Diseases of upper

respiratory tract
Dr.Mahmoud Elprawy
 Case Scenario
A young lady complains of nasal obstruction. ENT
examination shows a polypoid lesion in the nasal
cavity and paranasal sinuses. Biopsy examination
shows edematous stroma with numerous
eosinophils.
A.What is the diagnosis?

B.Is this lesion precancerous or not?

C.What are the expected complications?

Nose :
Inflammation ( nasal polyp and
rhinoscleroma )

Nasopharynx
Inflammation
Adenoid
Tumor : Nasopharyngeal angiofibroma
Nasopharyngeal Carcinoma

Tonsil
Inflammation ( Diphteria )

Larynx
Inflammation
Tumor ( sq cell carcinoma )

Pesudo-stratified columnar ciliated

epi with goblet cells except for larynx
and vocal cords >>> squamous epith
 Inflammatory Nasal Polyps

• Definition: finger like projections arising from the

mucosa of the nose and paranasal sinuses due to
inflammatory process.

• Causes:
1. Chronic hypertrophic rhinitis and sinusitis.
2. Repeated attacks of allergic rhinitis and
sinusitis.
N/E: = MUCOUS
Site: On the middle turbinate bones & within the
maxillary sinus.
Size: Variable sizes.
Shape: Pedunculated (may be sessile).
Surface: Smooth and shiny surface (opaque with
squamous metaplasia).

Consistency: Soft in consistency (gelatinous).

Colour: Pink or gray (mucoid).
Number: Multiple and bilateral.
M/E:

1- Covering epithelium:
- Hypeplastic pseudostratified ciliated.

- Squamous metaplasia is common.

2- Core of connective tissue with:

Edema.

Hyperplastic mucous glands, some cystic.

Mixed acute & chronic Inflammatory cells.

If eosinophils predominate; the polyps are allergic.MCQ

Complications:

Nasal obstruction.

Epistaxis.

Squamous cell carcinoma on top of squamous metaplasia

2) Chronic Specific inflammation (Granuloma)

• Tuberculosis

• leprosy

• Syphilis

• Rhinoscleroma may involve and destroy the

nasal structures.
 Rhinoscleroma
• A destructive infective granuloma of
upper respiratory tract

• primarily in the nose

• caused by Klebsiella
Rhinoscleromatis.

• It is endemic in Egypt.
• N/E:
1) The primary site is the nose:
- It is enlarged & hard.
- Mucous membrane is thick, granular & a nodular
stage or single large mass.

2) Extend to upper lip, nasal sinuses, naso- or

oropharynx, larynx and trachea with soft
tissue destruction MCQ
• M/E:

- Surface epithelium: hyperplasia or squamous

metaplasia.
- Subepithelium:
a- Mickulicz cells (hydropic degeneration of
macrophages). M>M MCQ
b- Russel bodies (hyaline change of plasma
cells). B>P MCQ
c- Lymphocytes and plasma cells.
d- Granulation tissue ending in fibrosis.
• Complications:
- Nasal obstruction.
- Epistaxis.
- Squamous cell carcinoma.
- Ulceration and 2ry bacterial infection.
- Nasal deformity

‫اى التهاب ينحسر او ينتشر او يتضاءل‬

- Spread of inflammation to upper lip, nasal sinuses,
naso- or oro-pharynx (pharyngoscleroma), larynx
(laryngoscleroma) & trachea.
 Nasopharynx
A- Inflammation (Nasopharyngitis)

(1) Acute Nasopharyngitis:

- It is the most common cause of sore throat MCQ
- Causes: Viral or Bacterial.
- Pathology: Acute catarrhal, mucopurulent, or
purulent inflammation.

(2) Chronic Nasopharyngitis:

- It follows acute Nasopharyngitis.
- Pathology: hypertrophic inflammation which passes to
atrophic one (pharyngitis sicca).
(3) Adenoids:

Definition: Inflammatory hyperplasia

of lymphoid tissue in the posterior

wall of nasopharynx

usually in children.

