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Pathology I > epithelial Neoplasia > Flashcards

epithelial Neoplasia Flashcards

1
Q

what is squamous papilloma and what causes it

A
  • benign, HPV induced proliferation of stratified squamous epithelium
  • HPV 6, 11
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2
Q

what are the clinical features of squamous papilloma

A
  • most common in adults
  • most common sites: soft palate, tongue, lips
  • soft, painless, exophytic nodule
  • numerous fingerlike surface projections- papillary appearance
  • white, red, normal in color
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3
Q

what is the tx for squamous papilloma and will it recurr

A
  • surgical excision
  • recurrence unlikely
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4
Q

what is verruca vulgaris

A
  • benign, HPV induced proliferation of stratified squamous epithelium
  • HPV 2
  • predominatly a skin lesion
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5
Q

what are the clinical features of verruca vulgaris

A
  • most common on skin of hands
  • rarely occurs intraorally
  • children and adults
  • painless papule or nodule with papillary projections
  • rough, pebbly surface
  • pink, white, yellow
  • may be multiple, clustered
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6
Q

what is the treatment for verruca vulgaris

A
  • skinL topical salicylic acid, lactic acid, liquid nitrogen cryotherapy
  • surgical excision for atypical cases
  • oral: surgical excision, laser ablation
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7
Q

what is the histo apperance of squamous papilloma

A

papillary epithelium

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8
Q

what is the histo of verruca vulgaris

A
  • papillary projections
  • all keratin
  • cup shaped proliferation
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9
Q

what is condyloma acuminatum

A
  • HPV induced proliferation of stratified squamous epithelium of the anogenital region, mouth and larynx
  • 90% cases- HPV 6 and 11 may have co-infection with high risk types
  • common STD
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10
Q

what are the clincial features and tx for condyloma acuminatum

A
  • dx in teens, adults
  • most common sites: labial mucosa, soft palate, lingual frenum
  • sessile, pink, exophytic mass
  • short, blunted surface projections
  • usually larger than papilloma greater than 1 cm
  • treatment: surgical excision, laser ablation
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11
Q

what is the histo apperance of condyloma acuminatum

A
  • papillary projections
  • more endophytic projections
  • koilocytes are the main feature
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12
Q

what is sebarrheic keratosis

A
  • benign proliferation of epidermal basal cells
  • common skin condition in elderly
  • positive correlation with sun exposure
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13
Q

what are the clinical features and tx for seborrheic keratosis

A
  • develops on the skin of face, trunk ,extremities
  • begin to develop in the 4th decade
  • sharply demarcated plaques
  • fissured, pitted, verrucous or smooth surface
  • stuck onto the skin
  • dermatosis papulosa nigra: variant of SK
  • tx: seldom removed, unless aesthetic purposes, may resemble melanoma
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14
Q

what is dermatosis papulosa nigra

A
  • a variant of SK
  • commonly observed in black individuals
  • multiple small (1-4mm) dark- brown to black papules on skin
  • scattered around the face, especially zygomatic, periorbital region
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15
Q

what is the histo of SK

A
  • proliferation of epidermis- basal epithelial cells
  • canthosis of epidermis
  • looks wide and thick
  • pseudocystic structures are most common characteristic
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16
Q

what is a melanocytic nevus

A
  • benign, local proliferation of nevus cells
  • may arise from surface epithelium or underlying connective tissue
  • very common
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17
Q

what are the clinical features and tx of melanocytic nevus

A
  • begin to develop during childhood, most earlier than 35 years
  • most common in white individuals
  • flat or elevated soft nodule
  • smooth surface
  • often mulitple
  • rare in oral cavity
  • tx: usually not indicated
  • if it changes in size may need biopsy
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18
Q

what is a tobacco pouch keratosis

A
  • smokeless tobacco: chewing tobacco, moist snuff, dry snuff
  • results from contact with caustic agents with tobacco
  • low malignant transformation potential
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19
Q

what are the clinical features and tx of tobacco pouch keratosis

A
  • grey/white fissured or wrinkled patch
  • diffuse, poorly defined margins
  • gingival recession
  • treatment: normal appearance 2-6 weeks after habit cessation
  • biopsy severe lesions
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20
Q

what is frictional keratosis

A
  • keratosis produced by trauma: teeth, ill fitting denturesw
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21
Q

what are the clinical features and tx of frictional keratosis

A
  • lower lip mucosa, lateral tongue, buccal mucosa
  • edentulous alveolar ridge- benign alveolar ridge keratosis (BARK)
  • diffuse white keratotic areas
  • tx: biopsy, no further tx because no malignant potential
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22
Q

describe nicotine stomatits

A
  • mucosal change of hard palate in response to heat in tobacco smoke
  • MC in pipe smoking
  • not premalignant
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23
Q

