Pulm Path 6: Upper Airways, Ear and Neck (Singh) Flashcards
(96 cards)
1
Q
Which 3 viruses are the major cause of infectious rhinitis?
A
- Adenoviruses
- Rhinoviruses
- Echoviruses
2
Q
The upper airways (i.e., nose, nasopharynx and sinuses) are lined by what type of epithelium?
A
Respiratory-type epithelium
3
Q
Allergic rhinitis is an example of what type of hypersensitivity rxn?
A
Type 1 - immediate
4
Q
Which 2 bacteria are most likely to be superimposed on infectious rhinitis?
A
- S. pneumoniae
- H. influenzae
5
Q
How does the nasal discharge differ grossly if rhinitis purely viral or has a superimposed bacterial infection?
A
- Viral will have clear nasal discharge
- Bacteria will cause thick, purulent, sometimes suppurative discharge
6
Q
Rhinitis/sinusitis characterized by marked mucosal edema, redness, and mucus secretion accompanied by a leukocytic infiltrate with prominent eosinophils describes what?
A
Allergic rhinitis
7
Q
Edematous nasal mucosa w/ loose stroma, often harboring hyperplastic or cystic mucous glands w/ a variety of infiltrates including neutrophils, eosinophils, plasma cells, and occasional cluster of lymphocytes is characteristic of what?
A
Nasal polyps
8
Q
What is the cause of nasal polyps?
A
Recurrent attacks of rhinitis
9
Q
Maxillary sinusitis occasionally arises from extension of an infection from where?
A
Periapical infection through bony floor of the sinus (oral flora)
10
Q
Obstruction and impairment of sinus drainage in sinusitis may lead to what 2 gross findings?
A
- Empyema = impounded suppurative exudate
- Mucocele = accumulation of mucus secretions
11
Q
Which patients are at higher risk for particularly severe forms of chronic sinusitis and by which type of organisms?
A
- Diabetics
- Fungi (i.e., Mucormycosis)
12
Q
Kartagener Syndrome is characterized by what triad and the sx’s are all caused by what?
A
- Bronchiectasis
- Situs inversus
- Sinusitis (less common)
- All sx’s due to defective ciliary action
13
Q
What are 2 possible complications which may arise due to spread of infection associated with chronic sinusitis?
A
- Speading into the orbit or penetrating surrounding bone –> osteomyelitis
- Spreading into cranial vault –> septic thrombophlebitis of a dural venous sinus
14
Q
What are 3 frequent complications which may arise from chronic sinusitis of the ethmoid sinus?
A
- Preseptal cellulitis
- Orbital cellulitis
- Subperiosteal abscess
15
Q
What are 3 conditions which can produce necrotizing ulcerating lesions of the nose and upper respiratory tract?
A
- Acute fungal infections (i.e., Mucormycosis)
- Granulomatosis w/ polyangiitis (Wegener)
- Extranodal NK/T-cell lymphoma, nasal-type
16
Q
Which sex, ethnicities, and age group is most frequently affected by extranodal NK/T-cell lymphomas?
A
- Males in the 5th-6th decade
- Most common in those of Asian or Latin American descent
17
Q
Extranodal NK/T-cell lymphomas are related to which virus?
A
EBV
18
Q
What are 3 systemic signs/sx’s related to lymphomas?
A
- Fever
- Night sweats
- Weight loss
19
Q
Acute invasive sinusitis requires what prompt treatment?
A
Emergent IV antifungal therapy to prevent extension into brain or sepsis
20
Q
Which bacteria are most commonly found superimposed on pharyngitis/tonsilitis of viral origin?
A
- β-hemolytic strep = most common
- S. aureus
21
Q
How are the hyphae formed by Mucormycetes distinct from Aspergillus hyphae?
A
Form nonseptate hyphae of variable width w/ frequent right-angle branching
22
Q
Involvement of which other organ system may develop in pt with rhinocerebral mucormycosis and what is seen?
A
- Lungs
- Lesions of combined hemorrhagic pneumonia w/ vascular thrombi and distal infarctions
23
Q
Which sinus is most often involved in obstruction of outflow in sinusitis leading to a mucocele?
A
Frontal sinus
24
Q
Proliferating masses of hyphae due to Aspergillus frequently form what?
A
“Fungus balls” = mycetoma
25
Describe the presentation of granulomatosis with polyangiitis in the sinus tract.
