Flashcards in Pathology lecture Deck (42):
What is the most common malignant ENT pathology?
Squamous cell carcinoma
What are the auditory meatus and external cana lined with?
Ceruminous gland (ear wax)
Middle ear is lined with?
> Columnar/cuboidal lined mucosa
> Ossicles - malleus, incus, stapes
Nasal vestibule is lined with
Nose, sinus is lined with
Similar to respiratory mucosa
Pseudostratified ciliated columnar.
Sero mucinous glands
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
Inflammation of middle ear
Bacterial - strep pneumonia, H influenze and Moxarella Catarrhalis.
Chronic bacterial otitis media
main bacterial culprit?
Is it a tumour?
No it is not a tumour.
Does NOT contain cholesterol.
Superior posterior middle ear and/or petrous apex
Stratified squamous epithelium in the middle ear - where it shouldn't be .
High cell turnover and abundant KERATIN production + inflammation.
- chronic otitis media
- perforated tympanic membrane (acquired)
which nerve is it associated with?
Associated with vestibular portion of vestibulocochlear nerve (VII)
Occur within temporal bone
80-90% of cerebellopontine angle tumours
95% sporadic, unilateral
Bilateral and young patient - schwannoma like tumour.
What other diagnosis should be considered?
Neurofibromatosis type 2
Neurofibromatosis type 1
Café au lait spots
Neurofibromatosis type 2
NF2 gene encodes merlin protein at Ch22q12
Bilateral vestibular schwannoma
Café au lait
Common in adults.
- aspirin sensitivity
- nickel exposure
If young - consider CYSTIC FIBROSIS
Connective tissue has been spread apart
Rhinitis & Sinusitis
> Infectious - common cold
> Allergic - hay fever. IgE mediated type 1
Granulomatosis with Polyangiitis (GPA) - Wegener's granulomatosis
probably in MSK section
> Small vessel vasculitis limited to respiratory tract and kidneys
> White patients an d>40 years old
> Present with pulmonary, renal disease, nasal symptoms of congestion, septal perforation
> Anti neutrophil antibody levels
> ANCA +ve
Is Wegener's ANCA positive or negative
What type of ANCA?
Types of ANCA +ve
Most common cause for ulceration in nasal septum?
Benign tumours in ENT
> Squamous papillomas
> Schneiderian papillomas
which virus does this cancer have a strong association with?
Epstein Barr virus
High incidence in far east.
Lymphocytes are a sign of?
What disease is Epstein Barr virus associated with?
& which cancer?
Epstein Barr Virus in carcinogenesis
> Seen in association with Burkitt’s lymphoma, other B-cell lymphomas and Hodgkin’s lymphoma
> Infects epithelial cells of oropharynx and B-cells
> Ubiquitous infection – most subclinical. Occasional infectious mononucleosis
> EBV hi-jacks and mimicks helper T-cell responses leading to proliferation and survival of B-cells. Mediated largely by latent membrane protein 1 (LMP-1). EBV encodes EBNA-2 activating cyclin D and promoting transition from G0 to G1.
> caused by
> Nodules are usually seen in?
> Polyp structure
> Reactive change in laryngeal mucosa secondary to -- vocal abuse, smoking, infection.
> Hypothyroidism sometimes
> Nodules usually seen in young women
> Bilateral on middle 1/3 to posterior 1/3 on vocal cord
> Polyps are unilateral and pedunculated
Laryngeal Contact Ulcer
> what are they
> commonly experienced by
Laryngeal contact ulcers are unilateral or bilateral erosions of the mucous membrane over the vocal process of the arytenoid cartilage (eroded beyond basement membrane)
Benign response to injury.
Chronic throat, voice abuse, gastro-oesophageal reflux.
Commonly experienced by singers
> two peaks of incidence
> related to exposure of? Which types
Under 5 years and between 20-40 years old
HPV exposure - types 6 and 11
Aggressive disease in children
Adults - often solitary and possibly not related to HPV 6 & 11
Finger like projections
Koilocytosis --- occurs in all types of HPV
What occurs in all types of HPV?
Appearance of koilocytes -
> Which cells do they arise in?
> chromaffin positive / non-chromaffin
> Tumours arising in clusters of neuroendocrine cells
> CHromaffin positive
-- sympathetic nervous system and can secrete catecholamines.
-- usually adrenal medulla or paravertebral - organ of Zuckerkandl
-- carotid bodies
-- aortic bodies
-- jugulotympanic ganglia
-- ganglia nodosum of vagus
-- clusters around oral cavity, nose, nasopharynx, larynx and orbit
-- above diaphragm,
Multiple endocrine neoplasia 2
- autosomal dominant
Multiple endocrine neoplasia 2
- leads to
Squamous Cell Carcinoma
- common sites
- risk factors
Common in head & neck - nose, sinuses, pharynx, larynx, oral cavity
Majority related to smoking and alcohol
HPV associated 16 & 18 - common sites
tongue base, tonsil, soft palate. young-ish person (0,40s,50s)
otherwise fit and healthy.
HPV associated tumours
- what colour do they stain
Vast majority relate to HPV type 16
Produces proteins E6 and E7 which disrupt p53 and Rb pathways respectively --> cellular immortality
Often present as lumps in the neck
T1a - one vocal cord
T1b - both vocal cords
T2 - extension into supra/subglottis
T3 - vocal cord fixation or extension into paraglottic space, minor thyroid cartilage involvement
T4a - thyroid cartilage, trachea, muscles of tongue, strap muscles, thyroid, oesophagus
T4b - prevertebral space, mediastinal structures, carotid artery
Stones in salivary glands
Mumps, bilateral parotitis
Associated orchitis (testiclular inflammation)
risk of secondary meningitis
Parotid is the most common salivary gland for
almost all tumours.
Tumours in smaller glands are more likely to be...
Second most common benign tumour of salivary glands
Usually over 50
Strong association with smoking
Bilateral and multi centric
Most common malignant cancer affecting salivary glands in the world
UK = adenoid cystic carcinoma
Adenoid cystic carcinoma
Most common malignant cancer affecting salivary glands in the UK
35% 5 year survival
Perineural invasion - associated pain or loss of function