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PATHOLOGY OF UPPER RESPIRARTORY  Slide 1 PATHOLOGY OF UPPER RESPIRARTORY  Slide 2 PATHOLOGY OF UPPER RESPIRARTORY  Slide 3 PATHOLOGY OF UPPER RESPIRARTORY  Slide 4 PATHOLOGY OF UPPER RESPIRARTORY  Slide 5 PATHOLOGY OF UPPER RESPIRARTORY  Slide 6 PATHOLOGY OF UPPER RESPIRARTORY  Slide 7 PATHOLOGY OF UPPER RESPIRARTORY  Slide 8 PATHOLOGY OF UPPER RESPIRARTORY  Slide 9 PATHOLOGY OF UPPER RESPIRARTORY  Slide 10 PATHOLOGY OF UPPER RESPIRARTORY  Slide 11 PATHOLOGY OF UPPER RESPIRARTORY  Slide 12 PATHOLOGY OF UPPER RESPIRARTORY  Slide 13 PATHOLOGY OF UPPER RESPIRARTORY  Slide 14 PATHOLOGY OF UPPER RESPIRARTORY  Slide 15 PATHOLOGY OF UPPER RESPIRARTORY  Slide 16 PATHOLOGY OF UPPER RESPIRARTORY  Slide 17 PATHOLOGY OF UPPER RESPIRARTORY  Slide 18 PATHOLOGY OF UPPER RESPIRARTORY  Slide 19 PATHOLOGY OF UPPER RESPIRARTORY  Slide 20 PATHOLOGY OF UPPER RESPIRARTORY  Slide 21 PATHOLOGY OF UPPER RESPIRARTORY  Slide 22 PATHOLOGY OF UPPER RESPIRARTORY  Slide 23 PATHOLOGY OF UPPER RESPIRARTORY  Slide 24 PATHOLOGY OF UPPER RESPIRARTORY  Slide 25 PATHOLOGY OF UPPER RESPIRARTORY  Slide 26 PATHOLOGY OF UPPER RESPIRARTORY  Slide 27 PATHOLOGY OF UPPER RESPIRARTORY  Slide 28 PATHOLOGY OF UPPER RESPIRARTORY  Slide 29 PATHOLOGY OF UPPER RESPIRARTORY  Slide 30 PATHOLOGY OF UPPER RESPIRARTORY  Slide 31 PATHOLOGY OF UPPER RESPIRARTORY  Slide 32 PATHOLOGY OF UPPER RESPIRARTORY  Slide 33 PATHOLOGY OF UPPER RESPIRARTORY  Slide 34 PATHOLOGY OF UPPER RESPIRARTORY  Slide 35 PATHOLOGY OF UPPER RESPIRARTORY  Slide 36 PATHOLOGY OF UPPER RESPIRARTORY  Slide 37 PATHOLOGY OF UPPER RESPIRARTORY  Slide 38 PATHOLOGY OF UPPER RESPIRARTORY  Slide 39 PATHOLOGY OF UPPER RESPIRARTORY  Slide 40 PATHOLOGY OF UPPER RESPIRARTORY  Slide 41 PATHOLOGY OF UPPER RESPIRARTORY  Slide 42 PATHOLOGY OF UPPER RESPIRARTORY  Slide 43 PATHOLOGY OF UPPER RESPIRARTORY  Slide 44
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PATHOLOGY OF UPPER RESPIRARTORY