- **Necrotizing granulomas** of the upper or lower respiratory tract or both
- **Necrotizing** or **granulomatous vasculitis** affecting **small-to-medium sized** vessels
- Can lead to **ulceration, necrosis**, or **perforation** of the septum
26
Enlarged, reddened tonsils (due to reactive lymphoid hyperplasia) dotted by pinpoints of exudate emanting from tonsillar crypts is known as what?
Follicular tonsillitis
27
Nasopharyngeal angiofibroma is a **benign** tumor found almost exclusively in whom?
Also associated with what GI disorder?
**- Adolescent males** who are **most often** **fair-skinned** and **red headed**
**-** Association w/ **FAP**
28
Nasopharyngeal angiofibroma arises from which layer of tissue and in which location?
**Fibrovascular stroma** of the **posterolateral** wall of the **ROOF** of the nasal cavity
29
What is the treatment of choice for nasopharyngeal angiofibroma?
Surgical removal
30
Sinonasal (Schneiderian) Papilloma most often occurs in which sex and age group?
**Adult males** between the **ages 30-60 yo**
31
What are the 3 forms the lesions of Sinonasal (Schneiderian) Papilloma occur as; which is most common?
- **Exophytic** = most common
- **Endophytic** (**inverted**)
- **Cylindrical**
32
Which form of Sinonasal (Schneiderian) Papilloma is uniquely aggressive and in a minority of cases may progress to malignancy?
**Endophytic (*Inverted)*** form
33
The exophytic and endophytic forms of Sinonasal (Schneiderian) Papilloma are associated with what virus?
**HPV** (types **6** and **11**)
34
What 2 locations are endophytic sinonasal papillomas found in?
- Nose
- Paranasal sinuses
35
What are the 2 benign (but potentially locally aggressive) tumors of the nose, sinuses, and nasopharynx?
- Nasopharyngeal angiogibroma
- Sinonasal (Schneiderian) papilloma
36
What are potential serious complications which may arise from a Sinonasal (Schneiderian) Papilloma?
- **Invasion** of the **orbit** or **cranial vault**
- **Malignant transformation**
37
Olfactory neuroblastomas arise from which cells and in which location?
**Neuroectodermal** **olfactory cells** present within the mucosa, particularly the **superior aspect** of the **nasal cavity**
38
What is the characteristic histology of Olfactory Neuroblastomas?
- **Small, blue, round** cell neoplasms
- **Nests** and **lobules** of well-circumscribed cells separated by **fibrovascular stroma**
39
What specific immunohistochemical markers are expressed by Olfactory Neuroblastomas?
- Neuron-specific **enolase**
- **Synaptophysin**
- **CD56**
- **Chromogranin**
40
What is unique about the age distribution of Olfactory Neuroblastomas; patients present with what signs/sx's?
- **Bimodal** distribution = **peaks** at **15 yo** and **50 yo**
- Present w/ **nasal obstruction** and/or **epistaxis**
41
Olfactory neuroblastomas may penetrate through the cribriform plate and produce what characteristic appearance on imaging?
"**Dumb-bell" shaped**
42
Where to NUT (midline) carcinomas occur?
- Nasopharynx
- Salivary gland
- Midline structures in thorax or abdomen
43
NUT (midline) carcinomas are often mistaken for what malignany?
SCC
44
What is the typical course and prognosis of NUT (midline) carcinoma?
- **Extremely aggressive**
- Most patients survive for **\<1 year** following dx
45
NUT (midline) carcinomas are associated with translocations involving what 2 proteins?
**NUT** and **BRD4**
46
What are the 3 patterns of Nasopharyngeal Carcinoma which may be seen?
1. **Keratinizing** SCC's
2. **Nonkeratinizing** SCC's
3. **Undifferentiated/basaloid carcinomas** w/ **abundant lymphocytic infiltrate** (formerly *lymphoepithelioma)*
47
What are the 3 factors which influence the origin of Nasopharyngeal Carcinomas?
1. Age
2. Hereditary
3. Infection with **EBV**
48
Nasopharyngeal carcinoma is the most frequent childhood cancer where?
Africa
49
Nasopharyngeal carcinoma is very common in adults where?
SE China
50
Which dietary and enviornemental factors are associated with Nasopharyngeal Carcinoma?
- Diets high in **nitrosamines**, such as **fermented foods** and **salted fish**
- **Smoking** and **chemical fumes**
51
What is seen histologically with the undifferentiated/basaloid type of nasopharyngeal carcinoma (i.e., cell types and characteristics)?
