Respiratory Pathology, UTHSC Fall 2022 D2 Pathology
Rhinitis
• The "common cold"
• Usually viral, with bacterial infection developing thereafter
• May also involve the pharynx, tonsils, bronchi
• Recurrences may lead to polyp formation
Hay fever
Allergic form of Rhinitis
- Antigen - Pollens, danders, etc
- IgE mediated (remember type I hypersensitivity)
Clinical features of Rhinitis
- Catarrhal discharge
- Mucopurulent discharge secondary to bacterial infection
Sinusitis
• Common infection secondary to breakdown in the normal secretion elimination system
• Predisposing factors: Typically upper viral respiratory infection
• Streptococcus pneumoniae, Haemophilus influenzae
Sinusitis - Clinical Features
• Acute vs. Chronic
• Headache, fever, facial pain, malaise
• Nasal discharge
• Maxillary sinusitis may mimic a toothache
Sinusitis - Treatment and Prognosis
• Acute-Amoxicillin or appropriate antibiotic
• Chronic
- Adult-Sinus surgery to enlarge ostea and eliminate blockage
- Children-Typically antibiotic therapy
• With treatment, the prognosis is good
Wegener's Granulomatosis
• Necrotizing granulomatous process of unknown etiology
• Potential serious condition underscoring the need for early diagnosis and treatment
• May initially present in a limited form (without renal involvement)
Wegener's Granulomatosis - Clinical Features
• Classically affect supper airway, lungs, kidneys
• Epistaxis, pain, nasal obstruction
• Later signs include ulceration and destruction of adjacent tissue or structures
• Any organ may be involved
Wegener's Granulomatosis - Clinical Features in the mouth
• Oral lesions
- Large, chronic ulcers
- "Strawberry gums"-pathognomonic
Wegener's Granulomatosis - Histology
• Subepithelial hemorrhage
• Poorly formed granulomas
• Scattered giant cells
• Vasculitis
, Wegener's Granulomatosis - Diagnosis
• Clinical, microscopic, and radiographic findings
• Indirect immunofluorescence of antineutrophil cytoplasmic antibodies (ANCA)
- Perinuclear (p-ANCA)
- Cytoplasmic (c-ANCA)
Wegener's Granulomatosis - Treatment and Prognosis
• Prednisone and cyclophosphamide
• Consultation and monitoring for response and toxicity
• Prior to immunosuppressive therapy, 95% died in 5 years
• Complete response (remission) expected in 90% of patients
Extranodal NK/T-Cell Lymphoma, Nasal Type (Angiocentric T-Cell Lymphoma,
Midline Lethal Granuloma)
• Aggressive, destructive process of T lymphocytes
• Diagnosis is often made after tertiary syphilis and Wegener's granulomatosa have
been ruled out
Extranodal NK/T-Cell Lymphoma, Nasal Type - Clinical Features
• Adults
• Nasal stuffiness, epistaxis
• Deep necrotic ulcerations
• May progress to palatal perforation
Extranodal NK/T-Cell Lymphoma, Nasal Type - Histology
• Angiocentric arrangement of atypical inflammatory cells
• Necrosis
Extranodal NK/T-Cell Lymphoma, Nasal Type- Treatment and Prognosis
• Localized lesions treated by radiation
• Chemotherapy for disseminated disease
• Good prognosis for localized disease; Less favorable for disseminated (30-50% 5-year
survival)
Nasopharyngeal Angiofibroma
• Benign but aggressive vascular neoplasm of the nasopharynx
• Lesion almost exclusively of male adolescents
• Lesion bears histologic resemblance to the nasal turbinates
Nasopharyngeal Angiofibroma - Clinical Features
• Nasal obstruction, epistaxis
• Anterior bowing of the posterior wall of the maxillary sinus
Nasopharyngeal Angiofibroma - Histology
• Dense fibrous connective tissue with myofibroblasts
• Numerous, variably-sized, thin-walled vessels
• Must know histology of the area
Nasopharyngeal Angiofibroma Treatment and Prognosis
• Surgical excision with preoperative embolization
• Radiation for recurrent or extensive lesions
• 20% recurrence rate; 95% survival
Papilloma (Fungiform Papilloma)
• Benign, papillary overgrowth of epithelium
