Upper Respiratory Tract Functions: Passageway for respiration. Receptors for smell. Filters incoming air to filter larger foreign material. Moistens and warms incoming air. Resonating chambers for voice.
Lower Respiratory Tract Functions: Larynx: maintains an open airway and assists in sound production. Trachea: transports air to and from lungs. Bronchi: branch into lungs. Lungs: transport air to alveoli for gas exchange
DISEASES OF UPPER RESPIRATORY TRACT: CongenitalImmotile cilia (Kartagener) syndrome:Definition: Congenital defect of ciliary movement.Childhood onset due to defective or non-functional cilia in therespiratory tract → chronic sinusitis, defective mucociliarytransport and bronchial clearance, bronchiectasia, chronic OtitisMedia and headaches, related to immotility of ependymal cilia inthe walls of cerebral ventricles; and absence of frontal sinuses.Status Of Reproduction: ♂ are infertile,1⁄2 of ♀ are im-pregnatable, the other1⁄2 sterile.1 ⁄2 have Kartageners triad, i.e chronic sinusitis, bronchiectasis sinusitisand situs inversus totalis.(A condition in which there is complete right to left reversal(transposition) of the thoracic and abdominal organs)
DISEASES OF UPPER RESPIRATORY TRACT RHINTIS & SINUSITIS1. Common cold: viral infection: rhinoviruses, adenoviruses,echoviruses → catarrhal inflammation with mucous discharge. Secondarybacterial infection → muco-purulent discharge.2. Allergic rhinitis (hay fever): Ig E mediated hypersensitivity reaction (type-I) to plant pollen antigens → Nasal Polyps. 2ry. infections arecommon → Chronic Rhintis.3. Chronic Rhinitis: AE: repeated bacterial infections. P.F.: DeviatedNasal Septum or Nasal Polyps. May → chronic sinusitis.4. Chronic Sinusitis: Most common bacterial.In DM may be fungal (mucormycosis). Rarely, it is associated with immotile mucormycosiscilia (Kartagener’s) syndrome.
Nasal polypsA. Low-power magnificationshowing edematousmasses lined by epithelium.B. High-power views showingedema and eosinophil-richinflammatory infiltrate.
DISEASES OF UPPER RESPIRATORY TRACTNASOPHARYNGITIS & TONSILLTIS-AE: viral, or bacterial infection (beta-hemolyticstreptococci)…..???streptococci- Morphology: tonsils are enlarged, red and dotted bypinpoints of exudate from the tonsillar crypts (folliculartonsillitis).-Local complications: Otitis Media, peritonsillar abscess("quinsy"), and tonsillar hypertrophy.- Remote post-streptococcal complications: RheumaticFever (RF) and glomerulonephritis (GN). RF GN
TUMORS OF THE NOSE, SINUSES & NASOPHARYNX1- NASOPHARYNGEAL ANGIOFIBROMA: Highly vascularbenign non-capsulated tumor of adolescent males.Epistaxis+/-Epistaxis2-INVERTED PAPILLOMA: Locally aggressive neoplasm (highrecurrence rate) of the Nose or the paranasal Sinuses; rare Sinusesprogression to carcinoma.3- ISOLATED PLASMACYTOMA: Malignant plasma cell tumor;solitary lesion, rare → to multiple myeloma (MM).4- OLFACTORY NEUROBLASTOMA: Highly malignant; neuro-endocrine tumors of the olfactory mucosa; positive forneuron-specific enolase and S-100 protein.
INVERTED PAPILLOMA :.NoseThe masses ofsquamousepithelium aregrowing inward;hence, the terminverted.
5- NASOPHARYNGEAL CARCINOMA:A- Keratinizing squamous cell crcinoma (WHO-1)B- Non-keratinizing squamous cell carcinoma (WHO-2)C- Undifferentiated carcinoma (WHO-3): = Lymphoepithelioma(admixed with dense lymphocytic infiltrate.-Age: children in Africa & Adults in China. China-PF: Epstein-Barr (EBV). Chromosomal.?? EBV-TTT. : Unresectable because of widespread metastases at thetime of diagnosis.-Undifferentiated carcinoma response better to radiotherapythan the keratinizing type.
LARYNGITISAE: Allergic, viral, bacterial or chemical (tobacco) injury. Allergic viral tobaccoAcute laryngitis: AE: viral (Parainfluenza virus) or bacteria. virusIn children → narrowing of the larynx, that causes stridor & inyoung infants laryngeal edema → airway obstruction & death(Tracheostomy is life saving). Laryngo-tracheo-bronchitis (croup).Chronic laryngitis: AE:Cigarette in adults → (dysplasia) → dysplasiaSCC ( Squamous Cell Carcinoma)
LARYNGEAL POLYPS & PAPILLOMASPolyps: ( Singer’s Nodule) Small inflammatory nodules onthe true vocal cords of signers & teachers; caused by overuse eachersof voice → hoarseness. They never give rise to Cancer XXX.Papillomas: AE: HPV-1, Multiple in children. AETend to recur after excision. May → Cancer. excisionTrue neoplasms; raspberry-like nodules, with delicate finger-like papillae covered by squamous epithelium; liable tofragmentation and bleeding. bleeding
Larynx: S. Node, Papilloma vs. CarcinomaDiagrammaticcomparison of abenign Singer’snode, papilloma andan exophyticcarcinoma of thelarynx to highlighttheir quite differentappearances.
