week 1 pathology Flashcards by J H

what are the Auditory meatus and external canal are lined by?

sebaceous and ceruminous glands.

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what is the middle ear lined by? what does the middle ear contain?

columnar lined mucosa.

Contains ossicles – malleus, incus and stapes

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what is in the inner ear

the cochlea, vestibular apparatus

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what lines the Nasal vestibule

stratified squamous, keratinized (skin)

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what lines the nose/sinus etc?

Schneiderian epithelium

identical to respiratory mucosa – pseudostratified ciliated columnar with Sero-mucinous glands (glands give ‘bogeys’)

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throat lined with what?

Respiratory and squamous epithelium depending on anatomical site (true cords = goal cords = squamous, underneath them = respiratory)

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what kind of glands are salivary glands?

Exocrine gland

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what are salivary glands made up of?

Acinar component and ductular component
Serous cells – darkly staining. Contain digestive enzymes including amylase
Mucinous component – clear grey staining
Peripheral myoepithelial cells – often flat or cuboidal with clear cytoplasm. Have some contractile properties

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what pathology can occur concerning the ear

Otitis media
Cholesteatoma
Tumours
Vestibular Schwannoma

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what is otitis media?

Inflammation of middle ear

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cause of otitis media

Usually viral. Occasionally bacterial – Strep. Pnuemoniae, H. Influenzae and Moxarella Catarrhalis. If chronic – Pseudomonas Aeruginosa

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what is a Cholesteatoma

Not a tumour and doesn’t contain cholesterol!!!

it is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. due to tympanic rupture/hole

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what is the normal lining of middle ear? what occurs in cholesteatoma?

cuboidal or columnar glandular epithelium

Abnormally situated squamous epithelium. High cell turnover and abundant keratin production. Associated inflammation

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what is a vestibular schwannoma? buzzword on mircosope?

a peripheral nerve benign tumour associated with CNVIII

verocay bodies

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Vestibular Schwannoma occurs where?

Occur within temporal bone and represent 80-90% of cerebellopontine angle tumours

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how do Vestibular Schwannoma usually present? when to associate with another disease?

95% are sporadic and unilateral. Equal gender distribution

If bilateral and young – consider neurofibromatosis (NF) type 2

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NF1 prevalence, genetics, description and signs?

1:3000. Autosomal dominant. Widespread neurofibromas. Bony defects, café au lait spots, axillary freckling, Lisch nodules

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NF2 prevalence, genetics, description and signs?

AD but usually sporadic mutation. 1:40000 incidence. NF-2 gene encodes merlin protein at Ch22q12
Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas
Café au lait

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pathology of the nose?

Rhinitis
Sinusitis
Polyp
Wegeners
NPC
Neuroblastoma

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who are nasal polyps common in? what to suspect if not in these people?

Common (not in children). Equal gender distribution.

if kids suspect CF

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causes of nasal polyps?

Numerous aetiologies – allergy, infection, asthma, aspirin sensitivity, nickel exposure (NSAID exacerbation asthmatic get nasal polyps)

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rhinitis and sinusitis cuases?

Infectious – common cold

Allergic – hay fever. IgE mediated type 1 hypersensitivity reaction.

what is Wegener’s granulomatosis/ Granulomatosis with polyangiitis

Autoimmune disorder of unkown aetiology characterised by a small vessel vasculitis limited to respiratory tract and kidneys

when does Wegener’s granulomatosis/ Granulomatosis with polyangiitis occur?

Rarely. Usually white patients and >40years old.

PC of Rare. Wegener’s granulomatosis/ Granulomatosis with polyangiitis

Present with pulmonary, renal disease or nasal symptoms of congestion, septal perforation etc.

commonest septal perforation?

cocaine

how to determine if Wegener’s granulomatosis/ Granulomatosis with polyangiitis?

biopsy (nose bc lung is more difficult) cANCA

what tumours can occur in the nose?

