Infectious Rhinitis.

Infectious rhinitis, the more elegant way of saying "common cold," is in most instances caused by one or more viruses. Major offenders are adenoviruses, echoviruses, and rhinoviruses.

They evoke a profuse catarrhal discharge that is familiar to all and the bane of the kindergarten teacher. During the initial acute stages, the nasal mucosa is thickened, edematous, and red;

the nasal cavities are narrowed; and the turbinates are enlarged. These changes may extend, producing a concomitant pharyngotonsillitis. Secondary bacterial infection enhances the

inflammatory reaction and produces an essentially mucopurulent or sometimes frankly suppurative exudate. But as everyone knows, these infections soon clear up—as the saying goes, in a

week if treated but after 7 days if ignored.

Figure 16-9 A, Nasal polyps. Low-power magnification showing edematous masses lined by epithelium. B, High-power view showing edema and eosinophil-rich inflammatory infiltrate.

Figure 16-10Inverted papilloma. The masses of squamous epithelium are growing inward; hence, the term inverted. (Courtesy of Dr. James Gulizia, Brigham and Women's Hospital,

Boston, MA.)

Figure 16-11Nasopharyngeal carcinoma, lymphoepithelioma type. The syncytium-like nests of epithelium are surrounded by lymphocytes. (Courtesy of Dr. James Gulizia, Brigham and

Women's Hospital, Boston, MA.)

Figure 16-12 A, Laryngeal carcinoma. Note the large, ulcerated, fungating lesion involving the vocal cord and piriform sinus. B, Histologic appearance of laryngeal squamous cell

carcinoma. Note the atypical lining epithelium and invasive keratinizing cancer cells in the submucosa.

Figure 16-13Diagrammatic comparison of a benign papilloma and an exophytic carcinoma of the larynx to highlight their quite different appearances.

Figure 16-14Carotid body tumor. A, Low-power view showing tumor clusters separated by septa (zellballen). B, High-power view of large, eosinophilic, slightly vacuolated tumor cells

with elongated sustentacular cells in the septa.

Figure 16-15Mucocele. A, Fluctuant fluid-filled lesion on the lower lip subsequent to trauma. B, Cystlike cavity filled with mucinous material and lined by organizing granulation tissue.

TABLE 16-4-- Histologic Classification and Approximate Incidence of Benign and Malignant Tumors of the Salivary Glands

Benign Malignant

Pleomorphic adenoma (50%) (mixed tumor) Mucoepidermoid carcinoma (15%)

Warthin tumor (5%–10%) Adenocarcinoma (NOS) (10%)

Oncocytoma (1%) Acinic cell carcinoma (5%)

Other adenomas (5%–10%) Adenoid cystic carcinoma (5%)

••Basal cell adenoma Malignant mixed tumor (3%–5%)

••Canalicular adenoma Squamous cell carcinoma (1%)

Ductal papillomas Other carcinomas (2%)

NOS, not otherwise specified. Data from Ellis GL, Auclair PL: Tumors of the Salivary Glands. Atlas of Tumor Pathology, Third Series. Washington, DC, Armed Forces Institute of

Pathology, 1996.

ear. In general, when they are first diagnosed, both benign and malignant lesions range from 4 to 6 cm in diameter and are mobile on palpation except in the case of neglected malignant

tumors. Although benign tumors are known to have been present usually for many months to several years before coming to clinical attention, cancers seem to demand attention more

promptly, probably because of their more rapid growth. Ultimately, however, there are no reliable criteria to differentiate, on clinical grounds, the benign from the malignant lesions, and

morphologic evaluation is necessary.

Date: 2016-04-22; view: 817