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Oral Pathology > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

what does anaplastic mean

A
  • loss of cellular differentiation

- characteristic of malignant tumors

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2
Q

what does benign mean

A
  • condition that, if left untreated, will not become life threatening
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3
Q

what is a benign tumour

A
  • not malignant and favourable for treatment and recovery
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4
Q

what does carcinoma mean

A
  • malignant tumour of EPITHELIUM
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5
Q

what does dysplasia mean

A
  • disordered growth

- alteration of size, shape and organization of cells

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6
Q

what does encapsulated mean

A
  • surrounded by capsule of fibrous connective tissue (benign)
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7
Q

what does hyperchromatic mean

A
  • staining more intensely than normal
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8
Q

what does in situ mean

A
  • dysplasia that is confined to tissue of origin, right before it crosses into basal layer
  • once in basal layer vessels can carry and metastasize
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9
Q

what is invasion

A
  • infiltration and active destruction of neighbouring tissue
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10
Q

what does malignant mean

A
  • resistant to treatment

- able to metastasize and kill the host

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11
Q

what is a malignant tumour

A
  • cancer

- tumour that is resistant to treatment, with potential for uncontrolled growth or recurrence, or both

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12
Q

what does metastasis mean

A
  • transport of neoplastic cells (cancer cells) to parts of the body remote from the primary tumour with establishment of new tumours at that site
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13
Q

what is a metastatic tumour

A
  • tumour formed by cells that have been transported from the primary tumour site, not connected to the primary tumour
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14
Q

what is a mitotic figure

A
  • dividing cells caught in process of mitosis
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15
Q

what is a neoplasia

A
  • new growth
  • formation of tumours by uncontrolled proliferation of cells
  • tumour = swelling, often used as a synonym for neoplasm
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16
Q

what is a neoplasm

A
  • tumour

- new growth of tissue which is uncontrolled and progressive

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17
Q

what is a nevus

A
  • circumscribed malformation on the skin or oral mucosa, also benign tumour of melanocytes (another word for mole)
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18
Q

what does odontogenic mean

A
  • tooth forming
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19
Q

what is oncology

A
  • study of tumors/neoplasms
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20
Q

what does pleomorphic mean

A
  • occurring in various forms
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21
Q

what is a primary tumour

A
  • original tumour, source of metastasis
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22
Q

what is a sarcoma

A
  • malignant tumour of CONNECTIVE tissue
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23
Q

what does undifferentiated mean

A
  • absence of normal differentiation = anaplasia
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24
Q

what is the difference between neoplasia and hyperplasia

A
  • unregulated and uncontrolled growth
  • cells are abnormal
  • new abnormal cells grow unregulated
  • in hyperplasia: normal cells proliferate in response to tissue damage – once stimulus is removed, healing occurs. some control on growth
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25
Q

along with a sample of the lesion, what else would a surgeon send for biopsy/pathology

A
  • patient information, ex: smoker, diabetic male, lesion – white patch, 2x8 mm buccal mucosa
  • 2-4 differential diagnoses
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26
Q

what can cause cancer

A
  • chemicals
  • viruses – oncogenic viruses
  • radiation – sunlight, x-rays
  • genetic mutation
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27
Q

what are characteristics of benign tumours

A
  • encapsulated
  • can invade adjoining tissues but cannot spread to distant sites
  • resemble normal cells
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28
Q

what are characteristics of malignant cells

A
  • invades and destroys tissue
  • unencapsulated and invasive
  • histologic appearance varies – can appear well differentiated (like normal cells) or poorly differentiated (do not resemble tissue from which it is derived)
  • can be pleomorphic: various size and shape of cells
  • hyperchromatic: dark nucleus
  • abnormal mitotic figures: due to growth
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29
Q

what does the prefix in the name of a tumour mean

A
  • the tissue/cell of origin
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30
Q

what is the suffix for benign tumours

A
  • -oma (ex osteoma)
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31
Q

what is the suffix for malignant tumours

A
  • carcinomas: of epithelial tissue, ex squamous cell carcinoma
  • melanoma: of melanocytes
  • sarcoma: of connective tissue, ex osteosarcoma (malignant tumour of bone)
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32
Q

what acronym do we use to remember malignant tumour names

A
  • SaMe Car (sarcoma, melanoma, carcinoma)
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33
Q

how do we treat benign and malignant tumours

A
  • benign: surgical excision or enucleation (removal of entire lesion without cutting it)
  • malignant: surgery, chemotherapy, radiation therapy, combination
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34
Q

