what is considered the "realm" of ENT
nose, nasal cavvity, nasopharynx, oral cavity, oropharynx, larynx,laryngopharynx and the structures within them like four pairs of nasal sinuses, auditory tubes, ears, nasolacrimal duct, tonsils, salivary glands
what are the main categories of diseases
DEGENERATIVE
INFLAMMTORY
NEOPLASTIC
deviations of normal anatomy and histology
what are the four main components of disease
etiology
pathogenesis
morphology
clinical manifestations
what type of mucosa does anything that touches food have in head/neck
squamous
what type of mucosa does an area that touches air have in the head/neck
columnar
how would PCCE in the head and neck become squamous if exposed to injurious stimuli?
squamous metaplasia
what are the common pathologic conditions of the oral cavity
teeth/gingivae/alveolar bone
inflammatory/reactive lsions
infections
leukoplakia/"hairy" leukoplakia
squamous tumors
odontogenic cysts/tumors
what is leukoplakia
white plaque
what are considered "upper" airway areas
nose
nasopharynx
paranasal sinuses
larynx
what types of problems can arise in any of the upper airway areas
inflammation and tumors
what physical structure separates upper and lower airway
trachea
what are the possible disease types of the ears
degeneration (otosclerosis)
inflammation
neoplasms
what is otosclerosis common in
conduction defect common in old people
what are the commmon pathologic conditions in the neck
branchial cyst
thyroglossal cyst
paraganglioma
what is characteristic of branchial cysts
painless cysts in neck below parotid glands
where would you look for thyroglossal cytss
midline
what is the paraganglioma a tumor of
carotid body
what is the role of the carotid body
monitors O2 and CO2
what is the degenerative disease of the salivary glands
xerostomia
what are the benign neoplasms of the salivary glands
pleomorphic adenoma (mixed tumor)
warthin tumor
what are the malignant neoplasms of the salivary glands
mucoepidermoid
adenoid cystic
adenocarcinoma
what types of salivary glands have both serous and mucinous parts
submandibular
what type of salivary gland is all serous
parotid
what salivary gland is all mucinous
sublingual
do we get new enamel after we are born
no
why is sugar bad for your teeth
because it feeds bacteria
what leads to tooth decay
processed carbs (sugars) providing food for bacteria
what types of bacteria contribute to acidic erosion of enamel
strep mutans,lactobacilli
what is the progression of tooth decay
tartar to plaque to calculus
what is caries
cavity (enamel erosion)
what is th emain predecessory to peridontal disease
gingivitis
what is gingivitis caused by largeley
actinobacilli, porphyromonas, prevotella species
how many types of bacteria are commonly in the mouth
300
what bacteria cause periodontal disease
actinobacillus
porphyromonas
prevotella
what areas can periodontal disease attack
soft tissue of the mouth (gingiva) then to periodontal ligaments, bone, and cementum
what is this
irritation fibroma
what types of people get irritation fibromas
people with dentures
is an irritation fibroma a true fibroma
no
what is this
irritation fibroma
what does pyogenic granuloma look like grossly
normal granulation tissue
what is this
pyogenic granuloma
will a pyogenic granuloma or irritation fibroma be more likely to blanch
pyogenic granuloma
where do pyogenic granulomas originate
gingiva
what is this
pyogenic granuloma
what is another name for an aphthous ulcer
canker sore
how many people get canker sores
40%
what is the etiology of canker sores
very obscure, painful, inflammatory cells at the base
is a canker sore a leukoplakia
NO
ulcer or lack of mucosa is more accurate
what can cause glossitis
bacterial/viral infections (like oral herpes simplex)
mechanical irritation or injury from burns, rough edges of teeth, or dental appliances
Exposure to irritants like tobacco, alcohol, hot foods, or spices
allergic reaction to toothpaste, mouthwash,breath fresheners,dyes in candy, plastic in dentures or retainers, or certain BP medication (ACE inhibitors)
inherited (occasionally)
what type of disorders can cause glossitis
iron deficiency anemia
pernicious anemia
other B vitamin deficiencies
what types of infections can cause glossitis
oral lichen planus
erythema multiforme
aphthous ulcer
pemphigus vulgaris
syphillis
what is this
glossitis
why is herpes called so
because herpetic vesicles "creep" over mucosal surfaces
what are the herpes viruses
CMV
VZV
HSV 1 and 2
what happens in the steps of herpes infection
vesicles first, then they are irritated, ulcerated, and inflamed
then they become pustulated
what is HSV 1 associated with
oral herpes (not as serious)
what is HSV 2 associated with
genital herpes (more aggresive)
do you lose the herpes virus once you get it
no, triggered off by random things
can you see the vesicled canker sores of herpes
not usually, normally ulcerated when you can see them
what stage of herpes is this canker sore in
dried vesicle with inflammation
what stage is this herpes canker sore in
dried vesicle with ulceration and secondary inflammation
what is the most likely bacteria to infect an ulcerated herpes sore
staph
what type of test is this from
Tzanck smear
how do you do a Tzanck smear
scrape vesicle, smear it, stain it with anything, and look for squamous nuclei (larger than normal)
what type of Tzanck smear will you get with most vesicles caused by herpes family viruses
