PATHOLOGY OF NASAL CAVITY AND PARANASAL SINUSES. LARYNX.
PATHOLOGY OF LUNGS.
 MANIFESTATIONS OF RESPIRATORY DISEASES
-normal ventilation is a process that occurs subconsciously
1.) Dyspnea = alteration of normal state of breathing
-represents any disorder of breathing associated with pain due to
breathing or active awareness of the process of breathing
principal causes of dyspnea include:
 -large airway obstruction - causes respiratory difficulties- coarse noise
(stridor)
 -small airway obstruction - produces an expiratory wheeze (as in astma)major problems occur on expiration- small airways tend to collapse as
intrathoracic pressure rises
 -fluid in the parenchyma or alveoli- such as in left ventricle heart failure
and pulmonary oedema- produces a decrease of vital capacity of
respiration
 -collapse and consolidation of the parenchyma - as in pneumonia- reduces
the vital capacity
 -destruction of lung tissue - such as in chronic emphysema-reduces the
vital capacity
 -diffuse pulmonary fibrosis - produces diffusion abnormalities
 -painful lesions of chest and pleura - trauma or inflammation of the pleuraproduces limited ventilation
 -fluid or air in the pleural cavity - reduces expansion of the lung
 - pulmonary embolism - produces perfusion defects and destruction of the
lung
2.) Cyanosis = bluish discoloration of the skin and mucous membranes
caused by the presence in the periphery blood of increased amounts of
reduced hemoglobin (over 5g/dl)
 two major mechanism may lead to cyanosis:
- central cyanosis -caused by admixture of deoxygenated venous blood in the
arterial blood, such as in congenital cyanotic heart diseases with right-to-left
shunt (such as Fallot tetralogy, transposition of large vessels, Eisenmenger
complex), in pulmonary arterio-venous fistula,
- peripheral cyanosis -caused by increased reduction of normally saturated
Hb, such as in a slowing of blood flow (caused by cold), in states of extreme
cutaneous vasoconstriction such as shock
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morphologic differences - in central cyanosis- blue discoloration of mucous
membranes, such as tongue, -in peripheral cyanosis -normal mucous
membranes
3.) chest pain - the lung parenchyma is not sensitive, but the pleura is
-chest pain is caused by those diseases which are associated with
pleural inflammation- such as bacterial pneumonia, lung infarction
-pleural pain is characterized by relation to ventilatory chests
movements- associated with pleural friction rub
4.) cough - is common symptom of respiratory diseases, may be caused by
- stimulation of cough reflex by the entry of foreign particles to the larynx, by
accumulation of secretion in the lower respiratory tract
cough may be- dry- without sputum - in interstitial lung diseases
or productive of sputum - in diseases affecting alveoli and airways
5.) hemoptysis = coughing blood
-is a symptom of serious respiratory disease, hemoptysis occurs in for
example--left heart failure
-necroses of lung parenchyma- such as large infarctions, pneumonia, tbc,
etc., in lung carcinoma
 LESIONS OF UPPER RESPIRATORY TRACT
-include diseases of nasal and paranasal cavities, nasopharyngeal lesions,
diseases of the larynx and trachea
1.) Acute infections of upper respiratory tract - are among the most common
human diseases
common cold (acute rhinitis) -clinical symptoms include congestion of nasal
mucosa accompanied by watery discharge, sore throat, mild increase in
temperature
pathogenesis:
-is usually caused by rhinoviruses, parainfluenza and
influenza viruses, etc
clinical course: the infection is self-limited, lasting for about a week
-in minority of cases- common cold may be complicated by
-bacterial otitis media
-or bacterial sinusitis
 - acute pharyngitis - manifests itself as sore throat
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-morphologic changes are mild- accompanied by cold
-more severe forms of pharyngitis are associated with tonsillitis or acute
pharyngotonsillitis
-marked hyperemia, larger amounts of exudate
pathogenesis:
-most often caused by beta-hemolytic streptoccoci and
adenovirous infections
acute pharyngitis may be also a component of infectious mononucleosis
(caused by EB-virus)
-pharyngitis ulcerosa- may be caused by herpes simplex and coxsackie
viruses
 acute laryngitis -caused by allergic insults, but also may be associted with
acute pharyngitis and common cold, caused by the same infectious agents
in small children- laryngeal inflammatory reaction (edema) may narrow the
airways to that extent that it may cause acute respiratory failure
 -diphteric laryngitis- caused by corynebacterium diphteriae
-causes acute membranous inflammation of the larynx, pharynx and
trachea- bacteria produce large amounts of exotoxins- that result in
1- necrosis of the mucosal membrane epithelium- covered by
dense fibrinopurulent exudate- diphteric membrane- may be aspirated- or
may cause obstruction of major airways
2- bacterial exotoxins may result in diphteric myocarditis,
peripheral neuropathy etc.
