Published on May 31, 2014
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
Mitos y realidades de las sustancias psicoactivas
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