Nasopharynx and Larynx Pathology Study Guide

Nasopharynx and Larynx Pathology Video

Nasopharynx

Rhinitis

Rhinitis is inflammation of the nasal mucosa.

Adenoviruses are the most commonly known cause of rhinitis.

Common symptoms of rhinitis include:

Sneezing
Congestion
Runny nose

A type I hypersensitivity reaction (such as one in response to pollen) causes allergic rhinitis, a form of rhinitis.

Rhinitis is characterized by an eosinophil filled inflammatory infiltrate.

Patients with eczema and asthma are classically susceptible to rhinitis.

Rhinitis is associated with asthma and eczema.

Rhinitis. Illustration depicting inflammation associated with allergic rhinitis BruceBlaus. Not altered. CC BY 3.0.
Rhinitis. Mechanism of non-allergic rhinitis: Imbalance between sympathetic and parasympathetic components in the nasal mucous membrane. Singhuh - Not altered. CC BY-SA 4.0
Rhinitis. Pathological changes in non-allergic rhinitis. Singhuh - Not altered. CC BY-SA 4.0
Rhinitis. Pollen from a variety of common plants: sunflower (Helianthus annuus, small spiky sphericals, colorized pink), morning glory (Ipomoea purpurea, big sphericals with hexagonal cavities, colorized mint green), hollyhock (Sildalcea malviflora, big spiky sphericals, colorized yellow), lily (Lilium auratum, bean shaped, colorized dark green), primrose (Oenothera fruticosa, tripod shaped, colorized red) and castor bean (Ricinus communis, small smooth sphericals, colorized light green). The image is magnified some x500, so the bean shaped grain in the bottom left corner is about 50 μm long. Dartmouth College Electron Microscope Facility - Not altered. Public Domain
Infectious Rhinitis. Antigen expression and histopathology of nasal respiratory epithelium of ferrets inoculated with different influenza viruses.There is high antigen expression with associated lesions characterized by neutrophilic rhinitis in the nasal respiratory epithelium of ferrets inoculated with H3N2 and pH1N1 on 1 dpi and lower expression on 4 dpi, while for H5N1 there is only occasional expression on 1 dpi. HE and immunoperoxidase counterstained with hematoxylin, 200×. Not Altered. CC. Comparison of temporal and spatial dynamics of seasonal H3N2, pandemic H1N1 and highly pathogenic avian influenza H5N1 virus infections in ferrets. van den Brand JM, Stittelaar KJ, van Amerongen G, Reperant L, de Waal L, Osterhaus AD, Kuiken T
Allergic Rhinitis. Nasal cytology: A) non-allergic rhinitis with eosinophils (NARES); B) non-allergic rhinitis with mast cells (NARMA); C) non-allergic rhinitis with neutrophils (NARNE); D) non-allergic rhinitis with eosinophils and mast cells (NARESMA) May-Grünwald- Giemsa staining, original magnification ×1,000. Not Altered. CC. Allergic and non-allergic rhinitis: relationship with nasal polyposis, asthma and family history. Gelardi M, Iannuzzi L, Tafuri S, Passalacqua G, Quaranta N
Chronic Rhinitis. Photomicrograph of chronic rhinosinusitis showing strong cytoplasmic immunostaining of surfactant protein-A in both nasal mucosa (A) and submucosal glands (B). Hematoxylin counterstain × 400. Not Altered. CC. Surfactant protein a expression in chronic rhinosinusitis and atrophic rhinitis. El-Anwar MW, Hamed AA, Mohamed AE, Nofal AA, Mohamed MA, Abdel-Aziz

Nasal Polyp

Nasal polyps are edematous, polypoid, irritated nasal mucosa.