what are the clinical features and treatment of nicotine stomatitis

A
  • most common in older men over 45 years
  • numerous elevated papules with punctate red centers on palate
  • palatal mucosa- diffusely grey or white
  • tx: reversible, palate usually returns to normal 2 weeks after smoking cessation
  • encourage patient to stop smoking
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24
Q

what is leukoplakia

A
  • a white plaque of questionable risk having excluded known diseases or disorders that carry no increased risk for cancer
  • precancerous lesion
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25
Q

what are the risk factors for leukoplakia

A
  • tobacco smoking- 80% of patients with leukoplakia, heavy smokers, larger and more lesions, may regress with smoking cessation
  • alcohol- synergistic effect with tobacco smoking
  • UV light- luekoplakia on lip vermillion- actinic chelitis
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26
Q

what are the clinical features for leukoplakia

A
  • middle age- eldery adults
  • male predilection
  • ventral tongue, FOM and soft palate are more likely to show dysplasia
  • well defined borders
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27
Q

what is dysplasia

A

abnormal cells that precede the development of cancer

28
Q

what do early/thin leukoplakias look like

A

-flat, white/grey plaque, may be translucentw

29
Q

what do homogenous/thick leukoplakias look like

A

leathery, fissured white plaque

30
Q

what do non homogenous leukoplakias look like

A

nodular or verrucous areas
- erythroleukoplakia: scattered patches of redness

31
Q

what is proliferative verrucous leukoplakia

A
  • multifocal disease
  • 4:1 female
  • mean age is 7th decade
  • more than 45% cases associated with tobacco
  • malignant transformation 70-100%
32
Q

what are the clinical features of proliferative verrucous leukoplakia

A
  • nonhomogenous leukoplakia
  • verrucous, nodular, erythroleukoplakia
  • gingiva is most common site
  • multifocal areas
33
Q

what is the histo for PVL

A

severe dysplasia, larger nuclei to cytoplasm ratio, arranged randomly, no nuclei in keratin, papillary exophytic keratin

34
Q

what is the tx for leukoplaki

A
  • incisional biopsy
  • guided by histologic dx
  • hyperkeratosis, mild dysplasia- require follow up
  • moderate, severe dysplasia, or carcinoma in situ
  • PVL is difficult to treat, high recurrence
  • SCC- refer to H and N oncology team
  • follow up every 3-6 months for PVL
35
Q

what is erythroplakia

A
  • a red patch that cannot be clinically or pathologically diagnoses as any other condition - precancerous lesion
  • almost all true erythroplakias demonstrate significant dysplasia, carcinoma in site or invasive SCC
  • related to tobacco and alcohol use
36
Q

what is an erythroleukoplakia

A

intermixed red and white lesion

37
Q

what are the clinical features and tx of erythroplakia

A
  • most common in middle aged aults
  • FOM, tongue, soft palate
    -well demarcated, erythematous patch
  • soft- velvety texture
    -tx: guided by histologic dx, dysplasia or carcinoma in situ- excised with clear margins, SCC refer to H&N oncology team
38
Q

what is actinic chelitis

A

-diffuse, precancerous alteration of lower lip vermilion
- excessive UV light
- light complexioned individual who sunburn easy

39
Q

what are the clinical features and tx for actinic chelitis

A
  • most common in fair skin individuals
  • middle age to elderly adults
  • strong male prediliction 10:1
  • blurring of vermillion border of lip and skin
  • rough scaly areas develop
  • tx: areas of induration, ulceration or leukoplakia should be biopsied, encourage sun protection
40
Q

what is squamous cell carcinoma

A
  • oral cancer- 2% of all cancer types in the US
  • most common oral cancer- 90% of oral cancer
  • multifactorial cause
41
Q

what are the risk factors for squamous cell carcinoma

A
  • extrinsic factors: tobacco, alcohol, UV light
  • smokers: 3x risk compared to non smokers
  • tobacco and alcohol: 15x risk
  • intrinsic factors: systemic states, general malnutrition or iron deficiency anemia, hereditary states. iron deficiency anemia- impaired cell immunity
42
Q

what are the clinical features of squamous cell carcinoma

A
  • most common in older adults over 50 years
  • male prediliction
  • most common sites: tongue, lateral and ventral surface: 50% , FOM is another common site
  • hard palate and dorsal tongue uncommon sites
  • may be asymptomatic
  • exophytic (mass forming)
  • endophytic (ulcerating) - rolled borders, indurated
  • leukoplakia ( white patch)
  • erythroplakia (red patch) or erythroleukoplakia
43
Q

