Upper Respiratory Tract
Passageway for respiration.
Receptors for smell.
Filters incoming air to filter larger foreign
Moistens and warms incoming air.
Resonating chambers for voice.
Lower Respiratory Tract
Larynx: maintains an open airway and assists
in sound production.
Trachea: transports air to and from lungs.
Bronchi: branch into lungs.
Lungs: transport air to alveoli for gas
DISEASES OF UPPER RESPIRATORY TRACT:
Immotile cilia (Kartagener) syndrome:
Definition: Congenital defect of ciliary movement.
Childhood onset due to defective or non-functional cilia in the
respiratory tract → chronic sinusitis, defective mucociliary
transport and bronchial clearance, bronchiectasia, chronic Otitis
Media and headaches, related to immotility of ependymal cilia in
the walls of cerebral ventricles; and absence of frontal sinuses.
Status Of Reproduction: ♂ are infertile,1⁄2 of ♀ are im-
pregnatable, the other1⁄2 sterile.
⁄2 have Kartagener's triad, i.e chronic sinusitis, bronchiectasis
and situs inversus totalis.(A condition in which there is complete right to left reversal
(transposition) of the thoracic and abdominal organs)
DISEASES OF UPPER RESPIRATORY TRACT
RHINTIS & SINUSITIS
1. Common cold: viral infection: rhinoviruses, adenoviruses,
echoviruses → catarrhal inflammation with mucous discharge. Secondary
bacterial infection → muco-purulent discharge.
2. Allergic rhinitis (hay fever): Ig E mediated hypersensitivity reaction (type-
I) to plant pollen antigens → Nasal Polyps. 2ry. infections are
common → Chronic Rhintis.
3. Chronic Rhinitis: AE: repeated bacterial infections. P.F.: Deviated
Nasal Septum or Nasal Polyps. May → chronic sinusitis.
4. Chronic Sinusitis: Most common bacterial.
In DM may be fungal (mucormycosis). Rarely, it is associated with immotile
cilia (Kartagener’s) syndrome.
A. Low-power magnification
masses lined by epithelium.
B. High-power views showing
edema and eosinophil-rich
DISEASES OF UPPER RESPIRATORY TRACT
NASOPHARYNGITIS & TONSILLTIS
-AE: viral, or bacterial infection (beta-hemolytic
- Morphology: tonsils are enlarged, red and dotted by
pinpoints of exudate from the tonsillar crypts (follicular
-Local complications: Otitis Media, peritonsillar abscess
("quinsy"), and tonsillar hypertrophy.
- Remote post-streptococcal complications: Rheumatic
Fever (RF) and glomerulonephritis (GN).
TUMORS OF THE NOSE, SINUSES & NASOPHARYNX
1- NASOPHARYNGEAL ANGIOFIBROMA: Highly vascular
benign non-capsulated tumor of adolescent males.
2-INVERTED PAPILLOMA: Locally aggressive neoplasm (high
recurrence rate) of the Nose or the paranasal Sinuses; rare
progression to carcinoma.
3- ISOLATED PLASMACYTOMA: Malignant plasma cell tumor;
solitary lesion, rare → to multiple myeloma (MM).
4- OLFACTORY NEUROBLASTOMA: Highly malignant; neuro-
endocrine tumors of the olfactory mucosa; positive for
neuron-specific enolase and S-100 protein.
INVERTED PAPILLOMA :.Nose
The masses of
hence, the term
5- NASOPHARYNGEAL CARCINOMA:
A- Keratinizing squamous cell crcinoma (WHO-1)
B- Non-keratinizing squamous cell carcinoma (WHO-2)
C- Undifferentiated carcinoma (WHO-3): = Lymphoepithelioma
(admixed with dense lymphocytic infiltrate.
-Age: children in Africa & Adults in China.
-PF: Epstein-Barr (EBV). Chromosomal.??
-TTT. : Unresectable because of widespread metastases at the
time of diagnosis.
-Undifferentiated carcinoma response better to radiotherapy
than the keratinizing type.
AE: Allergic, viral, bacterial or chemical (tobacco) injury.
Allergic viral tobacco
Acute laryngitis: AE: viral (Parainfluenza virus) or bacteria.
In children → narrowing of the larynx, that causes stridor & in
young infants laryngeal edema → airway obstruction & death
(Tracheostomy is life saving). Laryngo-tracheo-bronchitis (croup).
Chronic laryngitis: AE:Cigarette in adults → (dysplasia) →
SCC ( Squamous Cell Carcinoma)
LARYNGEAL POLYPS & PAPILLOMAS
Polyps: ( Singer’s Nodule) Small inflammatory nodules on
the true vocal cords of signers & teachers; caused by overuse
of voice → hoarseness. They never give rise to Cancer XXX.
Papillomas: AE: HPV-1, Multiple in children.
Tend to recur after excision. May → Cancer.
True neoplasms; raspberry-like nodules, with delicate finger-
like papillae covered by squamous epithelium; liable to
fragmentation and bleeding.
Larynx: S. Node, Papilloma vs. Carcinoma
comparison of a
node, papilloma and
carcinoma of the
larynx to highlight
their quite different
-Epithelial changes, ranging from
hyperplasia, dysplasia, CIS (carcinoma in
situ) to invasive squamous cell carcinoma.