Nasal polyps are classically associated with:

Cystic fibrosis
Aspirin-intolerant asthma
Recurrent rhinitis

Ten percent of asthmatic people have aspirin-intolerant asthma, which is defined by the triad of:

Asthma
Nasal polyps
Aspirin-induced bronchospasms

Nasal Polyp. Nasal polyp in right nostril. © MathieuMD. Not altered. CC BY-SA 3.0
Nasal Polyp. Nasal polyp appearing in the middle meatus. Mustafakapadiya. Not altered. CC BY-SA 4.0
Nasal Polyp. CT scan images after application of radioactive laced nasal steroids using long nozzle. Note the reach of the medication into the area where nasal polyps originate Mustafakapadiya - Not altered. CC BY-SA 4.0
Nasal Polyp. Histology of nasal polyp, magnification 25x (H&E stain) Roman M. Krenz. Not altered. CC BY-SA 3.0
Nasal polyps. Pathological findings of an earlier organized thrombus (8A: hematoxylin and eosin staining; original magnification, ×400) and organized thrombus (8B: hematoxylin and eosin staining; original magnification, ×200). Not Altered. CC. Correlation of computed tomography with pathological features in angiomatous nasal polyps. Dai LB, Zhou SH, Ruan LX, Zheng ZJ - PloS one (2012)

Angiofibroma

Angiofibromas consist of large blood arteries and fibrous tissue make up this benign tumor of the nasal mucosa, which is typically found in male adolescents.

Severe epistaxis is associated with angiofibromas.

Angiofibroma. Fibrous papulae LWozniak&KWZielinski. Not altered CC BY-SA 3.0
Nasopharyngeal Angiofibroma. Histologic images highlighting the vascular and stromal components characteristic of a nasopharyngeal angiofibroma. Image showing increased peripheral vascularity. Juvenile Nasopharyngeal Angiofibroma Presenting with Acute Airway Obstruction, Wheat C, Bickley RJ, Cohen EC, Wenzler D, Hunter N, Astiz D.- Case Rep Otolaryngol (2016). Not Altered. CC.

Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a malignant tumor of nasopharyngeal epithelium.

Epstein Barr virus (EBV) may be a cause of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma typically is observed in Chinese adults and African youngsters.

Histology of nasopharyngeal carcinoma shows pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a lymphocyte background.

Nasopharyngeal carcinoma frequently presents with cervical lymph node involvement.

Nasopharyngeal Carcinoma. FDG-PET/CT scan of a patient with nasopharyngeal cancer. Transverse slice demonstrating FDG-positive primary site Gulec SA et al. - Gulec SA, Hoenie E, Hostetter R, Schwartzentruber D. Not altered. CC BY 2.0
Nasopharyngeal Carcinoma. Undifferentiated nasopharyngeal carcinoma—low power KGH. Not altered. Public Domain
Nasopharyngeal Carcinoma. Undifferentiated nasopharyngeal carcinoma—med. power KGH Not altered. Public Domain
Nasopharyngeal Carcinoma. Undifferentiated nasopharyngeal carcinoma—high power KGH Not altered. Public Domain
Nasopharyngeal carcinoma. Micrograph showing a nasopharyngeal carcinoma. H&E. Nephron. Not altered. CC BY-SA 4.0
Nasopharyngeal Carcinoma. Immunohistochemical staining of MTAP in nasopharyngeal carcinoma. Non-neoplastic nasopharyngeal epithelial tissue (A) and representative low-stage NPC (B) show intact MTAP expression. While representative high-stage NPC (C) is deficient for MTAP expression. In addition, the expression of MTAP is also present either in the lymphocytes (A and C) or stromal cells (B) adjacent to the tumor or non-neoplastic mucosa. MTAP = methylthioadenosine phosphorylase, NPC = nasopharyngeal carcinoma. Characterization and Prognostic Significance of Methylthioadenosine Phosphorylase Deficiency in Nasopharyngeal Carcinoma. He H, Lee Y, Shiue Y, Lee S, Chen T, Li C. - Medicine (Baltimore). (2015). Not Altered. CC.

Larynx

Acute Epiglottitis

Acute epiglottis is inflammation of the epiglottis.

Hemophilus Influenzae type B is the most typical cause of acute epiglottis, especially in non immunized children.

