L1, Resp Pathology PDF

pathology - respiratory Upper respiratory tracts Diseases LECTURE (1) Upper respiratory tract diseases Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases  Acute catarrhal in...

pathology - respiratory Upper respiratory tracts Diseases LECTURE (1) Upper respiratory tract diseases Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases  Acute catarrhal inflammation caused by rhinovirus with few PATHOLOGY: neutrophils. ① SUBSIDES:  After few days with regeneration of the damaged epithelium. ② SECONDARY BACTERIAL INFECTION:  Suppurative inflammation (increase number of neutrophils). ③ SPREAD OF INFECTION TO: FATE: a) Middle ear → otitis media. b) Lower respiratory tract → bronchitis, bronchopneumonia. ④ CHRONICITY:  Especially in maxillary sinus (due to upward direction of drainage → easy for secretion to retain). Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases  Destructive infective granuloma. PATHOLOGY:  Caused by Klebsiella Rhinoscleromatis.  THE PRIMARY SITE IS NOSE:  Enlarged and hard.  Its mucous membrane is thickened granular → progresses to a hard large mass filling the nasal cavity.  Inflammation may extend to paranasal sinuses, nasopharynx, oropharynx, larynx and trachea.  It destructs soft tissue but bony structures limit its spread. SITE : A. Surface epithelium: areas of hyperplasia or squamous metaplasia. B. Subepithelial tissue :  Mickulicz cells (hydropic degeneration of macrophages) :  Large rounded cells having well defined borders.  Abundant clear or foamy cytoplasm.  Nucleus is small flattened, deeply stained and eccentric.  Russel bodies (hyaline change of plasma cells) :  Ovoid or rounded eosinophilic bodies. M/E:  Sometimes having pyknotic eccentric nuclei.  Granulation tissue & fibrosis. Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases ① Nasal obstruction. ② Nasal deformity. FATE & ③ Spread of inflammation to paranasal sinuses, nasopharynx, COMPLICATION : oropharynx, larynx and trachea. ④ Epistaxis. ⑤ Squamous cell carcinoma (on top of squamous metaplasia).  Finger-like projections. DEFINITION  Mostly represent swollen parts of inflamed nasal mucosa.  Patients with recurrent attacks of allergic rhinitis (have large FOUND IN numbers of eosinophils)  Chronic infections of nasal sinuses. DEFINITION  Inflammation of the para nasal sinuses. ① Extension from nasal cavity or ETIOLOGY ② Dental infections.  Obstructed drainage from the sinuses RESULTS IN  Accumulation of mucous secretion  Secondary bacterial infection. Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases CAUSES LOCAL GENERAL ① Trauma ① Hypertension ② Foreign body ② Generalized venous congestion ③ Weak Little’s area ③ Blood disease ④ Inflammation ④ Anticoagulant therapy ⑤ Tumors (benign or malignant) ⑤ Vitamin deficiency (K and C) DEFINITION  Inflammatory hyperplasia of the nasopharyngeal lymphoid tissue. AGE  Affecting mostly children.  Hyperplastic enlargement leads to: ① Nasal obstruction ② Mouth breathing.  If the case is neglected, it leads to adenoid facies: CLINICAL PICTURE ① Narrow nasal openings ② Open mouth. ③ Short upper lip ④ Absent naso-labial folds  Secondary bacterial infection with spread to middle ear leads to COMPLICATIONS otitis media and lower respiratory tract infection. Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases  Inflammation of the larynx may be caused by infections (virus or DEFINITION bacteria), irritation or overuse of the voice.  Inflammation and edema of the vocal cords cause hoarseness of CLINICAL PICTURE voice. ① Tuberculous laryngitis:  Consequence of protracted active tuberculosis, during which infected sputum is coughed up. FORMS ② Diphtheritic laryngitis:  Has fortunately become uncommon because of the widespread immunization of young children against diphtheria. Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases DEFINITION  Acute infectious disease caused by corynebacterium diphtheria.  Occurs in non-immunized children between 2-5 years of age. AGE  But may occur in adult. METHOD OF  Droplet infection. INFECTION  Via exotoxin: ① Locally: pseudomembranous inflammation. PATHOLOGY ② Reach distant organs via blood leading to degeneration of parenchymatous organs. ③ The draining cervical LN show lymphoid hyperplasia. RESPIRATORY  Epistaxis & Aspiration bronchopneumonia. NERVOUS  Temporary nerve paralysis & Peripheral neuritis. COMPLICATIONS CVS  Acute heart failure. PARENCHYMATOUS  Degeneration (Cloudy swell ing, fatty change) ORGANS and necrosis. Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases BENIGN: MALIGNANT:  Sinonasal papilloma :  Sinonasal carcinoma. EPITHELIAL:  Exophytic  Endophytic  Osteoma.  Sarcoma.  Chondroma.  Lymphoma. MESENCHYMAL  Fibroma.  Capillary haemangioma. SINONASAL PAPILLOMA SINONASAL CARCINOMA Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases BENIGN: NASOPHARYNGEAL FIBROMA (JUVENILE ANGIOFIBROMA). INCIDENCE  Uncommon, male children. ORIGIN  Fibrous tissue of periosteum.  Non capsulated grayish pink  Highly vascular mass N/E:  Projecting in nasopharynx  Extend to nasal cavity, cheek, orbit.  Cause bone destruction by pressure atrophy.  Small vascular spaces set in poorly cellular M/E fibrous tissue. COMPLICATION  Bleeding (epistaxis). MALIGNANT: NASOPHARYNGEAL CARCINOMA SQUAMOUS CELL  Keratininzing Squamous cell carcinoma. CARCINOMA  Non Keratininzing Squamous cell carcinoma UNDIFFERENTIATED  Related to Epstein Barr virus CARCINOMA Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases BENIGN: MALIGNANT:  Squamous cell papilloma.  Squamous Cell Carcinoma  Juvenile papillomatosis. SQUAMOUS CELL PAPILLOMA JUVENILE PAPILLOMATOSIS INCIDENCE  Commonest  Less common AGE  Adult  Children ETIOLOGY  Chronic irritation  Human papilloma virus. N/E  On the vocal cord (glottic)  On & outside the vocal cord i.e. SITE any part NUMBER  Single  Multiple SHAPE  Small sessile mass & soft  Small, pedunculated & soft. M/E  Squamous cell papilloma  Squamous cell papilloma.  No recurrence after  Recurrence is common.  May turn malignant  No malignant changes. PROGNOSIS  Spontaneous cure at puberty may occur Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases SQUAMOUS CELL CARCINOMA INCIDENCE  Common tumor of the larynx. PERCANCEROUS ① Squamous cell papilloma (of adult). LESIONS ② Leukoplakia ① VERRUCOUS CARCINOMA:  uncommon low grade papillary squamous cell carcinoma.  It is superficially invasive & has a relatively good prognosis. ② CLASSIC INVASIVE SQUAMOUS CELL CARCINOMA. PATHOLOGY Dr. M. Shalaby pathology - respiratory Upper respiratory tracts Diseases INTRINSIC EXTRINSIC INCIDENCE 80% 20% AGE Above 50 years Below 50 years SEX Male Female N/E: SITE: From vocal cords. (Glottic) Outside the vocal cords. SHAPE: Fung.> Ulcer > infiltrating Infiltrating>Ulcer> fung. M/E Well diff. Sq. C. Carcinoma. Poorly diff Sq C Carcinoma.  Good due to:  Bad due to: ① Early diagnosis (early ① Late diagnosis (dysphagia hoarseness of voice) then laryngeal signs & ② Slowly growing. symptoms). PROGNOSIS ③ Well differentiated tumor. ② Rapidly growing. ④ Easily removed due to ③ Undifferentiated. fungating growth. ④ Difficult removal due to infiltrative growth RADIO- Radiosensitive Radiosensitive SENSITIVITY ① Local to surrounding structure SPREAD ② Lymphatic to cervical L.N. ③ Blood: late and disseminates extensively GLOTTIC CARCINOMA SUPRA GLOTTIC CARCINOMA Dr. M. Shalaby