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BrookeNH10
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Dorma HSV-1 resides in
sensory ganglia
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2 things caused by HSV-1
- Fever blisters/cold sores
- Acute Herpetic Gingivostomatitis (peds or immunocompromised)
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Pt: Child 2-4 years
Sx: Drooling and refusal to eat
PE: Fiery red oral mucosa w/ vesicles and ulcers
Duration: 7-14 days
Acute Herpetic Gingivostomatitis (HSV-1)
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What test confirms Herpes?
Tzanck test
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What do you see on positive Tzanck test?
- Multinucleated giant cells
- Nuclei molding to one another (w/ intracellular inclusions, margination of chromatin --> ground glass appearance)
Confirms HSV-1
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Drug given to immunosuppressed HSV-1 pts?
Acyclovir (normal people tx is symptomatic)
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Marked increase in oral lesion in the last decade. Tranmission of this virus has been documented to occur in the absence of visible lesions.
HSV-II (genital herpes)
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Shallow, idiopathic oral ulcers that are painful, lasting a week to several weeks
Aphthous ulcers (HSV-II)
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Mucosal changes that are associated with squamous dysplasia, a precursor to squamous cell carcinoma.
Luekoplakia, erythroplakia
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White plaque on a mucosal surface; histologically, hyperkeratosis and squamous hyperplasia are seen, with or without dysplasia.
Leukoplakia
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Red, velvety mucosal lesion that usually show significant dysplasia or carcinoma in situ. More likely to progres to invasive squamous cell carcinoma.
Erythroplakia
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More likely to progress to invasive squamous cell carcinoma in oral cavity: Leukoplakia or Erythroplakia
Erythroplakia
Although both may contain foci of invasive carcinoma at the time of presentation.
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Squamous cell carcinoma is most common where: oral cavity, lip, or tongue
lower lip (sun hits it), more common in men because wearing lipstick is protective for women
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4 risk factors for intraoral squamous carcinoma
- Tobacco
- Alcohol
- Oral-genital
- Oral-Oral
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T or F: HPV genetic material is increasingly identified in oral squamous cancers
True (especially those in tonsils and base of the tongue)
Over 70% of newly diagnosed oropharyngeal cancers harbor oncogenic strains of HPV- esp. type 16 [90% of HPV related oropharyngeal carcinomas])
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_______show a greater tendence for early lymph node metasteses, bt are paradoxically associated w/ a better prognosis.
HPV-related cancers
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E6 binds and degrades
p53 protein
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E7 inhibits
Rb protin --> accumulation of p16 protein
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Which carcinomas have the best prognosis? oral cavity, lip, tongue
Lip = best prognosis
- (floor of mouth and base of tongue have the worst)
- HPV genetic material present = better prognosis
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Most common human infection
Infectious rhinitis
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3 Types of viruses that cause infectious rhinitis
Rhinovirus, Adenovirus, Echovirus
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Major cause of common cold
rhinovirus
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Rhinovirus binding site
is in a cleft that is no accessible to Ab (ICAM-1, CD54 molecule) on epithelial cells
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Inflammatory mediates (ie. bradykinin) in their response to rhinovirus cause
increased mucus secretion and congestion
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Hypersensitivity rxn of Allergic Rhinitis
Type I, IgE-mediated
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Reactive, non-neoplastic protrusions of edematous inflamed mucosa. Surgically removed to improve air movement and drainage.
Nasal Polyps
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Nasal polyps are esp. common in
children w/ CF
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Usually secondary to bacterial rhinitis
Acute sinusitis
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Fungi can colonize sinuses to form
non-invasive "fungal balls" (similar to ones found in cavitary lesions of the lungs)
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Pt. is asthmatic w/ recurring sinusitis that is refractory to conventional therapy. Sinuses are filled w/ "allergic mucin" (lamination, eosinophils, Charcot-Leyden crystals, hyphae)
Allergic fungal sinusitis (Fungal organsims do NOT invade)
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Mucor affects
Diabetic ketoacidosis and immunosuppressed (opportunistic fungi)
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In immunocompromised individuals, Mucor (fungus) is
angioinvasive and spreads to cranial vault --> thromboses and cerebral infarcts (can be life-threatening)
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3 things that invove upper airway lesiosn
- Mucor fungus
- Wegener's granulomatosis
- Angiocentric non-Hodgkin's lymphoma
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Pharyngitis and tonsilitis have _____ etiology?
