Chapter 16: Pulmonary Pathology of Head/Neck and Pulmonary Radiographic Correlations (Singh) Flashcards
(31 cards)
Infectious Rhinitis/Sinusitis
What are 4 causes of Viral (R/C/A/E) and 2 causes of Bacterial (SP/HI) rhinitis/sinusitis?
Viral: rhinovirus, coronavirus, adenovirus, echovirus
- clear rhinorrhea
Bacterial: Strep. pneumoniae, H. influenzae
- thick, purulent nasal secretions
leads to either 2nd infection or chronic rhinitis/sinusitis, which can then become inflammatory nasal polyps
Inflammatory Sinonasal Polyps
- develop due to chronic rhinitis/sinusitis (constant aggravation)
- causes edema in the stroma with large quantities of eosinophilic infiltrates
Allergic Fungal Sinusitis
- occurs due to hypersensitivity to fungal organisms like Aspergillus that colonizes the sinus tract
- see allergic mucin with high levels of eosinophils and fungal hypae that can lead to formation of mycetoma (fungal ball)
Acute Invasive Fungal Sinusitis
Who does it occur in and what species is most commonly implicated?
- typically seen in DIABETIC or Immunosuppressed pts. often due to ZYGOMYCOSIS species like Mucor
- requires IV antifungal therapy to prevent extension into brain or sepsis (treat aggressively)
- invades into wall and can get into brain or blood vessels
Granulomatosis with Polyangiitis (GPA)
- seen in middle-aged adults and can affect nasal passages, leading to ulceration/necrosis/perforation of the septum
- can also affect lungs and kidneys
Histo: granulomatous inflammation with classic necrobiotic necrosis (BLUE color)
What are 2 benign tumors (NA/SP) and 4 malignant tumors (ON/NMC/NC/ENCL) of the head and neck?
Benign: nasopharyngeal angiofibroma and sinonasal (Schneiderian) papilloma
Malignant: olfactory neuroblastoma, NUT midline carcinoma, and EBV-malignancies (nasopharyngeal carcinoma and extranodal NK/T cell lymphoma)
Nasopharyngeal Angiofibroma
Who does it occur in, what is its histology, and what condition is it associated with?
- nasopharyngeal polypoid mass occurring in YOUNG MEN; benign but can recur and bleed
Histo: vascular fibrous core lined by benign epithelium
- spindle cell proliferation
- looks like penile erectile tissue
- associated with Familial Adenomatous Polyposis (FAP) –> caused by APC mutation and causes the development of numerous colon polyps in childhood
Sinonasal Papilloma
Who does it occur in, what are its two growth types, and which one is worse?
- occurs in middle-aged MEN more than women
- 3 types: exophytic (external tree), endophytic (internal growth), and oncocytic (type of cell)
- endophytic subtypes have HIGH rate of recurrence, with a minority of cases progressing to malignancy (inc. rate of recurrence w/inc. risk of malignancy)
Olfactory Neuroblastoma
What is it and what does it histologically look like, where does it come from, and what patients does it affect?
- small round blue cell tumor that creates ROSETTEs on histological imaging; looks like “dumb-bell”-shaped tumor on CT (penetrates through cribiform plate)
- arises from neuroectoderm in the superior nasal passage
- has BIOMODAL distribution, affecting adolescent and middle-aged patients
Nasopharyngeal Carcinoma
What is it, where does it typically present, and what two patient populations does it commonly affect?
- essentially squamous carcinoma that is either keratinizing or non-keratinizing, or basophilic with lymphoid tissue (associated with EBV)
- arises in nasopharynx but mainly presents in the NECK as LN METASTASIS
- commonly occurs in Southeast Asian adults (ingestion of smoked fish w/nitrosamines, EBV) and young African children (EBV)
- can stain for EBER-1
Extranodal NK/T Cell Lymphoma
What is it, who does it occur in, and what symptoms does it present with?
