Pathology Flashcards
1
Q
Infectious Rhinitis
A
- Caused by one or more viruses
- Adeno
- Echo
- Rhino
- Changes may extend to produce pharyngotonsilitis
- Secondary bacterial infection enhances the inflammatory reaction
- Produces mucopurulent and sometimes suppurative exudate
2
Q
Allergic Rhinitis
A
- Initiated by hypersensitivity reactions to one of a larger group of allergens
- IgE-mediated
3
Q
Nasal Polyps
A
- Focal protrusions of mucosa from recurrent attacks of rhinits
- Polyps histologically consist of edematous mucosa having loose stroma, often harboring hyperplastic or cystic mucous glands, infiltrated w/ a variety of inflammatory cells (neutrophils, eosinophils, and plasma cells w/ occasional clusters of lymphocytes
4
Q
Chronic Rhinitis
A
- Sequel to repeated attacks of acute rhinitis w/ eventual development of superimposed bacterial infection
- Deviated septum or polyps w/ impaired drainage of secretions contribute to increased likelihood of microbial invasion
5
Q
Sinusitis
A
- Most commonly preceded by acute or chronic rhinitis, but maxillary sinusitis occassionally arises by extension of a periapical infection through the bony floor of the sinus
- Impairment of drainage is important contributor to process
- Obstruction of outflow (most often from the frontal, less commonly from anterior ethmoid) occasionally leads to mucocele
- Offending agents often normal inhabitants of oral cavity
- Is a component of Kartegener Syndrome
- Have potential to spread into orbit and penetrate surrounding bone or spread into cranial vault causing septic thrombophlebitis of dural venous sinus
6
Q
Necrotizing Lesions of Nose and Upper Airways
A
- Acute Fungal Infections - Diabetes/Immunosuppressed
- Granulomatosis w/ Polyangitis (Wegener’s)
- Extranodal NK/T-Cell Lymphoma - lymphoma which tumor cells harbor EBV, typically seen in males 5th/6th decade of life most commonly of Asian and Latin American Descent
7
Q
Pharyngitis and Tonsilitis
A
- Most commonly implicated are the rhinoviruses, echoviruses, and adenoviruses
- Less frequently RSV and various strains of influenza virus
- Bacterial infections may be superimposed on viral infections and may be primary invaders
- Most common offenders are the beta-hemolytic streptococci, but sometimes Staph aureus or other pathogens may be implicated
8
Q
Nasopharyngeal Angiofibroma
A
- Nasopharyngeal angio-fibroma is a benign, highly vascular tumor that occurs almost exclusively in adolescent males who are often fair-skinned and red headed
- 75% express androgen receptors
- Also in association w/ familial adenomatous polyps
- Believed to arise w/in the fibrovascular stroma of the posterolateral wall of the roof of the nasal cavity
- Surgical removal is treatment of choice
- Because of locally agressive nature and intracranial expansion, recurrence rates can be as high as 20%
9
Q
Sinonasal Papilloma
A
- Benign neoplasm arising from the respiratory or schneiderian mucosa lining the nasal cavity and paranasal sinuses
- Occur in 3 Forms
- Exophytic (Most Common)
- Endophytic (Most Important Biologically)
- Cylindrical
- HPV DNA, often types 6 and 11, has been identified in the exophytic and endophytic lesions, NOT cylindrical type
- Observed most commonly in adult males b/t ages 30 and 60
10
Q
Olfactory Neuroblastoma (Esthesioneuroblastoma)
A
- “Small round blue cell tumors”
- Arise from neuroectodermal olfactory cells present w/in the mucosa, particularly in the superior aspect of the nasal cavity, and express neuroendocrine markers by immunohistochemistry
- Bimodal age distribution w/ peaks at 15 and 50 years of age
- Typically present w/ nasal obstruction and/or epistaxis
11
Q
Sinonasal Undifferentiated Carcinoma (SNUC)
A
- Anaplastic carcinoma in the skull base of adults
- No histological differentation
- Positive for CK by immunohistochemistry confirming epithelial origin
- Very aggressive w/ 2 year median survival
