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84 Cards in this Set

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What are the infectious diseases of the oral/oropharynx?
Candida
What are the non-infectious, non-neoplastic diseases of the oral/oopharynx?
(1) Extravasation mucocele
(2) Lingual Thyroid
(3) Sarcoidosis
What is the neoplastic growth in the oral/oropharynx?
(1) Squamous Cell Carcinoma
(2) Tonsillar Lymphomas
Candida - clinically?
- Immunocompromised Patients
- "Thrush"
Candida pathology?
- superficial infection by oral flora
- hyphal = spaghetti
- yeast = meatballs.
Excravasation mucocele Clinically?
- lower lip mass
- floor of mouth cyst ("ranula")
- Ranula form sporadically and can track inferiorly --> asymmetry beside the neck
Extravasation Mucocele Pathology?
Etiology: minor salivary duct trauma
Mucin extravasation
Alcian blue (+)
Lingual Thyroid clinical?
- Children - old age - can be anyone
- dysphagia, foreign body sensation
- 10% are hypothyroid
Lingual Thyroid Radiograph?
- scintigraphy to demonstrate other thyroid and function of lingual thyroid
Pathology of Lingual Thyroid?
- only thyroid gland in greater than 70% (if remove it, the individual will become hypothyroid)
- unencapsulaed
- low malignant potential
Sarcoidosis clinical?
- young adults with fever, weight loss
- pulmonary, cutaneous involvement
- ENT: oral, S/N, larynx, salivary gland, ear
Sarcoidosis radiographic?
- screen with chest x-ray: hilar adenopahty
- ENG: non-destructive (Wegner's is destructive)
Sarcoidosis pathology?
- well definied, non-necrotizing granulomas
- no vasculitis
- elevated angiotensin converting enzyme
- lip biopsy (+) in --> 50%
SCC clinical?
- lower lip most common (sun smoking)
- tongue>FOM>gingiva>palate> tonsil (smoking)
SCC radiographic?
- staging - local extent, regional LNs, CXR
SCC Pathology?
Etiology: mutagens
- Prognosis is a function of size, grade, and stage.
The histology must have (1) intracellular bridges and (2) Cytokeratin
What disease of the salivary glands is infectious?
Sialadenitis +/- sialolithiasis (stones)
What disease of the salivary gland is non-infectious or non-neoplastic?
Sjogren’s syndrome
What disease of the salivary gland is neoplastic.
Pleiomorphic adenoma
Mucoepidermoid CA
Adenoid cystic CA
Siladeniits/Sialolithiasis clinica?
- Inflammation, parotid or sub-mand
- Non-obstructive – staph, strep, mumps
- Obstructive – duct stones +/- infxn
Why do you need radiogrphs for sialadenits or sialolithiasis?
Plain films to document stone (most stones are radio-opaque)
Sialadenitis/Sialolithiasis pathology?
-ductal stones: SMG>parotid
- acinar inflammation, fibrosis, atrophy
Sjogren's sydnrome clinical?
- Adults
- F>M
- Associated w/ keratoconjunctivitis sicca, xerostomia, connective tissue disease (RA, SLE, PAN, etc)
Sjogren's syndrome pathology?
- Major and minor glands involved
- Benign lymphoepithelial lesions
- Epimyoepithelial islands
Pleiomorphic Adenoma clinical?
- Adults
- F>M
- Slow growing, painless mass of major or minor salivary gland
- Parotid >others
Pleiomorphic adenoma pathology?
- Most common benign sal. gland neoplasm
- Discrete, unifocal, encapsulated
- Epithelium, myoepithelium, myxoid stroma
- Local recurrence potential, rare malignancy
Mucoepidermoid CA clinical?
- Children-adults
- Major or minor glands
- May have h/o prior irradiation
Mucoepidermoid CA pathology?
- Most common malignant sal. gland neoplasm
- Low/intermed grade: mucous > epidermoid
- High grade: epidermoid > mucous
- Mucicarmine stain (+)
Adenoid cystic CA clinical ?
- Adults
- M=F
- Salivary gland mass
- Major>minor
Adenoid cystic CA pathology?
- unencapsulated, infiltrative, perineural
- tubular or cribiform architecture
- mucinous basement membrane material
- course: local recurrences, late metastases
What is the infectious disease of sinonasal?
Allergic Fungal Sinusitis
What are the non-infectious, non-neoplastic diseases of the sinonasal?
Inflammatory (allergic) polyps
Sarcoidosis
Wegener's granulomatosis
What are the neoplastic diseases of the sinonasal?
Schneiderianpapillomas
Skin Lesions of Nasal Vestibule
Allergic fungal sinusitis clinical?
- Allergic response to fungi (Aspergillus)
- Children-young adults w/ headache
Allergic Fungal Sinusitis radiographic?
- Sinus opacification
- Maxillary, ethmoid most common
Allergic Fungal Sinusitis pathology?
- Mucoid plug w/ fungal hyphae
- GMS silver stain (+)
Inflammatory (allergic) polyps clinical?
- Any age
- Rhinnorhea, headaches
- Airborne allergens
- Children: r/o CF and Kartagener’s
Inflammatory (allergic) radiographic?
ST mass(es) in sinuses or nasal cavity
Inflammatory (allergic) pathology?
- Boggy polyps, up to several cm
- Respiratory epith, stromal edema, eos
Wegener's granulomatosis clinical?
- Adults
- M>F
- ENT, lung, and GU
- ENT: nasal cavity > sinuses > other ENT
Wegener's granulomatosis Radiographic?
- Sinus opacification
- Bone/ST destruction
Wegenere's granulomatosis pathology?
