Flashcards in URT and Salivary Disorders Deck (33):
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Common Infections
Otitis MediaTonsilitis/Pharyngitis
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Otitis Media
viral/bacterial ascending infection from nasopharynx that spreads to ear via eustachian tubeCommon in children and infantsExam: red, bulging tympanic membraneBacterial: febrile, more common to have purulent exudateStrep pneumo, H flu, MoraxellaViral: less of a fever, more common to have serous exudateRSV, Rhinovirus, CoronavirusComplications: perforation and possible loss of hearing
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Tonsilitis/Pharyngitis
mucosal edema, erythemia, and reactive lymphoid hyperplasia90% are viral -> Rhinovirus, Echovirus, AdenovirusIf bacterial -> Group A Strep or Staph aureusIf Group A Strep -> can caused Acute Rheumatic Fever and/or Post-Strep Glomerulonephritis - hematuriaWhite inflammatory exudates over tonsils
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Life Threatening Infections
(usually immunocompromised)Necrotizing External OtitisRhinocerebral Zyngomycosis
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Necrotizing External Otitis
Usually caused by Pseudomonas Rarely by AspergillusStarts with minor trauma to auditory canal, progressing with pain, swelling and purulent dischargeLate complications: osteomyelitis of mastoid bone (possibly causing Bell’s Palsy) and meningitis, extension to temporal boneIntracranial extensions! Tx: debride dead tissue and long-term abx
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Rhinocerebral Zygomycosis
Fungal infection that starts in sinonasal tract and spreads through blood vessels -> Can spread into CNSMASSIVELY destructive and very high mortality rateTypical fungi: Rhizopus, Absidia or MucorHistology: broad, non-septate hyphae with right angle branchingPt presents w/ sniffles, progresses over 1-3 d to intracranial extension, proptosis, etc.Tx: early detection and debridement, plus anti-fungal
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Epistaxis
Pyogenic GranulomaJuvenile Nasopharyngeal Angiofibroma
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Pyogenic Granuloma
Benign polypoid vascular proliferation of capillariesMore common in adultsCommon location is anterior nasal septumEtiology: trauma? Pregnancy?Gross appearance: smooth, lovulated, red polypoid massTx: Local excision. Recurrence is rare
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Juvenile Nasopharyngeal Angiofibroma
Benign neoplasm w locally destructive growthUsually in young males (no females) Originates in lateral or upper-posterior nasopharynxUnilateralHistology: antler-like thin walled vessels with collagenous stroma w stellate fibroblastsTx: complete resectionIf recurs: hormone modulation (estrogen therapy)
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Nasal Obstruction
Sinonasal inflammatory polypsSinonansal papillomasRhabdomyosarcomaOlfactory neuroblastomaSinonasal MelanomaNasopharyngeal Carcinoma
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Sinonasal Inflammatory Polyps
Non-neoplastic inflammatory swellings of sinonasal mucosaCan be unilateral or bilateralMost often in adults >20 y/oSymptoms: nasal obstruction, rhinorrhea and headacheAssociated with: CF, DM, allergies, infection, aspirin intoleranceGross: edematous pink/gray masses protruding into nasal cavityHistology: intact surface epithelium with a lot of eosinophilsTx: Excision
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Sinonasal Papillomas
Benign neoplasm of sinonasal mucosaRare to see malignant transformation -> but can cause damage if it impinges on local structuresAssociated with HPV 6 and 11Locally destructive, potentially fatalUsually unilateral, may be bilateralSx:nasal obstruction, epistaxis, pain3 forms: SeptalCylindrical (exophytic)Inverted (endophytic) -> much more difficult to resectTx: wide surgical incision
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Rhabdomyosarcoma
t(2;13), t(1;13)malignant tumor of skeletal muscleMost common sarcoma in head/neck of kidsMost common locations: orbit > nasopharynx > ear > sinonasal cavityGross: sarcoma botryoides (“grape-like mass”)Histology: looks like skeletal muscle (striated muscle fibers)Good survival at early stage
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Olfactory Neuroblastoma
Malignant small round blue cell tumorUnilateral nasal obstruction, epistaxis and visual disturbancesCenter of lesion is usually in cribiform plate -> possible damage to CN 1If stays confined, good prognosisIf extension into nasal cavity, orbit, sinuses, it can get very largeSx: epistaxis, headaches, visual disturbancesTx: radical surgery and radiationHistology: small, round blue cell w/ rosettesMarkers: NSE, Chromogranin, S100
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Sinonasal Melanoma
