ent pathology - monageoinformatics (1).pdf · malignant tumours: laryngeal carcinoma transglottic...
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ENT PATHOLOGY
Nasal cavities
Paranasal sinuses
Nasopharynx
Larynx
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http://www.ghorayeb.com/anatomysinuses.html
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Nasal Cavities
&
Paranasal Sinuses
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Inflammation (nasal cavity): Rhinitis
Infectious rhinitis (“common cold”)
Viral (adenoviruses, ECHOviruses, rhinoviruses)
Allergic rhinitis (“hay fever”)
Plant pollen, dust mites, animal allergens
Recurrent episodes chronic rhinitis
Complications: inflammatory (sinonasal) polyps,
sinusitis, superimposed bacterial infection
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Inflammation (paranasal sinuses): Sinusitis
Infectious sinusitis
Usually bacterial
Antecedent bacterial rhinitis or tooth
infection
Complications: empyema, orbital
osteomyelitis, bacterial meningitis, dural
venous sinus thrombophlebitis
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http://www.ghorayeb.com/anatomysinuses.
html
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Inflammation (paranasal sinuses): Sinusitis
Allergic sinusitis
Plant pollen, dust mites, animal allergens
+/- antecedent allergic rhinitis
Complications: inflammatory (sinonasal)
polyps, mucocoele, superimposed bacterial
infection
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Inflammation: Sinonasal Polyps
Inflammatory polyps
Complication of chronic allergic rhinitis or chronic allergic sinusitis
Nasal cavities & paranasal sinuses
Usually multiple & bilateral
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Inflammation: Sinonasal Polyps
GROSS
MORPHOLOGY:
Polypoid
Translucent
Moist
Oedematous
http://www.ghorayeb.com/NasalPolyps.html
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Inflammation: Sinonasal Polyps
MICROSCOPY:
Polypoid masses
Respiratory epithelium
Stroma containing mucous
glands, eosinophils,
lymphocytes, plasma cells
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Benign tumours: Sinonasal Papillomas
30 – 50 yr; M:F = 2:1
Multifocal, but usually unilateral
Unilateral nasal obstruction (commonest complaint)
Epistaxis, facial pain, purulent nasal discharge
Proptosis (inverted papillomas)
Risk of carcinoma with inverted variety
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Benign tumours: Sinonasal Papillomas
GROSS MORPHOLOGY:
Soft to firm, polypoid
Fungiform variety found on nasal septum
Inverted variety found on lateral nasal wall & in paranasal sinuses
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Benign tumours: Sinonasal Papillomas
MICROSCOPY:
Fungiform papilloma:
Fingerlike projections of
stratified squamous
epithelium covering
fibrovascular stroma
Inverted papilloma:
Invaginated nests of
benign stratified
squamous epithelium
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Malignant Sinonasal Tumours
CARCINOMAS
•Squamous cell
carcinoma (67%)
•Adenocarcinoma
(10 – 20%)OTHERS
•Olfactory
neuroblastoma
•Lymphoma
•Sarcoma
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Sinonasal Squamous Cell Carcinoma
50 – 70 yr.; M:F = 2:1
Nasal tumours: nasal obstruction,
rhinorrhoea, epistaxis, pain
Sinus tumours: symptoms similar to those of
chronic sinusitis
Risk factors: cigarette smoking, nickel ore,
inverted papilloma
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Sinonasal Squamous Cell Carcinoma
MICROSCOPY:
Usually, keratinizing
type of squamous cell
carcinoma
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Sinonasal adenocarcinoma
Risk factors: wood dust, leather tanning
agents
Salivary gland type
Usually adenoid cystic variety
M=F, 50 – 60 yr
Maxillary sinus*, nasal cavity, ethmoid sinuses,
sphenoid sinus
Non-Salivary gland type
Rare
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Sinonasal adenocarcinoma
Adenoid cystic carcinoma
Cribriform pattern of
tubular structures
Non-salivary gland type
sinonasal adenocarcinoma
Large glands lined by
neoplastic epithelium
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Olfactory Neuroblastoma
(Esthesioneuroblastoma)
Uncommon
Olfactory mucosa
40 yr; M=F
Nasal stuffiness,
epistaxis
Microscopy: nests of
small round cells in a
fibrillary background
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Nasopharynx
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Nasopharyngeal Carcinoma
M:F = 2.5 – 3: 1; average age = 50 yr.
