Pathology

Question 1

Describe the histology of the auditory meatus and middle ear

Answer 1

Auditory meatus and external canal are lined by epidermis (skin) - contains sebaceous and ceruminous glands (produces ear wax) – any pathologies you can get in the skin you can get here
Middle ear – columnar lined mucosa - contains ossicles – malleus, incus and stapes

Question 2

Describe the histology of the throat

Answer 2

True vocal chords are squamous, below that is respiratory

Question 3

Otitis media which is really smelly = ?

Answer 3

Pseudomonas aeruginosa

Question 4

What is cholesteatoma?

Answer 4

Not a tumour and doesn’t contain cholesterol
Basically Keratinizing squamous epithelium in the middle ear – looks normal on biopsy, just not where it should be
There is high cell turnover and abundant keratin production, associated inflammation
Presents with cheesy discharge – keratin. It can rupture the eardrum outwards

Question 5

Vestibular Schwannoma

• Associated with which nerve?
• Benign or malignant?

Answer 5

Associated with vestibular portion of vestibulocochlear nerve (VII). Occur within temporal bone and represent 80-90% of cerebellopontine angle tumours.
Benign tumour of Schwann cells

Question 6

If bilateral Schwannoma in a young person, what should you consider?

Answer 6

Neurofibromatosis Type II

Question 7

Give some aetiologies of nasal polyps

Answer 7

Allergy, infection, asthma, aspirin sensitivity, nickel exposure.

Question 8

In which organs is the vasculitis in GPA?

Answer 8

Kidneys and respiratory tract

Question 9

What is the most common malignant tumour found in the nose?

Answer 9

Squamous cell carcinoma

Question 10

Nasopharyngeal carcinoma (NPC) is associated with which virus?

Answer 10

Epstein-Barr virus

Question 11

What are laryngeal polyps caused by?

Answer 11

Inflammatory change after insult caused by vocal abuse, infection and smoking etc

Question 12

What is a contact ulcer?

Answer 12

Benign response to injury - chronic throat, voice abuse, gastrooesophageal reflux (GORD).
Pathology similar to nodules and polyps with addition of ulceration and granulation tissue

Question 13

Squamous papilloma/papillomatosis

• Incidence?
• Related to which virus?
• Difference between adults and children?

Answer 13

Two peaks of incidence - <5years and between 20-40 years.
Related to HPV exposure – types 6 and 11.
Children – aggressive disease – recurrent respiratory papillomatosis.
Adults – often solitary and possibly not related to HPV 6 & 11.

Question 14

What is a paraganglioma?

Answer 14

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.

Question 15

Give three risk factors for squamous cell carcinoma in the mouth/throat

Answer 15

Smoking
Alcohol
HPV

Question 16

Give some general rules when considering tumours of the salivary glands

Answer 16

1. Large glands are most common site for most tumours – parotid
2. Tumours in large glands are more likely to be benign
3. Tumours in minor glands are more likely to be malignant
4. Beware of pain as presenting symptom – facial nerve involvement

Question 17

What is a pleomorphic adenoma

Answer 17

A benign tumour most common in the parotid