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Ent 00 march 22
- 1. Head & Neck PathologyHead & Neck Pathology OTOLARYNGOLOGYOTOLARYNGOLOGY March. 29. 2015
- 3. Oropharynx • Viral • Bact. Infection (Pharyngitis). - B H Strept. • Tonsillitis - Peritonsilar abscess “Quinsy” - GN, & RH H Dis. • Laryngitis - TB - Diphtheritic pharyngitis. • Tumors of tonsilsTumors of tonsils
- 4. Pharyngitis
- 5. Tonsillitis & peritonsillar abscess “Quinsy”
- 6. Diphtheria
- 7. “UPPER” AIRWAYS • NOSE: Inflammation, Tumors • NASOPHARYNX: Inflammation, Tumors • PARANASAL SINUSES: Inflammation, Tumors • LARYNX: Inflammation, Tumors
- 8. Nose Skin of the nose; • DLE • Sebaceous hyperplasia • BCCa. Nasal #; • Hematoma • Deviation of septum • Deviation of nose.
- 9. Nose • Rhinitis • Sinusitis • Epistaxis Benign nasal tumors; • Hemangioma • Juvenile Angiofibroma • Papilloma. • Sq & Trans. Cell ca.
- 10. Rhinitis/Sinusitis • Very often allergic. • Very often associated with URI’s, usually viral • about every organism has been implicated at one time or another, bacteria, virus, fungus, etc.
- 11. NOSE/SINUS/NASOPHARYNX “TUMORS” • “Polyps”---really NOT a tumor • Angiofibroma • Papilloma • Neuroblastoma • Nasopharyngeal Carcinoma
- 12. INFLAMMATORY “POLYPS” OF NASAL CAVITY
- 14. Necrotizing ulcerating lesions of URT: • Acute fungal infections (e.g mucormycosis;, in immunosuppressed patients) • Wegener granulomatosis • lethal midline granuloma and now known to be a lymphoma of natural killer cells infected with EBV.
- 15. “NECROTIZING” Upper Airway Lesions • “WEGENER” Granulomatosis • “Lethal” Midline Granuloma
- 17. ANGIOFIBROMA
- 19. Nasopharyngeal carcinomas • often clinically occult for long periods, • present as metastases in the cervical lymph nodes in as many as 70% of the patients. • Radiosensitive • 5 Year survival; 50% to 70%
- 22. PET/CT Scan of a patient with nasopharyngeal cancer. Transverse slice demonstrating positive primary site
- 24. “lymphoepitheliomas”Nasopharyngeal carcinoma Three histologic variants; • Keratinizing SqCCa • Nonkeratinizing SqCCa, • Undifferentiated Ca. • EBV • Genetic
- 27. The Larynx
- 29. LARYNGITIS
- 30. Vocal cord nodule “singer’s nodes” smokers or singers
- 31. Nodules • bilateral symmetric epithelial swelling of ant/mid third of TVF • More in children, adolescents, females – softer intensity of voice causes hyperfunction • Result of abuse or misuse, ch. Irritation in heavy
- 32. Vocal fold polyps • Unilateral • Broad-based vs. Pedunculated • Formed by capillary break with leakage of blood resulting in local edema and organization with hyalinized stroma
- 33. Laryngeal papilloma • HPV (6 & 11). • 2% malignant transformation (HPV 16 &18) • single in adults • in childre, multiple & recurrent. recurrent respiratory papillomatosis (RRP), “Juvenile papillomatosis”
- 35. Papilloma
- 36. Leukoplakia • Spectrum of change in epithelium • HyperkeratosisDysplasia (mild, moderate, severe),CIS • 8% to 14% rate of malignant transformation
- 37. Carcinoma of larynx, Epidemiology • > 40 years • men /women = (7 : 1). • nearly all cases, in smokers, alcoholic, +/- asbestos • HPV • About 95% typical Sq C Ca.. • Incidence by Site • Supraglottic 25 - 40% • Glottic 60% to 75% • Subglottic < 5% • begin as in situ lesions, later appear as plaques, then ulcerating and fungating
- 38. Carcinoma of the larynx • persistent hoarseness. • The location of the tumor has a significant bearing on prognosis; • glottic tumors; 90% are confined to larynx at diagnosis. 1. symptoms early in the course of disease; 2. the glottic region has a sparse lymphatic supply, and spread beyond the larynx is uncommon. • the supraglottic larynx is rich in lymphatic spaces, and nearly a 1/3 of these tumors metastasize to regional (cervical) lymph nodes.
- 39. The subglottic tumors • remain clinically quiescent, • 1/3 die of the disease. • The usual cause of death is; - infection of the distal respiratory passages or - metastases and cachexia.