Bimodal age peak in undifferentiated variety:
2nd decade and 6th decade
Common in southeast China, Philippines,
parts of Africa
Low incidence in Western world
Jamaica: 0.4/100,000 (females); 1.1/100,000
(males)
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Nasopharyngeal Carcinoma
Aetiology:
Viral: Epstein-Barr Virus (EBV)
Undifferentiated and non-keratinizing varieties
EBV genome found in the neoplastic cells
Hereditary: HLA-A2, HLA-BW46
Environmental: salted fish, herbal
medicines
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Nasopharyngeal Carcinoma
Clinical presentation:
Cervical lymph node metastases with occult
primary
50 – 80% of patients with undifferentiated variety
Otitis media, hearing loss
Headache, cranial nerve deficits, epistaxis
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Nasopharyngeal Carcinoma
Gross morphology:
Normal nasopharynx or surface granularity or
obvious mass
Microscopy:
Three varieties –
Keratinizing squamous cell carcinoma
Non-keratinizing squamous cell carcinoma
Undifferentiated carcinoma
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Nasopharyngeal Carcinoma
Keratinizing squamous
cell carcinomaNonkeratinizing
squamous cell carcinoma
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Nasopharyngeal Carcinoma
Undifferentiated carcinoma:
Large neoplastic epithelial cells admixed with non-
neoplastic lymphoid cells
Nest of neoplastic
epithelial cellsNon-neoplastic
lymphoid cells
Diffuse (syncytial) arrangement
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Larynx
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Inflammation: Laryngitis
Infectious (viral, bacterial), allergic, or
chemical
Usually part of generalized upper respiratory
tract infection
Heavy exposure to tobacco smoke
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Inflammation: Laryngeal nodule
Laryngeal nodule; singer’s node; vocal cord polyp
Heavy smokers, singers, teachers, preachers
True vocal cords
Persistent hoarseness
Gross morphology: Smooth, rounded, few millimetres http://www.ghorayeb.com/vocalcordpolyp.html
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Inflammation: Laryngeal nodule
MICROSCOPY:
Hyperplastic, stratified
squamous epithelium
Loose myxoid stroma
Stroma may have
numerous (as shown
here) or few vascular
channels
Vascular channel
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Benign Tumours: Laryngeal Papillomas
Also called squamous papillomas
Found on true vocal cords
Usually single in adults
Often multiple in children
Gross morphology:
Soft, raspberry-like excrescences
Usually less than 1 cm in diameter
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Benign Tumours: Laryngeal Papillomas
MICROSCOPY:
Multiple, slender, finger-like projections
Hyperplastic stratified squamous epithelium
Cores of fibrovascular stroma
Fibrovascular stroma
Hyperplastic stratified
squamous epithelium
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Juvenile Laryngeal Papillomatosis
Multiple papillomas
Human Papilloma Virus (HPV) types 6 and 11
Frequently recur
Often spontaneously regress at puberty
Malignant transformation is rare
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Malignant Tumours: Laryngeal Carcinoma
60 – 70 yr; M>F
Jamaica: 4.7/100,000 (males); 0.2/100,000
(females)
Tobacco smoke**, alcohol, asbestos,
irradiation
Hyperplasia – Dysplasia – Carcinoma
sequence
Clinical presentation depends on site of origin
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Malignant Tumours: Laryngeal Carcinoma
TRANSGLOTTIC CANCERS
Cross the ventricle vertically
Involve both true vocal cord and
ventricular band
Associated with a fixed vocal cord
Very invasive
SUPRAGLOTTIC CANCERS
Epiglottis, ventricular band,
aryepiglottic fold, arytenoid body
Hoarseness only after becoming
quite large
Local or referred (to the ear) pain
Late (advanced stage) presentation
GLOTTIC CANCERS
True vocal cord
Persistent hoarseness
Early presentation
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Malignant Tumours: Laryngeal Carcinoma
GROSS MORPHOLOGY:
Polypoid, exophytic
mass
OR
Ulcerated mass
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Malignant Tumours: Laryngeal Carcinoma
MICROSCOPY:
95% are squamous cell carcinomas
Remainder are adenocarcinomas
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Malignant Tumours: Laryngeal Carcinoma
Surgery, radiotherapy
Approximately 33% of patients die
Causes of death include:
Infection
Widespread metastases
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http://www.ghorayeb.com/anatomysinuses.
html
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http://www.ghorayeb.com/LarynxLesions.ht
ml