LARYNGEAL CARCINOMA-Epithelial changes, ranging fromhyperplasia, dysplasia, CIS (carcinoma insitu) to invasive squamous cell carcinoma.- Gross: vary from dysplasia, CIS (carcinomain situ) to frankly malignant verrucose orulcerated nodule.- AE: Cigarette smoking is the majorcausative factor & cessation of smokingcauses regression of early lesions.Asbestos & HPV are contributing factors.-M/E : Squamous cell Carcinoma of varyingdegrees.- Prognosis: Carcinomas of the true vocalcord (intrinsic type) is better than Sq.C.C in the supraglottic location (above thecarcinomas above or below the vocal cord . true vocal cord)
Laryngeal carcinoma (Gross & M/E)q A. Note the large, fungating lesion involving the vocal cord and pyriform sinus.q B. Histologic appearance of laryngeal squamous cell carcinoma.q Note the atypical lining epithelium and invasive keratinizing cancer cells in the submucosa.
Diseases of Salivary Glands A Commitment to …Excellence
SIALADENITIS & SIALOLITHIASISSialadenitis: viral (mumps), bacterial (secondary to ductalobstruction) or autoimmune (Sjogren’s syndrome= syndromexerostomia (Dry Mouth- due to lack of saliva) +keratoconjunctivitis sicca= the sicca syndrome)Sialolithiasis: dehydration may -> obstruction of thesalivary ducts by inspissated food debris → stone formation& secondary bacterial sialadenitis (Staph. Aureus & Strept.Viridans). Submandibular salivary gland is most commonlyaffected; usually unilateral; with symptoms & signs of acutesuppurative inflammation.
Causes of Sialadenitisq Infectious q Autoimmune – Mumps (Sjogren’s) Sjogren’s (paramyxovirus) – Bacterial (usually associated with ductal obstruction)
Sjogren’s Syndromeq Immune-mediated destruction of the lacrimal and salivary glands, often occurring in association with glands rheumatoid arthritis (RA) or another autoimmune disorder.q Gross: Xerostomia and keratoconjunctivitis sicca + ..?q ME: shows dense lympho-plasmacytic inflammatory ME infiltrate with destruction of glandular tissue.
Sjogren’s syndromeq Etiology and pathogenesis – primary target is ductal epithelial cells of exocrine glands – B-cell hyperactivity - hypergammaglobulinemia, antinuclear antibodies. – primary defect is in T-helper cells (too many) – most have anti- RNA (anti -SS-A and anti-SS-B) antibodies – associated with HLA-DR3
Sjogren’s syndromeq C/P: – primarily in women > 40 – dry mouth, lack of tears. mouth – salivary glands enlarged. enlarged – 60% with other ConnectiveTissue Diseases. – 1% develop lymphoma, 10% with pseudolymphomas lymphoma
Sjogren’s syndromeq Pathology: – all secretory glands can be involved – intense lymphoplasmacellular infiltrates – secondary inflammation of corneal epithelium (due to drying) leads to ulceration and xerostomia – can develop respiratory symptoms if these glands are affected – 25% develop extraglandular disease (most with anti-SS-A) involving CNS, kidneys, skin and muscles
TUMORS OF THE SALIVARY GLANDS-Up to 80% arise in the parotid gland (15% malignant), 10% in thesubmandibular (40% malignant) & 10% in the minor salivary glands (Lessthan 50% malignant). Affect middle-aged adults, the malignant at an olderage than the benign.- Histological types:1- Pleomorphic adenoma 45% (benign).2- Warthin’s tumor 11% (benign)3- Muco-epidermoid carcinoma 15% (malignancy)4- Adenoid cystic carcinoma 10% (malignant)5- Acinic cell carcinoma 03% (malignant)
Pleomorphic Adenoma (mixed tumor of salivary gland)q Most common salivary gland tumor 45% (Benign).q Most often arises in superficial parotidq Gross: Circumscribed, glistening, myxoid lesionq M/E: shows heterogeneous mix of ducts, acini, and sheets of cells in a myxoid or chondroid stromaq Complete resection is necessary to prevent recurrence (10% recurrence rate).q Low percentage show malignant areas.
Pleomorphic adenoma: Gross: shows sharplycircumscribed, yellow-white tumor protrudes above the level of thesurrounding glandular substance.
Warthin’s Tumorq Papillary cystadenoma lymphomatosum or (adenolymphoma). 11% (Benign)q Infrequent benign tumor of the parotid glandq Well-encapsulated green-brown mass with cleft-like spaces on the cut surface.q Mixture of oncocytic epithelium and subjacent lymphoid tissue.q 10% recurrence rate.
Warthin’s Tumor: Tumorq A. Lower-power view showing epithelial and lymphoid elements.q Note the follicular germinal center beneath the epithelium.q B. Cleftlike spaces separate the lobules of tumor covered by a regular double layer of eosinophilic epithelial cells based on a lymphoid stroma.
Mucoepidermoid carcinomaA. Mucoepidermoidcarcinoma showingislands having squamouscells as well as clear cellscontaining mucin.B. Mucicarmine stains themucin reddish-pink.
Adenoid cystic carcinoma in a salivary gland.A. Low-power view.The tumor cells havecreated a cribriform patternenclosing secretions.B. High-power view showingpolygonal tumor cellssurrounding thecystic space filled withsecretions.
.(Carotid body tumor (ParagangliomaA. Low-power viewshowing tumor clustersseparated by finevascular septa(zellballen appearance).B. High-power view oflarge, eosinophilic,slightly vacuolatedcells with elongatedsustentacular cells in thesepta.