Ear, Nose and Throat Histopathology

470 Pages·1987·27.853 MB·English

by  L. Michaels MD, FRCPath, FRCP(C), FCAP, DPath (auth.)

L. Michaels
Ear, Nose and Throat
Histopathology
With 405 Figures
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo
L. Michaels MD, FRCPath, FRCP(C), FCAP, DPath
Professor of Pathology and Director,
Department of Pathology and Bacteriology,
Institute of Laryngology and Otology (University of London).
Honorary Consultant Pathologist,
Royal National Throat, Nose and Ear Hospital,
London, England.
ISBN-13: 978-1-4471-3334-6 e-ISBN-13: 978-1-4471-3332-2
DOl: 10.1007/978-1-4471-3332-2
British Library Cataloguing in Publication Data
Michaels, L.
Ear, nose and throat histopathology.
I. Otolaryngology I. Title 617'. 51 RF46
ISBN-13: 978-1-4471-3334-6
Library of Congress Cataloging-in-Publication Data
Michaels, L. (Leslie)
Ear, nose, and throat histopathology.
Includes bibliographies and index.
I. Ear - Diseases. 2. Nose - Diseases. 3. Throat - Diseases. 4. Histology, Pathological. I. Title. [DNLM: I.
Otorhinolaryngologic Diseases - pathology. 2. Otorhinolaryngologic Neoplasms - pathology. WV 100 M621eJ
RF47.5.M53 1987 617'.5107'583 86-31475
ISBN-13: 978-1-4471-3334-6
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Preface
In this work I endeavour to explain the morphological changes in diseases of the human
ear, nose, larynx and pharynx. Efficient ENT practice, like that in other surgical specialties,
relies on close collaboration between surgeon and pathologist through the medium of
biopsies. Accordingly much of the present volume emphasizes diagnostic surgical pathology.
The role of the pathologist is, however, a broader one-in otolaryngology as in other
specialties-contributing as well to an understanding of the disease processes. For this pur
pose autopsy study is important and nowhere more so than in the disease of the inner ear,
an area which has been developed mainly by otologists, but neglected by pathologists. It
is hoped that, by displaying the interest and potential for development of such fields, this
book may stimulate some pathologists to work in them. I kept in mind while writing the
possibility that it might also be useful to ENT clinicians as a review of the pathology of
their specialty.
The content of this monograph displays to a large extent the pattern of practice of the
specialist institution from which it emanates. The last publication to review the broad field
of otorhinolaryngological pathology from an active ENT hospital was Histopathology of
the Ear, Nose and Throat by Andrew Eggston and Dorothy Wolff (Williams and Wilkins)
published in 1947. The 40 years which have elapsed since that work appeared have seen
important developments in otolaryngology, some of which are reflected in differences
between that volume and the present one. The successeli of antibiotic therapy have required
a reduction in size of my sections on bacterial infection. Conversely the current frequency
of congenital and early childhood hearing losses and the vast modem problem of deafness
in the elderly have led me to dwell on the pathology of these conditions. Forty years of
increased cigarette smoking and other environmental hazards together with important
improvements in endoscopic biopsy methods have demanded an emphasis on mucosal car
cinomas and their antecedents. Nevertheless, in spite of the recent expansion in the
boundaries of clinical otolaryngology, I have resisted the temptation to enlarge this work
beyond the classical confines of the ear, the nose and the throat, because of the availability
of other recent specialist pathology books in those regions bordering ENT. With regard
to dermatopathology I have varied the amount of description of particular entities according
to the present clinical practice of otolaryngologists, writing little on nasal skin but much
more on external ear lesions. There have also been changes in general histopathology since
Eggston and Wolff's treatise. Technical developments, particularly in electron microscopy
and, more recently, immunochemistry, have produced important changes in the detail, if
vi Preface
not the major outlines, of much ENT histopathology, and these have been incorporated
into the present volume. I have also elaborated on some newer methods of the laboratory
handling of specimens in the hope that it will encourage a more detailed analysis of ENT
material in many centres.
There are already a few early signs on the horizon of the likely direction of the evolution
of ear, nose and throat histopathology. I hope that this work will be of some value as a
stepping-stone to the next exposition of the field.
Acknowledgements
I am happy to acknowledge my debt to Professor D. F. N. Harrison for the provision of
much of the material upon which this work is based and to the scientific staff in the Depart
ment of Pathology and the Institute of Laryngology and Otology, London, for the technical
preparation of this material. With regard to the latter I am particularly grateful for the
skills of the following members of the staff: Mr. John Boxall, Principal, Mr. Tony Frohlich,
Chief, Mr. Colin Brewer, Chief, and Mr. John Cooper and Mr. Neil Bilbe, Senior, Medical
Laboratory Scientific Officers. Thanks are also due to the Department of Clinical Photo
graphy at the Institute of Laryngology and Otology: Mr. Andrew Gardner, Miss Caroline
Lonnen and Mr. Mark Swinford (now at St. Bartholomew's Hospital). Mrs. Judith Revesz
expertly processed the manuscript, Dr. Len Crome critically reviewed it and Mr. Michael
Jackson, Medical Editor of Springer-Verlag, gave much encouragement when progress on
it seemed slow. Mr. Peter Zwarts, Librarian, helped with the references. Thanks are also
due to clinicians, pathologists and medical laboratory scientific officers who provided
material, collaboration and advice.