- **Large** **epithelial** cells w/ **oval** or **round** vesicular nuclei
**- Prominent nucleoli**, and **indistinct cell borders** in a **SYNCYTIUM-like array**
- Admixed w/ **abundant lymphocytes** (predominantly **T cells**)
52
What may be detected via in-situ hybridization or immunohistochemistry in the malignant epithelial cells of nasopharyngeal carcinoma?
- **EBV encoded RNA's** such as **EBER-1**
- Proteins such as **LMP-1**
53
How do nasopharyngeal carcinomas typically present; most often metastases where?
- **Nasal obstruction**
- **Epistaxis**
- **Majority** of cases present in the **neck** (**cervical LN metastasis**)
54
What is the standard tx for nasopharyngeal carcinoma and which variant is the most/least sensitive to tx?
- **Radiotherapy** is standard tx
- **Undifferentiated** carcinoma is the **most** radiosensitive = **best prognosis**
- **Keratinizing SCC** is the **least** radiosensitive = **worse prognosis**
55
Laryngoepiglottitis in children is most often due to what 3 underlying organisms?
- Respiratory syncytial virus
- *Haemophilus influenza*
- β-hemolytic streptococci
56
Why is laryngoepiglottitis more serious in childre/infants?
**Smaller airways**; sudden swelling of epiglottis and vocal cords may cause obstruction --\> **medical emergency**
57
Laryngotracheobronchitis (aka croup) is often seen in whom and with what sign/sx?
- **Children**
- Inflammatory narrowing of airway --\> **inspiratory stridor**
58
Reactive nodules of the vocal cords are most often seen in whom?
- **Smokers**
- Pts who impose great strain on their vocal cords (i.e., **Singers**)
59
How do singers nodules differ from polyps in terms of distribution?
- **Singers nodules** = bilateral
- **Polyps** = unilateral
60
Reactive nodules (vocal cord nodules and polyps) are covered with what histologically and what is seen at their core?
- Covered by **squamous epithelium** that may become **kerotic**, **hyperplastic**, or slightly **dysplastic**
- **Core** composed of **loose myxoid CT**
61
Reactive nodules of the vocal cords will present with what signs/sx's?
Risk of malignancy?
- Change in voice + **hoarsness**
- Virtually **never** give rise to cancer
62
What is seen on histologic examination of laryngeal squamous papillomas (i.e., morphology, cell types, and core)?
- **Multiple** slender, **finger-like projections**
- Supported by **central fibrovascular core**
- Covered by **stratified squamous epithelium**
63
Laryngeal squamous papillomas are caused by what?
**HPV** types **6** and **11**
64
Laryngeal squamous papillomas are usually single lesions in whom?
Multiple lesions in?
- **Single** lesions in **adults**
- **Multiple** lesions in **children --\> *Juvenile laryngeal papillomatosis***
65
Chance of malignancy w/ laryngeal squamous papillomas and typical course?
- **Benign** and **do NOT** become malignant
- Often **spontaneously** regress at puberty, but some affect pt's endure numerous surgeries before this occurs
66
Recurrent respiratory papillomatosis typically occurs in whom and is associated with what?
- Children and adolescents
- Associated w/ **HPV** **6** and **11**; thought to be **acquired during birth**
67
Recurrent respiratory papillomatosis may diffusely involve what?
Lungs
68
Laryngeal carcinoma is most often what type of carcinoma and seen in whom?
- SCC
- **Men \>60 yo** who **smoke**
69
What is the hyperplasia-dysplasia-carcinoma sequence seen in laryngeal carcinomas?
Hyperplasia --\> atypical hyperplasia --\> dysplasia --\> carcinoma in situ --\> invasive carcinoma
70
The likelihood of the development of an overt laryngeal carcinoma is directly proportional to what?
**Grade of dysplasia** when the lesion is first seen
71
What are the risk factors for laryngeal carcinoma?
- Smoking
- Alcohol
- HPV infection
- Asbestos
- Irradiation
72
Where may laryngeal carcinomas arise and how does this fit with the terms **intrinsic** and **extrinsic**?
- Usually on the **vocal cords**
- May also arise on **epiglottis** or **aryepiglottic folds** or in **pyriform sinuses**
- Those confined in **larynx proper** = **intrinsic**; those arising or extending outside the larynx = **extrinsic**
73
Laryngeal carcinomas begin as in situ lesions which later have what gross appearance on the mucosal surface?