Cause: it follows rhinitis,

nasopharyngitis, tonsillitis.
- Adenoid Facies: MCQ
* Narrow nasal openings.
* Open mouth.
* Short upper lip.
* Protruding central upper
incisors.
* Absent nasolabial fold.
* Fibrosis and atrophy occurs
after puberty
N/E:
Swelling in the nasopharynx
which reachs maximum size
at 3 years of age producing
obstruction and mouth
breathing.
M/E:
hyperplasia of the lymphoid tissue with
chronic non-specific inflammation.

Complications:
- Nasal obstruction and mouth
breathing.

- 2ry infection with spread to middle

ear (otitis media) or down the
respiratory tract).
Nasopharyngeal fibroma (Juvenile angiofibroma)
Incidence: Uncommon, male children.

Origin: From the fibrous tissue of periosteum.

N/E: Non capsulated grayish pink

highly vascular mass
projecting in the nasopharynx
may extend to nasal cavity, cheek, orbit.
cause bone destruction by pressure atrophy.
M/E: Small vascular spaces set in poorly
cellular fibrous tissue.

Complication:
Bleeding (epistaxis).
 Nasopharyngeal carcinoma

• Adenocarcinoma: related to wood

dust (e.g. in furniture workers) MCQ

• Squamous cell carcinoma.

• Anaplastic carcinoma (related to

Epstein Barr virus).MCQ Nasopharyngeal carcinoma
Remember >>> Burkitt lymphoma also
caused by EBV MCQ
Tonsils
I- Inflammation

A- Acute Inflammations:

(1) Diphtheria:

- Acute infectious fever caused by

corynebacterium diphtheriae, in unimmunised
children between 2-5y
- Method of infection: droplet infection.

- Pathology:
via exotoxin:

1- Locally: pseudomembranous inflammation.

2- Reach distant organs via blood →→Acute toxemia

3- The draining cervical L.Ns and spleen show

lymphoid hyperplasia and focal necrosis.

Ccomplication is an important Question

Acute tonsillitis naked eye vs.microscopic picture
 Larynx
I- Inflammation (Laryngitis)
A- Acute laryngitis:
Causes:
- Infective: mostly viral
- Non infective: Excessive or faulty use of vocal cords,
tobacco smoke, and atmospheric pollution
Pathology:
- Acute catarrhal which may pass to muco-purulent, or
purulent inflammation.
Acute Laryngitis naked eye vs. microscopic
picture
 Squamous Cell Carcinoma of
the Larynx
Incidence: is a common tumour of the larynx.
Percancerous lesions are:
- Squamous cell papilloma (of adult). - Leukoplakia
Pathology:
1) Verrucous carcinoma:
2) Classic invasive squamous cell carcinoma.
 Intrinsic Extrinsic
Incidence 80% ‫حلو‬ 20% ‫وحش‬
Sex Male Female
Age Above 50 years Below 50 years
N/E:
Site: From vocal cords. (Glottic) Outside the vocal cords.
Shape: Fung.> Ulcer > infiltrating Infiltrating>Ulcer> fung.
M/E: Well diff. Sq. C. Carcinoma. Poorly diff Sq C Carcinoma.
Prognosis: Good due to: Bade due to:
*Early diagnosis (early * Late diagnosis (dysphagia
hoarseness of voice) then laryngeal signs &
symptoms).
* Slowly growing. * Rapidly growing.
* Well differentiated tumor. * Undifferentiated.
* Easily removed due to * Difficult removal due to
fungating growth. infiltrative growth
Radiosensitivity Radiosensitive. Radiosensitive.
RadioResistant
Spread. Local to surrounding structure
Lymphatic to cervical L.N.
Blood: late and disseminates extensively
 Glottic
Carcinoma

Supra-Glottic
Carcinoma
Descripe the pathological
feature
THANK YOU