12
Q
NUT Midline Carcinoma
A
- Uncommon tumor that may occur in the nasopharynx, salivary gland, or in the other midline structures in the thorax or abdomen
- Characteristic transfusion resulting in fusion gene product which may be a future therapeutic target (BRD4-NUT)
- Can occur at any age (infancy to late adulthood)
- Extremely agressive and resistant to conventional therapy
- Most patients survive less than a year following diagnosis
13
Q
Nasopharyngeal Carcinoma
A
- Thought to take 1 of 3 patterns:
- Keratinizing Squamous Cell Carcinomas
- Nonkeratinizing Squamous Cell Carcinomas
- Undifferentiated/Basaloid Carcinomas
- Abundant non-neoplastic, lymphocyte infiltrate
- 3 Factors Influence Origins of These Neoplasms
- Heredity
- Age
- Infection w/ EBV
- As well as diets high in nitrosamines (fermented foods/salted fish)
- Often clinically occult for long periods
- Present w/ nasal obstruction, epistaxis, and often metastases to cervical lymph nodes in as many as 70% of the patients
- Nonkeratinizing Type = better prognosis
- Ketanizing Type = worst prognosis 20% 5-year survival
14
Q
Cholesteatomas
A
- Associated w/ chronic otitis media
- Non-neoplastic, cystic lesions 1-4 cm in diameter
- Lined by keratinizing squamous epithelium or meta-plastic mucus-secreting epithelium, and filled w/ amorphous debris
- Sometimes contain spicules of cholesterol
- Pathogenesis not clear, proposed that chronic inflammation and perforation of the eardrum w/ ingrowth of the squamous epithelium or metaplasia of the secretory epithelial lining of the middle ear are responsible for the formation of a squamous cell nest that becomes cystic
- Can erode into the ossicles, labyrinth, adjacent bone, or surrounding soft tissue and sometimes produce visible neck masses
15
Q
Otosclerosis
A
- Abnormal bone deposition in the middle ear about the rim of the oval window into which the footplate of the stapes fits
- Both ears usually affected
- Fibrous ankylosis of the footplate followed by bony overgrowth anchoring it into the oval window
- Degree of immobilization governs the severity of the hearing loss
- Familial in most instances
- Autosomal dominant transmission w/ variable penetrance
16
Q
Caries
A
- Fermenting sugars by bacteria → acidic metabolites → demineralization of tooth
17
Q
Gingivitis
A
- Inflammation of the gums
- Result of poor oral hygiene and leads to the accumulation of dental plaque and calculus
- Dental plaque is colorless biofilm that collects b/t and on the surface of the teeth
- It contains a mixture of bacteria, salivary protein, and desquamated eptihelial cells
- If not removed mineralized to calculus (tartar)
18
Q
Periodontitis
A
- Inflammation of the supporting structures of the teeth
- Can lead to complete destruction of the periodontal ligament, leading to loosening and eventual loss of teeth
- May be associated w/ underlying systemic disease and may contribute to development of systemic infectious diseases
19
Q
Aphthous Ulcers (Canker Sores)
A
- Painful, superficial oral mucosa ulcerations of unknown etiology
- Tend to be prevalent w/in certain families and may also be associated w/ immunologic disorders
- Celiac Disease
- IBD
- Behcet Disease
- Single or Multiple
- Shallow, hyperemic ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema
20
Q
Irritation Fibroma
A
- Submucosal nodular mass of fibrous connective tissue stroma (reactive), occurs primarily on the buccal mucosa along the bite line or the gingiva
- Tx = Complete Excision
21
Q
Pyogenic Granuloma
A
- Inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women
- Surface of lesion is often ulcerated and red to purple in color
- Histologically, highly vascular proliferation of organizing granulation tissue
- Complete surgical excision is the definitive treatment for these lesions
22
Q
Peripheral Ossifying Fibroma
A
- Reactive in nature
