Path Test 3: ENT
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Dorma HSV-1 resides in
2 things caused by HSV-1
- Fever blisters/cold sores
- Acute Herpetic Gingivostomatitis (peds or immunocompromised)
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)
What test confirms Herpes?
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)
Drug given to immunosuppressed HSV-1 pts?
Acyclovir (normal people tx is symptomatic)
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)
Shallow, idiopathic oral ulcers that are painful, lasting a week to several weeks
Aphthous ulcers (HSV-II)
Mucosal changes that are associated with squamous dysplasia, a precursor to squamous cell carcinoma.
White plaque on a mucosal surface; histologically, hyperkeratosis and squamous hyperplasia are seen, with or without dysplasia.
Red, velvety mucosal lesion that usually show significant dysplasia or carcinoma in situ. More likely to progres to invasive squamous cell carcinoma.
More likely to progress to invasive squamous cell carcinoma in oral cavity: Leukoplakia or Erythroplakia
Although both may contain foci of invasive carcinoma at the time of presentation.
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
4 risk factors for intraoral squamous carcinoma
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])
_______show a greater tendence for early lymph node metasteses, bt are paradoxically associated w/ a better prognosis.
E6 binds and degrades
Rb protin --> accumulation of p16 protein
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
Most common human infection
3 Types of viruses that cause infectious rhinitis
Rhinovirus, Adenovirus, Echovirus
Major cause of common cold
Rhinovirus binding site
is in a cleft that is no accessible to Ab (ICAM-1, CD54 molecule) on epithelial cells
Inflammatory mediates (ie. bradykinin) in their response to rhinovirus cause
increased mucus secretion and congestion
Hypersensitivity rxn of Allergic Rhinitis
Type I, IgE-mediated
Reactive, non-neoplastic protrusions of edematous inflamed mucosa. Surgically removed to improve air movement and drainage.
Nasal polyps are esp. common in
children w/ CF
Usually secondary to bacterial rhinitis
Fungi can colonize sinuses to form
non-invasive "fungal balls" (similar to ones found in cavitary lesions of the lungs)
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)
Diabetic ketoacidosis and immunosuppressed (opportunistic fungi)
In immunocompromised individuals, Mucor (fungus) is
angioinvasive and spreads to cranial vault --> thromboses and cerebral infarcts (can be life-threatening)
3 things that invove upper airway lesiosn
- Mucor fungus
- Wegener's granulomatosis
- Angiocentric non-Hodgkin's lymphoma
Pharyngitis and tonsilitis have _____ etiology?
- Grp A, Beta-hemolytic strep (rheumatic fever and post-infectious glomerulonephritis)
Androgen-dependent vascular fibrous proliferation having teh appearance of erectile tissue arising in the nasopharynx.
Nasopharyngeal angiofibroma (Males age 10-25)
Benign epithelial neoplasm, but the ______ subtype recurs and is associated w/ invasive carcinoma.
Sinonasal papillomas, Inverted papilloma
5 year survival of Olfactory Neuroblastoma
Soft mass/small blue cell tumor in the roof of the nasal fossa. Arises from neuroepithelial elements in the olfactory membrane
Olfactory Neuroblastoma tx
Surgery + radiation
Squamous cell carcinoma associated w/ nickel refiners and woodworkers. it has a very poor prognosis.
3 histologic patterns of Nasopharyngeal Carcinoma (NPC)
- 1) Keratinizing SCC
- 2) Non-keratinizing SCC
- 3) Undifferentiated carcinoma
Fluid-filled mass, occurs following trauma, leads to disruption of salivary gland
(Mucus dissects into stroma to produce a cyst-like lesion
Where is mucocele typically seen?
Pleomorphic adenoma: Males or females
More common in females (4th decade)
Benign mixed tumor of salivary gland origin
Most common neoplasm of salivary glands (affects parotic most then submandibular)
Pleomorphic adenoma (benign)
Second most common salivary gland tumor. Seen in
Warthin tumor affects, histology?
- Parotid gland
- Proliferating oncocytic cells an dense lymphoid stroma
Most common MALIGNANT salivary gland tumor
Mucoepidermoid carcinoma (parotid, minor salivary gland tumors)
- Low grade = good prognosis
- High grade = bad prognosis
Types of cells in Mucoepidermoid carcinoma
Squamous, mucous, intermediate
Characteristically invades nerves and is a malignant salivary gland tumor
Adenoid cystic carcinoma
Neoplastic cells demonstrate serous acinar differentiation
Acinic cell carcinoma (Parotid Gland)
Bacteria that causes Acute Epiglottitis
Pts. sit in sniffing dog position and have a huge cherry red epiglottis, intubation is required to maintain airway.
Pts. who stress their vocal cords. Hoarseness. Neither neoplastic or pre-neoplastic
Reactive Laryngeal Nodules
Reactive Laryngeal Nodule
- Center: connective tissue (myxoid, fibrous)
- Covering: Squamous epithelium
Squamous laryngeal papilloma most commonly seen in middle-aged men
Solitary Laryngeal Papilloma
More likely to contain dysplasia
Born to mothers who have genital HPV lesions, infants acquire virus as they travel through birth canal --> Laryngeal nodes
- 6, 11 (ones that progress to SCC are 11)
- Laser tx
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
Thyroglossal tract cysts:
- TGTC: Midline, must resect entire tract
- Branchial Cysts: Anterolateral neck, young adults, squamous or columnar epithelium (prominent lymphoid component)
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.
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