- EBV-related tumor that can cause necrotic destruction of the paranasal sinuses
- biopsy shows NECROSIS (EBER stain)
- occurs in middle-aged Asian and Latin American pts.
symptoms: fever, night sweats, weight loss (systemic signs of lymphoma)
What are Vocal Cord nodules?
- also called “Singer’s nodules” because they usually occur in pts. that use their voice frequently; expansion of soft tissue underlying the vocal fold (soft and translucent)
- not malignant and is NOT a neoplasm; shows edema and loose stroma under benign squamous epithelium
What is Laryngeal Squamous Papilloma?
- benign squamous NEOPLASM with a papillary appearance and is strongly associated with HPV 6/11
- has grossly, friable papillary masses and shows benign/mildly atypical squamous epithelium with multiple papillae
- either solitary or in association with recurrent respiratory papillomatosis
What is Recurrent Respiratory Papillomatosis?
- occurs in children and adolescents typically
- associated with HPV 6/11 and is acquired at birth, through vaginal delivery, being first born, or being born to mothers < 20 yo
- can spread down the trachea and diffusely involve the lungs, but malignant progress is seen in < 1%
Laryngeal Carcinoma
What is it, who is it commonly seen in, and what 3 things does it have strong associations with?
- squamous carcinoma; has ulcerated lesion with rolled edges and keratin pearls on histology
- most commonly seen in > 60 yo MALES
- has strong associations with: SMOKING, ALCOHOL, and HPV INFECTIONS (especially in young adults)
What 3 organisms are commonly responsible for Otitis Media (S/M/H) and what organism is responsible for Chronic Otitis media in diabetics?
OM: Strep. pneumoniae, Moraxella catarrhalis, H. influenzae
OM in D: Pseudomonas aeruginosa
What is a Cholesteatoma?
- cystic lesion that arises in chronic otitis media (“Ear Zit”); lined by benign squamous epithelium with trapped keratin debris
- is a REACTIVE process (NOT NEOPLASM) but can enlarge and erode adjacent bone
What is Otosclerosis?
- abnormal inherited AD bony deposition typically at the stapedial footplate
- causes CONDUCTIVE HEARING LOSS
prosthetic implants can help recover hearing
Brachial Cysts
Who does it occur in, where does it arise from, and what does it look like histologically?
- occurs in young adults as a lump anterior to sternocleidomastoid muscle on neck
- frequently arises from 2nd brachial arch
Histo: simple cyst lined by stratified squamous/respiratory epithelium with surrounding fibrous tissue
- US shows simple cyst
Thyroglossal Duct Cysts
Where does it occur and what does it look like histologically?
- remnant nests of tissue from thyroid migration, with cystic change that can occur around the tongue, hyoid bone, or thyroid cartilage
Histo: has respiratory lining with thyroid follicles (filled with pink colloid)
Carotid Body Tumor
What is it, where does it arise from, and what does it look like histologically and on imaging?
- tumors of neural crest origin arising from autonomic paraganglia that can arise sporadically or in association with MEN 2
- 15-40% will be malignant (histo cannot tell)
- metastasis or local invasion
Histo: nest of cells (ZELLBALLEN) that has S-100 staining
Imaging: shows “Lyre Sign”
What is the name for the pattern that Bronchiopneumonia produces on imaging?
“Tree-in-bud”
- see vessels peripherally with small “buds” coming off of them
What is the name of the pattern that Lobar Pneumonia can produce on imaging?
What is it called when it has massive consolidation and what does it look like?
What do abscesses in Lobar pneumonia look like on imaging?
- see consolidation in the lobe
- if massive consolidation takes place, can see “Bulging Fissure” sign, which is a dark underline to the bottom of the consolidation
- abscesses will have air-fluid levels in them
What are 3 organisms that are likely to cause a Lobar Pneumonia (SP/SA/GN) and what 3 organisms are likely to cause abscess formation (KP/SA/A)
lobar = Strep pneumo, Staph aureus, gram (-)s
abscess = Klebsiella pneumo, Staph aureus, anaerobes