- May arise from a long-standing pyogenic granuloma or develop de novo from cells of the periodontal ligament
- Appear as red, ulcerated, and nodular lesions of the gingiva
23
Q
Peripheral Giant Cell Granuloma
A
- Reactive/Inflammatory process
- Histologically, striking aggregation of multinucleate, foreign body-like giant cells separated by a fibroangiomatous stroma
24
Q
Herpes Simplex Virus Infections
A
- HSV-1 is most common
- Primary infections typically occur in children b/t 2-4 years old
- 10-20% present w/ acute herpetic gingivostomatitis (vesicles and ulcerations of mucosa, lymphadenopathy, fever, anorexia, and irritability)
- Vesicles
- Few millimeters to large bullae filled w/ a clear, serous fluid
- Rupture to yield painful, red-rimmed, shallow ulcerations
- Eosinophilic intranuclear viral inclusions, giant cells, Tzanck test positive
- Clear w/in 3-4 weeks, becomes dormant in trigeminal ganglion
25
Q
Oral Candidiasis (Thrush)
A
- Candida albicans - normal component of the oral flora in approx. 50% of the population
- Immunocompromised individuals, diabetics and patients on broad spectrum antibiotics
- Most Common Clinical Form: Pseudomembranous Form (Thrush)
- Characterized by a superficial, gray to white inflammatory membrane composed of matted organisms enmeshed in a fibrnosuppurative exudate that can be readily scraped off to reveal an underlying erythematous inflammatory base
26
Q
Raspberry/Strawberry Tongue
A
Scarlet Fever
27
Q
Koplik Spots
A
Measles
28
Q
Acute Pharygitis
Enlargement of Lymph Nodes in the Neck
Palatal Petechiae
A
Infectious Mononucleosis
29
Q
Pseudomembrane
A
Diptheria
30
Q
Reticulate
Lacelike
White Keratotic
A
Lichen Planus
31
Q
Vesicles and Bullae Prone to Rupture
A
Pemphigus
Bullous Pemphigoid resembles but can be differentiated histologically (Not Inside the Mouth)
32
Q
Maculopapular, Vesiculobullous Eruption
A
Erythema Multiforme
33
Q
Hairy Leukoplakia
A
- In pts w/ HIV and may portend the development of AIDS
- Caused by EBV
- Takes form of white, confluent patches of fluffy (“hairy”), hyperkeratotic thickenings, almost always situated on the lateral border of the tongue
- CANNOT be scraped off
- Distinctive microscopic appearance consists of hyperparakeratosis and acanthosis w/ “balloon cells” in the upper spinous layer
34
Q
Leukoplakia and Erythroplakia
A
- Leukoplakia
- White patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease
- Up to 25% are premalignant
- Erythroplakia
- Red, velvety, possibly eroded area w/in the oral cavity that usually remains level w/ or may be slightly depressed in relation to the surrounding mucosa
- Epithelium in such lesions tends to be markedly atypical, and the risk of malignant transformation is much higher than is leukoplakia
- Both found in persons aged 40-70
- 2:1 Male Preponderance
- Although these lesions have multifactorial origins, the use of tobacco is a common antecedent
35
Q
Squamous Cell Carcinoma
A
- 95% of cancers of the head and neck are SCCs
- Pathogenesis is multifactorial
- North America and Europe - chronic abusers of smoked tobacco and alcohol
- India and Asia - chewing of betel quid and paan
- Actinic radiation (sunlight) and, particularly, pipe smoking are known predisposing influences for cancer of the lower lip
- In oropharynx, 70% of SCCs, particularly those involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of HPV, particularly HPV-16
- Patients w/ HPV-positive SCC have greater long-term survival than those w/ HPV-negative tumors
- Typically create ulcerated and protruding masses that have irregular and indurated borders
- As a group these tumors tend to infiltrate locally before they metastasize to other sites
36
Q
Verrucous Carcinoma
A
- SCCA w/ a very “wart-like” appearance and more insidious growth pattern
- Usually blander than typical SCCA but has a “pushing” pattern or growth
- Treated w/ laser instead of surgery
37
Q
Dentigerous Cyst
A
- Cyst that originates around the crown of an unerupted tooth