very raremalignant & likely to metastasizePOOR prognosisHistology: black spots (pigmented melanin)Polyploid mass causing obstructionTx: surgical resection of large part of nasal plate
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Nasopharyngeal Carcinoma
Associated with EBVUncommon in USA but more common in Asia (in adults) and Africa (in kids)3 patterns: Keratinizing Squamous Cell Carcinoma: least radiosensitive, worst prognosis, dividing slowlyNon-keratinizing SCCUndifferentiatied: most radiosensitive, best prognosisTx: radiation
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Midline Destructive Lesions
Wegener's GranulomatosisExtranodal NK/T cell Lymphoma
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Wegener's Granulomatosis
non-infective vasculitisTriad: Sinonasal, Lung, KidneyUlceration/necrosis of palate due to obstruction of blood vesselsMore common in males, 30-50 y/oPossible autoimmuneSymptoms of nasal involvement: sinusitis, purulent rhinorrhea, obstruction, painPathology - ulceration in the palateLabs: increased ESR, cANCA (anti-proteinase3)Histology: caseating granulomas plus necrosisTx: If limited: steroids or cyclophosphamide If systemic: high-dose steroids and cyclophosphamide and possible TNF antagonist
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Extranodal NK/T cell Lymphoma
VERY rare in US, more common in AfricaHighly destructive angiocentric T Cell Lymphoma (malignant T cells attack the blood vessels)Extreme tissue loss (bone, soft tissue)Radiologic findings are same as Wegener’sHistology: tumor cells express NK markers (CD2, CD16, CD56, TIA-1, cytoplasmic CD3)Prognosis: if localized, not so bad. If systemic, rapidly lethal
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Hoarseness
Laryngeal NodulesLaryngeal PolypsLaryngeal Papilloma and PapillomatosisSquamous Cell Carcinoma of the Larynx
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Laryngeal Nodules
non-neoplasticDue to chronic irritation -> trauma or inflammation“Singer’s nodules” -> bilateralSingle nodule, following voice abuse, infection, alcohol, smoking, hypothyroidismMost common in middle 1/3
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Laryngeal Polyps
Unilateral Caused by: voice abuse, infection, EtOH, smoking, hypothroidSimgle, on middle 1/3Benign
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Laryngeal Papilloma and Papillomatosis
Benign, exophytic neoplastic growthAdult type -> single lesion that rarely recursJuvenile type -> multiple lesions with high recurrence Often associated with HPV 6 and 11, may be acquired at birthUsually regresses at pubertyRx: laser ablation, antiviral therapyMalignant transformation
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Squamous Cell Carcinoma of the Larynx
>95% are squamous cellM 50 y/oRisk Factors: smoking, EtOH, asbestosSymptoms: hoarseness, dysphagia, hemoptysisComplication: Infection/metastasisLocations: glottic, supraglottic, subglottic, transglottic (rare, but worse)
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Parotid Gland Enlargement
Sjogren'sSalivary Gland Neoplasms - Pleomorphic Adenoma, Warthin Tumor, Mucoepidermoid Carcinoma
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Sjogren Syndrome
Auto-immune disease most common in women >50 y/oAssociated with other autoimmune diseasesImmune-mediated destruction of lacrimal and salivary glandsSymptoms: dry eyes, dry mouth (xerostomia), blurred vision, dysphagiaLabs: auto-antibodies against SS-A and SS-BCommon complication (~5%) -> Non-Hodgkin’s Lymphoma
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Pleomorphic Adenoma
Tumor in the parotid gland w/ MIXOID MATRIXmost common, usually asymptomatic, with epithelial and stromal componentTx: surgically removing parotid (Risk: damage CN VII), need to do a wide excision thoughCells are of myoepithelial origin
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Warthin Tumor
(aka Papillary Cystadenoma Lymphomatosum)10% bilateral (greatest percent of these 3 neoplasms)Histology: lymphocytic infiltrateProminent pink cytoplasm w/ pink infiltrate
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Mucoepidermoid Carcinoma
Most common malignant salivary gland tumorImportant translocation t(11;19)Fusion gene MEC1-MAML2Turnover of cAMP pathway, malignant formationComposed of mucocytes & epidermoid cells
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Developmental and Neoplastic Lesions of Neck
Branchial Cleft CystThyroglossal Duct CystParaganglioma
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Branchial Cleft Cyst
remnant of 2nd branchial cleft that remains patentLATERAL side of neckCyst wall can be either squamous or columnar with lymphoid infiltrate
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Thyroglossal Duct Cyst
remnant of thyroglossal ductMIDLINE on neckMoves when you move tongue / swallowCommonly w/ lymphoid infiltrateTx: excision
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