what is the treatment for SCC

A
  • consists of radical excision, possible radiation/chemotherapy
  • tumor size and metastatic spread- best indicators of prognosis
  • oral and pharyngeal 5 year survival: 64%
44
Q

what is the histo for SCC

A
  • need to see invading inslands of dysplastic sqmoua islands with dark purple cells in between the islands
45
Q

describe verrucous carcinoma

A
  • low grade variant of oral SCC
  • smokeless tobacco particularly implicated
46
Q

what are the clinical features and tx for verrucous carcinoma

A
  • most common in older adults abve 55 years
  • male predilection
  • mandibular vestibule, buccal mucosa, gingiva, tongue, and hard palate
  • exophytic thick white or pink, papillary surface
  • patients usually asymptomatic
  • tx: complete surgical excision, 90% are disease free after 5 years
47
Q

what is the histo for verrucous carcinoma

A
  • broad bulbous rete ridges and deep parakeratin clefts
48
Q

what is HPV positive oropharyngeal SCC

A
  • HPV 16 and 18 implicated
  • 225% increase from 1988 to 2004
  • oropharyngeal infection with HPV 16 causes 14x risk for SCC
  • HPV implicated in 70% of SCC
  • HPV viral genes: E6 and E7- prooncogenic
49
Q

does HPV in oral cancer have significant clinical implications

A

no

50
Q

while HPV ____ oropharyngeal HPV is on the rise, HPV _____ oropharyngeal SCC has declined

A
  • positive, negative
51
Q

why have HPV. positive inclined and HPV negative declined

A
  • increase in oral sexual behavior and decline in tobacco use
52
Q

HPV + carcinoma is strongly associated with:

A

sexual behavior

53
Q

what are the clinical features ofr HPV positive oropharyngeal SCC

A
  • median age is mid 50’s
  • male 4:1
  • increasing incidence in younger patients
  • oropharyngeal sites: soft palate, base of tongue, tonsillar region, and posterior pharyngeal wall
  • persistent sore throat, dysphagia, hoarseness
  • unexplained weight loss
  • cervical lymphadenopathy
  • clinically present similarly to oral SCC
54
Q

what is the tx for HPV positive oropharyngeal SCC

A
  • 70% of HPV associated OPSCC patients present with stage III/IV disease
  • minimally invasive surgical techniques, radiation/chemotherapy
  • prevention- encourage HPV vaccine
  • gardasil 9 recommended
  • protectie against: HPV 6,11,16,18,31,33,45,52,58
55
Q

what is the prognosis for HPV positive oropharyngeal SCC

A
  • HPV positive POSCC has improved outcomes
  • 3 year survival greater than 82% HPV positive vs 57% HPV negative OPSCC
56
Q

what is basal cell carcinoma

A
  • most common skin cancer
  • locally invasive, slowly spreading malignancy
  • arises from basal cell layer of skin
  • 80% cases arise in head and neck
  • chronic exposure from UV light
57
Q

what are the clinical features and tx for basal cell carcinoma

A
  • most common in patients younger than 40
  • most common in white individuals with fair skin
  • 2x more common in males
  • firm, painless papule, slowly enlarges and develops central depression
  • teleangiectatic blood vessels often present
  • tx: radical surgery, rare metastasis, 95% cure rate
58
Q

what is the histo for basal cell carcinoma

A
  • hypochromic islands that look like droplets coming off epithelium
59
Q

what is a melanoma

A
  • malignant neoplasm of melanocytic origin
  • may arise de novo or from a benign entity
  • UV light major causative factor
60
Q

what are the risk factors for melanoma

A
  • fair complexion
  • a tendency to sunburn or freckle easily
  • excessive history of melanoma
  • family history of melanoma
  • personal history of dysplastic or congential nevus
  • personal history of excessive common nevi
61
Q

what are the clinical features of melanoma

A
  • most common in 5-9th decade
  • most common site for women is lower extremeities
  • most common site for men is back
  • ABCDE of melanoma
  • oral melanoma: MC on palate, maxillary alveolar ridge
62
Q

what is the tx for melanoma

A
  • radical surgical excision
  • depth of invasion correlates with prognosis
  • 5 year prognosis for oral melanoma: 10-25%
  • 5 year prognosis for skin melanoma: thin and confined to skin-90%. regional metastasis- 40-78% distant metastasis- 15-20%
63
Q

what is the ABCDE checklist for melanoma

A
  • A: asymmetry
  • B: border: uneven or jagged
    -C: color: more than one color
  • D: diamter: greater than 6mm
  • E: evolution: moles that evolve suddenly in size, shape, color, elevation
64
Q

what is the histo for melanoma

A

islands of malignant melanocytes and aberrant pigmentation and cells look irregular

65
Q
A

Pathology I (24 decks)

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