Page 533 - Textbook of Pathology, 6th Edition

1. Tuberculosis or lupus of the nose is uncommon and other small cell malignancies like rhabdomyosarcoma, 517
occurs secondary to pulmonary tuberculosis and usually undifferentiated carcinoma, lymphoma or Ewing’s sarcoma.
produces ulcerative lesions on the anterior part of the septum Rosettes are found in about 10% of tumours.
of the nose.
2. CARCINOMAS. Majority of carcinomas of the nasal cavity
2. Leprosy begins as a nodule that may ulcerate and and paranasal sinuses are squamous cell carcinomas,
perforate the septum. commonly called sinonasal carcinomas. They are seen more
3. Syphilis may involve the nose in congenital form causing commonly in the elderly with history of heavy smoking and
destruction of the septum, or in acquired tertiary syphilis in severe chronic sinusitis, in nickel refinery workers and in
the form of gummas perforating the septum. In either case, wood workers. The tumour extends locally to involve the
characteristic saddle-nose deformity occurs due to collapse surrounding bone and soft tissues and also metastasises
of bridge of the nose. widely. Other types of malignancies found uncommonly in
4. Aspergillosis may involve the paranasal sinuses where this location are: adenocarcinoma, adenoid cystic carcinoma,
the septate hyphae grow to form a mass called aspergilloma. mucoepidermoid carcinoma, small cell carcinoma,
lymphoma and malignant melanoma.
5. Mucormycosis is an opportunistic infection caused by
Mucorales which are non-septate hyphae and involve the
nerves and blood vessels. PHARYNX
6. Wegener’s granulomatosis is a form of necrotising NORMAL STRUCTURE
vasculitis with granuloma formation affecting the upper
respiratory tract, lungs and kidneys. In 15-50% of cases, the The pharynx has 3 parts—the nasopharynx, oropharynx
condition may evolve into malignant lymphoma. (pharynx proper) and the laryngopharynx. The whole of
pharynx is lined by stratified squamous epithelium. The
7. Lethal midline granuloma or polymorphic reticulosis lymphoid tissue of the pharynx is comprised by the tonsils
is a rare and lethal lesion of the upper respiratory tract that and adenoids.
causes extensive destruction of cartilage and necrosis of
tissues and does not respond to antibiotic treatment. Besides
the necrosis, lymphoid infiltrates of pleomorphic and atypical INFLAMMATORY CONDITIONS CHAPTER 18
cells admixed with small lymphocytes, plasma cells and LUDWIG’S ANGINA. This is a severe, acute streptococcal
macrophages are seen. Currently, the condition is considered cellulitis involving the neck, tongue and back of the throat.
to be a T cell lymphoma that may respond to chemotherapy The condition was more common in the pre-antibiotic era as
and radiotherapy (page 380). a complication of compound fracture of the mandible and
periapical infection of the molars. The condition often proves
TUMOURS fatal due to glottic oedema, asphyxia and severe toxaemia.

The tumours of nose, nasal cavity and paranasal sinuses are VINCENT’S ANGINA. Vincent’s angina is a painful
uncommon. However, benign and malignant tumours of condition of the throat characterised by local ulceration of
epithelial as well as mesenchymal origin can occur. the tonsils, mouth and pharynx. The causative organism is The Eye, ENT and Neck
Vincent’s bacillus. The condition may occur as an acute illness
Benign Tumours involving the tissues diffusely, or as chronic form consisting
1. CAPILLARY HAEMANGIOMA. Capillary haeman- of ulceration of the tonsils.
gioma of the septum of nose is a common benign lesion. If DIPHTHERIA. Diphtheria is an acute communicable disease
the surface is ulcerated and the lesion contains inflammatory caused by Corynebacterium diphtheriae. It usually occurs in
cell infiltrate, it resembles inflammatory granulation tissue children and results in the formation of a yellowish-grey
and is called ‘haemangioma of granulation tissue type’ or pseudomembrane in the mucosa of nasopharynx, oropharynx,
‘granuloma pyogenicum’. tonsils, larynx and trachea. C. diphtheriae elaborates an
2. SINONASAL PAPILLOMAS. Papillomas may occur in exotoxin that causes necrosis of the epithelium which is
the nasal vestibule, nasal cavity and paranasal sinuses. They associated with abundant fibrinopurulent exudate resulting
are mainly of 2 types—fungiform papilloma with exophytic in the formation of pseudomembrane. Absorption of the
growth, and inverted papilloma with everted growth, also exotoxin in the blood may lead to more distant injurious
called Schneiderian pailloma. Each of these may be lined with effects such as myocardial necrosis, polyneuritis,
various combinations of epithelia: respiratory, squamous and parenchymal necrosis of the liver, kidney and adrenals. The
mucous type. constitutional symptoms such as fever, chills, malaise,
obstruction of the airways and dyspnoea are quite marked.
Malignant Tumours The condition has to be distinguished from the membrane
of streptococcal infection.
1. OLFACTORY NEUROBLASTOMA OR ESTHESIO-
NEUROBLASTOMA. It occurs over the olfactory mucosa TONSILLITIS. Tonsillitis caused by staphylococci or
as a polypoid mass that may invade the paranasal sinuses streptococci may be acute or chronic. Acute tonsillitis is charac-
or skull. It is a highly malignant small cell tumour of neural terised by enlargement, redness and inflammation. Acute
crest origin that may, at times, be indistinguishable from tonsillitis may progress to acute follicular tonsillitis in which