(From Path book and lecture, 7/8 Feb 2001, by Brian Buschman)
Return to Semester Four Goodies
Return to The
Unofficial Ross Page
Infections rhinitis is the common cold and common allergies are allergic rhinitis. Recurrent attacks of allergic rhinitis lead to nasal polyps which are not real neoplasms but are collections of mucous tissue.
Chronic rhinitis can lead to a deviated nasal septum or nasal polyps. Chronic rhinitis can also lead to chronic sinusitis.
Sinusitis usually follows rhinitis and is usually caused by agents of the oral cavity, most often bacterial. Diabetics may have a mucormycosis sinusitis. Once in a while sinusitis may be secondary to and a part of Kartagener’s syndrome (immotile cilia syndrome). The loss of action of the cilia lead to congestion and trapping of the offending agent in the sinuses. Other parts of Kartagener’s include bronchiectasis.
Pharyngitis and tonsillitis are most often caused by rhinovirus, adenovirus and echovirus. Complications include local spread leading to peritonsillar abscesses and/or otitis media. If it’s cause is streptococcal it has the possible complications of glomerulonephritis (post-streptococcal).
Candida is a normal part of the oral flora but in diabetics and immunocompromised individuals they can get oral thrush. It may also show up in people who’s normal flora is messed up because of antibiotic therapy.
Most oral/facial herpetic lesions are caused by HSV-1. The vesicles clear up spontaneously but the virus hides in the trigeminal ganglion and will come back later.
Ulcers of various causes on the lips and gums are called aphthous ulcers. They can be related to stress, endocrine problems, inflammatory bowel disease (Crohn’s) or Behcet’s syndromes. They may also be of unknown causes.
Hairy cell leukoplakia is a whitish, hair-like patch that grows on the oral mucosa of those infected with HIV, HPV or EBV. It may have koilocytosis (the presence of binucleated cells with a perinuclear halo) which is an indication that it’s caused by HPV.
Leukoplakia is a whitish lesion, usually from proliferation of oral mucosa, that cannot be better classified. It may be cancerous or may not be. Since they are unclassified lesions you need to be careful to determine if it is precancerous or not.
Erythroplakia is a red area of unknown problem. It is similar to leukoplakia but more prone to become malignant.
Condlyoma accuminatum is a benign lesion of HPV types VI and XI.
Squamous cell carcinomas are the number one type of oral cancer in the US. Most people are older as they tend to result from years of smoking and/or drinking. Eating fruit is correlated with lower rates. The favored sites include the floor of the mouth, the tip and base of the tongue and the hard palate.
1) Nasopharyngeal angiofibroma is a vascular tumor that is most often seen in adolescent males. It is a hard and fibrous tumor that has a tendency to bleed a lot when being removed.
2) Inverted papillomas are benign but aggressive neoplasms of the nose and paranasal sinuses. They have a high recurrence rate.
3) Isolated plasmocytomas are malignant plasma cells that arise in lymphoid structures. They are like malignant melanomas yet only involve one spot.
4) Olfactory neuroblastomas are highly malignant neuroendocrine tumors of the olfactory mucosa. They can only truly be diagnosed by a stain for neuron-specific enolase and S-100 protein.
5) Nasopharyngeal carcinomas are of one of three types.
a. Keratinizing squamous cell carcinomas (WHO-1) are well differentiated carcinomas.
b. Non-keratinizing squamous cell carcinomas (WHO-2).
c. Undifferentiated carcinomas (WHO-3). These are so undifferentiated that they require the use of tissue markers to determine the tissue of origin.
Nasopharyngeal carcinomas have a very strange epidemiological pattern but most exhibit EBV.
Laryngitis results from an insult of about any type but is usually associated with UR infections. Specifically young children are affected by laryngoepidlottitis caused by H. influenzae or b-hemolytic strep. It may be caused by trauma such as the that resulting from the intubation tube during surgery.
Laryngotracheobronchitis is also called croup. It is primarily seen in children. It significantly closes their airways which leads to the characteristic “stridor.”
Chronic laryngitis such as from smoking predisposes to laryngeal polyps. They lead to hoarseness and are not precancerous. Singers might get a little worried about them since it will do obvious damage to their career.
These are true neoplasms having a fibrous center with an epithelial cover. Children sometimes get them related to HPV-1. Those come in groups and are very hard to get rid of.
Branchial cysts are found in the anteriolateral neck and are about 2-5 cms. They are epithelial lined and may contain lymphoid tissues.
Thyroglossal duct cysts are usually located midline-anteriorly. They are usually 1-2 cms and may contain residual thyroid follicles.
Otitis media is a middle ear infection most often in young children. It may be viral with serous fluid or bacterial with a supprative fluid. When acute it is often viral but often has bacterial involvement when chronic. Sometimes it has fungus in the case of the diabetic.
Cholesteatomas are associated with otitis media and are not true neoplasms. They have a squamous boarder and a center of necrotic squames and junk.
Otosclerosis is an abnormal deposition/resorption of bone in the middle ear. It leads to bone build up around the ossicles that closes them off leading to deafness. It’s usually familial (aut. dominant) and occurs bilaterally.
Siaadenitis is the term for salivary gland inflammation. It may be viral, bacterial or autoimmune and tends to prefer the parotid gland. Autoimmune diseases include Sjogren’s syndrome which shows xerostomia (dry mouth) and keratoconjunctivitis (dry eyes) since it sends antibodies after all the head’s glands.
Stones in the glands and associated ducts are called sialolithiasis.
Most (80%) tumors of salivary glands are parotid tumors.
Pleomorphic adenomas represent about 60% of parotid tumors. They are benign tumors with tongue-like projections out of it’s otherwise encapsulated self. Removal has a high recurrence rate to the entire gland is usually removed.
Warthin’s tumor is also called a papillary cystadenoma lymphomastosum and usually occurs in older men. They are recognizable by being benign encapsulated masses that produce a mucus or serous secretion. Their follicles are lined by a characteristic “double-epithelium” and they have germinal centers.
Mucoepidermoid carcinomas are the most common malignancies of the salivary glands. They are made of mucus secreting cells and squamous cells. Low grade mucoepidermoid carcinomas has more mucus cells while the high grade ones have more squamous cells.
Adenoid cystic carcinomas are the most common tumor in the minor salivary glands. They form a cribriform pattern with fluid trapped between the cells.
This is a very uncommon tumor with cells having a clear or vacuolated pattern. They often metastasize to cervical lymph nodes.
Return to Semester Four Goodies
Return to The Unofficial
Ross Page