The following photographs have been published by myself in other works and permission
to reproduce them is gratefully acknowledged. Source details are as follows:
Michaels L (1987) In: Ruben R, Alberti PW (eds) Otologic medicine and surgery. Churchill
Livingstone, Edinburgh, Chap 1.02
Figs. 1.9-2.28
Michaels L (1987) In: Ruben R, Alberti PW (eds) Otologic medicine and surgery. Churchill
Livingstone, Edinburgh, Chap 3.03
Figs. 2.1, 2.3-2.18, 3.1-3.13, 3.15-3.19,4.1--4.12,5.1-5.13
Michaels L (1987) In: Ruben R, Alberti PW (eds) Otologic medicine and surgery. Churchill
Livingstone, Edinburgh, Chap 3.04
Figs. 6.1 and 6.2, 7.1, 8.2-8.6, 9.1-9.4, 9.6 and 9.7, 10.1, 10.4 and 10.5, 11.2-11.6
Michaels L (1984) Pathology of the larynx. Springer, Heidelberg BerlilJ. New York Tokyo
Figs. 28.2-28.21, 29.1-29.4, 30.1-30.14, 31.1-31.17, 32.1-32.4, 33.1-33.11, 34.1-34.11,
35.1-35.28,36.1-36.9,36.11-36.21, 37.1-37.15, 38.1-38.17
London, 1987 Leslie Michaels
Contents
Part A THE EAR
1 The Normal Ear ...................................................... 3
Examination in the Histopathology Laboratory ........................... 3
Normal Histology .................................................... 11
2 Non-neoplastic Lesions ofthe External Ear ................................ 25
Malformations .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Inflammatory Lesions ................................................. 27
Metabolic Conditions ................................................. 33
Lesions Simulating Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3 Otitis Media ......................................................... 41
Microbiology ........................................................ 41
General Pathological Changes .......................................... 41
Acute Otitis Media ................................................... 42
Chronic Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Cholesterol Granuloma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Tympanosclerosis ..................." ................................. 46
Cholesteatoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Secretory Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
9omplications ....................................................... 51
Tuberculous Otitis Media .............................................. 53
Vlll Contents
4 Neoplasms ofthe External Ear ......................................... . 55
Epithelial Neoplasms ................................................. . 55
Melanotic Neoplasms ................................................ . 61
Neoplasms of Bone and Cartilage ...................................... . 62
Neural Neoplasms ................................................... . 64
Neoplasms of Muscle ................................................ . 64
Histiocytosis X ...................................................... . 64
5 Neoplasms and Similar Lesions of the Middle Ear .......................... . 67
Developmental Tumour-like Anomalies ................................. . 67
Neoplasms ......................................................... . 68
Metastatic Neoplasms ................................................ . 75
6 Malformations and Congenital Lesions ofthe Inner Ear 77
Pathogenesis in Relation to Development ................................ . 77
Problems in Classification ............................................. . 77
Structural Forms of Malformation ..................................... . 78
Aetiology of Malformations ........................................... . 80
Haemorrhage in the Inner Ear in Very Low Birth Weight Infants ............ . 85
7 Trauma; Ototoxicity ................................................. . 89
Trauma ............................................................ . 89
Ototoxic Damage to the Inner Ear ...................................... . 90
8 Infections of the Inner Ear .......................................... ... . 95
Viral Infections ..................................................... . 95
Bacterial Infections .................................................. . 97
Mycotic Infections ................................................... . 100
Syphilis ............................................................ . 101
9 Meniere's Disease; Pathology of the Vestibular System; Presbyacusis .......... 103
Meniere's Disease .................................................... 103
Pathology of the Vestibular System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 106
Presbyacusis ......................................................... 108
10 Bony Abnormalities ................................................... 113
Paget's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113
Osteogenesis Imperfecta ............................................... 115
Osteopetrosis ........................................................ 116
Achondroplasia ...................................................... 116
Otosclerosis .'........................................................ 117
Contents ix
11 Neoplasms of the Inner Ear 121
Primary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
Directly Invading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 124
Metastatic. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 125
Part B THE NOSE AND PARANASAL SINUSES
12 The Normal Nose and Paranasal Sinuses .................................. 131
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 131
Histology ........................................................... 133
Examination at Autopsy ............................................... 135
Examination of Surgical Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 136
13 Infections ........................................................... 137
Acute Inflammation .................................................. 138
Bacterial Infections ................................................... 139
Mycotic Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145
Myospherulosis ...................................................... 149
Protozoal Infections .................................................. 150
14 Non-infective Inflammatory Conditions ................................... 153
Nasal and Paranasal Polyposis. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. 153
Nasal and Polyposis with Stromal Atypia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155
Inspissated Mucus .................................................... 156
Nasal Polyposis and the Immotile-Cilia Syndrome ......................... 156