2.) Chronic infections of upper respiratory tract
 -chronic rhinitis- chronic inflammation of the nasal cavity- repeated
nonspecific chronic bacterial infections may have a form of hyperplastic
rhinitis- possible obstruction of airways
or of atrophic chronic rhinitis-associated with strong odor from
the respiratory tract (ozena)
-chronic inflammatory and allergic nasal polyps -repeated attacks of acute
rhinitis may result in the development of inflammatory nasal polypspseudotumors composed of edematous stroma, abundant inflammatory
cells, including neutrophils, eosinophils, lymphocytes and plasma cells,
eosinophils are more numerous in allergic nasal polyps
-nasal inflammatory polyp may cause nasal obstruction- need to be
removed surgically
-antrochoanal polyp- arises from the mucosa of paranasal sinuses,
most often of maxillary sinus, it passes throgh ositum into the nasal cavity,
becomes injured, prominent vascular changes with angiomatoid
proliferation, fibrosis, deposits of hemosiderin, ulceration, etc. mimics tumor
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 -rhinoscleroma- is an uncommon chronic infection
respiratory tract- more often in eastern Europe (Poland)
of
ther
upper
-it its caused by Klepsiella rhinoscleromatis
morphology:-accumulation of foamy macrophages (Miculizc cells) filled with
bacteria and lymphoplasmacytic infiltration in nasal mucosa- result in
formation of polypoid masses and ulcerations
 -paranasal sinusitis - infiltration of accessory air sinuses (maxillary,
ethmoid, frontal)
-common complication of acute rhinitis that results from the obstruction of
the nasal openings caused by infiltration and edema of the nasal mucosa
 -Wegener s granulomatosis- is a rare disease that affects respiratory tract,
lungs and kidneys
-lesions of the nasal and paranasal mucosa are the most common and
the most characteristic of the disease
-in upper respiratory tract- there are lesions characterized by
necrotizing destructive granulomas- associated with severe vasculitis
pathogenesis: probably a form of necrotizing allergic vasculitis
 TUMORS OF UPPER RESPIRATORY TRACT
TUMORS OF NASAL CAVITY
1. - schneiderian papilloma-the most common benign tumor of the mucosa of nasal and paranasal
cavities
-histologically composed of exyphytic papillary protrusions made up of
fibrovascular stromal papillae covered by benign stratified squamous
epithelium
-common manifestation - is epistaxis (bleeding from the nasal mucosa)
and/or obstruction- removed surgically
-inverted papilloma -is a variant of squamous papilloma- similar histological
morphology, but endophytic growth pattern -has higher tendency for local
recurrences
2. sinonasal hemangiopericytoma- rare benign tumor of sinonasal mucosa, it
accounts for about 0.5% of sinonasal tumors
-it is highly vascularized, tumour cell are spindle shaped, arranged
around blood vessels in peritheliomatous structures, perivascular
hyalinization is common
-benign
 malignant tumors
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all these tumors are rare,
1. squamous cell carcinoma
2. malignant lymphoma
3. adenocarcinoma of nasal and paranasal mucosa- rare, three different
groups

intestinal type of adenocarcinoma (ITAC) is aggressive, high
grade adenocarcinoma, histologicaly identical with colorectal
cancer

non-intestinal type adenocarcinoma papillary- less aggressive,
slowly growing, low if any metastatic potential, locally aggressive
growth pattern

salivary
gland
type
adenocarcinoma,
most
commonmucoepidermoid ca, adenoid cystic ca, less ggressive than ITAC
4. olfactory neuroblastoma (estesioneuroblastoma)- high grade malignant
tumor of adults, middle and old age, the tumor has poor prognosis
5. Lethal midline granuloma
-this term was originally applied to a group of diseases characterized by
