Pathology Flashcards
Cholesteatoma
Collection of dead skin cells which become stuck in the ear, release enzymes which break down bone.
What usually happens to the ear drum preceding cholesteatoma?
Retraction of the ear drum creating pockets in which the dead skin cells can collect.
What nerve is affected in vestibular schwannoma ?
Vestibulocochlear nerve CN VIII within the temporal bone
What symptoms does someone present with in vestibular schwannoma?
Hearing loss
Tinitus
Dizziness
What should be considered if a young patient presents with bilateral vestibular schwannoma?
Neurofibromatosis type 2
What is neurofibromatosis type 2?
Autosomal dominant sporadic mutation
Encodes for the merlin protein
Where does the mutation occur in neurofibromatosis type 2?
Ch22q12
What clinical signs are present in neurofibromatosis type 2?
Cafe au lait spots
Cataracts
What are the causes of nasal polyps?
Allergic
Infection
Asthma
Nickel exposure
If a young patient <20 presents with nasal polyps what is the risk?
Cystic fibrosis
What is glomerulonephritis with polyangitis?
Small vessel vasculitis with necrosis (ulceration)
What is the clinical presentation of someone with glomerulonephritis and polyangitis?
SOB, wheeze, cough, Rhinorrhea, septal ulcers
Glomerulonephritis, Haematuria
Increased BP
Glomerulonephritis is pANCA +ve. T/F?
False
cANCA +VE
Why are most malignant tumours of the nose squamous cell carcinoma?
Irritation of the respiratory epithelium and subsequent metaplasia as squamous cells are more resistant to irritation.
Who are usually affected by sinonasal papillomas?
Over 50 male
What three types of sinonasal papillomas are there?
Inverted
Exophytic
Oncocytic
What factors increase the risk of sinonasal polyps?
HPV
Smoking
Organic solvents
Welding
What is primary presenting complaint of someone with sinonasal polyps?
Blocked nose
What is the risk of malignant change in sinonasal polyps?
Very low they very rarely undergo malignant change.
What has a strong causative link to nasopharyngeal carcinomas?
Ebsteinn barr virus
Volatile nitrosamines
What are risk factors for developing nasopharyngeal carcinomas?
Occupational exposure to hard wood dust, formaldehyde Family history Smoking Alcohol HPV
What is the prognosis for someone with nasopharyngeal carcinomas?
Highly malignant locally invasive with early lymphatic spread.
What cancer is Ebsteinn Barr virus linked to?
Hodgkins lymphoma
Excessive B cell proliferation due to T helper cells being hijacked by the virus.
What are laryngeal polyps?
A reactive change secondary to vocal abuse or infection
What endocrine condition can rarely present with laryngeal polyps?
Hypothyroidism
What two age groups are affected by squamous papillomas?
<5 years
20-40 years
How are children affected by squamous papilloma?
Usually a more aggressive disease profile but regresses during puberty
Risk of malignancy
What are some risk factors for childhood squamous papillomas?
vaginal delivery
In adults how do squamous papillomas present?
Often solitary papillomas.
How do squamous papillomas present histologically?
Finger like projections with a fibrovascular core and squamous cover.
What are paragangliomas?
Clusters of neuroendocrine cells
What do sympathetic paragangliomas do and where are they generally located?
Secrete catelchoamines
Paravertebral sites
Where are parasympathetic paragangliomas generally found?
Related to the great vessels of the head and neck.
How common are paragangliomas and what condition are they linked to?
Very rare, if present they are often part of a MEN2
What do paragangliomas look like histologically?
Nest of round neuroendocrine cells surrounded by a delicate vascular septum.
If a patient presents with a squamous cell carcinoma of the oropharynx what is the most likely cause?
HPV type 16
What is the prognosis of someone with a HPV type 16 related squamous cell carcinoma of the oropharynx?
Very good as it responds to therapy very well
What risk factors for squamous cell carcinomas are there?
Smoking and alcohol
What is a sialolithiasis ?
Stones within the salivary glands
If a young patient presents with a unilaterally painful salivary gland what do you think?
Consider a tumour, parotid is the most common tumour
Who is generally affected by a pleomorphic adenoma?
Women between 30-70 who have had a past exposure to radiation.
What is the risk associated with pleomorphic adenomas?
Very difficult to excise due to risk of recurence
Longstanding risk of malignant transformation
How do pleomorphic adenomas present histologically?
Well circumscribed partially encapsulated
Epithelial/ myoepithelia cells
Who is generally affected with worthing tumours?
Male over 50
How do Worthings tumours present?
Linked to the parotids, bilateral multi centric
Well circumscribed but can be cystic
How do mucoepidermidoid carcinomas present?
Well circumscribed often infiltrative
Varied squamous or mucous cells
Cystic or solid
How do adenoid cystic carcinomas present?
Grey white infiltrative mass
Skip lesions
Cribiform punched out appearance
What 4 types of tumours affect the salivary glands?
Pleomorphic adenoma
Worthings tumour
Mucoepidermidoid carcinoma
Adenoid cystic carcinoma