• Primarily located on the nasal septum
Rhinitis
• The "common cold"
• Usually viral, with bacterial infection developing thereafter
• May also involve the pharynx, tonsils, bronchi
• Recurrences may lead to polyp formation
Hay fever
Allergic form of Rhinitis
- Antigen - Pollens, danders, etc
- IgE mediated (remember type I hypersensitivity)
Clinical features of Rhinitis
- Catarrhal discharge
- Mucopurulent discharge secondary to bacterial infection
Sinusitis
• Common infection secondary to breakdown in the normal secretion elimination system
• Predisposing factors: Typically upper viral respiratory infection
• Streptococcus pneumoniae, Haemophilus influenzae
Sinusitis - Clinical Features
• Acute vs. Chronic
• Headache, fever, facial pain, malaise
• Nasal discharge
• Maxillary sinusitis may mimic a toothache
Sinusitis - Treatment and Prognosis
• Acute-Amoxicillin or appropriate antibiotic
• Chronic
- Adult-Sinus surgery to enlarge ostea and eliminate blockage
- Children-Typically antibiotic therapy
• With treatment, the prognosis is good
Wegener's Granulomatosis
• Necrotizing granulomatous process of unknown etiology
• Potential serious condition underscoring the need for early diagnosis and treatment
• May initially present in a limited form (without renal involvement)
Wegener's Granulomatosis - Clinical Features
• Classically affect supper airway, lungs, kidneys
• Epistaxis, pain, nasal obstruction
• Later signs include ulceration and destruction of adjacent tissue or structures
• Any organ may be involved
Wegener's Granulomatosis - Clinical Features in the mouth
• Oral lesions
- Large, chronic ulcers
- "Strawberry gums"-pathognomonic
Wegener's Granulomatosis - Histology
• Subepithelial hemorrhage
• Poorly formed granulomas
• Scattered giant cells
• Vasculitis
, Wegener's Granulomatosis - Diagnosis
• Clinical, microscopic, and radiographic findings
• Indirect immunofluorescence of antineutrophil cytoplasmic antibodies (ANCA)
- Perinuclear (p-ANCA)
- Cytoplasmic (c-ANCA)
Wegener's Granulomatosis - Treatment and Prognosis
• Prednisone and cyclophosphamide
• Consultation and monitoring for response and toxicity
• Prior to immunosuppressive therapy, 95% died in 5 years
• Complete response (remission) expected in 90% of patients
Extranodal NK/T-Cell Lymphoma, Nasal Type (Angiocentric T-Cell Lymphoma,
Midline Lethal Granuloma)
• Aggressive, destructive process of T lymphocytes
• Diagnosis is often made after tertiary syphilis and Wegener's granulomatosa have
been ruled out
Extranodal NK/T-Cell Lymphoma, Nasal Type - Clinical Features
• Adults
• Nasal stuffiness, epistaxis
• Deep necrotic ulcerations
• May progress to palatal perforation
Extranodal NK/T-Cell Lymphoma, Nasal Type - Histology
• Angiocentric arrangement of atypical inflammatory cells
• Necrosis
Extranodal NK/T-Cell Lymphoma, Nasal Type- Treatment and Prognosis
• Localized lesions treated by radiation
• Chemotherapy for disseminated disease
• Good prognosis for localized disease; Less favorable for disseminated (30-50% 5-year
survival)
Nasopharyngeal Angiofibroma
• Benign but aggressive vascular neoplasm of the nasopharynx
• Lesion almost exclusively of male adolescents
• Lesion bears histologic resemblance to the nasal turbinates
Nasopharyngeal Angiofibroma - Clinical Features
• Nasal obstruction, epistaxis
• Anterior bowing of the posterior wall of the maxillary sinus
Nasopharyngeal Angiofibroma - Histology
• Dense fibrous connective tissue with myofibroblasts
• Numerous, variably-sized, thin-walled vessels
• Must know histology of the area
Nasopharyngeal Angiofibroma Treatment and Prognosis
• Surgical excision with preoperative embolization
• Radiation for recurrent or extensive lesions
• 20% recurrence rate; 95% survival
Papilloma (Fungiform Papilloma)
• Benign, papillary overgrowth of epithelium
• Primarily located on the nasal septum