what is leukoplakia

A
  • a premalignant lesion
  • clinical term, NOT histological term
  • white plaque like, does not rub off, no specific cause identified
  • histologically: hyperkeratosis, hyperplasia
35
Q

what is epithelial dysplasia

A
  • a premalignant lesion
  • abnormal cell growth
  • premalignant
  • in 5%-25% of leukoplakias, floor of mouth, ventrolateral tongue, lip, soft palate
36
Q

what do we do if we see a premalignant lesion

A
  • attempt to identify the cause,
  • rough teeth
  • rough places on dentures, fillings, crowns
  • smoking or other tobacco use (smoker’s keratosis), especially pipes
  • holding chewing tobacco or snuff in mouth for a long period of time
  • remove the cause
  • if not, biopsy
  • if in hot spots, maybe remove anyway
37
Q

what is erythroplakia

A
  • a premalignant lesion
  • granular or velvet red patch
  • floor of mouth
  • tongue
  • soft palate
  • 1 erythro for every 60 leuko
  • however, 90% epithelial dysplasia
  • must perform biopsy
  • treatment varies
38
Q

what is spekled leukoplakia

A
  • premalignant
  • red and white
  • very common
39
Q

what is the microscopic diagnosis of epithelial dysplasia

A
  • disordered growth = premalignant (squamous cell carcinoma)
  • revert to normal – remove stimulus
  • no invasion into connective tissue
  • surgically removed
  • dysplasia in other tissues NOT considered premalignant condition, only epithelium
  • carcinoma in situ – when the epithelial dysplasia involves the full thickness of the epithelium
40
Q

what is the clinical appearance of squamous cell carcinoma

A
  • clinical appearance: exophytic appearance. early tumours – eryth or leuko or combo
  • microscopic: invasion of tumour cells. through basement membrane – hyperchromatic, mitotic figures
41
Q

what are common oral areas we see squamous cell carcinoma

A
  • floor of mouth
  • ventrolateral tongue
  • soft palate
  • tonsillar pillar
  • retromolar pad
42
Q

what are some extra oral areas we may see squamous cell carcinoma

A
  • vermillion border of lips

- skin – associated with sun. better prognosis than intraoral

43
Q

what are risk factors for developing squamous cell carcinoma

A
  • tobacco (smoking, snuff, chewing)
  • alcohol consumption
  • chronic irritation – no evidence of progression to cancer (ie ill-fitting denture)
  • HPV 16
44
Q

what is a papilloma

A
  • epithelial tumour
  • squamous cell epithelium
  • benign. pedunculated or sessile
  • exophytic (grows out)
  • cauliflower like
  • soft palate and tongue
  • color – depends on keratin
  • surgical excision of the base
45
Q

what are some options for differential diagnoses for a papilloma

A
  • verruca vulgaris and condyloma acuminatum
  • different histologically
  • same treatment
46
Q

what is squamous cell carcinoma

A
  • aka epidermoid carcinoma
  • a malignant tumour of squamous epithelium
  • the most common primary malignancy of the oral cavity
  • it can infiltrate adjacent tissues and form distant metastases
  • usually metastasizes to lymph nodes in the neck and then to distant sites, such as the lungs and liver
  • clinically, it usually is an exophytic ulcerative mass
  • can infiltrate and destroy bone
47
Q

what can cause squamous cell carcinoma

A
  • exposure to the sun causes the lips to turn from dark pink to mottled grayish pink
  • the interface becomes blurred; linear fissures are seen at right angles to the line of the interface
  • solar cheilitis: a condition in which mild to severe epithelial dysplasia occurs
  • most patients are over 40 years old; most have been men, but the incidence has increased in women
  • tobacco: smoking, snuff dipping, tobacco chewing
  • alcohol consumption
48
Q

what is the TNM staging system

A
  • universal “communication and treatment planning” protocol
  • considers the following:
  • tumour size
  • nodes – palpable, same side, opposite side
  • metastasis
  • stages I-IV
  • prognosis worsens
49
Q

what is the TNM staging

A
  • T: tumour
  • T1: less than 2 cm in diameter
  • T2: 2-4 cm in diameter
  • T3: greater than 4 cm in diameter
  • T4: invades adjacent structures
  • N: nodes
  • N0: no palpable nodes
  • N1: ipsilateral palpable nodes
  • N2: contralateral or bilateral nodes
  • N3: fixed palpable nodes
  • M: metastasis
  • M0: no distant metastasis
  • M1: clinical metastasis
50
Q

