patoloji-ders-notlari

Title

Serdar Balcı

Diseases and Tumors of the Upper Respiratory Tract

Serdar BALCI, MD

ACUTE INFECTIONS

Common cold

Nasal congestion

Watery discharge

Sneezing

Scratchy, dry sore throat

Slight increase in temperature

rhinoviruses

coronaviruses

respiratory syncytial viruses

parainfluenza and influenza viruses

adenoviruses

enteroviruses

even group A β-hemolytic streptococci

40% cause cannot be determined

complicated by the development of bacterial otitis media or sinusitis

Streptococcal tonsillitis

peritonsillar abscesses

poststreptococcal glomerulonephritis and acute rheumatic fever

Coxsackie virus A infection

pharyngeal vesicles
Ulcers
- herpangina

Infectious mononucleosis

Epstein-Barr virus (EBV)

important cause of pharyngitis

kissing disease

Acute bacterial epiglottitis

young children

H. influenzae

pain and airway obstruction

Acute laryngitis

inhalation of irritants

allergic reactions

agents that produce the common cold

Tuberculosis laryngitis

Consequence of protracted active tuberculosis

Infected sputum is coughed up

Diphtheritic laryngitis

Widespread immunization
C. diphtheriae implants on the mucosa of the upper airways
Elaborates a powerful exotoxin
Necrosis of the mucosal epithelium
Dense fibrinopurulent exudate
Superficial, dirty-gray pseudomembrane of diphtheria
Sloughing and aspiration of the pseudomembrane
- Obstruction of major airways
Absorption of bacterial exotoxins
- Myocarditis, peripheral neuropathy, or other tissue injury

Laryngotracheobronchitis

Parainfluenza virus most common cause

respiratory syncytial virus

inspiratory stridor and harsh

persistent cough

laryngeal inflammatory reaction narrow the airway → respiratory failure

Viral infections in the upper respiratory tract

predispose the patient to secondary bacterial infection
- staphylococci, streptococci, and H. influenzae

Laryngitis

bacterial infection caused diffuse mucosal hyperemia and multifocal purulent exudates

Autopsy Pathology: A Manual and Atlas

Large, yellow exophytic exudates caused by invasive aspergillosis

Autopsy Pathology: A Manual and Atlas

marked edema and focal necrosis resulting in obstruction after traumatic intubation

Autopsy Pathology: A Manual and Atlas

NASOPHARYNGEAL CARCINOMA

Nasopharyngeal Carcinoma

Strong epidemiologic links to EBV
High frequency of this form of cancer among the Chinese
- viral oncogenesis on a background of genetic susceptibility?
EBV replicates in the nasopharyngeal epithelium
Infects nearby tonsillar B lymphocytes
Transformation of the epithelial cells
EBV genome is found in virtually all nasopharyngeal carcinomas

Demonstration by in situ hybridization of EBER in nasopharyngeal undifferentiated carcinoma

Rosai and Ackerman’s Surgical Pathology

Keratinizing squamous cell carcinoma
Nonkeratinizing squamous cell carcinoma
Undifferentiated carcinoma
- most common
- most closely linked with EBV
- large epithelial cells
- indistinct cell borders
- syncytial growth
- prominent eosinophilic nucleoli

Nasopharyngeal carcinoma of keratinizing squamous cell type

Rosai and Ackerman’s Surgical Pathology

Nasopharyngeal carcinoma of differentiated nonkeratinizing type

Rosai and Ackerman’s Surgical Pathology

Nasopharyngeal carcinoma. Undifferentiated type.

**Large neoplastic cells are present admixed with a lymphocytic stroma. **

Differential Diagnosis in Surgical Pathology

Lymphoepithelioma like carcinoma

The other name for undifferentiated carcinoma
EBV directly infects B lymphocytes
Marked proliferation of reactive T lymphocytes causes atypical lymphocytosis
a striking influx of mature lymphocytes
Lymphocytes are not part of the neoplastic process
Large neoplastic cells in a background of reactive lymphocytes may give rise to an appearance similar to that in non-Hodgkin lymphomas
- Immunohistochemical stains may be required

Nasopharyngeal carcinomas

invade locally
spread to cervical lymph nodes
metastasize to distant sites
radiosensitive
5-year survival rates of 50%
- even for advanced cancers

LARYNGEAL TUMORS

Vocal cord nodules

Vocal cord polyps

smooth, hemispherical protrusions

<0.5 cm in diameter

Located on the true vocal cords

Fibrous tissue covered by stratified squamous mucosa

can be ulcerated from contact trauma with the other vocal cord

heavy smokers or singers (singer’s nodes)

Rosai and Ackerman’s Surgical Pathology

Laryngeal papilloma

Squamous papilloma of the larynx

Benign neoplasm

Located on the true vocal cords

Rarely more than 1 cm

Multiple, slender, finger-like projections

Supported by central fibrovascular cores

Covered by an orderly, typical, stratified squamous epithelium

**Laryngeal papillomatosis **

Rosai and Ackerman’s Surgical Pathology

Autopsy Pathology: A Manual and Atlas

Single in adults
Multiple in children
- Recurrent respiratory papillomatosis
- Recurrence after excision
- Caused by human papillomavirus (HPV) types 6 and 11
- Cancerous transformation is rare
- Spontaneously regress at puberty
- Vertical transmission from an infected mother during delivery

Carcinoma of the Larynx

2% of all cancers
>40 years
More common in men (M:F=7:1)
Nearly all cases occur in smokers
Alcohol and asbestos exposure
Human papillomavirus
- 15% of tumors
- Better prognosis
95% squamous cell carcinomas
Adenocarcinomas are rare
- Arise from mucous glands
Glottic tumors
- On the vocal cords
- 60-75%
Supraglottic
- Above the cords
- 25-40%
Subglottic
- Below the cords
- <5%
Location of the tumor important for prognosis
Glottic tumors
- 90% confined to the larynx at diagnosis
- Interference with vocal cord mobility → Symptoms early
- Glottic region has a sparse lymphatic supply
Supraglottic
- Rich in lymphatic spaces
- 1/3 metastasize to regional (cervical) lymph nodes
Subglottic
- Remain clinically quiescent
- Manifest as advanced disease

Begin as in situ lesions

Pearly gray, wrinkled plaques on the mucosal surface

Ulcerating and fungating

Robbins Basic Pathology

Autopsy Pathology: A Manual and Atlas

Rosai and Ackerman’s Surgical Pathology

Autopsy Pathology: A Manual and Atlas