Pulmonary Pathology IV

Question 1

Normal features of respiratory epithelium include:

Answer 1

Ciliated cells
Goblet cells
Mucous glands
Lymphoid aggregates

Question 2

Viruses involved in nasopharyngeal infections

Answer 2

Rhinovirus
Coronavirus
Adenovirus
Echovirus

Question 3

Bacteria involved in nasopharyngeal infections

Answer 3

S. Pneumonia

H. Influenzae

Question 4

How do the secretions in a viral and bacterial sinus infection vary?

Answer 4

Virus - clear rhinorrhea

Bacteria - thick, purulent sputum

Question 5

What WBC accompanies a type 1 hypersensitivity of the nasopharynx?

What type of secretions?

Answer 5

Eosinophilia infiltrate

Edema, rhinorrhea

Question 6

4 pathologies capable of causing causing chronic rhinitis/sinusitis

Answer 6

Viral infection
Bacterial infection
Allergic rhinitis/sinusitis
Type 1 hypersensitivity

Question 7

Inflammatory sinonasal polyps

Answer 7

True polyps w/ associated epithelium.

Edema filled with eosinophilic infiltrates.

Question 8

What can cause sinus obstruction?

Answer 8

Empyema

Mucocele

Question 9

What is the pathway of infection to the maxillary sinuses?

Answer 9

Via the periapical tissues (oral flora)

Question 10

Where can an ethmoid sinus infection spread?

Answer 10

Orbit

Question 11

Where can an infection in the frontal sinuses spread?

Answer 11

Cranial vault

Question 12

Allergic fungal sinusitis def:

On histology:

What could is possibly lead to?

Answer 12

Occurs as a result of hypersensitivity to Aspergillus in the sinus tract.

Allergic mucin, fungal hyphae.

Mycetoma (fungus ball)

Question 13

Acute invasive sinusitis

Answer 13

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.

Question 14

What is found on histology in Granulomatosis w/ Polyangiitis?

Answer 14

Necrobiotic necrosis (blue-ish)

Question 15

Nasopharyngeal angiofibroma

Answer 15

Nasopharyngeal polyploid mass.

• young men
• vascular fibrous core lined w/ benign epithelium
• benign, but can bleed
• associated w/ FAP

Question 16

Sinonasal (Schneiderian) papilloma

Answer 16

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.

Question 17

Olfactory neuroblastoma

Answer 17

“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.

Question 18

Nasopharyngeal carcinoma

Answer 18

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.

Question 19

Risk factors for nasopharyngeal carcinoma

Answer 19

Heredity, age, EBV

Chinese/Southwest Asian adults (nitrosamines, EBV)
African children (EBV)

Question 20

Extranodal NK/T-cell lymphoma

Answer 20

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

Question 21

Vocal cord nodules

Answer 21

Expansion of the soft tissue underlying the vocal cord

• “Singer’s node”
• histologically, edema and loose stroma underlie benign squamous epithelium

Question 22

Laryngeal squamous papilloma

Answer 22

Benign squamous neoplasm w/ papillary appearance.

Associated w/ HPV 6 and 11.

Can be solitary or present w/ recurrent respiratory papillomatosis.

Question 23

Recurrent respiratory papillomatosis

Answer 23

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.

Question 24

Laryngeal carcinoma

Answer 24

Squamous carcinoma

Men > 60 y/o
Strong association w/:
-smoking
-alcoholism (synergistic effect w/ smoking)
-HPV infection

Question 25

3 bacteria involved in otitis media

Answer 25

S. Pneumoniae
M. Catarrhalis
H. Influenzae

Question 26

Bacteria in chronic OM in diabetic pts.

Answer 26

P. Aeruginosa

Question 27

Cholesteatoma

Answer 27

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.

Question 28

Otosclerosis

Answer 28

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.

Question 29

Branchial cyst

Answer 29

Young pts.
2nd pharyngeal arch

Histologically: cyst lined by stratified squamous epithelium w/ surrounding fibrous tissue +/- lymphoid tissue

Question 30

Thyroglossal duct cyst

Answer 30

Remnant nest of tissue from thyroid migration

Question 31

Carotid body tumor (parasympathetic paraganglioma)

Answer 31

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.