Common symptoms of acute epiglottis include:

Fever
Sore throat
Dysphagia
Drooling
Muffled voice
Inspiratory stridor

Possible airway obstruction is a complication of acute epiglottis.

Acute Epiglottitis. Swollen epiglottis in laryngoscopy Dr. Koshiro. Not altered. CC BY-SA 3.0
Acute Epiglottitis. CT imaging showing the "halloween sign" Chaustanley - Not altered. CC BY-SA 3.0
Acute Epiglottitis. Left column: Normal epiglottis. Right column: Epiglottitis. Med Chaos - Not altered. CC BY-SA 3.0
Acute Epiglottitis. Acute epiglottitis; Lateral view in X-ray imaging. The lateral soft-tissue radiograph reveals the "thumb sign" that indicates a swollen epiglottis, suggestive of epiglottitis. The diagnosis was confirmed on subsequent imaging and laryngoscopy. The patient recovered following treatment with predonine and ceftriaxone. Med Chaos. Not altered. CC0

Laryngotracheobronchitis (Croup)

Laryngotracheobronchitis is an upper airway inflammation.

Laryngotracheobronchitis is also known as croup.

Parainfluenza virus is the most frequent cause of laryngotracheobronchitis.

Laryngotracheobronchitis presents with an inspiratory stridor and a harsh, “barking” cough.

Laryngotracheobronchitis. AP x-ray of the neck in a child with croup demonstrating the steeple sign; narrowing of the the trachea. Frank Gaillard. Not altered. CC BY-SA 3.0

Vocal Cord Nodule (Singer’s Nodule)

Vocal cord nodules are benign growths on vocal cord(s).

Vocal cord nodules result from overuse of the vocal cords.

Hoarseness is a common finding in patients with vocal cord nodules.

Vocal cord nodules are typically bilateral.

Histology of vocal cord nodules show connective tissue that is in the state of myxoid degeneration.

Treatment of vocal cord nodules is to be silent and talk less to allow the vocal cords to recover.

Vocal Cord Nodule. Vocal folds. Anatomist90. Not altered. CC BY-SA 3.0
Vocal cord nodules. Microscopically, specimen demonstrated vocal cord actinomycosis (hematoxylin and eosin). Vocal cord actinomycosis mimicking a laryngeal tumor: Yoshihama K, Kato Y, Baba Y - Case reports in otolaryngology (2013). Not Altered. CC.

Laryngeal Papilloma

Laryngeal papilloma is a benign papillary tumor of the vocal cord.

Patients with laryngeal papillomas may present with a raspy voice.

Laryngeal papillomas are often:

Single in adults
Multiple in children

HPV 6 and HPV 11 are common causes of laryngeal papillomas.

Squamous Papilloma of the Larynx. Laryngeal papilloma without atypia in a patient with adult-onset RRP (HEx20). Recurrent respiratory papillomatosis: HPV genotypes and risk of high-grade laryngeal neoplasia: Omland T, Lie KA, Akre H, Sandlie LE, Jebsen P, Sandvik L, Nymoen DA, Bzhalava D, Dillner J, Brøndbo K - PloS one (2014). Not Altered. CC.
Laryngeal papillomatosis. CT volume rendering of the upper airway in a person with tracheobronchial papillomatosis. Not altered. CC0

Laryngeal Carcinoma

Laryngeal carcinomas are epithelioid malignancies that effect the larynx.

Squamous cell carcinoma is the most common type of laryngeal carcinoma.

Laryngeal carcinoma typically develops from the vocal cord’s epithelial lining.

Symptoms of laryngeal carcinoma include:

Hoarseness
Coughing
Stridor

Risk factors for laryngeal carcinoma include:

Alcohol use
Tobacco smoking

Laryngeal papillomas are an uncommon predisposing lesions that may progress to laryngeal carcinoma.

Laryngeal Carcinoma. KGH. Not altered Public Domain
Laryngeal Carcinoma. Larynx, removed At right: Fingertip, At the bottom: Holder Paweł Kuźniar. Not altered. CC0