Nasal, oral and pharyngeal diseases: Pathology review

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Nasal, oral and pharyngeal diseases: Pathology review

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A 50-year-old man presents to the office with a two-month history of hoarseness and sore throat. He initially came to the office approximately two months ago with similar symptoms and was treated empirically for an upper respiratory infection. Since then, he has developed night sweats and experienced a 2 kg (4.4 lb) weight loss. He has not experienced heartburn, hearing loss, epistaxis, or nasal congestion. He smokes one pack of cigarettes per day and consumes 3 alcoholic beverages daily. Vital signs are within normal limits. On physical examination, the left tonsil is enlarged, with an area of ulceration present on the mucosa. Overproduction of which of the following proteins is most likely involved in the pathogenesis of this patient’s condition? 


While in the ENT Clinic, two people present with trouble breathing through the nose and have frequent nose bleeds. One of them is a 25 year old individual named Andrew, and the other one is an 18 year old individual named Sarah. Andrew says the problems appeared gradually and feels like something is stuck in the nose. Andrew also has a history of aspirin allergy. On examination, everything seems normal, except for a decrease in the sense of smell. Sarah, on the other hand, has noted these problems ever since childhood. Sarah also mentioned that the symptoms get worse during the spring or proximity to flowers. On examination, presentation is nasal congestion and red, itchy, swollen eyes with frequent bouts of sneezing. Blood tests were normal in both individuals.

Now, from what we can gather, both have some type of nasal, oral, or pharyngeal disease. But first, a bit of anatomy. The nasopharynx is an open chamber located below the base of the skull and behind the nasal cavity. The nasopharynx contains structures like the adenoids, also known as the pharyngeal tonsils; the Waldeyer's tonsillar ring, which is a ring-like arrangement of lymphoid tissue in both the nasopharynx and oropharynx; the Rosenmüller fossa, which is part of the lateral recess of the nasopharynx and a common site of nasopharyngeal cancers; and the eustachian tube orifices. Now, the nasopharynx connects the nasal cavity and oropharynx, which is posterior to the oral cavity that contains structures like the salivary glands, soft and hard palate, tongue, and tonsils.


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