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Flashcards in Pathology lecture Deck (42):
1

What is the most common malignant ENT pathology?

Squamous cell carcinoma

2

What are the auditory meatus and external cana lined with?

Epidermis.

Sebaceous

Ceruminous gland (ear wax)

3

Middle ear is lined with?

> Columnar/cuboidal lined mucosa
> Ossicles - malleus, incus, stapes

4

Nasal vestibule is lined with

Squamous

5

Nose, sinus is lined with

Schneiderian epithelium

Similar to respiratory mucosa

Pseudostratified ciliated columnar.

Sero mucinous glands

6

Salivary Gland

Exocrine

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

7

Otitis media

Usual causes?

Inflammation of middle ear

Usually VIRAL.

Bacterial - strep pneumonia, H influenze and Moxarella Catarrhalis.

8

Chronic bacterial otitis media

main bacterial culprit?

Pseudomonas aeruginosa

9

Cholesteatoma

Is it a tumour?

Pathogenesis

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.

Pathogenesis
- chronic otitis media
- perforated tympanic membrane (acquired)

10

Vestibular Schwannoma

which nerve is it associated with?

Often BENIGN

Associated with vestibular portion of vestibulocochlear nerve (VII)

Occur within temporal bone

80-90% of cerebellopontine angle tumours

95% sporadic, unilateral

11

Bilateral and young patient - schwannoma like tumour.

What other diagnosis should be considered?

Neurofibromatosis type 2

12

Neurofibromatosis type 1

Autosomal dominant

Widespread fibromas

Bony defects
Café au lait spots
axillary freckling
Lisch nodules

13

Neurofibromatosis type 2

Autosmal dominant

NF2 gene encodes merlin protein at Ch22q12

Bilateral vestibular schwannoma

Multiple meningiomas

Gliomas

Café au lait

14

Nasal polyps

Common in adults.

Often bilateral

Aetiology//
- allergy***
- infection
- asthma
- aspirin sensitivity
- nickel exposure

If young - consider CYSTIC FIBROSIS


Histology//

Hugely oedematous
Connective tissue has been spread apart

15

Rhinitis & Sinusitis

> Infectious - common cold
> Allergic - hay fever. IgE mediated type 1

16

Granulomatosis with Polyangiitis (GPA) - Wegener's granulomatosis

probably in MSK section

> Autoimmune

> Small vessel vasculitis limited to respiratory tract and kidneys

> Rare

> White patients an d>40 years old

> Present with pulmonary, renal disease, nasal symptoms of congestion, septal perforation

> Anti neutrophil antibody levels

> ANCA +ve

17

Is Wegener's ANCA positive or negative

What type of ANCA?

ANCA +ve

cANCA

18

Types of ANCA +ve

pANCA
cANCA

19

Most common cause for ulceration in nasal septum?

Cocaine

20

Benign tumours in ENT

> Squamous papillomas
> Schneiderian papillomas
> Angiofibromas

21

Nasopharyngeal carcinoma

which virus does this cancer have a strong association with?

Epstein Barr virus

High incidence in far east.

Males

22

Lymphocytes are a sign of?

Chronic inflammation

23

What disease is Epstein Barr virus associated with?

& which cancer?

Glandular fever.

Nasopharyngeal carcinoma

24

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.

25

Laryngeal Polyps

> 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

26

Laryngeal Contact Ulcer

> what are they
> commonly experienced by
> causes

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

27

Squamous papilloma/papillomatosis

> two peaks of incidence
> related to exposure of? Which types
> Appearance

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
Warty

Koilocytosis --- occurs in all types of HPV

28

What occurs in all types of HPV?

Koilocytosis

Appearance of koilocytes -

29

Paraganglioma

> 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


> Non-chromaffin
-- 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

30

Multiple endocrine neoplasia 2

- genetics
- leads to

Autosomal dominant

Paragangliomas

31

Squamous Cell Carcinoma

- common sites
- risk factors

Common in head & neck - nose, sinuses, pharynx, larynx, oral cavity

Majority related to smoking and alcohol

32

HPV associated 16 & 18 - common sites

tongue base, tonsil, soft palate. young-ish person (0,40s,50s)

otherwise fit and healthy.

non smokers

33

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

Brown stain

34

Laryngeal SCC

- staging

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

35

Sialolithiasis

Stones in salivary glands

36

Paramyxovirus

Mumps, bilateral parotitis

Associated orchitis (testiclular inflammation)

risk of secondary meningitis

37

Parotid is the most common salivary gland for

almost all tumours.

38

Tumours in smaller glands are more likely to be...

Malignant

39

Warthin's tumour

Second most common benign tumour of salivary glands

Usually over 50

Parotid

Strong association with smoking

Bilateral and multi centric

40

Mucoepidermoid carcinoma

Most common malignant cancer affecting salivary glands in the world

UK = adenoid cystic carcinoma

41

Adenoid cystic carcinoma

Most common malignant cancer affecting salivary glands in the UK

40+ years
PAROTID
Palate

35% 5 year survival

Perineural invasion - associated pain or loss of function

Multiple recurrences

42

Pleomorphic adenoma

> most common in
> found where

Most common tumour
Females, 60+
Parotid
difficult to excise

Can transform into a malignancy if long term