Pulmonary Pathology Part 6 Flashcards
What are some causes of infections rhinitis/sinusitis?
- Rhinovirus, coronavirus, adenovirus, echovirus
- S. pneumoniae, H. influenzae
What kind of secretions are in bacterial rhinitis/sinusitis?
- Thick, purulent
What kind of secretions are in viral rhinitis/sinusitis?
- Clear
What is can cause allergic rhinitis/sinusitis?
- A variety of allergens that are inhaled
- Type 1 hypersensitivity reaction (inflammatory infiltrate with eosinophils)
What can chronic rhinitis/sinusitis cause?
- Inflammatory sinonasal polyps
What do inflammatory sinonasal polyps look like?
- Edema in stroma and eosinophilic infiltrates
What are some unique aspects of sinusitis?
- There can be obstruction due to empyema or mucocele
- Infection can travel through the periapical flora in the mouth and into the maxillary sinus
What is allergic fungal sinusitis?
- Hypersensitivity reaction fto fungal organisms
What do we see histologically in allergic fungal sinusitis?
- Allergic mucin
- Fungal hyphae
- +/- mycetoma (fungal ball)
What is active invasive sinusitis?
- Typically occurs in diabetics or immunocompromised patients
- Often zygomycosis species
- Emergent situation requiring IV antifungal therapy to prevent extension into brain or sepsis
What is granulomatosis with polyangiitis?
- Typically in middle aged adults
- Can cause ulceration, necrosis, and perforation of the nasal septum
- Can also affect lungs and kidneys
What do we see on histology for granulomatosis with polyangiitis?
- Granulomatous inflammation/vasculitis
- Classic “necrobiotic” necrosis
What is nasopharyngeal angiofibroma?
- Nasopharyngeal polypoid mass
- Occurs in young men
- Benign, but may recur and bleed
- Associated with FAP
What is FAP?
- An inherited mutation in the APC gene
- Numerous colon polyps develop in childhood and adolescence
What is sinonasal (schneiderian) papilloma?
- Occurs in middle aged men more than women
- Three types
What are the three types of sinonasal papilloma?
- Exophytic
- Endophytic
- Oncocytic
What is the worst type of sinonasal papilloma?
- Endophytic due to inward growth
- Has a high rate of recurrence but a minority of cases progress to malignancy
What is olfactory neuroblastoma?
- Called “small round blue cell tumor”
- Arises from neuroectoderm in the superior nasal passage
- Can grow through the cribriform plate and into the cranial cavity
What are the peak ages for olfactory neuroblastoma?
- Adolescence
- Middle age
What is nasopharyngeal carcinoma?
- Essentially squamous carcinoma
- Arises in nasopharynx but majority of cases present in the neck (lymph node metastasis)
What are the risk factors for nasopharyngeal carcinoma?
- Hereditary
- Age
- EBV
Who is most affected by nasopharyngeal carcinoma?
- Chinese/southeast asian adults (ingestion of smoked fish with nitrosamines, EBV)
- Young african children (EBV)
What is extranodal NK/T cell lymphoma?
- Increased incidence in Asia and Latin America for any age
- Can cause necrotic destruction of paranasal sinuses
- Prognosis is variable depending on signs and symptoms
What are the systemic signs of extranodal NK/T cell lymphoma?
- Fever
- Night sweats
- Weight loss
What are vocal cord nodules?
- Called “singers nodules”
- Expansion of the soft tissue underlying the vocal cord
- Grossly, soft and translucent
What does a vocal cord nodule look like on histology?
- Edema and loose stroma underlie benign squamous epithelium
What is a laryngeal squamous papilloma?
- Benign squamous neoplasm with papillary appearance
What does laryngeal squamous papilloma have a strong association with?
- HPV 6 and 11
- Could be solitary or with recurrent respiratory papillomatosis
What does laryngeal squamous papilloma look like grossly?
Friable papillary masses
What does laryngeal squamous papilloma look like histologically?
- Benign or mildly atypical squamous epithelium with multiple papillae
What is recurrent respiratory papillomatosis?
- Typically in children and adolescents
- Associated with HPV 6 and 11 thought to be acquired during birth
- Can diffusely involve lungs
- Malignant progression in <1%
What are some high associations with recurrent respiratory papillomatosis?
- Mother <20
- Vaginal delivery
- First born
What is laryngeal carcinoma?
- Squamous carcinoma
- Most commonly seen in men >60
What are the strong associations in laryngeal carcinoma?
- Smoking
- Alcohol
- HPV infection
What is the correlation between smoking and alcohol and laryngeal carcinoma?
- Extreme synergistic effect
What organisms can cause otitis media?
- S. pneumoniae
- M. catarrhalis
- H. influenzae
What organism can cause otitis media in diabetics?
- P. aeruginosa
What is cholesteatoma?
- Cystic lesion that arises in chronic otitis media
- Reactive process, not a neoplasm, but can enlarge and erode adjacent bone
What is a cholesteatoma lined with?
- Benign squamous epithelium with trapped keratin debris
What is otosclerosis?
- Abnormal bony deposition, typically at the stapedial footplate
- Appears familial with an AD inheritance pattern but really unknown
What happens in otosclerosis?
- Conductive hearing loss is the primary complication
Who is most likely to have a branchial cyst?
- Young adults
Where does a branchial cyst come from?
- 2nd branchial arch
What does a branchial cyst look like?
- Simple cyst lined by stratified squamous or respiratory epithelium with surrounding fibrous tissue
What is a thyroglossal duct cyst?
- Remnant nests of tissue from thyroid migration with cystic change
What is a carotid body tumor?
- Neural crest origin
- Arises from autonomic paraganglia
- May arise sporadically
What is a carotid body tumor associated with?
- MEN-2
What is the prognosis and mortality of a carotid body tumor?
- Prognosis: 15-40% will be malignant
- Fatality may be linked to metastasis or local invasion