- Viral
- Grp A, Beta-hemolytic strep (rheumatic fever and post-infectious glomerulonephritis)
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Androgen-dependent vascular fibrous proliferation having teh appearance of erectile tissue arising in the nasopharynx.
Nasopharyngeal angiofibroma (Males age 10-25)
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Benign epithelial neoplasm, but the ______ subtype recurs and is associated w/ invasive carcinoma.
Sinonasal papillomas, Inverted papilloma
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5 year survival of Olfactory Neuroblastoma
50-60%
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Soft mass/small blue cell tumor in the roof of the nasal fossa. Arises from neuroepithelial elements in the olfactory membrane
Olfactory Neuroblastoma
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Olfactory Neuroblastoma tx
Surgery + radiation
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Squamous cell carcinoma associated w/ nickel refiners and woodworkers. it has a very poor prognosis.
Sinonasal carcinomas
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3 histologic patterns of Nasopharyngeal Carcinoma (NPC)
- 1) Keratinizing SCC
- 2) Non-keratinizing SCC
- 3) Undifferentiated carcinoma
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Fluid-filled mass, occurs following trauma, leads to disruption of salivary gland
Mucocele
(Mucus dissects into stroma to produce a cyst-like lesion
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Where is mucocele typically seen?
Lip mucosa
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Pleomorphic adenoma: Males or females
More common in females (4th decade)
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Benign mixed tumor of salivary gland origin
Pleomorphic adenoma
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Most common neoplasm of salivary glands (affects parotic most then submandibular)
Pleomorphic adenoma (benign)
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Second most common salivary gland tumor. Seen in
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Warthin tumor affects, histology?
- Parotid gland
- Proliferating oncocytic cells an dense lymphoid stroma
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Most common MALIGNANT salivary gland tumor
Mucoepidermoid carcinoma (parotid, minor salivary gland tumors)
- Low grade = good prognosis
- High grade = bad prognosis
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Types of cells in Mucoepidermoid carcinoma
Squamous, mucous, intermediate
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Characteristically invades nerves and is a malignant salivary gland tumor
Adenoid cystic carcinoma
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Neoplastic cells demonstrate serous acinar differentiation
Acinic cell carcinoma (Parotid Gland)
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Bacteria that causes Acute Epiglottitis
H. influenzae
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Pts. sit in sniffing dog position and have a huge cherry red epiglottis, intubation is required to maintain airway.
Acute epiglottitis
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Pts. who stress their vocal cords. Hoarseness. Neither neoplastic or pre-neoplastic
Reactive Laryngeal Nodules
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Reactive Laryngeal Nodule
- Center: connective tissue (myxoid, fibrous)
- Covering: Squamous epithelium
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Squamous laryngeal papilloma most commonly seen in middle-aged men
Solitary Laryngeal Papilloma
More likely to contain dysplasia
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Born to mothers who have genital HPV lesions, infants acquire virus as they travel through birth canal --> Laryngeal nodes
Laryngeal papillomatosis
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Laryngeal Papillomatosis:
Virus types?
Tx?
- 6, 11 (ones that progress to SCC are 11)
- Laser tx
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SCC of the Larynx:
Most commonly seen in?
Good prognostic sign?
- Cigarette smokers
- Hoarseness due to CA on vocal cord, means it's in its early stages
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Neck
Thyroglossal tract cysts:
Branchial Cysts
- TGTC: Midline, must resect entire tract
- Branchial Cysts: Anterolateral neck, young adults, squamous or columnar epithelium (prominent lymphoid component)
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Extraadrenal pheochomocytomas
Paragangliomas
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Affects neuroendocrine cells (sometimes as part of AD MEN II Syndrome) and cells result in zellballen nesting pattern. enolas, chromogranin, synaptophysin and S-100 protein positive.
Paraganglioma
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