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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
Where do many of the nasopharynx carcinomas arise from?
Eustachian tube opening
26
What is NUT midline carcinoma?
Highly aggressive variant of SCC | Chromosome 15 fusing with BRD4 or BRD3 genes on chromosomes 19 or 9 respectively
27
What is the diagnostic criteria for wegener disease?
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
How do inflammatory polyps present?
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
What do inflammatory nasal polyps look like histologically?
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
If an inflammatory polyp occurs in a child what should you suspect?
CF
31
What is the presentation of a schneiderian papilloma?
Men between the ages of 30 and 50 with unilateral nasal obstruction Epistaxis, facial pain, purulent discharge and proptosis may occur
32
What is the recurrence rate of a schneiderian papilloma treated by local excision?
50 to 70 % within 1 to 2 years
33
Where are the organisms of rhinosporidiosis at?
In the epithelium and the underlying stroma
34
Which nasal papilloma variant is most likely to undergo malignant transformation?
Oncocytic
35
Where do most nasopharyngeal carcinomas arise from?
The eusthacian tube opening in the fossa of rosenmuller
36
In patients with normal appear nasopharynx and suspected carcinoma, what should be done and why?
Random biopsies | Because 70% of the time it will yield something
37
How is nasopharyngeal carcinoma treated? And which type has the poorest prognosis?
With radiation | Keratinizing is the least radio sensitive
38
Is NUT-midline carcinoma associated with EBV or HPV?
No | So if positive in situ hybridization then not NUT
39
What is the average survival time for NUT midline carcinoma?
9 to 10 months
40
What does NUT midline carcinoma look like histologically?
Monotonous population of cells Abrupt squamous differentiation Tumor necrosis may be seen and brisk mitotic activity
41
What is the grouping for adenocarcinomas in the sinonasal tract?
Salivary-type and non salivary-type (intestinal type and non intestinal type)
42
What are some complications of untreated bacterial sinusitis?
Orbital cellulitis, meningitis, intracranial abscess, cavernous sinus thrombosis
43
What is a nasal glial heterotopia?
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
How do nasal glial heterotopia present?
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
What is a histologic differential for a nasal glial heterotopia?
Fibrotic nasal polyp Large astrometric cells may be misidentified as histiocytes Do GFAP to stain glial cells
46
How is allergic fungal sinusitis described histologically?
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
What is in the differential for allergic fungal sinusitis?
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
How do you tell the difference in the cysts of rhinosporidiosis vs the cyst in oncocytic type of schneiderian polyp?
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
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?
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
How do respiratory epithelial adenomatoid hamartomas appear histologically?
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
What are lobular capillary hemangiomas associated with clinically and where do they occur?
Hormonal factors and local trauma 1/3 arise in the nasal cavity - anterior nasal septum 2/3 in the oral cavity - gingiva
52
What does a glomangiopericytoma look like histologically?
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
What hormone is thought to be involved with development of a nasopharyngeal angiofibroma?
Testosterone
54
What is the most common salivary gland type adenocarcinomas in the sinonasal tract?
Adenoid cystic adenocarcinoma
55
How is adenoid cystic carcinoma describe histologically?
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
What can be in the differential for small round blue cells in the sinonasal tract?
SCC, SNUC, malignant melanoma, olfactory neuroblastoma, extranodal NK/T cell lymphoma, rhabdomyosarcoma, Ewing sarcoma/PNET
57
What is included in the category nasopharyngeal carcinoma?
SCC, keratinizing and nonkeratinizing, and basoloid
58
What is associated with the development of nasopharyngeal carcinoma?
EBV, diets high in volatile nitrosamines, smoking, formaldehyde, chemical fumes, radiation exposure
59
What is the most common initial presentation for nasopharyngeal carcinoma?
An asymptomatic cervical mass (posterior triangle or jugulodigastric)
60
What is the staining pattern of nasopharyngeal carcinoma?
``` Positive for HMCK (CK5/6) CK7 and CK20 are negative P63 is strong nuclear reaction P16 is negative Strong diffuse EBER ```
61
What stain is associated with poor prognosis in malignant mucosal melanoma?
Matrix metalloproteinase 14

Head And Neck (6 decks)

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