**Pearly gray, wrinkles plaques**, ultimately **ulcerating** and **fungating**
74
Laryngeal carcinoma most often manifests clinically with what signs/sx's?
- **Persistent** hoarsness
- **Dysphagia**
- **Dysphonia**
75
3 most common bacteria responsible for **acute** otitis media?
- ***S**treptococcus pneumoniae*
- ***M**oraxella catarrhalis*
- ***H**. influenza*
**\*SMH\***
76
What are the most common causative agents of **chronic** otitis media?
- *Pseudomona aeruginosa*
- *Staphylococcus aureus*
- Some fungi
77
Otits media in the diabetic pt is most often caused by which organism and what serious complication may arise?
- *P. aeruginosa*
- Is **especially aggressive** and spreads widely, causing **destructive necrotizing otitis media**
78
What are cholesteatomas; and what are they associated with?
- Non-neoplastic, **CYSTIC lesions** lined by **benign squamous epithelium** w/ trapped **keratin debris** and sometimes **spicules of cholesterol**
- Associated w/ **chronic otitis media**
79
The reactive nature of cholesteatomas may lead to what complications?
- **Erode** into the **ossicles**, the **labyringht**, **adjacent bone**, or **surrounding soft tissue**
- May produce **visible neck masses**
80
What is the primary complication of Otosclerosis?
Conductive hearing loss
81
Otosclerosis is due to abnormal bony deposition where?
**Stapedial footplate** anchoring it to the **oval window**
82
What is the inheritance pattern of Otosclerosis?
Familial, **autosomal dominant** w/ **variable penetrance**
83
Branchial cysts are thought to arise from what remnant and are most commonly observed in whom?
- **Second branchial arch**
- Young adults btw **ages 20-40 yo**
84
Where are branchial cysts most often anatomically?
**Upper lateral** aspect of neck along the **SCM**
85
What is the histology of branchial cysts?
**Simple cyst** lined by **stratified squamous** or **respiratory epithelium** w/ surrounding **fibrous tissue** +/- **lymphoid** tissue w/ prominent **germinal centers**
86
Thyroglossal duct cysts arise from what?
- **Remenant nests of tissue** from **thyroid migration**
- Origin at base of tongue (**foramen cecum**) to its definitive midline location in anterior neck
87
What type of epithelium are thyroglossal duct cysts lined with when located near base of tongue vs. lower locations in anterior neck?
- **Base of tongue** --\> **stratified squamous epithelium**
- **Lower** --\> **pseudostratified columnar epithelium**
88
Paragangliomas (carotid body tumors) are most commonly found where and form what?
- **Adrenal medulla** ---\> **pheochromocytomas**
- **Extra-adrenal** occuring in the **head** and **neck region**
89
What is the origin of paragangliomas (carotid body tumors)?
Neural crest
90
Paragangliomas (carotid body tumors) typically develop in what 2 locations and differ how?
- **Paravertebral paraganglia** --\> **sympathetic** connections and are **chromaffin-positive**, stain for catecholamines
- **Paraganglia** related to **great vessels** of the **head** and **neck** (i.e., **carotid bodies**) --\> **parasympathetic** innervation and infrequently release catecholamines
91
Carotid body tumors are chiefly composed of what histologically and are surrounded by?
- **Nests** (**zellballen**) of **round** to **oval chief cells** (neuroectodermal in origin)
- Surrounded by **delicate VASCULAR septae**
92
Which 5 neuroendocrine cell markers do the chief cells of carotid body tumors stain strongly for?
- Chromogranin
- Synaptophysin
- Neuro-specifc enolase
- CD56
- CD57
93
What supporting network of cells is seen in carotid body tumors and what do they stain for?
- **Spindle**-shaped **stromal cells**, called **sustentacular cells**
- Positive for **S-100**
94
What is the growth of carotid body tumors like and when are they most often seen?
- **Slow-growing** and **painless masses**
- Usually arising in the **fifth** and **sixth decades**
95
Carotid body tumors may arise how and how does the pattern differ based on the underlying cause?
- **Sporadically**
- **Autosomal dominant** assoc. w/ **MEN-2** --\> often **multiple** and **b/l**
96
How aggressive are carotid body tumors, where do they metastasize and what is the prognosis?
- Frequently **recur** after **incomplete resection**
- May metastasize to **regional LN's** and **distant sites**
- **50%** are **fatal** due to **infiltrative growth** (**histology** CANNOT tell!)
