Pathology 1st Slide Set Flashcards
What type of reaction is allergic rhinitis?
Type 1 hypersensitivity
IgE mediated
What is noncardiogenic pulmonary edema due to?
Injury to the alveolar septa
if there is death from nasopharyngeal angiofibroma then what causes it?
hemorrhage and intracranial extension
Describe the characteristic for resolution of infectious rhinitis?
Self limiting
Treatment for nasopharyngeal angiofibroma
surgical removal
Acute sinusitis is commonly preceded by what?
Acute or chronic rhinitis
What are the offending agents in sinusitis?
Oral cavity microbes or may be allergic (NOT viruses)
either incomplete expansion of the lungs or collapse of previously inflated lung
atelectasis
Exophytic and inverted subtypes of sinonasal (schneiderian) papilloma are associated with what?
HPV subtype 6 and 11
The most common form of laryngitis in adults is encountered in what people
heavy smokers
What is the histological manifestation of ALI and ARDS?
Diffuse alveolar damage (DAD)
Recurrent attacks of rhinitis may eventually lead to what?
Focal protrusion of mucosa producing so called nasal polyps (up to 3 to 4 cm in length)
Treatment for a nasopharyngeal carcinoma
Radiation
-undifferentiated is more sensitive but also most aggressive
What are the 4 steps in the pathogenesis of ALI/ARDS?
- endothelial activation
- Adhesion and extravasated of neutrophils
- Accumulation of intraalveolar fluid and formation of HYALINE MEMBRANES
- Resolution
sequestration most commonly come to attention in INFANTS as mass lesions and are external to the lung
extralobar
Tumor with association with familial adenomatous polyps
Nasopharyngeal angiofibroma
What contributes to the likelihood of microbial invasion in chronic rhinitis?
A deviated septum or nasal polyps with impaired drainage of secretions
Are nasal polyps linked to Atopy?
No
Enlarged, redened tonsils (due to reactive lymphoid hyperplasia) dotted by pinpoints of exudate emanating from the tonsillar crypts
follicular tonsillitis
When large or multiple what may nasal polyps encroach upon?
Airway and impair sinus drainage
sequestration that usually presents in OLDER CHILDREN often due to recurrent localized infection or bronchiectasis and occurs within the lung
intralobar
Laryngitis in adult heavy smokers predisposes to what
squamous epithelial metaplasia and sometimes overt carcinoma
Where can an inverted sinonasal papilloma extend?
orbit or cranial vault
What are the main viruses that cause infectious Rhinitis?
- adenovirus
- Rhinovirus
- Echovirus
Focal or generalized pulmonary or plueral fibrosis causes what type of ateletasis?
contraction
In ALI the lungs have UNEVEN functional abnormalities. Areas of infiltration and consolidation are poorly aerated creating what?
Ventilation-perfusion mismatch
What does a patient with an olfactory neuroblastoma usually present with?
nasal obstruction and/or epistaxis
if pulmonary hypoplasia is bilateral what is the likely cause?
unilateral?
Oligohydramnios
Diaphragmatic hernia
What causes a severe form of of chronic sinusitis and in what kind of patients?
- fungi (mucormycosis or aspergillus)
- diabetes and immunocompromised
This arises from abnormal detachments of primitive foregut and are most often located in he hilum or middle mediastinum
foregut cyst
what are causes of compression atelectasis
- transudate, exudates, blood
- tumor
- air (pneumothorax
Allergic rhinitis is characterized by what clinically
- mucosal edema
- redness
- mucus secretion
- accompanied by a leukocytic infiltration in which eosinophils are prominent
Benign tumor arising from the respiratory mucosa of nasal cavity and paranasal sinuses
Sinonasal (Schneiderian) Papilloma
Abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure
Acute lung injury (noncardiogenic pulmonary edema)
What does the wall of a bronchogenic foregut cyst contain?
- bronchial glands
- cartilage
- smooth muscle
Occasionally arises by extension of a periapical infections through the bony floor of the sinus
Maxillary sinusitis
Which nasopharyngeal carcinoma is composed of large epithelial cells with oval or round vesicular nuclei, prominent necleoli, and indistinct cell borders disposed in a syncytium like array
undifferentiated basaloid variant
papillomas are caused by what virus
HPV 6 and 11
What is seen in serum by PCR with undifferentiated basaloid variant pharyngeal carcinoma
EBV genomes and EBV encodes RNAs such as EBER-1 and LMP-1
alveolar capillaries are engorged, and an intra-alveolar transudate appears as finely granular pale pink material
hemodynamic pulmonary edema
if multiple papillomas occur in a child they are referred to as what?
juvenile laryngeal papillomatosis
Patient presents with acute respiratory failure often following an illness of less than 3 weeks duration that resembles and upper respiratory tract infection. Age 59. Death within 1 to 2 months
Acute interstitial pneumonia or idiopathic ALI-DAD
Decreased pulmonary weight, volume, and acini for body weight and gestational age
pulmonary hypoplasia
Histology for olfactory neuroblastoma
- “small, round blue cell tumor”
- nests and lobules of well-circumscribed cells that are separated by a fibrovascular stroma
- Many have fibrillary matrix that ultrastrucutally corresponds to tangles of neuronal cell processes
Explain the changes when a bacterial infection is super imposed on infectious rhinitis
-mucopurulent and sometimes frankly suppurative exudate
epidemiology for sinonasal (schneiderian) papilloma
- M>F
- 30-60
Associations with Extranodal NK/T cell lymphoma nasal type
- EBV
- Male, 40s-50s, Asian and Latin American
- Aggressive
Early in the course of ALI the lungs become stiff due to what?