positive
why would a Tzanck smear be positive if someone has Herpes
because it causes intranuclear inclusions and enlarged nuclei
what color intranuclear inclusions will HSV have on H and E
red
what color intranuclear inclusions will CMV have on H and E
blue
what are synonyms for thrush mouth
monilla or candida
what will be present in thrush mouth
whitish oral film without underlying inflammation/redness
what is thrush mouth common in
babies, diabetics, immunocompromised people
what type of tissue does candida affect mostly
moist, nonkeratinized stratified squamous mucosa
what places on the body does candida usually affect
mouth
vagina
moist genital skin areas
(basically everyone has it lying around waiting ofr an immunocompromised condition to occur)
what is this
candida (white filmy patches not firmly attached to the underlying moist nonkeratinized stratified squamous mucosa with minima redness)
what type of stain is this and what will be stained red
PAS stain
yeast and pseudohyphae
what is this
leukoplakia
is leukoplakia always premalignant
no, mostly not
remember that this is a clincal description, not a specific clinical or pathological entity, and can go from hyperkeratosis/inflammation to carcinoma
what is "hairy" leukoplakia a sign of
HIV
waht is this
hairy leukoplakia, diagnostic of HIV
what are the steps of normal tissue to squamous cell carcinoma
normal to hyperplasia/hyperkeratosis to mild/moderate dysplasia to severe dysplasia/CIS to SCC
what is this a classic appearance of
infiltrating or infiltrative squamous cell carcinoma of the mouth
what are the levels of differentiation of squamous cell cancer
well
moderate
poor
what is apparent in well differentiated squamous cell cancer
pearls
what level of differentiation of squamous cell cancer is this
well differentiated
what is usually visible in moderately differentiated squamous cell cancer
intercellular bridges (not pearls)
will squamous cells even look squamous in poorly differentiated SCC
no (squamous or immunochemical markers like cytokeratin markers to determine)
what is this
well differentiated SCC (notice pearls)
what is this
moderately differentiated SCC (tonofibrils and desmosomes apparent)
what is this
poorly differentiated SCC (large mitoses)
what is more important in cancer diagnosis: staging or grading
staging (metastasis) more important than grading (cell type)
are odontogenic cysts normally malignant? what is the main question with them?
no, benign
question: developmental cyst or inflammatory cyst
what do both developmental and inflammatory cysts develop from
remnants of odontogenic epithelium (epithelium that gives rise to teeth)
what are the types of odontogenic cysts (general)
inflammatory cysts (radicular, periapical most common)
developmental cysts (dentigerous most common)
malignant tumors of odontogenic origin (ameloblastomas (rare))
what type of cyst is this
dentigerous cyst (loose looking tissue around the tooth)
what type of epithelium lines the teeth
odontogenic
what are many rhinitis/sinusitises associated with
allergies and upper respiratory (viral) infections
what could prove that a rhinitis or sinusitis is allergic in origin
eosinophils
what are the types of nose/sinus/nasopharynx tumors
polyps (not relaly tumors)
angiofibroma
papilloma
plasmacytoma
neur
what are the vast majority of "tumors" in the nose, nasal cavity, or nasal pharynx
polyps/inflammatory polyps
what types of tissue would be included in an angiofibroma
BV and fibrous tissue
is an angiofibroma benign or malignant
benign
what does a plasmacytoma look like
plasma cell
how would you approach a plasmacytoma
do serum-protein electrophoresis to see if it were part of an overall plasma cell dysplasia
are most plasmacytomas associated with clonal proliferations in bone marrow?
no (this would be multiple myeloma)
what can many solitary plasmacytomas develop into
malignancies
what will be associated with neuroblastomas
rossettes
what will be present in nasopharyngeal carcinomas
lymphocytes
what type of carcinoma will nasopharyngeal carincoma be
SCC
what is shown above
inflammatory polyps of the nasal cavity
what will inflammatory polyps be associated with
inflammaoion of their mucosa of origin and also will have inflammatory changes within those mucosae
what do inflammatory polyps look ilke
edematous, boggy swelling
where do most nasal polyps originate
internal nose
what's going on with this guy
nasal polyps
what are two necrotizing upper airway lesions
wegener granulomatosis
lethal midline granuloma
are necrotizing upper airway lesions minor ailments
no, very serious, often fatal
what cells are lethal midline granulomas thought to be a malignant tumor of
natural killer cells
what is shown here
necrotizing upper airway lesion
what are the two types of papillomas in the upper airway
papilloma and inverted papilloma
where is the only part of the body that harbors inverted papillomas
uppper airway
is a papilloma or inverted papilloma more likely to become a malignancy
inverted
what is this here
inverted papilloma
what is this
angiofibroma
how would you prove that an angiofibroma does have BVs involved
factor VIII stain (will stain endothelial cells that those BVs will have)
what is this
plasmacytoma
what is a plasmacytoma
proliferation of plasma cells, which often look classically like normal plasma cells
what are the four features of normal plasma cells
...
