Pulmonary Pathology IV Flashcards
Normal features of respiratory epithelium include:
Ciliated cells
Goblet cells
Mucous glands
Lymphoid aggregates
Viruses involved in nasopharyngeal infections
Rhinovirus
Coronavirus
Adenovirus
Echovirus
Bacteria involved in nasopharyngeal infections
S. Pneumonia
H. Influenzae
How do the secretions in a viral and bacterial sinus infection vary?
Virus - clear rhinorrhea
Bacteria - thick, purulent sputum
What WBC accompanies a type 1 hypersensitivity of the nasopharynx?
What type of secretions?
Eosinophilia infiltrate
Edema, rhinorrhea
4 pathologies capable of causing causing chronic rhinitis/sinusitis
Viral infection
Bacterial infection
Allergic rhinitis/sinusitis
Type 1 hypersensitivity
Inflammatory sinonasal polyps
True polyps w/ associated epithelium.
Edema filled with eosinophilic infiltrates.
What can cause sinus obstruction?
Empyema
Mucocele
What is the pathway of infection to the maxillary sinuses?
Via the periapical tissues (oral flora)
Where can an ethmoid sinus infection spread?
Orbit
Where can an infection in the frontal sinuses spread?
Cranial vault
Allergic fungal sinusitis def:
On histology:
What could is possibly lead to?
Occurs as a result of hypersensitivity to Aspergillus in the sinus tract.
Allergic mucin, fungal hyphae.
Mycetoma (fungus ball)
Acute invasive sinusitis
Occurs in immunocompromised patients and diabetics.
Infection of Zygomatosis (Mucor).
It is emergent. Pt needs IV anti-fungals to stop it from invading cranial vault or causing sepsis.
What is found on histology in Granulomatosis w/ Polyangiitis?
Necrobiotic necrosis (blue-ish)
Nasopharyngeal angiofibroma
Nasopharyngeal polyploid mass.
- young men
- vascular fibrous core lined w/ benign epithelium
- benign, but can bleed
- associated w/ FAP
Sinonasal (Schneiderian) papilloma
Middle-aged people, M>F
3 types: exophytic, endophytic and oncophytic
Endophytic subtypes have a higher rate of recurrence and, in some cases (10%), can breach the basement membrane and become cancerous.
Olfactory neuroblastoma
“Small round blue cell tumor”
Arises from neuroectoderm in superior nasal passage (NE tumor)
Bimodal age distribution: adolescent and middle-aged patients
Classic feature on CT: “dumb-bell” shape. Primary leasing can penetrate cranial vault via the cribiform plate.
Nasopharyngeal carcinoma
Basically squamous cell carcinoma and can be keratinizing or non-keratinizing.
Arise in the nasopharynx as small lesions, but present in neck as a cervical LN metastasis.
Risk factors for nasopharyngeal carcinoma
Heredity, age, EBV
Chinese/Southwest Asian adults (nitrosamines, EBV) African children (EBV)
Extranodal NK/T-cell lymphoma
EBV-related tumor.
Causes necrotic destruction of paranasal sinuses.
Presents w/ fever, night sweats, weight loss (mimics infection).
Increased incidence in Asia and Latin America
Can occur at any age
Prognosis is variable
Vocal cord nodules
Expansion of the soft tissue underlying the vocal cord
- “Singer’s node”
- histologically, edema and loose stroma underlie benign squamous epithelium
Laryngeal squamous papilloma
Benign squamous neoplasm w/ papillary appearance.
Associated w/ HPV 6 and 11.
Can be solitary or present w/ recurrent respiratory papillomatosis.
Recurrent respiratory papillomatosis
Usually in kids. Associated w/ HPV 6 and 11 and acquired at birth. -mothers <20 y/o -vaginal delivery -first born child
Becomes malignant in <1% of patients.
Laryngeal carcinoma
Squamous carcinoma
Men > 60 y/o Strong association w/: -smoking -alcoholism (synergistic effect w/ smoking) -HPV infection
3 bacteria involved in otitis media
S. Pneumoniae
M. Catarrhalis
H. Influenzae
Bacteria in chronic OM in diabetic pts.
P. Aeruginosa
Cholesteatoma
Cystic lesion that arises in chronic OM.
Lesion lined by benign squamous epithelium w/ trapped keratin debris.
Reactive process - not a neoplasm - but can erode nearby bone.
Otosclerosis
Abnormal deposition of bone at the state dial footplate —> conductive hearing loss.
Unknown mechanism, but has an AD pattern.
Stapes is replaced w/ an implant.
Branchial cyst
Young pts.
2nd pharyngeal arch
Histologically: cyst lined by stratified squamous epithelium w/ surrounding fibrous tissue +/- lymphoid tissue
Thyroglossal duct cyst
Remnant nest of tissue from thyroid migration
Carotid body tumor (parasympathetic paraganglioma)
Tumor of neural crest cells arising from autonomic ganglia.
- may arise sporadically
- associated w/ MEN2
- wedges between bifurcation of common carotid a.
Histologically: nest of cells (zellballen), S-100 stain.
Prognosis: 15-40% can be malignant, but cannot tell w/ histology.
