Lesion of the upper respiratory tract

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Information about Lesion of the upper respiratory tract

Published on May 31, 2014

Author: ttylim

Source: slideshare.net

  Izatty Lim 0308188 Acute Infections Nasopharyngeal Carcinoma Laryngeal Tumors MBBS Batch 4 10 December 2013

 Lesion o A localized pathological change in a bodily organ or tissue  Upper Respiratory Tract o Composed of the nose and nasal cavity, paranasal sinuses, pharynx (throat), larynx. o Conducting portion

 among the most common afflictions of humans  Manifesting as “common cold”  occur in the fall and winter & are self-limiting  complicated by the development of bacterial otitis media or sinusitis (minority)  most common pathogens: o Rhinoviruses o coronaviruses, respiratory syncytial viruses, parainfluenza and influenza viruses, adenoviruses, enteroviruses, and sometimes even group A β-hemolytic streptococci also have been implicated o 40% cases, cause cannot be determined

 signs and symptoms localized to the pharynx, epiglottis, or larynx: o Acute pharyngitis o Acute bacterial epiglottis o Acute laryngitis  Clinical features: o nasal congestion + watery discharge o Sneezing o scratchy o dry sore throat o slight increase in temperature ( young children)

o Manifest as sore throat, may caused by a host of agents. o Mild(most common)  minimal physical findings frequently accompanies a cold o More severe  tonsillitis, associated with marked hyperemia + exudates, ( β-hemolytic streptococcal and adenovirus infections)  Streptococcal tonsillitis o important to recognize & treat early  peritonsillar abscesses (“quinsy”) or poststreptococcal glomerulonephritis & acute rheumatic fever.  Coxsackievirus A infection  pharyngeal vesicles and ulcers (herpangina).  Infectious mononucleosis o caused by Epstein-Barr virus (EBV)  important cause of pharyngitis o bears the moniker of “kissing disease”—common mode of transmission

o young children o caused by H. influenza o pain & airway obstruction are the major findings o abrupt onset  * need to maintain an open airway for a child ( fatal consequences)  vaccination against H. influenzae .

 causes: o inhalation of irritants o allergic reactions o agents that produce the common cold  usually involve: o pharynx o nasal passages o larynx.

 In children,  parainfluenza virus  most common cause of laryngotracheobronchitis (croup) o other agents (eg. respiratory syncytial virus) may also precipitate this condition.  self-limited o croup may cause frightening inspiratory stridor and harsh, persistent cough.  laryngeal inflammatory reaction o narrow the airway sufficiently to cause respiratory failure.  Tuberculous and diphtheritic. o consequence of protracted active tuberculosis infected sputum is coughed up. o uncommon  immunization of young children against diphtheria toxin.  Corynebacterium diphtheria inhaled & implants on the mucosa of the upper airways o laborates a powerful exotoxin that causes necrosis of the mucosal epithelium + dense fibrinopurulent exudate  classic superficial, dirty-gray pseudomembrane of diphtheria. o The major hazards: sloughing and aspiration of the pseudomembrane (causing obstruction of major airways) and absorption of bacterial exotoxins (producing myocarditis, peripheral neuropathy, or other tissue injury).  Predispose the patient to secondary bacterial infection, particularly by staphylococci, streptococci, and H. influenza

 rare neoplasm  invade locally  spread to cervical lymph nodes  metastasize to distant sites  tend to be radiosensitive  5-year survival rates of 50% are reported for even advanced cancers  Important due to o strong epidemiologic links to EBV o the high frequency among Chinese (possibility of genetic susceptibility)  EBV genome found in all nasopharyngeal carcinoma

 3 histologic variants: o Keratinizing squamous cell carcinoma o Non-keratinizing squamous cell carcinoma o Undifferentiated carcinoma (most common & closely linked to EBV) • large epithelial cells having indistinct cell borders • prominent eosinophilic nucleoli  striking influx of mature lymphocytes o similar in infectious mononucleosis  appearance similar to non-Hodgkin  presence of large neoplastic cells with background of reactive lymphocytes  immunohistochemical stains  epithelial nature of the malignant cells

 variety of non-neoplastic, benign & malignant neoplasms of squamous epithelial and mesenchymal  origin may arise in the larynx, but only vocal cord nodules, papillomas, and squamous cell carcinomas are significant  most common presenting feature is hoarseness

 Vocal cord nodules ("polyps") o smooth, hemispherical protrusions (<0.5 cm in diameter) o Located (most often) on the true vocal cords o fibrous tissue o covered by stratified squamous mucosa o heavy smokers or singers (singer's nodes)  result of chronic irritation/abuse. o Lead to breathy and hoarse voice pathogenesis o represent a response to vocal trauma  trauma of the laryngeal mucosa o alteration of the permeability of blood vessels o allowing the extravasation of edema fluid, fibrin or erythrocytes o reactive processes develop with the formation of labyrinthine vascular spaces

 Laryngeal papilloma  human papillomavirus (HPV) types 6 & 11 o benign, often spontaneously regress at puberty. o usually on true vocal cords o forms a soft, raspberry-like excrescence (rarely more than 1 cm in diameter) o Histologically, • multiple, slender, finger-like projections • supported by central fibrovascular cores • covered by an orderly, typical, stratified squamous epithelium. o papilloma on the free edge of the vocal cord  ulceration + hemoptysis. o usually single in adults o often multiple in children  recurrent respiratory papillomatosis (RRP), tendency to recur after excision believed due to vertical transmission from an infected mother during delivery. o HPV vaccine  protect women in reproductive age group against types 6 and 11 • prevention of RRP in children

 represents only 2% of all cancers.  > 40 years  men (7 : 1)  ~95% are typical squamous cell lesions.  adenocarcinomas (rare), presumably arising from mucous glands.  60% - 75% cases  glottic tumors o usually keratinizing, well- to moderately differentiated o Non-keratinizing & poorly differentiated carcinomas may also be seen  25% - 40%  supraglottic, <5%  subglottic

 major etiologic factors include : o smoking o alcohol o previous radiation exposure o Human papillomavirus sequences  begin as in situ lesions  pearly gray, wrinkled plaques on the mucosal surface ulcerating and fungating  Clinical manifestation  persistent hoarseness  Surgery/ radiation/combined therapeutic treatments  many patients can be cured o but ~1/3 die  distal respiratory passages / widespread metastases and cachexia

 Robbins Basic Pathology 9th Edition • By Kumar Abbas Aster  Pathogenesis of vocal cord polyps o http://www.ncbi.nlm.nih.gov/pubmed/7114717

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