Pulm Path Pt 4

Question 1

What are normal histologic features of respiratory epithelium?

Answer 1

• ciliated cells
• goblet cell
• mucus glands
• lymphoid aggregates

Question 2

What are the most likely complications of an ethmoid sinusitis infection?

Answer 2

• preseptal cellulitis
• orbital cellulitis ***
• subperiostal abscess

Question 3

What are the most likely complications due to frontal sinusitis infection?

Answer 3

• osteomyelitis
• mucocele
• meningitis ***
• epidural abscess

Question 4

What is allergic fungal sinusitis?

Answer 4

occurs as a result of hypersinsitivity to fingal organisms (Aspergillus) that have colonized the sinus tract

Question 5

What are the histologic feature of allergic fungal sinusitis?

Answer 5

• allergin mucin

- may see fungal hyphae

Question 6

When do you typically see fungal sinusitis?

Answer 6

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

Question 7

Middle aged patient, with ulceration, necrosis and perforation of the septum
- lungs and kidneys also affected

Histology shows:
- granulomatous inflammation/vasculitis and necrosis

Answer 7

Granulomatosis with Polyangiitis (GPA)

- aka nee Wegener granulomatosis

Question 8

Young man with nasopharyngeal polypoid mass that recurrently bleeds

Histology shows vascular fibrous core lined by benign epithelium

Answer 8

Nasopharyngeal angiofibroma
- is benign

NOTE: associated with Familial Adenomatous Polyposis (FAP)

Question 9

What causes FAP?

Answer 9

• mutation in APC gene, typically inherited
• numerous colon polyps develop in childhood and adolescence
• invariable progression to carcinoma by middle age

Question 10

What are the 3 types of Sinonasal (Schneiderian) papilloma?

Answer 10

1. exophytic
2. endophytic
3. oncocytic

NOTE: endophytic subtypes have a high rate of recurrence, minority of cases (10%) may progress to malignancy

Question 11

Small round blue cell tumor

• arises from neuroectoderm in superior nasal passage (neuroendocrine tumor)
• has a “dumb-bell” shape, penetrates through the cribriform plate)

Answer 11

Olfactory neuroblastoma

NOTE: 2 age peaks

• adolescence
• middle age

Question 12

squamous carcinoma (keratizing or non-keratizing), basophilic with lymphoid tissue
- arises in nasopharynx, but majority of cases present in neck (lymph node metastasis)

Answer 12

Nasopharyngeal carcinoma

NOTE: 1st lesion typically small due to lack of space in nasopharynx
- a larger metastasis is typically what is diagnosed first

Question 13

What are the risk factors for nasopharyngeal carcinoma?

Answer 13

• genes
• age
• EBV
• Chinese/Southeast Asian adults
• Young African children (EBV-related)

Question 14

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

Answer 14

Extranodal NK/T cell lymphoma

- presents with systemic signs of lymphoma: fever, night sweats, weight loss

Question 15

What are “singer’s nodules”?

Answer 15

vocal cord nodules

• expansion of soft tissue underlying the vocal fold
• grossly, soft and translucent
• histologically, edema and loose stroma underlie benign squamous epithelium

Question 16

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

Answer 16

Laryngeal squamous papilloma

Question 17

Squamous carcinoma most commonly seen in men over 60

• strong association with smoking, alcohol and HPV infection
• ** synergistic effects!

Answer 17

Laryngeal carcinoma

Question 18

What does the “Shake My Head” pneumonic stand for with Otitis media?

Answer 18

• Strep. pneumonia
• Moraxella catarrhalis
• Haemophilus influenzae

NOTE: chronic Otitis media in diabetics likely caused by Pseudomonas aeruginosa (very specific, different antibiotic!)

Question 19

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

Answer 19

Cholesteatoma

- is squamous “debris”

Question 20

Abnormal bony deposition, typically at the stapedial footplate
- conductive hearing loss is main complication

Answer 20

Otosclerosis

Question 21

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)

Answer 21

Branchial cyst

Question 22

What is the most common cystic tumor of the neck in infants and young children?

Answer 22

thyroglossal duct cyst

Question 23

What is the most common cystic tumor of the neck in adolescents?

Answer 23

thyroglossal duct cyst

Question 24

What is the most common cystic tumor of the neck in adults?

Answer 24

metastatic cystic carcinoma

Question 25

What is a thyroglossal duct cyst?

Answer 25

remnant nests of tissue from thyroid migration, with cystic change

Question 26

What is a carotid body tumor?

Answer 26

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