description about ear nose and throat neoplastic and non neoplastic disease

1. Dept. of Anatomic Pathology
Faculty of Medicine
Brawijaya University

2. Definition :
Benign semitransparent nasal lesions that
arise from the mucosa of the nasal cavity or
from one or more of the paranasal sinuses
Nasal Polyp

3. Epidemiology :
* Incidence :
-children : 0,1%
-adults : 1-4%
* Race :
-Polyps occur in all races and social classes
* Sex :
-male : female = 2-4 : 1 (in adults)
* Age :
-usually >20 years, more common >40 years
-rare in children <10 years

4. Etiology :
- chronic inflammation
- allergy
- vasomotor imbalance
- autonomic nervous system dysfunction
- genetic predisposition

5. injury to airway epithelial cell
by allergen, virus, or trauma /
turbulent airflow
*ulceration/prolapse of the submucosa
*reepithelialization
*new gland formation
Pathogenesis of Nasal Polyps
POLYP
1. Bernstein’s theory
↑inflammatory
process
↑sodium absorption
water retention
2. Vasomotor imbalance theory
↑ Vascular permeability  edema  POLYP
3. Epithelial rupture theory
Prolapse of the lamina propria mucosa  POLYP

6. Morphology :
- The most common location : middle meatus
- Multiple polyps
-Occur in children with :
-chronic sinusitis
-allergic rhinitis
-cystic fibrosis (mucoviscidosis)
-allergic fungal sinusitis
-Usually from Ethmoidal cellulae
- Solitary polyp
-Usually from Maxillary sinus  ostia 
Choane and Nasopharynx (Choanal Polyp/
Antro Choanal Polyp)
- Types :
-Seromucous/Fibro-oedematous/Fibroangiomatous

7. MICROS :
-Pseudostratified ciliated columnar epithelium with
thickening of the epithelial basement membrane
-Stroma : edematous, poorly vascularization,
lacks of innervation (except at the base)
-Hyperplasia of the seromucous glands / almost
absent or rare glands
-Hyperplasia of the gland can cause cystically
dilated and degenerated glands containing
inspissated mucous
-Infiltration of eosinophil, neutrophil, degranulated
mast cells, plasma cells, lymphocytes, and
myofibroblasts

12. Symptoms :
- nasal airway obstruction
- postnasal drainage
- dull headaches
- snoring
- rhinorrhea
- hyposmia or anosmia
- frog face deformity

13. Diagnosis :
1. History taking
2. Physical incl. nasal examination
* Anterior Rhinoscopy
- Multiple/Solitary Polyp
* Posterior Rhinoscopy
- Choanal Polyp
* Endoscopy
3. Imaging Studies
- RÖ Photos
- CT scan
- MRI
4. Histopathologic Examination

14. Treatment :
- Medical Care
* Corticosteroid
-topical
-oral
- Surgical Care
Differential Diagnoses :
- Encephalocele
- Papilloma
- Juvenile nasopharyngeal angiofibroma
- Inverting papilloma

15. Nasopharyngeal
Carcinoma
Definition :
Malignant epithelial tumor arising in the
nasopharyngeal mucosa, that includes
keratinizing squamous cell carcinoma and
nonkeratinizing squamous cell carcinoma
(differentiated and undifferentiated)

16. Epidemiology :
* In 2000 : ± 65.000 new cases and 38.000 deaths
* Incidence :
# > : Chinese
Southeast Asians (e.g. Thailand, Philippines,
Vietnam)
North Africans (e.g. Algeria and Morocco)
Arctic region (e.g. Canada and Alaska).
# >>: Hong Kong (1 in 40 men develop NPC before
the age of 75 years)
* Sex : men 2-3 x women
* Age distribution : males = females
Incidence ↑ after the age of 30 years,
peaks at 40-60 years

18. Etiology :
* genetic
* infection by Epstein-Barr Virus (EBV)
* environmental factors (dietary / nondietary)
- volatile nitrosamines in preserved food
- salted fish
- cigarette smoking
- occupational exposure to smoke
- chemical fumes and dusts
- formaldehyde exposure
- radiation exposure

20. Localization :
The most common site of origin is the lateral
wall of the nasopharynx, especially the fossa
of Rosenmüller, followed by the superior
posterior wall
Macroscopy :
The tumour can appear as :
- a smooth bulge in the mucosa
- a discrete raised nodule with or without
surface ulceration
- a frankly infiltrative fungating mass
- sometimes no grossly visible lesion is seen

21. Histopathology :
*(keratinizing) squamous cell carcinoma
-show clearcut evidence of keratinization
-less marked association with EBV
-older age group
*nonkeratinizing carcinoma
-most common type
-do not show clearcut evidence of keratinization
-subdivided into:
# differentiated
-stratified or tiled arrangement
-well-defined cell margins
# undifferentiated
-syncytial appearance
-indistinct cell margins
-some tumor cells may be spindle-shaped

22. Tumour spread :
# Extensive loco-regional infiltration :
* Extension to nasal cavity, oropharynx
* Erosion of skull base, palatum, paranasal
sinuses
* Intracranial spread (via eroded bone or
basal foramina)
* Infiltration of cranial nerves
* Extension to more distant structures
(infratemporal fossa, orbit, hypopharynx)
# Regional (cervical) nodes : uni / bilateral
# Haematogenous dissemination :
bone, lung, liver, and distant nodes