Loss of functional surfactant
in which form of nasopharyngeal carcinoma do most patients have anti-EBV antibodies against early antigens or viral capsid antigens
Nonkeratinizing form
Carcinoma of the larynx often manifests clinically as what?
persistent hoarseness, dysphagia, and dysphonia
consequences of hemodynamics pulmonary edema
decrease in O2 and increase risk of infection
Frequently there is superficial desquamation or ulceration of mucosal epithelium and a variable inflammatory infiltrate of neutrophils, lymphocytes, and plasma cells subjacent to the epithelium
Chronic rhinitis
Nasopharyngeal carcinoma geographic distribution
- African children
- Chinese adults
The main predisposing factors to ALI or ARDS?
- Shock
- oxygen therapy
- SEPSIS
- diffuse pulmonary infection
- gastric aspiration
- Trauma
Describe the time frame and clinical presentation for primary pharyngeal carcinomas
clinically occult for long periods and present with nasal obstruction, epistaxis, and often metastases to cervical lymph nodes
papillomatous growth of SQUAMOUS cell-lined fronds downward from mucosal surface into the underlying stromal tissue
inverted sinonasal papilloma
what are foregut cysts lined by microscopically?
ciliated pseudostratified columnar epithelium
What is the clinical significance of chronic sinusitis?
More uncomfortable than disabling but have potential of spreading into the orbit or of penetrating into surrounding bone to give rise to osteomyelitis or spreading into cranial vault, causing septic thrombophlebitis of a dural venous sinus
uniformly associated with translocations that create fusion genes encoding chimeric proteins comprised of most of NUT, a chomatin regulator, and a portion of a “chromatin reader” usually BRD4
NUT midline carcinoma
Vascular tumor, almost always in adolescent males especially red-haired and fair-skinned
Nasopharyngeal angiofibroma
3 subtypes of sinonasal (Schneiderian) papilloma in decreasing order of prevalence
- Exophytic (fungating)
- Inverted (endophytic)
- Cylindrical (oncocytic)
epidemiology for squamous cell carcinoma of larynx
chronic male smokers in 50s
Describe the histology of a nasal polyp
Edematous mucosa having loose stroma, often harbor into hyperplastic or cystic mucous glands, infiltrated with a variety of inflammatory cells, including neutrophils, EOSINOPHILS, and plasma cells with occasional clusters of lymphocytes
describe the malignancy of an inverted sinonasal papilloma?
10% malignant transformation
Because olfactory neuroblastomas are of neuroendocrine origin, the tumor cells contains what on electron microscopy and express what b IHC?
- membrane bound secretory granules
- neuron-specific enolase, synaptophysin, CD56, and chromogranin
Describe the mucosal covering of a nasal polyp with chronicity
May become ulcerated or infected
Major importance of strep throat?
possible development of late sequelae such as rheumatic fever and glomerulonephritis
Describe the mucosal covering of a polyp in the absence of a bacterial infection
Intact
Describe the initial acute stages of infectious Rhinitis
- nasal mucosa thickened, edematous, and red
- nasal cavities narrowed
- turbinates enlarged
describe the resolution of papillomas
often spontaneously regress at puberty
A discrete area of lung tissue that lacks any connection to the airway system and has an abnormal blood supply arising from the aorta or its brances
pulmonary sequestration
Reactive nodules are smooth round small protrusions on the true vocal cords arising in what people
- Singers (bilateral)
- Smokers - polyps - (unilateral)
Kartagener syndrome is secondary to defective what?
Ciliary action (dyenin)
What are the bacteria that cause super infections on top of viral pharyngitis and tonsillitis?
- beta-hemolytic strep (strep throat)
- S. aureus (occasionally)
3 forms of nasopharyngeal carcinoma
- Keratinizing squamous cell carcinoma
- Nonkeratinizing squamous cell carcinoma
- undifferentiated basaloid carcinoma that have an abundant non-neoplastic, lymphocytic infiltrate
describe the progression to carcinoma of the larynx
squamous hyperspasia to dysplasion to carcinoma
What are the three ways to get a necrotizing ulcerating lesion of the upper respiratory tract?
