, pink basement membrane material that separates these invagination so from the fibrosis, edematous and focally inflamed stroma

51
Q

What are lobular capillary hemangiomas associated with clinically and where do they occur?

A

Hormonal factors and local trauma

1/3 arise in the nasal cavity - anterior nasal septum
2/3 in the oral cavity - gingiva

52
Q

What does a glomangiopericytoma look like histologically?

A

It is a sub epithelial well-delineated but unencapsulated cellular tumor, effacing or surrounding the normal structures
There is usually a well-developed zone of separation between the surface epithelium and the tumor
Bone remodeling can be seen but is NOT true invasion
Vascular channels demonstrate prominent peritheliomatous hyalinization

53
Q

What hormone is thought to be involved with development of a nasopharyngeal angiofibroma?

A

Testosterone

54
Q

What is the most common salivary gland type adenocarcinomas in the sinonasal tract?

A

Adenoid cystic adenocarcinoma

55
Q

How is adenoid cystic carcinoma describe histologically?

A

It is invasive with peri neural and bone invasion
Small basoloid cells with hyperchromatic nuclei and scant cytoplasm arranged in tubules, cribriform glands, and sold sheets
Reduplicated basement membrane material and bluish glycosaminoglycan material within the spaces are common

Distinguish from undifferentiated small cell carcinoma and basaloid SCC by its lower mitotic rate and presence of myoepithelial cell differentiation

56
Q

What can be in the differential for small round blue cells in the sinonasal tract?

A

SCC, SNUC, malignant melanoma, olfactory neuroblastoma, extranodal NK/T cell lymphoma, rhabdomyosarcoma, Ewing sarcoma/PNET

57
Q

What is included in the category nasopharyngeal carcinoma?

A

SCC, keratinizing and nonkeratinizing, and basoloid

58
Q

What is associated with the development of nasopharyngeal carcinoma?

A

EBV, diets high in volatile nitrosamines, smoking, formaldehyde, chemical fumes, radiation exposure

59
Q

What is the most common initial presentation for nasopharyngeal carcinoma?

A

An asymptomatic cervical mass (posterior triangle or jugulodigastric)

60
Q

What is the staining pattern of nasopharyngeal carcinoma?

A 
Positive for HMCK (CK5/6)
CK7 and CK20 are negative 
P63 is strong nuclear reaction
P16 is negative 
Strong diffuse EBER
61
Q

What stain is associated with poor prognosis in malignant mucosal melanoma?

A

Matrix metalloproteinase 14

Head And Neck (6 decks)

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