Relatively rare Benign lesions – squamous papillomas, “Schneiderian” papillomas. Angiofibromas Malignant lesions – Most commonly Squamous cell carcinoma Also primary adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

what two things are Nasopharyngeal carcinoma associated with?

Epstein Barr virus as well as volatile nitrosamines in food

what does EBV cause? how?

many lymphomas, also Nasopharyngeal carcinoma Infects epithelial cells of oropharynx and B-cells

pathology of the throat?

``` Laryngeal polyps Ulcers Papillomas Dysplasia/cancer paraganglioma ```

what are Laryngeal polyps | due to?

Reactive change in laryngeal mucosa secondary to - vocal abuse, reflux, infection and smoking. Occ. in hypothyroidism.

difference between Laryngeal polyps and nodules

Nodules and polyps are largely interchangeable terms. Nodules are usually seen in young women and are bilateral on middle 1/3 to posterior 1/3 on vocal cord. Polyps are unilateral and pedunculated

what is a contact ulcer? causes of contact ulcer?

Benign response to injury Chronic throat, voice abuse, gastrooesophageal reflux (GORD

what is Squamous papilloma/ papillomatosis + Two peaks of incidence?

papiloma = projection/fingers/warts/benign <5years and between 20-40 years

Squamous papilloma/ papillomatosis due to?

Related to HPV exposure – types 6 and 11

difference between Squamous papilloma/ papillomatosis in kids and adults?

Children – aggressive disease Adults – often solitary and possibly not related to HPV 6 & 11.

what is a Paraganglioma?

Tumours arrising in clusters of neuroendocrine cells dispersed throughout the body.

two types of Paraganglioma? where are they found?

Chromaffin positive and negative (positive = below abdomen + can produce adrenaline and negative =above + rarely produce adrenaline)

Paraganglioma usually occurs in who? what should be considered if Paraganglioma occurs in young and fit?

>50s genetic testing as maybe due to MEN2 + others

commonest places of SCC

Common tumour in head and neck – nose, sinuses, pharynx, larynx and oral cavity

causes of SCC in old? young?

smoking and alcohol sex (HPV 16). Largely in the oropharynx.

HPV SCC of head and neck PC and treatment

HPV type 16 Produces proteins E6 and E7 which disrupt p53 and RetinoBlastoma pathways respectively, leading to cellular immortality Tumours have a distinct appearance and a greatly improved prognosis and sensitivity to radiochemotherapy.

what are the Salivary Glands

Parotid Submandibular Sublingual Minor salivary glands

pathology of the salivary glands

Sialolithiasis – stones Paramyxovirus – mumps, bilateral parotitis. Assoc orchitis. Risk of secondary meningitis Tumours – general rules

where is the commonest site for all tumours in the salivary glands? malinant tumours?

parotid Tumours in smaller glands are more likely to be malignant

what PC to watch out for in malignant salivary gland?

young and a painful mass (as facial nerve travels through parotid). [note: usually malignant tumour is painless lump until end stage/bone mets]

what is the most common tumour of the salivary glands?

Pleomorphic adenoma

who does Pleomorphic adenoma occur in?

Usually females over 60 in parotid with a long history. Can occur at any age in any gland.

treatment of Pleomorphic adenoma

Difficult to excise – recurrence If longstanding risk of malignant transformation

what is Warthin’s Tumour? who does it occur in?

2nd commonest BT males over 50. Rare outwith the parotid. Strong association with smoking. Often bilateral and multicentric

what is commonest and second commonest salivary gland tumours?

1-Pleomorphic adenoma 2-Warthin’s Tumour

commonest malignant tumour of salivary gland worldwide? in UK?

Worldwide =mucoepidermoid carcioma | In the UK =adenoid cystic carcinoma

adenoid cystic carcinoma occurs in who? survival rate? PC?

Usually over 40 and parotid but most common malignant tumour of the palate. 35% 5year survival (cancer creeps up nerve and slowly recurs and kills) Frequent perineural invasion – assoc pain or loss of function.