Pulm Path Pt 4 Flashcards
What are normal histologic features of respiratory epithelium?
- ciliated cells
- goblet cell
- mucus glands
- lymphoid aggregates
What are the most likely complications of an ethmoid sinusitis infection?
- preseptal cellulitis
- orbital cellulitis ***
- subperiostal abscess
What are the most likely complications due to frontal sinusitis infection?
- osteomyelitis
- mucocele
- meningitis ***
- epidural abscess
What is allergic fungal sinusitis?
occurs as a result of hypersinsitivity to fingal organisms (Aspergillus) that have colonized the sinus tract
What are the histologic feature of allergic fungal sinusitis?
- allergin mucin
- may see fungal hyphae
When do you typically see fungal sinusitis?
typically occurs in diabetic or immunosupressed patients
- often due to Zygomycosis species
NOTE: is an emergent situation requiring IV antifungal therapy to prevent extension into brain or sepsis
Middle aged patient, with ulceration, necrosis and perforation of the septum
- lungs and kidneys also affected
Histology shows:
- granulomatous inflammation/vasculitis and necrosis
Granulomatosis with Polyangiitis (GPA)
- aka nee Wegener granulomatosis
Young man with nasopharyngeal polypoid mass that recurrently bleeds
Histology shows vascular fibrous core lined by benign epithelium
Nasopharyngeal angiofibroma
- is benign
NOTE: associated with Familial Adenomatous Polyposis (FAP)
What causes FAP?
- mutation in APC gene, typically inherited
- numerous colon polyps develop in childhood and adolescence
- invariable progression to carcinoma by middle age
What are the 3 types of Sinonasal (Schneiderian) papilloma?
- exophytic
- endophytic
- oncocytic
NOTE: endophytic subtypes have a high rate of recurrence, minority of cases (10%) may progress to malignancy
Small round blue cell tumor
- arises from neuroectoderm in superior nasal passage (neuroendocrine tumor)
- has a “dumb-bell” shape, penetrates through the cribriform plate)
Olfactory neuroblastoma
NOTE: 2 age peaks
- adolescence
- middle age
squamous carcinoma (keratizing or non-keratizing), basophilic with lymphoid tissue - arises in nasopharynx, but majority of cases present in neck (lymph node metastasis)
Nasopharyngeal carcinoma
NOTE: 1st lesion typically small due to lack of space in nasopharynx
- a larger metastasis is typically what is diagnosed first
What are the risk factors for nasopharyngeal carcinoma?
- genes
- age
- EBV
- Chinese/Southeast Asian adults
- Young African children (EBV-related)
EBV-related tumor, with increased incidence in Asia or Latin America
- affects any age, peak in middle age
- can cause necrotic destruction of paranasal sinuses
Extranodal NK/T cell lymphoma
- presents with systemic signs of lymphoma: fever, night sweats, weight loss
What are “singer’s nodules”?
vocal cord nodules
- expansion of soft tissue underlying the vocal fold
- grossly, soft and translucent
- histologically, edema and loose stroma underlie benign squamous epithelium
Benign squamous neoplasm, with papillary appearance
- strong association with HPV types 6 & 11 ***
- typically children and adolescents
- grossly, friable papillary masses
- histologically, benign or mildly atypical squamous epithelium with multiple papillae
- can be solitary or in association with recurrent respiratory papillomatosis
Laryngeal squamous papilloma
Squamous carcinoma most commonly seen in men over 60
- strong association with smoking, alcohol and HPV infection
- ** synergistic effects!
Laryngeal carcinoma
What does the “Shake My Head” pneumonic stand for with Otitis media?
- Strep. pneumonia
- Moraxella catarrhalis
- Haemophilus influenzae
NOTE: chronic Otitis media in diabetics likely caused by Pseudomonas aeruginosa (very specific, different antibiotic!)
Cystic lesion that arises in chronic Otitis media
- lined by benign squamous epithelium with trapped keratin debris
- reactive process (not neoplasm), but can enlarge and erode adjacent bone
Cholesteatoma
- is squamous “debris”
Abnormal bony deposition, typically at the stapedial footplate
- conductive hearing loss is main complication
Otosclerosis
Cyst found in young adults, most frequently arises from 2nd branchial arch
- hostologically, simple cyst lined by stratified squamous or respiratory epithelium with surrounding fibrous tissue (+/- lymphoid tissue)
Branchial cyst
What is the most common cystic tumor of the neck in infants and young children?
thyroglossal duct cyst
What is the most common cystic tumor of the neck in adolescents?
thyroglossal duct cyst
What is the most common cystic tumor of the neck in adults?
metastatic cystic carcinoma
What is a thyroglossal duct cyst?
remnant nests of tissue from thyroid migration, with cystic change
What is a carotid body tumor?
neural crest in origin, arising from autonomic paraganglia
- paravertebral paraganglia
- may be associated with MEN2
- nest of cells Zellballen demonstrated with S-100 stain
- 15-40% will be malignant
- fatality linked to metastasis or local invasion