  1. 1. Human Respiratory System
  2. 2. Components of the Upper Respiratory Tract
  3. 3. Upper Respiratory Tract  Functions:  Passageway for respiration.  Receptors for smell.  Filters incoming air to filter larger foreign material.  Moistens and warms incoming air.  Resonating chambers for voice.
  4. 4. Lower Respiratory Tract  Functions:  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 exchange
  5. 5. Components of the Lower Respiratory Tract
  6. 6. DISEASES OF UPPER RESPIRATORY TRACT
  7. 7. DISEASES OF UPPER RESPIRATORY TRACT: Congenital 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. 1 ⁄2 have Kartagener's triad, i.e chronic sinusitis, bronchiectasis sinusitis and situs inversus totalis.(A condition in which there is complete right to left reversal (transposition) of the thoracic and abdominal organs)
  8. 8. 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 mucormycosis cilia (Kartagener’s) syndrome.
  9. 9. Nasal polyps A. Low-power magnification showing edematous masses lined by epithelium. B. High-power views showing edema and eosinophil-rich inflammatory infiltrate.
  10. 10. DISEASES OF UPPER RESPIRATORY TRACT NASOPHARYNGITIS & TONSILLTIS -AE: viral, or bacterial infection (beta-hemolytic streptococci)…..??? streptococci - Morphology: tonsils are enlarged, red and dotted by pinpoints of exudate from the tonsillar crypts (follicular tonsillitis). -Local complications: Otitis Media, peritonsillar abscess ("quinsy"), and tonsillar hypertrophy. - Remote post-streptococcal complications: Rheumatic Fever (RF) and glomerulonephritis (GN). RF GN
  11. 11. TUMORS OF THE NOSE, SINUSES & NASOPHARYNX 1- NASOPHARYNGEAL ANGIOFIBROMA: Highly vascular benign non-capsulated tumor of adolescent males. Epistaxis+/- Epistaxis 2-INVERTED PAPILLOMA: Locally aggressive neoplasm (high recurrence rate) of the Nose or the paranasal Sinuses; rare Sinuses 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.
  12. 12. INVERTED PAPILLOMA :.Nose The masses of squamous epithelium are growing inward; hence, the term inverted.
  13. 13. 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. China -PF: Epstein-Barr (EBV). Chromosomal.?? EBV -TTT. : Unresectable because of widespread metastases at the time of diagnosis. -Undifferentiated carcinoma response better to radiotherapy than the keratinizing type.
  14. 14. NASOPHARYNGEAL CARCINOMA (Microscopic) (WHO-3): (WHO-2)
  15. 15. LARYNGITIS AE: Allergic, viral, bacterial or chemical (tobacco) injury. Allergic viral tobacco Acute laryngitis: AE: viral (Parainfluenza virus) or bacteria. virus 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) → dysplasia SCC ( Squamous Cell Carcinoma)
  16. 16. LARYNGEAL POLYPS & PAPILLOMAS Polyps: ( Singer’s Nodule) Small inflammatory nodules on the true vocal cords of signers & teachers; caused by overuse eachers of voice → hoarseness. They never give rise to Cancer XXX. Papillomas: AE: HPV-1, Multiple in children. AE Tend to recur after excision. May → Cancer. excision True neoplasms; raspberry-like nodules, with delicate finger- like papillae covered by squamous epithelium; liable to fragmentation and bleeding. bleeding
  17. 17. Larynx: S. Node, Papilloma vs. Carcinoma Diagrammatic comparison of a benign Singer’s node, papilloma and an exophytic carcinoma of the larynx to highlight their quite different appearances.
  18. 18. LARYNGEAL CARCINOMA -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 ulcerated nodule. - 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 degrees. - 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)
  19. 19. Laryngeal carcinoma (Gross & M/E) q A. Note the large, fungating lesion involving the vocal cord and pyriform sinus. q B. Histologic appearance of laryngeal squamous cell carcinoma. q Note the atypical lining epithelium and invasive keratinizing cancer cells in the submucosa.
  20. 20. LARYNGEAL SQUAMOUS CELL CARCINOMA
  21. 21. SALIVARY GLANDS
  22. 22. Diseases of Salivary Glands A Commitment to …Excellence
  23. 23. SIALADENITIS & SIALOLITHIASIS Sialadenitis: viral (mumps), bacterial (secondary to ductal obstruction) or autoimmune (Sjogren’s syndrome= 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 suppurative inflammation.
  24. 24. Causes of Sialadenitis q Infectious q Autoimmune – Mumps (Sjogren’s) Sjogren’s (paramyxovirus) – Bacterial (usually associated with ductal obstruction)
  25. 25. Sjogren’s Syndrome q Immune-mediated destruction of the lacrimal and salivary glands, often occurring in association with glands rheumatoid arthritis (RA) or another autoimmune disorder. q Gross: Xerostomia and keratoconjunctivitis sicca + ..? q ME: shows dense lympho-plasmacytic inflammatory ME infiltrate with destruction of glandular tissue.
  26. 26. Sjogren’s syndrome q Etiology and pathogenesis – primary target is ductal epithelial cells of exocrine glands – B-cell hyperactivity - hypergammaglobulinemia, antinuclear antibodies. – primary defect is in T-helper cells (too many) – most have anti- RNA (anti -SS-A and anti-SS-B) antibodies – associated with HLA-DR3
  27. 27. Sjogren’s syndrome q C/P: – primarily in women > 40 – dry mouth, lack of tears. mouth – salivary glands enlarged. enlarged – 60% with other ConnectiveTissue Diseases. – 1% develop lymphoma, 10% with pseudolymphomas lymphoma
  28. 28. Sjogren’s syndrome q Pathology: – 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
  29. 29. Sjogren’s syndrome
  30. 30. Sjogren’s syndrome Intense lymphoplasmacytic infiltrate with ductal epithelial hyperplasia
  31. 31. Sjogren’s syndrome: Pathology
  32. 32. Salivary Glands Neoplasia A Commitment to
  33. 33. 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)
  34. 34. Pleomorphic Adenoma (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.
  35. 35. Pleomorphic adenoma: Gross: shows sharply circumscribed, yellow-white tumor protrudes above the level of the surrounding glandular substance.
  36. 36. 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.
  37. 37. Warthin’s Tumor 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.
  38. 38. Warthin’s Tumor: Papillary oncocytic epithelium + prominent lymphoid component. component
  39. 39. Warthin’s Tumor: Tumor q A. Lower-power view showing epithelial and lymphoid elements. 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.
  40. 40. Mucoepidermoid carcinoma A. Mucoepidermoid carcinoma showing islands having squamous cells as well as clear cells containing mucin. B. Mucicarmine stains the mucin reddish-pink.
  41. 41. Adenoid cystic carcinoma in a salivary gland. A. Low-power view. The tumor cells have created a cribriform pattern enclosing secretions. B. High-power view showing polygonal tumor cells surrounding the cystic space filled with secretions.
  42. 42. .(Carotid body tumor (Paraganglioma A. Low-power view showing tumor clusters separated by fine vascular septa (zellballen appearance). B. High-power view of large, eosinophilic, slightly vacuolated cells with elongated sustentacular cells in the septa.
  43. 43. THE END
  • EhsanAhmed20

    Jun. 9, 2019
  • aisuganesan

    Mar. 29, 2019
  • mehrdadfarahmanesh

    Feb. 15, 2019
  • FrancisMusonda1

    Jan. 21, 2018
  • gennadiishcherbakov

    Feb. 12, 2014
  • shruthips279

    Aug. 21, 2013

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