- Gross: vary from dysplasia, CIS (carcinoma
in situ) to frankly malignant verrucose or
- AE: Cigarette smoking is the major
causative factor & cessation of smoking
causes regression of early lesions.
Asbestos & HPV are contributing factors.
-M/E : Squamous cell Carcinoma of varying
- Prognosis: Carcinomas of the true vocal
cord (intrinsic type) is better than Sq.C.C in the supraglottic location (above the
carcinomas above or below the vocal cord . true vocal cord)
Laryngeal carcinoma (Gross & M/E)
q A. Note the large,
fungating lesion involving
the vocal cord and
q B. Histologic appearance
of laryngeal squamous cell
q Note the atypical lining
epithelium and invasive
keratinizing cancer cells in
Diseases of Salivary
A Commitment to
SIALADENITIS & SIALOLITHIASIS
Sialadenitis: viral (mumps), bacterial (secondary to ductal
obstruction) or autoimmune (Sjogren’s syndrome=
xerostomia (Dry Mouth- due to lack of saliva) +
keratoconjunctivitis sicca= the sicca syndrome)
Sialolithiasis: dehydration may -> obstruction of the
salivary ducts by inspissated food debris → stone formation
& secondary bacterial sialadenitis (Staph. Aureus & Strept.
Viridans). Submandibular salivary gland is most commonly
affected; usually unilateral; with symptoms & signs of acute
Causes of Sialadenitis
q Infectious q Autoimmune
– Mumps (Sjogren’s)
– Bacterial (usually
q Immune-mediated destruction of the lacrimal and
salivary glands, often occurring in association with
rheumatoid arthritis (RA) or another autoimmune
q Gross: Xerostomia and keratoconjunctivitis sicca + ..?
q ME: shows dense lympho-plasmacytic inflammatory
infiltrate with destruction of glandular tissue.
q Etiology and pathogenesis
– primary target is ductal epithelial cells of exocrine
– B-cell hyperactivity - hypergammaglobulinemia,
– primary defect is in T-helper cells (too many)
– most have anti- RNA (anti -SS-A and anti-SS-B)
– associated with HLA-DR3
– primarily in women > 40
– dry mouth, lack of tears.
– salivary glands enlarged.
– 60% with other ConnectiveTissue Diseases.
– 1% develop lymphoma, 10% with pseudolymphomas
– all secretory glands can be involved
– intense lymphoplasmacellular infiltrates
– secondary inflammation of corneal epithelium (due to drying) leads
to ulceration and xerostomia
– can develop respiratory symptoms if these glands are affected
– 25% develop extraglandular disease (most with anti-SS-A) involving
CNS, kidneys, skin and muscles
TUMORS OF THE SALIVARY GLANDS
-Up to 80% arise in the parotid gland (15% malignant), 10% in the
submandibular (40% malignant) & 10% in the minor salivary glands (Less
than 50% malignant). Affect middle-aged adults, the malignant at an older
age than the benign.
- Histological types:
1- Pleomorphic adenoma 45% (benign).
2- Warthin’s tumor 11% (benign)
3- Muco-epidermoid carcinoma 15% (malignancy)
4- Adenoid cystic carcinoma 10% (malignant)
5- Acinic cell carcinoma 03% (malignant)
(mixed tumor of salivary gland)
q Most common salivary gland tumor 45% (Benign).
q Most often arises in superficial parotid
q Gross: Circumscribed, glistening, myxoid lesion
q M/E: shows heterogeneous mix of ducts, acini, and
sheets of cells in a myxoid or chondroid stroma
q Complete resection is necessary to prevent recurrence
(10% recurrence rate).
q Low percentage show malignant areas.
Pleomorphic adenoma: Gross: shows sharply
circumscribed, yellow-white tumor protrudes above the level of the
surrounding glandular substance.
Pleomorphic adenoma. M/E: note cartilage admixed with
benign glandular epithelial elements.
A. Low-power view showing a
well-demarcated tumor with
normal parotid acini below.
B. High-power view showing
amorphous myxoid stroma
resembling cartilage, with
interspersed islands and
strands of myoepithelial cells.
q Papillary cystadenoma lymphomatosum
or (adenolymphoma). 11% (Benign)
q Infrequent benign tumor of the parotid gland
q Well-encapsulated green-brown mass with
cleft-like spaces on the cut surface.
q Mixture of oncocytic epithelium and
subjacent lymphoid tissue.
q 10% recurrence rate.
q A. Lower-power view showing
epithelial and lymphoid
q Note the follicular germinal
center beneath the epithelium.
q B. Cleftlike spaces separate
the lobules of tumor covered
by a regular double layer of
eosinophilic epithelial cells
based on a lymphoid stroma.
islands having squamous
cells as well as clear cells
B. Mucicarmine stains the
Adenoid cystic carcinoma
in a salivary gland.
A. Low-power view.
The tumor cells have
created a cribriform pattern
B. High-power view showing
polygonal tumor cells
cystic space filled with
.(Carotid body tumor (Paraganglioma
A. Low-power view
showing tumor clusters
separated by fine
B. High-power view of
cells with elongated
sustentacular cells in the