1. Faculty of Allied Medical Sciences Histopathology and Cytology (MLHC-201)

2. Prof. Dr. Noha Ragab PATHOLOGY OF THE RESPIRATORY SYSTEM PATHOLOGY OF THE RESPIRATORY PASSAGES

3. Intended Learning Outcomes By the end of this lecture, the student should know : 1- The causes of sinusitis and epistaxis. 2- The benign and malignant tumors of the respiratory passages. 3- Pathology of the larynx and the pharynx.

5. EPISTAXIS OR NOSE BLEED EPISTAXIS OR NOSE BLEED This very common condition, most often the result of a trauma, may also be caused by: 1. Systemic diseases including hypertension 2. Blood diseases. 3. Local inflammatory reactions or neoplastic diseases of the nasal tissue. 4. Ulceration and perforation caused by various factors including trauma, infection and cocaine abuse.

6. INFLAMMATION OF THE AIR SINUSES OR SINUSITIS SINUSITIS: During the acute phase of rhinitis, the edematous nasal mucosa around the drainage foramen of the sinuses closes the opening of the air sinuses. During the acute phase of rhinitis, the edematous nasal mucosa around the drainage foramen of the sinuses closes the opening of the air sinuses. The mucus accumulates inside the sinus cavities and provides an adequate medium for the growth of bacteria and fungi. The mucus accumulates inside the sinus cavities and provides an adequate medium for the growth of bacteria and fungi.

8. TUMORS OF THE RESPIRATORY PASSAGES

9. A- BENIGN TUMORS OF THE RESPIRATORY PASSAGES 1- NASAL POLYP: 1- NASAL POLYP: Nasal polyps consist of focal accumulation of edema fluid and inflammatory exudate in the submucosa of the nasal cavity followed by a fibrotic reaction of the surrounding soft tissue. Nasal polyps consist of focal accumulation of edema fluid and inflammatory exudate in the submucosa of the nasal cavity followed by a fibrotic reaction of the surrounding soft tissue.

11. 2- PAPILLARY LESIONS OF THE UPPER RESPIRATORY PASSAGES: There are three distinct varieties of papillary lesions that may affect the upper respiratory passages: There are three distinct varieties of papillary lesions that may affect the upper respiratory passages: 1. Fungiform papilloma - 50% of cases 2. Inverted papilloma - 45% of cases 3. Oncotic papilloma - 5% of cases.

13. 3- JUVENILE ANGIOFIBROMA : This is a rare tumor of vascular origin found only in males during adolescence. The high vascularity of these tumors makes surgical removal very difficult. This is a rare tumor of vascular origin found only in males during adolescence. The high vascularity of these tumors makes surgical removal very difficult.

14. MALIGNANT TUMORS OF THE UPPER RESPIRATORY PASSAGES The malignant tumors of the nasal cavities are either of epithelial origin, in which case they are a carcinoma, or rarely of mesenchymal origin, in which case they are a sarcoma. The malignant tumors of the nasal cavities are either of epithelial origin, in which case they are a carcinoma, or rarely of mesenchymal origin, in which case they are a sarcoma. The tumors of epithelial origin can be a squamous cell carcinoma, a transitional cell carcinoma or an adenocarcinoma The tumors of epithelial origin can be a squamous cell carcinoma, a transitional cell carcinoma or an adenocarcinoma

15. THE PHARYNX

16. PATHOLOGY OF THE PHARYNX 1- PHARYNGITIS Acute pharyngitis is often associated with severe edema of the soft tissue causing narrowing of the air passage, leading to inadequate aeration of the respiratory units. Acute pharyngitis is often associated with severe edema of the soft tissue causing narrowing of the air passage, leading to inadequate aeration of the respiratory units. The edematous reaction often extends to the middle ear through the opening of the auditory canal (Eustachian tube). The edematous reaction often extends to the middle ear through the opening of the auditory canal (Eustachian tube). Microscopic examination reveals congestion of the blood vessels of the area, edema of the soft tissue that is heavily infiltrated with acute inflammatory cells, namely neutrophils and macrophages. Microscopic examination reveals congestion of the blood vessels of the area, edema of the soft tissue that is heavily infiltrated with acute inflammatory cells, namely neutrophils and macrophages.