HPV 16 vs oral cancers

A
  • oral cancer due to HPV = back fo tongue, tonsillar pillars, oropharynx. typically seen in younger populations
  • oral cancer due to smoking and alcohol = buccal mucosa, floor of mouth, alveolar ridge, anterior tongue and lateral borders. typically in older populations
51
Q

signs and symptoms of HPV 16 related cancers

A
  • hoarseness
  • continual sore throat, throat infection not responding to antibiotics
  • pain when swallowing or difficulty swallowing
  • pain when chewing
  • continual lymphadenopathy
  • non-healing oral lesions
  • bleeding in the mouth or throat
  • ear pain
  • lump in throat or feeling that something is stuck in the throat
52
Q

what are the treatments and prognosis for squamous cell carcinoma

A
  • surgical
  • radiation/chemo
  • radiation results in xerostomia due to salivary gland damage
  • HPV related – better prognosis even though discovered later
  • size of tumour - smaller
  • in cervical lymph nodes
  • metastases distance
53
Q

what is a verrucous carcinoma

A
  • pebbly white and red surface – a lot of keratin
  • form of SCC – smokeless tobacco
  • better prognosis. rarely metastasizes, men over 55 years old, vestibule and buccal mucosa
54
Q

what is basal cell carcinoma

A
  • caused by excessive sun exposure
  • extra oral only
  • rolled borders, non healing
  • prognosis good to fair. rarely metastasizes, invasive
55
Q

what are the microscopic characteristics of basal call carcinoma

A
  • composed of basal cells derived from squamous epithelium

- a proliferation of basal cells into underlying connective tissue

56
Q

what is the treatment of basal cell carcinoma

A
  • surgical excision
  • radiation therapy may be used to treat large lesions
  • rarely metastasizes
57
Q

what are salivary gland tumours

A
  • may arise in either major or minor salivary glands
  • minor salivary gland tumours are most often located at the junction of the hard and soft palate
  • major – parotid, submandibular or sublingual
58
Q

what are adenomas and adenocarcinomas

A
  • salivary gland tumours
  • adenomas are benign
  • adenocarcinomas are malignant
59
Q

what are the different kinds of salivary gland tumours

A
  • pleomorphic adenoma
  • monomorphic adenoma
  • mucoepidermoid carcinoma
  • adenoid cystic carcinoma
60
Q

what is a pleomorphic adenoma

A
  • a benign salivary gland tumour – 90% of all salivary gland tumours
  • microscopic: an encapsulated tumour composed of tissue that appears to be a mix of both epithelium and connective tissue
  • the most common extraoral location is the parotid gland; the most common intraoral location is the palate
  • slow-growing, painless, dome-shaped mass
  • > 40 years old
61
Q

how do we treat pleomorphic adenomas

A
  • parotid gland – remove part of gland containing tumour
  • minor gland – surgical excision
  • tumour grows with projections into surrounding tissue therefore difficult to remove entirely
  • CAN undergo malignant transformation
62
Q

what is a monomorphic ademona

A
  • a benign encapsulated salivary gland tumour. occurs less often than the pleomorphic adenoma
  • a uniform pattern of epithelial cells
  • occurs most commonly in adult females
  • occurs most often in the upper lip and buccal mucosa
  • treatment: surgical excision
63
Q

what is a warthin tumour

A
  • (papillary cystadenoma lymphomatosum) is a unique type of monomorphic adenoma
  • an encapsulated tumour with epithelial and lymphoid tissue. a painless, soft, compressible or fluctuant mass
  • usually occurs on the parotid gland, rarely intraorally. often develops bilaterally
  • occurs predominantly in adult men
64
Q

what is an adenoid cystic carcinoma

A
  • malignant tumour
  • major or minor salivary glands
  • unencapsulated, infiltrates surrounding tissue
  • slow growing – parotid common, palate common
  • excision followed by radiation if necessary
  • metastasis possible, usually distant – LUNGS
  • can metastasize in lymph nodes
  • poor prognosis
65
Q

what is a mucoepidermoid carcinoma

A
  • a malignant salivary gland tumour
  • unencapsulated, infiltrating tumour
  • a combination of mucous cells interspersed with squamous-cell like epithelial cells called epidermoid cells
  • major gland tumours are most often found in the parotid gland , minor tumours on the palate
  • appear clinically as slowly enlarging masses
  • may appear in bone as either a unilocular or multilocular radiolucency
  • may occur over a wide age range; usually occurs in adults, but is the most common malignant salivary gland tumour in children
  • treatment: surgical excision
66
Q

