Pathology Flashcards
The auditory meatus and external canal are lined by what?
Epidermis (skin)
What glands are found along the auditory meatus and external canal?
Sebaceous and ceruminous glands
What type of mucosa lines the middle ear?
Columnar mucosa (glandular)
What is the nasal vestibule lined by?
Keratinised stratified squamous epithelium
What are the majority of the nose and the sinuses lined by?
Respiratory epithelium- pseudo stratified ciliated columnar which is mucus secreting
What two types of epithelium can be found in the throat?
Respiratory or squamous, depending on the site
What type of glands are salivary glands? What two components do they have?
Exocrine glands with acinar and ductular components.
What is otitis media?
Inflammation of the middle ear
Is otitis media more likely to be bacterial or viral?
Viral
If otitis media is bacterial, what are some organisms which can cause it?
Strep Pneumoniae, H. Influenzae, Moraxella Catarrhalis
What organism is most likely to be the cause of chronic otitis media?
Pseudomonas Aeruginosa
Where can cholesteatoma occur?
Superior posterior middle ear and/or petrous apex
Give two causes of cholesteatoma?
Chronic otitis media or perforated tympanic membrane
What is the abnormality which occurs in cholesteatoma?
There is abnormally situated squamous epithelium in the middle ear with high cell turnover and abundant keratin
Vestibular Schwannoma is associated with what nerve?
The vestibular nerve (part of CNVIII)
Within which bone does vestibular schwannoma occur?
Temporal
95% of cases of vestibular schwannoma are?
Sporadic and unilateral
What should be considered in a patient with bilateral vestibular schwannoma who is young?
Neurofibromatosis Type 2
How is type 2 neurofibromatosis inherited?
Autosomal dominant (but usually sporadic)
Which is more common, NF1 or NF2?
NF1
What gene is affected in NF2?
NF2 gene which encodes the merlin protein (tumour suppressor)
Give 4 features of NF2?
Bilateral vestibular schwannoma, multiple meningiomas, gliomas and cafe au lait macules
Who are unlikely to get nasal polyps?
Children
What should be considered in a young patient with nasal polyps?
CF
Give some examples of causes of nasal polyps?
Allergy, infection, asthma, aspirin sensitivity
What is allergic rhinitis/sinusitis mediated by?
IgE
Who does GPA tend to affect?
White patients > 40
Patients with GPA will be positive for what?
cANCA
Give two examples of benign tumours of the nose?
Squamous papillomas, angiofibromas
What is the most common malignant lesion in the nose?
Squamous cell carcinoma
Where has a high incidence of nasopharyngeal carcinoma? Which sex is this most common in?
Far East- more common in males
Nasopharyngeal carcinoma has a very strong association with what?
Epstein-Barr virus
Where does Epstein-Barr virus affect?
Epithelial cells of the oropharynx and B cells
The Epstein-Barr virus encodes EBNA-2, activating ? to promote transition from ?
Cyclin D, G0-G1
What happens in a laryngeal polyp?
There is a reactive change in laryngeal mucosa secondary to vocal abuse, infection or smoking
What endocrine condition can laryngeal polyps occur in?
Hypothyroidism
Who are laryngeal nodules usually seen in and where?
Younger women, usually bilateral on the middle-posterior 1/3rds of the vocal cords
Are laryngeal polyps usually unilateral or bilateral?
Unilateral
What is a benign response to injury which can occur in the throat?
Contact ulcer
Give 3 causes of a contact ulcer?
Chronic throat, GORD, vocal abuse
When are the two peak incidences of squamous papilloma in the throat?
< 5 years, and 20-40 years
Squamous papilloma in the throat is related to what?
HPV types 6 and 11
In which group of people is squamous papilloma a more aggressive disease?
Children
What are paraganglioma?
Clusters of neuroendocrine cells dispersed through the body
What two types of paraganglioma exist?
Chromaffin positive and non-chromaffin
In chromaffin positive paraganglioma, what can the sympathetic nervous secrete?
Chatecholamines
Where do chromaffin positive paragangliomas usually occur?
Adrenal medulla or paravertebral
Where are some areas where non-chromaffin paragangliomas are likely to occur?
Carotid/aortic bodies, nose, nasopharynx, larynx, orbit
What age group is most likely to be affected by non-chromaffin paraganglioma?
Can occur at any age but most commonly > 50
Non-chromaffin paraganglioma can occur as part of what genetic condition?
MENII
If non-chromaffin paraganglioma is inherited, how does this occur? How is it more likely to present?
Autosomal dominant- usually multiple and a higher chance of being malignant
What is the major cancer of the head and neck? What are the major risk factors for this?
Squamous cell carcinoma- smoking and alcohol
Squamous cell cancers associated with HPV are most likely to be where? What type of HPV is most commonly the cause?
Oropharynx / Type 16
How does HPV cause squamous cell carcinoma?
Produces E6 and E7 proteins which disrupt p53 and Rb respectively
What is sialolithiasis?
Salivary gland stones
What does paramyxovirus cause?
Mumps causing bilateral parotitis
Which salivary gland is the most common site for tumours?
Parotid
Are tumours in smaller salivary glands more likely to be benign or malignant?
Malignant
If someone is young and presenting with a painful mass in a salivary gland, what should you be thinking about?
Malignancy
What is the most common tumour of a salivary gland?
Pleomorphic adenoma
A pleomorphic adenoma can occur in anyone at any age, but what is the most common presentation?
Females > 60 in the parotid gland with a long history
What is the risk of malignant transformation with a pleomorphic adenoma?
There is a risk if it is longstanding
Warthin’s tumours of the salivary glands are most likely to affect who?
Males > 50
Warthin’s tumours are rare outside which salivary gland? They have a strong association with what?
Rare outside the parotid- strong association with smoking
What is the most common malignant tumour of the salivary glands in the UK?
Adenoid cystic carcinoma
Adenoid cystic carcinoma is the most common tumour of where?
The palate
A Mickey Mouse like cell is most likely to be what?
Eosinophil
A round, dark purple cell with no cytoplasm is most likely to be what?
Lymphocyte
A tumour producing keratin is most likely to be what?
SCC
What cell signifies acute inflammation?
Neutrophil
What cells signify chronic inflammation?
Lymphocytes and macrophages
On histology, areas which look like twiglets are most likely to be?
Fungi
On histology, finger like projections are?
Papillomas
What do darkening, shrinking cells on histology signify?
Necrosis
HPV associated SCC in the tonsils will usually present in who?
A young, healthy individual