27. ENDOPHYTIC EXOPHYTIC

33. Clinical features :
* ± 50% cases : multiple symptoms
* 10% cases : asymptomatic
* Painless enlargement of upper cervical lymph
node(s) is the most common presenting feature
* Nearly half of the patients complain of nasal
symptom(s), particularly blood stained post-
nasal drip
* Symptoms related to Eustachian tube
obstruction (such as serous otitis media) also
commonly occur
* More advanced disease : headache and
symptoms related to cranial nerve involvement

34. Symptoms :
Neck mass 42%
Nasal (post nasal drip, discharge, bleeding, obstruction) 46%
Aural (tinnitus, discharge, ear ache, deafness) 42%
Headache 16%
Ophthalmic (double vision, squint, blindness) 6%
Facial numbness 5%
Speech / swallowing problem 2%
Weight loss 4%
Physical signs :
Enlarged neck node(s) 72%
Bilateral neck nodes 35%
Neck nodes extending to supraclavicular fossa 12%
Cranial nerve palsy 10%
Deafness 3%
Dermatomyositis 1%

35. Diagnosis :
1. History taking
2. Physical incl. nasopharyngeal examination
- Posterior Rhinoscopy
- Nasopharyngoscopy
3. Biopsy
4. Serology
5. Imaging Studies
- RÖ Photos
- CT Scan
- MRI

38. Treatment :
Radiation therapy :
- treatment of choice
- complete remission in 83%
- 10-year survival rate 43%
- some suggest combining with
Chemotherapy
Differential Diagnoses :
- Malignant Lymphoma
- Olfactory Neuroblastoma
- Nasopharyngeal angiofibroma

39. Prognosis :
Significantly affected by :
* Patient age : better in young individuals
* Clinical staging
* Location of regional metastases, better for :
- homolateral rather than contralateral metastases
- metastases limited to upper neck as opposed to
lower cervical regions
* Histopathological predictive factors :
 prognosis is worse if one or more of :
- keratinizing squamous cell carcinoma
- marked anaplasia and/or pleomorphism
- high cell proliferation rate
- lack of lymphocytic infiltrate
- high microvessel count
* Unfavorable prognosis :
- cranial nerve, orbit, and intracranial involvement

40. LARYNGEAL
CARCINOMA
Definitions :
Carcinoma that arises from the laryngeal
epithelium (glottis, supraglottis and subglottis)
Most cancers originate in the glottis (60-65%)
Supraglottic cancers : less common (30-35%)
Subglottic tumours are least frequent (<5%)
More than 90% of laryngeal carcinoma are
squamous cell carcinoma

41. Epidemiology :
* Incidence rates :
 - Men : 2,5 to 17,1 per 100.000 person/year
 - Women : 0,1 to 1,3 per 100.000 person/year
* Race :
 - black : white = 3,5 : 1
* Sex :
 - In 1950, male : female = 15 : 1
 - In 2000, male : female = 5 : 1
* Age :
 - middle aged / older
 - peak : decade 5-6

43. Etiology :
* Smoking : the most important risk factor
-Death from laryngeal cancer :
heaviest smokers 20X nonsmokers
* Alcohol
* Others :
-polycyclic aromatic hydrocarbons,
metal dust, cement dust, varnish,
lacquer

44. Morphology :
- Protruding pink to gray mass, often ulcerated
- Microscopic :
*squamous cell carcinoma ( >90% )
(well / moderately / poorly differentiated
Spreading :
- Direct extension to adjacent structures
- Lymphatic spread to regional lymph nodes
(cervical lymph nodes)
-Hematogenous spread : lung, liver, bone, etc

47. Symptoms :
Depend on the size and location of the tumor
-Hoarseness
-Lump in the neck
-Sore throat
-Persistent cough
-Stridor
-Bad breath
-Earache ("referred")
-Dysphagia
-Odynophagia
-Coughing blood
-Weight loss

48. Diagnosis :
1. History taking
2. Physical incl. laryngeal examination
- Indirect Laryngoscopy
- Direct Laryngoscopy
3. Biopsy
4. Imaging Studies
- RÖ Photos
- CT Scan
- MRI

50. Differential Diagnosis :
* Inflammation
- Laryngeal TB
- Mycotic laryngitis
- Laryngeal granuloma
* Benign tumor : Papilloma
* Laryngeal nodule
(Polyp; Singer’s nodule)

51. Treatment :
•Surgery
- (Tracheotomy)
- Partial / Total Laryngectomy
•Radiotherapy
•Chemotherapy
 alone or in combination
(depends on the location, type, and
stage of the tumor)

53. Prognosis :
Significantly affected by :
* Clinical staging (TNM)
* Localization
- The best prognosis : Glottic Ca
- The worst prognosis : Subglottic Ca
* Patient age : better in young individuals
* Performance status
* Histopathological predictive factors
- Resection margins
- Histopathologic grading
- Lymphovascular invasion
- Perineural invasion
- Extracapsular spread in lymph node metastases

54. Thank You
For Your Attention