Pathology of ENT

Question 1

What is the normal histology of the auditory meatus and external canal?

Answer 1

Epidermis - stratified squamous epithelium

Contain sebaceous glands and ceruminous glands

Question 2

What is the epithelium of the middle ear?

Answer 2

Columnar lined mucosa

Eustachian tube is respiratory epithelium

Question 3

What type of cells are contained within the salivary gland?

Answer 3

Acinar 
Ductal
Serous cells - contain amylase
Mucinous 
Peripheral myoepithelial cells

Question 4

What bacteria can cause otitis media?

Answer 4

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Pseudomonas 
Staph aureus

Question 5

What is a cholesteatoma?

Answer 5

Chronic otitis media and perforated tympanic membrane leads to abnormally situated squamous epithelium in the middle ear (normal is cuboidal or columnar glandular) causing an abundance of keratin production with associated inflammation

Question 6

What is a vestibular schwannoma - also called an acoustic neuroma?

Answer 6

Associated with the vestibular portion of CN 8

Occurs with temporal bone at the cerebellopontine angle

Question 7

What should be considered in a bilateral vestibular schwannoma in a young patient?

Answer 7

Neurofibromatosis type 2

Question 8

What will neurofibromatosis present as?

Answer 8

Neurofibromas
Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas 
Cafe au lait spots
Cataracts

Question 9

What is the inheritance of neurofibromatosis type 2?

Answer 9

AD

Tumour suppressor gene - merlin protein on chromosome 22

Question 10

What can cause a nasal polyp?

Answer 10

Allergy
Infection
Asthma
Aspirin sensitivity
Nickel exposure

Question 11

What should be considered in a nasal polyp in a child under 5?

Answer 11

CF (AR CFTR gene on chromosome 7)

Question 12

What mucosa should a nasal polyp be covered with?

Answer 12

Respiratory epithelium - squamous epithelium is a metaplastic change

Question 13

What will GPA present with?

Answer 13

Pulmonary - SOB, wheeze, chest pain
Renal - haematuria, glomerulonephritis, hypertension
Nasal symptoms - congestion, septal perforation - saddle nose

Question 14

What antibody test can be used to diagnose GPA?

Answer 14

cANCA

Anti-PR3

Question 15

What antibody test is used for microscopic polyangiitis?

Answer 15

pANCA

Anti-MPO

Question 16

What benign lesions commonly affect the nose?

Answer 16

Squamous papilloma
Schneiderian papilloma
Angiofibroma

Question 17

What malignant lesions commonly affect the nose?

Answer 17

Squamous cell carcinoma (men, smoking and a previous schneiderian papilloma) 
Primary adenocarcinoma
Nasopharyngeal carcinoma
Neuroblastoma
Lymphoma

Question 18

What are the different types of schneiderian papilloma?

Answer 18

Inverted, exophytic or oncocytic

Inverted most common - found on the lateral wall and paranasal sinus

Question 19

What increases the risk of schneiderian papilloma?

Answer 19

Over 50
Male
HPV
Smoking
Organic solvents
Welding

Question 20

What will a schneiderian papilloma present with?

Answer 20

Blocked nose

Sinusitis

Question 21

What does a nasopharyngeal carcinoma have an association with?

Answer 21

EBV
Volatile nitrosamines in food
Occupation, family history

Question 22

What cancers does EBV have an association with?

Answer 22

Burkitt’s lymphoma
B-cell lymphoma
Hodgkin’s lymphoma
Nasopharyngeal carcinoma

Question 23

How does EBV cause cancer?

Answer 23

Hi-jacks and mimics CD4+ T cells leading to proliferation and survival of B cells
EBV encodes a protein to activate cyclin D, promoting cell transition from G0 to G1

Question 24

What can cause a laryngeal polyp?

Answer 24

Vocal abuse
Infection
Smoking
Hypothyroidism

Question 25

What is the difference between a nodule and a polyp?

Answer 25

Nodule - young women, will be bilateral on middle 1/3rd to posterior 1/3rd on vocal cord Polyps are unilateral and pedunculated

Question 26

What is a contact ulcer?

Answer 26

Benign response to injury Posterior vocal cord Caused by chronic throat clearing, voice abuse, GORD or intubation

Question 27

What is squamous papilloma related to?

Answer 27

HPV exposure - types 6 and 11 Children - aggressive disease Adults - often solitary and possible not related to HPV 6&11

Question 28

What is a paraganglioma?

Answer 28

Tumour arising in clusters of neuroendocrine cells dispersed throughout the body

Question 29

What is a chromaffin positive paraganglioma?

Answer 29

Sympathetic nervous system and can secrete catecholamines | Usually adrenal medulla or paravertebral - organ of zuckerkandl (bifurcation of aorta)

Question 30

What is a non-chromaffin paraganglioma?

Answer 30

Carotid body Aortic body Jugulotympanic ganglia Ganglia nodosum of vagus with clusters around oral cavity, nose, nasopharynx, larynx and orbit

Question 31

What will occur with MEN2?

Answer 31

Pheochromocytoma Thyroid medullary carcinoma Parathyroid lesion

Question 32

Where can a squamous cell carcinoma arise in the H&N?

Answer 32

``` Nose Sinus Pharynx Larynx Oral cavity ```

Question 33

What are risk factors for SCC?

Answer 33

Smoking and alcohol | HPV - common in oropharynx

Question 34

How will HPV cause cancer?

Answer 34

Produces proteins E6 and E7 which disrupt p53 and RB pathways (tumour suppressors) leading to cellular mortality

Question 35

What is sialolithiasis?

Answer 35

Stones in the salivary glands leading to pain, swelling and bacterial infections

Question 36

What infections can infect the salivary glands?

Answer 36

Paramyxovirus - mumps causing bilateral parotitis. Associated with orchitis, pancreatitis and secondary meningitis

Question 37

What are the general rules for salivary gland tumours?

Answer 37

Parotid most common site Tumours in the smaller glands are likely to be malignant If young and painfull mass = MALIGNANCY

Question 38

What is a pleomorphic adenoma?

Answer 38

Most common tumour of the parotid gland Usually females int he 4th-6th decade If longstanding can transform into carcinoma ex pleomorphic adenoma

Question 39

What is warthin's tumour?

Answer 39

``` Second most common benign tumour Males over 50 Rare outwith parotid Strong assoc with smoking Bilateral and multicentric ```

Question 40

What is the most common salivary tumour worldwide and in the uk?

Answer 40

Worldwide: mucoepidermoid carcinoma UK: adenoid cystic carcinoma

Question 41

Why is the survival rate of an adenoid cystic tumour so low (5 year 35%)?

Answer 41

Frequent perineural invasion - assoc pain or LOF