what are two things that plasmacytomas wil ALL with time become and express
multiple myelomas and express monoclonal gammopathy
what is this
rosette
what is this
neuroblastoma/olfactory ethesioneuroblastoma
are esthesioneuroblastomas of the olfactory nerve common
no, very rare (may have rosettes, like any other neuroblastoma)
what is this
nasopharyngeal carcinoma
what do nasopharyngeal carcinomas look like usually
half carcinoma and half lymphoma
what is this
normal vocal cords
what types of tumors of the vocal cords exist
supraglottic and infraglottic tumors
what do we have here
laryngitis
what are the four cardinal signs of acute inflammation grossly
red, swollen, edematous, ...?
what are the tumors of the vocal cord
polyps
papillomas
carcinomas
are singer's nodes tumors
not really
can the true neoplasms of the vocal cords be distinguished grossly
no, usually just histologically
any guesses
polyp or singer's node
what is this
papilloma (maybe cancer microscopically)
what do vocal cord carcinomas usually look like
ulcerated, irregular, indureated, invasive, destructive, and with secondary necrosis
what are the huge cells under the stratified squamous mucosa??
what is the black stuff and why is it used?
malignant, invasive, squamous cells
india ink; if surgical margins are not free of tumor cells, then the doctor didnt get it all
whats going on here
otitis externa
what types of things infect the outer ear
anything that infects the skin
what is this
tympanic membrane
what's going on here
middle ear infection
what types of things infect the midle ear most commonly
strep
h. flu (under 2)
moraxella
what is this
chronic serious otitis media
what is gonig on here
cerumen impaction!
what is the most commmon cause of ear abnormality and/or cause of decreased hearing
cerumen impaction
what is otosclerosis
abnormal bone deposition between the footplate of the stapes and oval window
what is otosclerosis one of the most common forms of
conduction hearing loss
when does otosclerosis start
middle age, progresses bilaterally often
what is this
branchial cleft cyst
do branchial cleft cysts become inflamed? malignant?
yes
no
what is this
thyroglossal duct cyst
what is this if you find it on the midline of someone, bulging outward
thyrogossal duct cyst
what regulates the blood pressure in the carotid artery
carotid sinus
what regulates the blood chemistry (O2 and CO2 and pH and temp) in the carotid artery
carotid body
what can the carotid body have
carotid body tumors
what is this and what are they called
carotid body tumor
zellballen
if you have a salivary gland that looks like pancreatic tissue, but there are no islets, what do you ahve
parotid gland
if you have a 100% mucinous salivary gland, which is it
sublingual gland
if you have a salivary gland that is both serous and mucnous, what gland is it
submandibular gland
what is this condition and how do you know
chronic sialadenitis (probably) due to the squamous metaplasia of an interlobular duct
what is this
mucocele of an accessory salivary gland duct (big cyst filled with mucin and lined by mucinous columnar epithelium, often inflamed and/or squamous metaplastic
why would a mucocele of an accessory salivary gland duct get big
if it gets blocked off
what is this
mucocele
what is this
swollen parotid gland
what could have caused a swollen parotid gland (assumed until proven otherwise)
mumps
what is this
seminiferous tubule infected by mumps (orchitis)
what is the main occupant of the submandibular triangle
submandibular gland
what are the most common benign salivary gland tumors
pleomorphic adenoma (mixed tumor)
warthin tumor (papillary cystadenoma lymphomatosum)
what are the most common malignant salivary gland tumors
mucoepidermoid carcinoma
adenoid cystic carcinoma
what type of tumor are all malignant salivary gland tumors
adenocarcinomas
why would a pleomorhpic adenoma be called mixed
it has CT and epithelial tissue
are any pleomorhpic adenomas malignant
no
what types of wartharin tumors exist
papillary form, cysts, many lymphocytes
where do adenoid cystic carcinomas grow
along nerve roots
what type of tumor is thi
pleomorhpic adenoma (mixed tumor)
are mixed tumors generally benign or malignant
benign
what do pleomorhpic adenomas look like and feel like
round soft cartilage balls
what are theses
papillary cystadenoma lymphomatosum/warthin tumor
why are papillary cystadenoma lymphomatosums good names for these tumors
lymphs inside papilla, cyst shown by white area
what is this
mucoepidermoid carcinoma
why are mucoepidermioid carcinomas perfect names for the salivary gland malignancy
squamous with cystic spaces and also mucus-y
what is the number one malignancy of the salivary gland
mucoepidermoid carcinoma
what is this
adenoid cystic carcinoma
where do adenoid cystic carcinomas grow
tumor cells grow along nerve spaces
how long do patients live after being diagnosed with adenoid cystic carcinoma
a long time wihtout any treatment, usually die from other causes