- Necrotizing granulomatous vasculitis
- ↑c-ANCA in >85% w/ active disease
Schneiderian papillomas Clinical?
- Adolescents, adults
- Local symptoms
- ST mass on either nasal septum or lat wall
Schneiderian papillomas Radiographic?
- Unilateral nasal cavity ST mass
- +/- sinus opacification
Schneiderian papillomas pathology?
- Fungiform/exophytic: septal wall, no ↑risk CA
- Oncocytic – lateral wall, 5-10% risk of CA
- Inverted – lateral wall, 5-10% risk of CA
What are the infectious diseases of the nasopharynx?
Infectious Mononucleosis
What are the non-infectious, non-neoplastic diseases of the nasopharynx?
Sarcoidosis
Wegener's granulomatosis
What are the neoplastic diseases of the nasopharynx?
Teratoma
Angiofibroma
Nasopharyngeal Carcinoma
Infectious Mononucleosis clinical?
- Adolescents, young adults most common
- Fever, sore throat, malaise
- Tender posterior LNs, hepatosplenomegaly
Infectious Mononucleosis pathology?
- Tonsillitis/lymphadenitis
- Reactive B and T lymphocyte hyperplasia
- IgM and IgG serologies against viral Ags
- Self-limited in immunocompetent patients
Teratoma clinical?
- Majority in children; rare after 2 yrs old
- Dysphagia or airway obstruction
Teraoma Radiographic?
ST mass in NP
Teratoma Pathology?
- Germ cell tumor: 3 germ cell layers present
- Mature vs. immature
- Pure teratoma or mixed w/ other GCTs
- No malignant potential in kids
Angiofibroma clinical?
- Adolescent-young adult males
- Nasal obstruction & epitaxis
- Lateral or posterior NP wall mass
Angiofibroma radiographic?
- CT: ST mass w/ contrast enhancement
- Angiography: vascular hypretrophy
Angiofibroma pathology?
- Sessile, lobulated ST mass
- Benign fibrous tumor w/ ↑numbers of thin-walled vessels w/o smooth muscle
Nasopharyngeal carcionoma clinical?
- Adults
- M>W
- China>US
- Associated w/ EBV
Nasopharyngeal carcionoma radiographic?
- ST mass of lat NP (fossa of Rosenmuller)
- +/- bone destruction/invasion
Nasopharyngeal Carcinoma pathology?
- Undifferentiated>squamous
- Undiff. type has admixed benign lymphs
- Undiff. also easier to treat (unlike other neoplasms)
What are the infectious diseases of the ear?
Otis Media
What are the non-infectious, non-neoplastic diseases of the ear?
Sarcoidosis
What are the neoplastic diseases of the ear?
- Cholesteatoma
- 8th CN Schwannoma
- Jugulotympanic Paraganlioma
- External canal SCC
Otitis Media Clinical?
- Young children w/ recent URI, fever, otalgia, ↓hearing, bulging immobile TM due to undrained middle ear fluid
Otis Media Pathology?
- Never biopsied
- Micro: sterile or (+) staph, strep, H. flu
Cholesteatoma clinical?
- Any age; peak 20s-30s
- M>F
- Hearing loss, pain
- Middle ear +/- mastoid mass
Cholesteatoma Pathology?
- Cyst of benign squamous epithelium w/ accumulation of loose keratin
- May show foreign body reaction
Jugulotympanic Paraganglioma clinical?
- Adults
- F>M
- Middle ear ST mass associated w/ jugular vein bulb
Jugulotympanic Paragnaglioma
Radiographic?
- CT: ST mass w/ local destruction
- Angio: well-vascularized
Jugulotympanic Paragnaglioma Pathology?
- Benign but invasive paraganglioma
- Chief and sustentacular cells, “zellballen”
- Synaptophysin/chromogranin Ab stains
External Canal SCC clinical?
- Adults
- M>F
- Non-healing mass or ulcer of external ear
External Canal SCC pathology?
- Etio: sun exposure (actinic damage)
- Differential: melanoma, basal cell CA
What are the infectious diseases of the larynx?
- Sqaumous Papillomas (HPV)
- Acute Epiglottits
What are the non-infectious, non-neoplastic diseases of the larynx?
Vocal Cord Polyps
What are the neoplastic lesions of the larynx?
Squamous Cell Carcinoma
Squamous Papillomas clinical?
- Children: 2-3 yrs, multiple lesions, frequent local recurrence
- Adults: single lesions, less frequent recurrence, less frequent spread
Squamous Papillomas (HPV) pathology?
- Bland squamous papilloma
- May have HPV changes
- 10% spread distally
- 2%  CA
Acute Epiglottitis clinical?
Child or adult w/ fever, upper airway obstruction, stridor
Acute Epiglottitis radiographic?
Lat view showing epiglottic edema
Acute Epiglottits Pathology?
- Acute inflammation, bacteria, usually H. flu
- Course: may die if airway not established
Vocal Cord Polpys clinical?
- Adults w/ hoarseness & history of voice abuse
- AKA laryngeal nodule, “singer’s nodule”
Vocal Cord Polyps Pathology.
- Benign stromal expansion
- Benign surface squamous epithelium
Squamous cell carcinoma of the larynx clinical?
- Adults
- M>W
- Smokers/drinkers w/ voice changes
Squamous Cell Carcinoma of the larynx radiographic.
For staging, local extent, regional LNs, mets
Squamous Cell Carcinoma of the larynx pathology.
- Etio: tobacco, EtOH, prior neck irradiation
- Incidence: glottic > supraglottic >subglottic