- Radiographically
- Unilocular lesions most often associated w/ impacted third molar teeth
- Complete removal is curative
38
Q
Odontogenic Keratocyst
A
- Aggressive behavior
- Diagnosed in male patients b/t ages 10 and 40 w/in the posterior mandible
- Radiographically
- Present as well-defined unilocular or multilocular radiolucencies
- Treatment requires complete removal of the lesion, because OKCs are locally aggressive and recurrence rates for inadequately removed lesions can reach 60%
39
Q
Periapical Cyst
A
- Inflammatory in origin
- Found at apex of teeth
- Develop as a result of long-standing inflammation of the tooth (pulpitis), which may be caused by advanced carious lesions or by trauma to the tooth
40
Q
Ameloblastoma
A
- Arises from odontogenic epithelium
- Commonly cystic, slow growing, and locally invasive but has an indolent course in most cases
- Typically requires wide surgical resection
41
Q
Odontoma
A
- Most common type of odontogenic tumor, arises from epithelium but shows extensive depositions of enamel and dentin
- Odontomas are probably hamartomas rather than true neoplasms and are cured by local excision
42
Q
Laryngotracheobronchitis (Croup)
A
- Parainfluenza Virus
- Nonspecific respiratory symptoms (rhinorrhea, sore throat, cough) and low grade fever
- 1-2 Days
- Characteristic Signs
- Hoarseness
- Barking Cough
- Inspiratory Stridor
43
Q
Reactive Nodules
A
- Vocal Cord Nodules and Polyps
- Sometimes develop on the vocal cords, most often in heave smokers or in individuals who impose great strain on their vocal cords
- Smooth, rounded, sessile, or pedunculated excrescences, generally only a few millimeters in the greatest dimension
- Located usually on the true vocal cords
- Renke’s edema cuases edematous thickening of the vocal cords
- Characteristically change the character of the voice and often cause progressive hoarseness
- Virtually never give rise to cancers
44
Q
Squamous Papilloma
A
- Benign located on the true vocal cords
- Soft, raspberry-like rearely more than 1 cm in diameter
- Histologically
- Multiple slender, finger-like projections supported by central fibrovascular cores and covered by an orderly stratified squamous epithelium
- Traumatized, may lead to ulceration that can be accompanied by hemoptysis
45
Q
Papillomatosis
A
- Juvenile laryngeal papillomatosis
- Multiple in children, caused by HPV types 6 and 11
- Do NOT become malignant, but frequently recur
- Often spontaneously regress at puberty, but some affected patients endure numerous surgeries before this occurs
46
Q
Carcinoma of the Larynx
A
- Typically squamous cell carcinoma seen in male chronic smokers
- Vary from smooth, white or reddened focal thickenings, sometimes roughened by keratosis, to irregular verrucous or ulcerated white-pink lesions
- Commonly seen in men in the sixt decade of life and often manifests clinically as persistent hoarseness, dysphagia, and dysphonia
- Prognosis dependent on clinical staging
47
Q
Branchial Cyst (Cervical Lymphoepithelial Cyst)
A
- Arise from remnants of the second branchial arch in young adults (20-40 years)
- Benign cysts on the upper lateral aspect of the neck along the sternocleidomastoid muscle
- Morphology: fibrous wall lined by stratified squamous or psuedostratified columnar epithelium w/ lymphoid tissue w/ prominent germinal centers
- Readily excised
48
Q
Thyroglossal Duct Cyst
A
- Embryologically the thyroid anlage begins in the region of the foramen cecum at the base of the tongue; as the gland develops it descends to its definitive midline location in the anterior neck
- Remnants of this developmental tract may persist, producing cysts
- 1-4 cm in diameter
- May be lined by stratified squamous or psuedostratified columnar epithelium
- Connective tissue wall of the cyst may harbor lymphoid aggregates or remnants of recognizable thyroid tissue
- Treatment = excision