- Acute fungal infection
- Granulomatosis with polyangiitis
- Extranodal NK/T cell lymphoma nasal type
Soggy lungs become firm and brown from fibrosis and thickening of the alveolar walls (brown induration), hemosiderin-laden macrophages are abundant
Long standing hemodynamic pulmonary congestion as seen in mitral stenosis
What syndrome?
Sinusitis
Bronchiectasis
Situs inversus
Karagener syndrome
What is admixed with the epithelial cells of undifferentiated basaloid variant pharyngeal carcinoma
abundant mature, normal appearing lymphocytes, which are predominantly T cells
What environmental factors have been linked to nasopharyngeal carcinoma?
- diets high in nitrosamines such as fermented foods and salted fish
- smoking
- chemical fumes
Three classifications of a foregut cyts depending on wall structure
- bronchogenic (most common)
- esophageal
- enteric
how do you distinguish brochioles from bronchi
lack of cartilage and lack of submucosal glands within their walls
papillomas are usually _____ in adults but are often _____ in children
single
multiple
Where do nasopharyngeal angiofibromas arise and what are the characteristics
- with fibrovascular stroma of posterolateral roof of nasal cavity
- classified as benign
- may be locally aggressive and extend intracranially
Where do the suppurative infections of chronic rhinitis often extend
Air sinuses
Benign neoplasms usually located on the true vocal cords that form soft respberry-like proliferations rarely more than 1 cm in diameter
Laryngeal squamous papillomas
Do papillomas become malignant?
no but frequently recur
What type of organisms usually cause infectious rhinitis?
Virus
What is the acinus composed of
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
Histology of squamous papillomas
multiple slender, finger-like projections supported by central fibrovascular cores and covered by an orderly stratified squamous epithelium
another name for undifferentiated basaloid carcinoma that have an abundant non-neoplastic lymphocytic infiltrate
lymphoepithelioma
What is the characteristic clinically of Reactive Nodules on the vocal cords
change the character of the voice and often cause progressive hoarseness
What are the most common allergens that cause allergic rhinitis
Plant pollens, fungi, animal allergens, dust mites
When you have a bacterial super infection on top of viral pharyngitis and tonsillitis what do you find?
whitish exudative material overlying reddened, swollen tonsils (psuedomembrane)
resorption atelectasis stems from what?
mediastinum goes where?
complete obstruction (excessive secretions; mucus plugs; aspiration; exudates of smaller bronchi)
towards
A sequel to repeated attacks of acute rhinitis, either microbial or allergic in origin, with the eventual development of superimposed bacterial infection
Chronic rhinitis
the epithelial alteration of carcinoma of the larynx are most often related to waht?
tobacco smoke . . with alcohol increases risk even more
What does an olfactory (esthesioneuroblastoma) neuroblastoma arise from?
neuroectoderm in superior nasal cavity
Impairment of drainage of sinus by inflammatory edema of mucosa that when complete, it impound the suppurative exudate
Empyema
Severe Acute lung injury (ALI) is also called what?
Acute respiratory distress syndrome (ARDS)
Which type of atelectasis is NOT reversible?
contraction
uncommon tumor that may occur in nasopharynx, salivary gland, or other midline structure in thorax or abdomen
NUT midline Carcinoma
Profound dyspnea and tachypnea followed by increasing cyanosis and hypoxemia, respiratory failure and appearance of DIFFUSE BILATERAL INFILTRATES
ALI
Nature and description of NUT midline carcinoma
- resembles squamous cell carcinoma’
- extremely aggressive and resistant to conventional therapy
- most paitents survive for less than a year
When a papilloma is on the free edge of the vocal cord, trauma may lead to ulceration and be accompanied by what?
hemoptysis
Age for olfactory neuroblastoma?
bimodal peaks at 15 and 50
characterized by distinctive geographic distribution, a close anatomic relationship to lymphoid tissue, and an association with EBV infection
nasopharyngeal carcinoma
Do reactive nodules give rise to cancers?
Virtually never
if pulmonary hypoplasia is severe then what is the outcome?
fatal shortly after birth
hemosiderin laden macrophages (“heart failure” cells) may be seen within alveoli
hemodynamic pulmonary edema
Majority of death in an ALI patient are due to what?
Sepsis or multi organ failure and, in some cases, direct lung injury
What is the term used to describe widespread ALI of unknown etiology associated with a rapidly progressive clinical course
Acute interstitial pneumonia or idiopathic ALI-DAD
Pharyngitis and tonsillitis are most commonly caused by what agents?
Viruses
- Adeno
- echo
- rhino
Obstruction of what sinus most often leads to accumulation of mucous secretions . .. mucocele
Frontal
Less commonly anterior ethmoid
What happens if inverted sinonasal papiloma is not completely excised?
may recur
What agents in infants and young children with their small airways cause laryngoepiglottitis that may induce sudden swelling of the epiglottis and vocal cords as to constitute a medical emergency . . . croup
- RSV
- Haemophilus influenza
- B-hemolytic strep
defective development of both lungs (or one more than the other)
pulmonary hypoplasia
