Faculty of Allied Medical Faculty of Allied Medical SciencesSciences

Histopathology and CytologyHistopathology and Cytology

((MLHC-201MLHC-201))

Prof. Dr. Noha RagabProf. Dr. Noha Ragab

PATHOLOGY OF THE PATHOLOGY OF THE RESPIRATORY RESPIRATORY

SYSTEMSYSTEMPATHOLOGY OF THE PATHOLOGY OF THE

RESPIRATORY PASSAGESRESPIRATORY PASSAGES

Intended Learning OutcomesIntended Learning Outcomes

By the end of this lecture, the student By the end of this lecture, the student should knowshould know: :

11 - -The causes of sinusitis and epistaxisThe causes of sinusitis and epistaxis..

22 - -The benign and malignant tumors of The benign and malignant tumors of the respiratory passagesthe respiratory passages..

33 - -Pathology of the larynx and the Pathology of the larynx and the pharynxpharynx..

EPISTAXIS OR NOSE BLEEDEPISTAXIS OR NOSE BLEED

This very common condition, most often the This very common condition, most often the result of a trauma, may also be caused result of a trauma, may also be caused by:by:

1.1. Systemic diseases including Systemic diseases including hypertensionhypertension

2.2. Blood diseases.Blood diseases.

3.3. Local inflammatory reactions or Local inflammatory reactions or neoplastic diseases of the nasal tissue. neoplastic diseases of the nasal tissue.

4.4. Ulceration and perforation caused by Ulceration and perforation caused by various factors including trauma, various factors including trauma, infection and cocaine abuse.infection and cocaine abuse.

INFLAMMATION OF THE AIR INFLAMMATION OF THE AIR SINUSES OR SINUSITISSINUSES OR SINUSITIS

SINUSITISSINUSITIS::

During the acute phase of rhinitis, During the acute phase of rhinitis, the edematous the edematous nasal mucosa around the drainage foramen of the sinuses nasal mucosa around the drainage foramen of the sinuses closes the opening of the air sinuses. closes the opening of the air sinuses.

The mucus accumulates inside the sinus cavities and The mucus accumulates inside the sinus cavities and provides an adequate medium for the growth of bacteria provides an adequate medium for the growth of bacteria and fungi. and fungi.

TUMORSTUMORS  OF THE OF THE RESPIRATORY RESPIRATORY

PASSAGESPASSAGES

A- BENIGN TUMORS OF THE A- BENIGN TUMORS OF THE RESPIRATORY PASSAGESRESPIRATORY PASSAGES

1- 1- NASAL POLYP:NASAL POLYP:  

Nasal polyps consist of focal accumulation Nasal polyps consist of focal accumulation of edema fluid and inflammatory exudate of edema fluid and inflammatory exudate in the submucosa of the nasal cavity in the submucosa of the nasal cavity followed by a fibrotic reaction of the followed by a fibrotic reaction of the surrounding soft tissue.surrounding soft tissue.  

2- 2- PAPILLARY LESIONS OF THE PAPILLARY LESIONS OF THE UPPER RESPIRATORY UPPER RESPIRATORY PASSAGESPASSAGES: :

There are three distinct varieties of There are three distinct varieties of papillary lesions that may affect the papillary lesions that may affect the upper respiratory passages:upper respiratory passages:

1.1. Fungiform papilloma - 50% of cases Fungiform papilloma - 50% of cases

2.2. Inverted papilloma - 45% of cases Inverted papilloma - 45% of cases

3.3. Oncotic papilloma - 5% of cases. Oncotic papilloma - 5% of cases.

3- 3- JUVENILE ANGIOFIBROMAJUVENILE ANGIOFIBROMA:: This is a rare tumor of vascular origin found This is a rare tumor of vascular origin found

only in males during adolescence. The high only in males during adolescence. The high vascularity of these tumors makes surgical vascularity of these tumors makes surgical removal very difficult. removal very difficult.

MALIGNANT TUMORS OF THE MALIGNANT TUMORS OF THE UPPER RESPIRATORY UPPER RESPIRATORY

PASSAGESPASSAGES

The malignant tumors of the nasal cavities The malignant tumors of the nasal cavities are either of epithelial origin, in which case are either of epithelial origin, in which case they are a carcinoma, or rarely of they are a carcinoma, or rarely of mesenchymal origin, in which case they mesenchymal origin, in which case they are a sarcoma.are a sarcoma.

The tumors of epithelial origin can be a The tumors of epithelial origin can be a

squamous cell carcinoma, a transitional squamous cell carcinoma, a transitional cell carcinoma or an adenocarcinoma cell carcinoma or an adenocarcinoma

THE PHARYNXTHE PHARYNX

PATHOLOGY OF THE PATHOLOGY OF THE PHARYNXPHARYNX

1- 1- PHARYNGITISPHARYNGITIS

Acute pharyngitis is often associated with severe Acute pharyngitis is often associated with severe edema of the soft tissue causing narrowing of the air edema of the soft tissue causing narrowing of the air passage, leading to inadequate aeration of the passage, leading to inadequate aeration of the respiratory units. respiratory units.

The edematous reaction often extends to the middle The edematous reaction often extends to the middle ear through the opening of the auditory canal ear through the opening of the auditory canal (Eustachian tube). (Eustachian tube).

MicroscopicMicroscopic examination reveals congestion of the examination reveals congestion of the blood vessels of the area, edema of the soft tissue blood vessels of the area, edema of the soft tissue that is heavily infiltrated with acute inflammatory that is heavily infiltrated with acute inflammatory cells, namely neutrophils and macrophages. cells, namely neutrophils and macrophages.

2- 2- TONSILLITIS:TONSILLITIS:

The lymphatic drainage of the upper respiratory tree is done The lymphatic drainage of the upper respiratory tree is done through the tonsils. through the tonsils.