Granuloma Following Local Steroid Injections ............................ 157
Cholesterol Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 157
Rhinitis Caseosa ..................................................... 158
Granuloma Pyogenicum ............................................... 159
Organizing Haematoma ............................................... 159
Giant Cell Granulomatous Lesions ...................................... 159
Wegener's Granulomatosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 160
Midline Granuloma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 162
Eosinophilic Angiocentric Fibrosis ...................................... 163
15 Papilloma ........................................................... 165
Papillomas of Nasal Vestibule and Nostril ................................ 165
Papillomas of Nasal Cavity and Paranasal Sinuses ......................... 165
16 Malignant Neoplasms of Surface Epithelium ............................... 171
Squamous Cell Carcinoma of Nasal Vestibule ............................. 171
Squamous Carcinoma of Mucosae ...................................... 171
Cylindric Cell Carcinoma .............................................. 174
x Contents
17 Non-epidermoid Epithelial Neoplasms .................................... 177
Adenocarcinoma ..................................................... 177
Pleomorphic Adenoma ................................................ 180
Carcinoma ex Pleomorphic Adenoma and Malignant Mixed Tumour ......... 181
Oncocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 181
Acinic Cell Carcinoma ................................................ 181
Clear Cell Carcinoma ................................................. 182
Adenoid Cystic Carcinoma ..............................._ . . . . . . . . . . . . .. 182
Mucoepidermoid Carcinoma ........................................... 185
Necrotizing Sialometaplasia ............... . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 186
18 Neuroectodermal Tumours ............................................. 189
Encephalocele and Glioma ............................................. 189
Meningioma ...... '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 190
Neurogenic Tumours ................................................. 191
Malignant Melanoma ................................................. 192
Olfactory Neuroblastoma .............................................. 194
Melanotic Neuroectodermal Tumour ofInfancy (Melanotic Progonoma) ...... 199
19 Vascular Neoplasms; Myogenic Neoplasms ................................ 203
Hereditary Haemorrhagic Telangiectasia (Osler-Weber-Rendu Disease) ....... 203
Capillary Haemangioma of Nasal Septum ................................ 203
Cavernous Haemangioma ....................................... ~ . . . .. 205
Angiomatosis ........................................................ 205
Haemangiosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206
Systemic Angioendotheliomatosis ....................................... 206
Haemangiopericytoma ................................................ 206
Myogenic Neoplasms ................................................. 207
Neoplasms of Striated Muscle .......................................... 209
20 Neoplasms of Fibrous Tissue ............................................ 211
Fibroma ............................................................ 211
Fibromatosis .......................................... : ............. 211
Fibrosarcoma ........................................................ 212
Fibrohistiocytic Tumours .............................................. 213
Myxoma ............................................................ 215
21 Neoplasms of Cartilage and Bone ........................................ 219
Chondroma ......................................................... 219
Chondrosarcoma .................................... . . . . . . . . . . . . . . . .. 220
Osteoma ............................................................ 22 J
Fibrous Dysplasia, Ossifying Fibroma, Cementifying Fibroma: Benign
Fibro-osseotis Lesion ............................................... 222
Contents xi
Osteosarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 224
Ewing's Sarcoma ..................................................... 226
22 Miscellaneous Conditions: Lymphoma and Plasmacytoma; Histiocytosis X;
Extranodal Sinus Histiocytosis; Teratomas and Cysts; Tumours Arising Outside
ofthe Sinonasal Tract ................................................. 227
Lymphoma and Plasmacytoma ......................................... 227
Histiocytosis X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 230
Extranodal Sinus Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 231
Dermoid Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 231
Nasolabial Cyst ...................................................... 231
Teratoma ........................................................... 233
Mucocele ........................................................... 234
Tumours Arising Outside of the Sino nasal Tract 234
Part C THE NASOPHARYNX
23 Normal Anatomy and Histology; Adenoids; Infections; Developmental Lesions ... 239
Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239
Examination at Autopsy ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239
Histology ........................................................... 239
Adenoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 240
Infections ........................................................... 241
Nodules and Cysts of Embryological Origin ............................... 241
Congenital Choanal Atresia ............................................ 243
24 Epithelial Neoplasms .................................................. 245
Epidermoid Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 245
Non-epidermoid Neoplasms ............................................ 250
Pituitary Adenoma ................................................... 250
25 Non-epithelial Neoplasms .................... ,. . . . . . . . . . . . . . . . . . . . . . . . .. 253
Angiofibroma (Juvenile Nasopharyngeal Angiofibroma) .................... 253
Rhabdomyosarcoma ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 257
Chordoma .......................................................... 259
Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 261
Part D THE PALATINE TONSIL
26 Normal Anatomy, Histology; Inflammatory Diseases. . . . . . . . . . . . . . . . . . . . . . .. 265
Normal Anatomy .................................................... 265