severe destructive ulcerations in the middle of the face including the nasal
cavity
-in most cases so called LMG represents high grade malignant lymphoma of
T-cell type (if Wegener and rare fungal infections were excluded)
microscopically: characterized by diffuse infiltration composed of atypical
lymphoid tumor cells accompanied by extensive tissue necroses and
ulcerations of the surface of the mucosa (caused by angiodestructive growth
of this type of lymphoma)
TUMORS OF NASOPHARYNX
1. juvenile nasopharyngeal angiofibroma-occurs in males between 10 and 25 years of age
-grossly- polypoid
nasopharynx
mass
protruding
from
the
posterior
wall
of
the
-histologically- composed of loose fibrous stroma with abundant blood
vessels, androgen receptors
prognosis: can recur, no metastases, chemotherapy may be sometimes
necessary
2. -nasopharyngeal carcinoma (Schmincke’s lymphoepithelioma )
-rare tumor associated closely with EBV infection - EBV-genome found in all
cases of NC
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-morphology: malignant epithelial tumor- undifferentiated carcinoma or
squamous nonkeratinizing or keratinizing carcinoma always associated with
abundant lymhocytic infiltration in the tumor stroma
-undifferentiated carcinoma- most common type, characterized by
syncytial pattern of tumor cells- large epithelial cells- resemble transitional
cells of the urothelium- prominent large clear nuclei, cytoplasm indistinctive,
large amounts of reactive mature lymphocytes in the tumor stroma
clinical course: highly malignant tumor- locally agressive with rapid spread
to cervical lymph nodes-often first clinical presentation of the tumor -is
cervical lymphadenopathy
- distant metastases are common- the tumor has good radiosensitivity
PSEUDOTUMORS AND TUMORS OF THE LARYNX
1-vocal cord nodule (polyp) -polypoid protrusion with smooth surface
located on the vocal cords- results from chronic irritation
-it occurs in heavy smokers, singers, teachers (singer nodes)
histology: -the nodules are composed of fibrous stroma-covered by mature
stratified squamous epithelium, there are recent or organized hemorrhages
in the stroma, edema and inflammatory cells
2-laryngeal papilloma -benign neoplasm, located on the true vocal
cords
- composed of soft finger-like multiple protrusions supported
fibrovascular stroma- covered by mature stratified epithelium
by
-when located on the free edge of the cord- ulceration may occur -resulting
in hemoptysis and exuberant epithelial regeneration- may mimick carcinoma
3- juvenile laryngeal papillomatosis
in adults- the papilloma is usually single- but in children more oftenmultiple
juvenile laryngeal papillomatosis- caused by HPV (human papilloma virus 6
and 11)
never become malignant- often spontaneous regression
3 -carcinoma of larynx
common malignant tumor - most commonly after 40 years of age- more often
in men
-environmental influences- smoking cigarettes, alcohol abuse, asbestos
exposure- may play a role in pathogenesis
histologic findings: in 95% -squamous cell carcinoma
rarely-adenocarcinoma, adenoid cystic carcinoma- arising in mucous glands
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-carcinoma arises within the laryngeal epithelium- laryngeal dysplasia -is
preneoplastic lesion - laryngeal intraepithelial neoplasia- LIN - carcinoma in
situ
-frank carcinoma- macroscopically - gray ulcerated mucosal plaques
clinical features: -persistent hoarseness is the most typical presentation
at presentation- most carcinomas are confined to the larynx- prognosis is
better
laryngeal carcinomas in advanced stage- pain, dysphagia, haemoptysis
cause of death-in most patients with laryngeal ca- infections of respiratory
tract
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