- 40. Glottic SCC
- 44. Microinvasive or Superficially Invasive Squamous Cell Carcinoma Invasive Squamous Cell Carcinoma
- 46. SQUAMOUS CELL CARCINOMA OF LARYNX/Mic
- 48. The 10 leading cancers by gender. site Iraqi Tumor Regestry 2007
- 49. Breast Lung & bronchus Leukemia Bladder Brain &CNS NHL Colorectal Larynx Skin excluding Melanoma Stomach Uterus including Cervix and corpus) Hodgkin disease Thyroid Kidney, pelvis& ureter Ovary Prostate Pancreas Bone & cartilage Liver &bile ducts Esophagus Type of cancer, in Iraq, by primary tumor site (2004) 6
- 50. EARS • DEGENERATION: OTOSCLEROSIS • INFLAMMATION: • NEOPLASMS:
- 53. The Tympanic Cavity Chorda Tympani N. (CN VII) Tendon of Tensor Tympani M. (V3) Incus Tendon of Stapedius M. (CN VII) Stapes Cut edge of tympanum Malleus
- 57. CERUMEN CAST
- 58. OTOSCLEROSIS
- 59. NECK • Lymph node • BRANCHIAL (cleft) CYST • THYROGLOSSAL (duct/tract) CYST • PARAGANGLIOMA (Carotid Body Tumor) • Other
- 63. CAROTID BODY TUMOR “balls of cells” “zellballen” ZELLBALLEN
- 64. Whole-body PET scan using 18 F-FDG
Editor's Notes
- The “realm” of “ENT”, or otolaryngology, includes diseases of the nose, nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, laryngopharynx, “upper” airway, defined as airspaces leading ultimately into the lung, and all the structures in these spaces, such as the for pairs of nasal sinuses, auditory tubes, ears, nasolacrimal duct, tonsils, and salivary glands. ENT docs do thyroid surgery too.
- What is “upper” airway defined as? If this area was infected, would it be called an “upper” respiratory infection? Would you expect that if parts of an upper airway were lined by the same types of epithelium then they might be subject to the same types of inflammations and neoplasms? Answer: YES
- These conditions cover 99% of what might appear as a tumor in the nose, nasal, cavity, or nasal pharynx, and simple ”polyps”, also called “Inflammatory polyps” are the vast majority
- Not only are inflammatory “polyps” associated with inflammation of their mucosa of origin, but they show inflammatory changes in them!
- Multiple appearances of nasal polyps
- These are two very serious, i.e., potentially and often fatal aggressive granulomatous proliferations of the upper airway. They are often hard to distinguish from each other clinically and even histologically. “Lethal” midline granuloma is thought to be a malignant tumor of NK (Natural Killer) cells.
- Papilloma and “inverting” or “inverted” papilloma of upper airways.
- Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma) is a histologically benigm but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males.[3] Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.
- Esthesioneuroblastomas of the olfactory nerve (really bulb or tract) are exceedingly rare. This will probably be the only one you will ever see. Like any other neuroblastoma, it may have “rosettes”.
- Nasopharyngeal Ca. invade locally, spread to cervical lymph nodes, and then metastasize to distant sites. They tend to be radiosensitive, and 5-year survival rates of 50% are reported even for patients with advanced cancers.
- Positron emission tomography (PET); is an imaging technique that produces a 3D image of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule (FDG). 3D images of tracer concentration within the body are then constructed by computer analysis. In modern PET-CT scanners, 3D imaging is often accomplished with the aid of a CTX-ray scan performed on the patient during the same session, in the same machine.
- Nasopharyngeal carcinomas almost always look like they are half carcinoma and half lymphoma. Draw a line which separates an “epithelial” looking part of the tumor from a “lymphoid” appearing part
- World’s most normal vocal cords.
- Vocal cord nodule; less than 0.5 cm in diameter, located, most often, on the true vocal cords. The nodules are composed of fibrous tissue and covered by stratified squamous mucosa. the result of chronic irritation or abuse.
- junction of anterior to middle VF experience maximal shearing and collision forces.
- Papilloma, but there may be some cancer microscopically.
- Carcinomas are usually ulcerated, irregular, indurated, invasive, and destructive, with secondary necrosis. For all practical purposes regard them all as squamous.
- What are those huge cells under the stratified squamous mucosa? Cancer cells, i.e.’, malignant invasive squamous cells. Are they invasive? Of course, otherwise the would not be UNDER the mucosa, would they?
- Otitis externa
- World’s most normal tympanic membrane.
- Acute middle ear infection
- Chronic “serous” otitis media
- Cerumen impaction, probably the most common ear abnormality and/or cause of decreased hearing.
- Otosclerosis, abnormal bone deposition between the footplate of the stapes and oval window, one of the commonest forms of conduction hearing loss, begins in middle age, get progressive, usually bilateral, often familial.
- Common pathologic conditions of the “neck” itself.
- Branchial cleft cysts are developmental remnants of the branchial clefts, they can become inflamed, as a rule they do not become malignant, and this is a CLASSICAL appearance
- Thyroglossal duct cyst, same general etiology, appearance, and behavior, as a branchial cleft cyst. The presence of remnants of thyroid follicles in the wall of the cyst, if you are lucky enough to find it, is thrilling to a pathologist. Find the follicles. This is another example where remembering a little bit of embryology helps a lot.
- Tumors of the carotid body are composed of “balls of cells”, or “zell-ballen” in German. There is an infinitely confusing relationship to the terms paragangliomas, glomus tumors, chemodectomas, with respect to carotid body tumors. For purposes of sanity we will say, carotid body tumors ore tumors of the carotid body receptor cells which are cells near the carotid sinus that are sensitive to pO2, pCO2, pH, and even temperature, and are called carotid body tumors, and appear as little round balls microscopically. Pathologists have spent their whole life being confused about the proper nomenclature of these tumors with respect to the other mentioned terms, so I am not going to propagate the confusion more.