Any infection of the area may affect the tonsils, condition Any infection of the area may affect the tonsils, condition known as tonsillitis commonly seen in children. known as tonsillitis commonly seen in children.

On On examinationexamination, the tonsils are enlarged, congested and , the tonsils are enlarged, congested and have a rough external surface that may be covered with have a rough external surface that may be covered with inflammatory exudate. Exudate is also found inside the inflammatory exudate. Exudate is also found inside the tonsillar crypts.tonsillar crypts.

MicroscopicMicroscopic examination: the inflammatory exudate is examination: the inflammatory exudate is

made of leukocytes, epithelial debris and bacteria, the made of leukocytes, epithelial debris and bacteria, the surrounding tissue is edematous and congested and there surrounding tissue is edematous and congested and there may be some degree of lymphoid hyperplasia. may be some degree of lymphoid hyperplasia.

PATHOLOGY OF THE PATHOLOGY OF THE LARYNXLARYNX

The larynx, like the upper part of the respiratory The larynx, like the upper part of the respiratory passages, is subject to two common pathologies: passages, is subject to two common pathologies: The inflammatory reactions and the neoplasms. The inflammatory reactions and the neoplasms.

There are specific symptoms that usually point There are specific symptoms that usually point to a pathology of the larynx. They consist of: to a pathology of the larynx. They consist of:

1-Hoarseness of the voice1-Hoarseness of the voice, the most common, is due , the most common, is due to alteration of the vocal cordsto alteration of the vocal cords..

2-Pain and dysphasia (problems in speech) 2-Pain and dysphasia (problems in speech) are are caused by excessive muscle contraction caused by excessive muscle contraction

3-Haemoptysis (3-Haemoptysis (expectoration of blood) is due to expectoration of blood) is due to erosion of the superficial blood vessels of the larynx. erosion of the superficial blood vessels of the larynx.

4-Respiratory distress 4-Respiratory distress resulting from narrowing of resulting from narrowing of the airways. the airways.

LARYNGITISLARYNGITIS

I- NON-SPECIFIC LARYNGITISI- NON-SPECIFIC LARYNGITIS Laryngitis whether diffuse or localized may be Laryngitis whether diffuse or localized may be

caused by an infectious organism, like the caused by an infectious organism, like the Streptococcus, the Hemophilus influenzae or it Streptococcus, the Hemophilus influenzae or it could be a reaction to an allergen.could be a reaction to an allergen.

PathologicalPathological examination of the larynx during examination of the larynx during the active phase reveals a red, congested the active phase reveals a red, congested laryngeal mucosa which at time may be laryngeal mucosa which at time may be covered with a mucous or mucopurulent covered with a mucous or mucopurulent exudate. exudate.

TUMORS OF THE LARYNXTUMORS OF THE LARYNX

A- A- BENIGN TUMORS OF THE LARYNXBENIGN TUMORS OF THE LARYNX

LARYNGEAL POLYP:LARYNGEAL POLYP: It is very common among heavy smokers. Because of the It is very common among heavy smokers. Because of the

high incidence of this lesion among singers or any high incidence of this lesion among singers or any individual with constant strain on their vocal cords, it has individual with constant strain on their vocal cords, it has been called "singer's nodule“.been called "singer's nodule“.

It usually consists of a pedunculated nodule, not larger It usually consists of a pedunculated nodule, not larger than one centimeter in diameter, located most often on than one centimeter in diameter, located most often on one of the vocal cords.one of the vocal cords.  

On microscopic examination, the polyp consists of a On microscopic examination, the polyp consists of a central core of fibro-vascular connective tissue infiltrated central core of fibro-vascular connective tissue infiltrated with inflammatory cells, and an external lining made of with inflammatory cells, and an external lining made of stratified squamous epithelium. stratified squamous epithelium.

B- MALIGNANT TUMORS OF B- MALIGNANT TUMORS OF THE LARYNXTHE LARYNX..

Most malignancies of the larynx are of Most malignancies of the larynx are of epithelial origin. epithelial origin.

Have a 7 to 1 male predominance and Have a 7 to 1 male predominance and affects most commonly the vocal cords. affects most commonly the vocal cords.

Most neoplastic lesions of the larynx Most neoplastic lesions of the larynx originate in areas of epithelial dysplasia originate in areas of epithelial dysplasia resulting from risk factors that includeresulting from risk factors that include: : cigarette smoking, alcohol cigarette smoking, alcohol consumption, asbestos exposure , consumption, asbestos exposure , irradiation exposure and the presence irradiation exposure and the presence of a papilloma.of a papilloma.

Squamous cell carcinoma of the Larynx

QuestionsQuestions

CompleteComplete: :

11 - -What are the causes of epistaxisWhat are the causes of epistaxis? ?

22 - -List some examples for the benign List some examples for the benign tumors of the respiratory passagestumors of the respiratory passages..

33 - -What does the microscopic What does the microscopic examination of pharyngitis revealexamination of pharyngitis reveal? ?

44 - -What are the benign tumors of the What are the benign tumors of the larynxlarynx ? ?

AssignmentsAssignments

AtherosclerosisAtherosclerosis كامل ابراهيم كامل رنا ابراهيم رنا طة رشدي طة رغدة رشدي رغدة أحمد الرحيم عبد علي ناصر أحمد داليا الرحيم عبد علي ناصر داليا ابراهيم الله عبد ابراهيم دعاء الله عبد دعاء كبكاب جبر شكري كبكاب ايمن جبر شكري ايمن ابراهيم محمود محمد محمود ابراهيم ايمان محمود محمد محمود ايمان صبرى الحميد عبد صبرى سمر الحميد عبد سمر

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