18. 2- TONSILLITIS: The lymphatic drainage of the upper respiratory tree is done through the tonsils. The lymphatic drainage of the upper respiratory tree is done through the tonsils. Any infection of the area may affect the tonsils, condition known as tonsillitis commonly seen in children. Any infection of the area may affect the tonsils, condition known as tonsillitis commonly seen in children. On examination, the tonsils are enlarged, congested and have a rough external surface that may be covered with inflammatory exudate. Exudate is also found inside the tonsillar crypts. On examination, the tonsils are enlarged, congested and have a rough external surface that may be covered with inflammatory exudate. Exudate is also found inside the tonsillar crypts. Microscopic examination: the inflammatory exudate is made of leukocytes, epithelial debris and bacteria, the surrounding tissue is edematous and congested and there may be some degree of lymphoid hyperplasia. Microscopic examination: the inflammatory exudate is made of leukocytes, epithelial debris and bacteria, the surrounding tissue is edematous and congested and there may be some degree of lymphoid hyperplasia.

20. PATHOLOGY OF THE LARYNX The larynx, like the upper part of the respiratory passages, is subject to two common pathologies: The inflammatory reactions and the neoplasms. The larynx, like the upper part of the respiratory passages, is subject to two common pathologies: The inflammatory reactions and the neoplasms. There are specific symptoms that usually point to a pathology of the larynx. They consist of: There are specific symptoms that usually point to a pathology of the larynx. They consist of: 1-Hoarseness of the voice, the most common, is due to alteration of the vocal cords. 2-Pain and dysphasia (problems in speech) are caused by excessive muscle contraction 3-Haemoptysis (expectoration of blood) is due to erosion of the superficial blood vessels of the larynx. 4-Respiratory distress resulting from narrowing of the airways.

21. LARYNGITIS I- NON-SPECIFIC LARYNGITIS Laryngitis whether diffuse or localized may be caused by an infectious organism, like the Streptococcus, the Hemophilus influenzae or it could be a reaction to an allergen. Laryngitis whether diffuse or localized may be caused by an infectious organism, like the Streptococcus, the Hemophilus influenzae or it could be a reaction to an allergen. Pathological examination of the larynx during the active phase reveals a red, congested laryngeal mucosa which at time may be covered with a mucous or mucopurulent exudate. Pathological examination of the larynx during the active phase reveals a red, congested laryngeal mucosa which at time may be covered with a mucous or mucopurulent exudate.

22. TUMORS OF THE LARYNX A- BENIGN TUMORS OF THE LARYNX LARYNGEAL POLYP: LARYNGEAL POLYP: It is very common among heavy smokers. Because of the high incidence of this lesion among singers or any individual with constant strain on their vocal cords, it has been called "singer's nodule“. It is very common among heavy smokers. Because of the high incidence of this lesion among singers or any individual with constant strain on their vocal cords, it has been called "singer's nodule“. It usually consists of a pedunculated nodule, not larger than one centimeter in diameter, located most often on one of the vocal cords. It usually consists of a pedunculated nodule, not larger than one centimeter in diameter, located most often on one of the vocal cords. On microscopic examination, the polyp consists of a central core of fibro-vascular connective tissue infiltrated with inflammatory cells, and an external lining made of stratified squamous epithelium. On microscopic examination, the polyp consists of a central core of fibro-vascular connective tissue infiltrated with inflammatory cells, and an external lining made of stratified squamous epithelium.

23. B- MALIGNANT TUMORS OF THE LARYNX. Most malignancies of the larynx are of epithelial origin. Most malignancies of the larynx are of epithelial origin. Have a 7 to 1 male predominance and affects most commonly the vocal cords. Have a 7 to 1 male predominance and affects most commonly the vocal cords. Most neoplastic lesions of the larynx originate in areas of epithelial dysplasia resulting from risk factors that include: cigarette smoking, alcohol consumption, asbestos exposure, irradiation exposure and the presence of a papilloma. Most neoplastic lesions of the larynx originate in areas of epithelial dysplasia resulting from risk factors that include: cigarette smoking, alcohol consumption, asbestos exposure, irradiation exposure and the presence of a papilloma.

24. Squamous cell carcinoma of the Larynx

25. Questions Complete : 1- What are the causes of epistaxis ? 2- List some examples for the benign tumors of the respiratory passages. 3- What does the microscopic examination of pharyngitis reveal ? 4- What are the benign tumors of the larynx?

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

27. Thank You