Pathology

Question 1

what conditions affect the ear?

Answer 1

otitis media
cholesteatoma
tumours
vestibular schwannoma

Question 2

what is otitis media?

Answer 2

inflammation of the middle ear

Question 3

what causes otitis media?

Answer 3

occasionally bacterial but usually viral.

Strep. pneumonia, H. influenzae and Moxarella catarrhalis

Question 4

what causes chronic otitis media?

Answer 4

pseudomonas aeruginosa, Staph. aureus, fungal

Question 5

when is otitis media seen in the pathology department?

Answer 5

only if requires exclusion

Question 6

what is a cholesteatoma?

Answer 6

abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum.

A cholesteatoma often develops as a cyst, or sac, that sheds layers of old skin.

Question 7

who gets cholesteatoma?

Answer 7

common, any age group

Question 8

where do you get cholesteatoma?

Answer 8

superior posterior middle ear and/or petrous apex

Question 9

what is the pathogenesis of cholesteatoma?

Answer 9

chronic otitis media and perforated tympanic membrane (acquired)

Question 10

what is the pathology of cholesteatoma?

Answer 10

the normal lining of middle ear is cuboidal or columnar glandular epithelium.

Abnormally situated squamous epithelium. High cell turnover and abundant keratin production. Associated inflammation

Question 11

what is a vestibular schwannoma?

Answer 11

associated with vestibular portion of vestibulocochlear nerve (VII)
occur within the temporal bone

Question 12

what percent of cerebellopontine angle tumours do vestibular schwannoma?

Answer 12

80-90%

Question 13

who gets vestibular schwannoma?

Answer 13

95% are sporadic and unilateral

equal gender distribution

Question 14

what should you consider if you have vestibular schwannoma when you are bilateral and young?

Answer 14

consider neurofibromatosis (NF) type 2

Question 15

what is grossly seen in vestibular schwannoma?

Answer 15

circumscribed tan/white/yellow mass

Question 16

what is neurofibromatosis type 2?

Answer 16

AD but usually sporadic mutation.

1:40000 incidence. NF-2 gene encodes merlin protein at Ch22q12

Neurofibromas
Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas
Café au lait
Cataracts

Question 17

what conditions affect the nose?

Answer 17

rhinitis 
sinusitis 
polyp 
GPA (Wegner's) 
tumors

Question 18

rhinitis and sinusitis:

Answer 18

Infectious – common cold

Allergic – hay fever. IgE mediated type 1 hypersensitivity reaction.

Question 19

nasal polyps:

Answer 19

common (not in children)

equal gender distribution

Question 20

what is the numerous etiologies of nasal polyps?

Answer 20

allergy, infection, asthma, aspirin sensitivity, nickel exposure

Question 21

what should you consider in a young person with nasal polyps?

Answer 21

CF

Question 22

what is granulomatosis with polyangiitis?

Answer 22

it is an autoimmune disorder of unknown etiology characterized by a small vessel vasculitis and necrosis, usually limited to respiratory tract and kidneys

Question 23

who gets GPA?

Answer 23

rare. >40 years

Question 24

what do patients with GPA present with?

Answer 24

Present with pulmonary, renal disease or nasal symptoms of congestion, septal perforation etc.

Question 25

what is the characteristics of GPA?

Answer 25

Characterised by high frequency of anti-neutrophil antibody levels – ANCA +ve cANCA – GPA pANCA – microscopic polyangiitis

Question 26

what are nasal tumors?

Answer 26

they are relatively rare

Question 27

what are benign nasal lesions?

Answer 27

squamous papillomas, “Schneiderian” papillomas. Angiofibromas

Question 28

what are malignant nasal lesions?

Answer 28

Most commonly Squamous cell carcinoma Also primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

Question 29

what is schneiderian papilloma?

Answer 29

inverted, exophytic or oncocytic

Question 30

who gets schneiderian papilloma?

Answer 30

tends to be over 50's and more common males

Question 31

what is the etiology of schneiderian papilloma?

Answer 31

HPV (low risk), smoking, organic solvents, welding

Question 32

what re the symptoms of schneiderian papilloma?

Answer 32

blocked nose

Question 33

where do you find schneiderian papilloma?

Answer 33

Inverted and oncocytic on lateral walls and paranasal sinuses, exophytic on nasal septum

Question 34

what is the incidence of nasopharyngeal carcinoma?

Answer 34

low incidence in UK | Very high in Far East

Question 35

who gets nasopharyngeal carcinoma?

Answer 35

males>females

Question 36

what is nasopharyngeal carcinoma associated with?

Answer 36

EBV as well as volatile nitrosamines in food | occupation, family history

Question 37

what is the histological appearance of cells in nasopharyngeal carcinoma?

Answer 37

keratinising SCC or non-keratinizing

Question 38

EBV carcinogensis:

Answer 38

Seen in association with Burkitt’s lymphoma, other B-cell lymphomas and Hodgkin’s lymphoma Infects epithelial cells of oropharynx and B-cells Ubiquitous infection – most subclinical. Occasional infectious mononucleosis EBV hi-jacks and mimicks helper T-cell responses leading to proliferation and survival of B-cells. Mediated largely by latent membrane protein 1 (LMP-1). EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1.