what are odontogenic tumours

A
  • tooth forming tissues, most are benign
67
Q

how do we characterize odontogenic tumours

A
  • by origin:
  • epithelial odontogenic tumours
  • mesenchymal odontogenic tumours
  • mixed odontogenic tumours
  • peripheral odontogenic tumours
68
Q

what is an ameloblastoma

A
  • benign
  • can be invasive
  • destruction
  • death if in max (spreads to brain)
  • soap bubble
  • 80% in mandible, causes expansion of bone
  • complete surgical excision, though common to reoccur
69
Q

what is a calcifying epithelial odontogenic tumour

A
  • benign
  • pindborg tumour
  • unilocular or multilocular
  • calcifications visible
  • less frequent than ameloblastoma
  • excision – can reoccur though less likely than ameloblastoma
70
Q

what is an adenomatoid odontogenic tumour

A
  • benign
  • 70% in females
  • does not reoccur
  • younger than 20 years
  • maxilla more common
  • seen with impacted teeth
71
Q

how does an adenomatoid odontogenic tumour appear if with impacted teeth

A
  • asymptomatic
  • like dentigerous cysts; except extends beyond CEJ and down root
  • excision/enucleation; removal of tumour only
72
Q

what is a mesenchymal odontogenic tumour

A
  • benign
  • 10-29 years old
  • soap bubble
  • poorly defined
  • cause displacement
  • most reoccur within 2 years
  • excision
73
Q

what is a central cementifying fibroma

A
  • ossifying – more bone
  • or cemento-ossifying; bone in cementum
  • benign; radiolucent to radiopaque. excision. recurrence is rare
74
Q

what is a mixed odontogenic tumour

A
  • odontoma: enamel, denten, cementum, and pulp
  • most common odontogenic tumour
  • compound: numerous small teeth, anterior max
  • complex: tooth tissues, does not resemble tooth, posterior mandible
  • clinically: prevent eruption, surgical treatment, rare to recur
75
Q

what is an ameloblastic fibro-odontoma

A
  • benign
  • cross between ameloblastic fibroma and complex odontoma
  • young adults
76
Q

what is a hemangioma

A
  • a benign vascular tumour
  • proliferation of blood vessels
  • limited growth
  • many present at birth
  • deep – macroglossia
  • superficial – bluish
  • spontaneous remission
  • surgical or injection of sclerosing solution
77
Q

what are the ABCDEs of melanin producing tumours

A
  • used when assessing pigmented skin lesions
  • asymmetry: if one half different from other
  • borders: irregular?
  • colour: varies from tan/black to red/blue
  • diameter: greater than 6 mm
  • evolving: changing!
78
Q

what is a melanocyte nevi

A
  • benign
  • tumours on skin
  • buccal mucosa
  • 2x as common in women
  • if ulcerate or change, malignant (needs excision)
79
Q

what is a malignant melanoma

A
  • tumour of melanocytes
  • malignant
  • all melanomas are malignant
  • usually secondary in oral
  • aggressive
  • blue to black mass
  • rapid growth
  • prognosis poor
  • surgery and chemo
80
Q

what is osteoma

A
  • benign
  • slow growing
  • radiopaque mass within bone – associated with Gardner’s syndrome – genetic disorder
81
Q

what is osteosarcoma

A
  • malignant tumour of bone
  • most common primary malignant tumour of bone under 40 yrs
  • average age of occurrence is 37 for jaw
  • swelling, pain
  • destructive
  • radiopaque or radiolucent
  • chemo and excision
  • 20% live past 5 years
82
Q

what is leukemia

A
  • overproduction of atypical white blood cells
  • acute: proliferation of immature wbcs, mostly children/young adults
  • fills up space so normal cells can’t be produced then spill into blood stream and affect other organs
  • treat immediately
  • chronic: mature wbcs, adults, slower progression. bone marrow transplant, chemo for chronic. oral manifestation – gingival enlargement with persistent bleeding
83
Q

what is lymphoma

A
  • non hodgkins - 89%. many various forms. T cell and B cell – 85% B cell. neoplasm of lymph nodes. aggressive. begins in lymph nodes/lymph tissue and then spreads via blood strea. may show intraoral neoplasms. slow. prognosis varies
  • hodgkins lymphoma: reed sternberg cells – one of most curable forms of cancer. orderly spread from one lymph node to another. affects B cells. tx: chemo, radiation. 90% cure rate.

Oral Pathology (9 decks)

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