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Oral Pathology > 10 Epithelial Pathology > Flashcards

10 Epithelial Pathology Flashcards

1
Q

squamous papilloma

A
  • benign proliferation, may be viral
  • low infectivity and virulence
  • usually <1/2cm
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2
Q

verruca vulgaris

A
  • HPV virus, frequent in kids
  • infrequent in oral cavity, usually <5mm
  • cutaneous horn form = keratin accumulation
  • cryotherapy, surgery, 2/3 will disappear in 2 years
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3
Q

condyloma acuminatum

A
  • viral, considered STD

- teens, young adults

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4
Q

verruciform xanthoma

A
  • whites, 40-70yrs old, females
  • 50% gingiva and alveolar mucosa
  • most <2cm
  • hyperplastic epithelium, accumulation of lipid laden histiocytes
  • papillary lesion, unknown cause
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5
Q

focal epithelial hyperplasia

A
  • viral proliferation of squamous cells
  • multiple flat rounded papule clusters (not white)
  • hallmark is considerable acanthosis
  • spontaneous regression after months to years
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6
Q

seborrheic keratosis

A
  • skin condition of elderly, hereditary tendency
  • benign proliferation of epidermal basal cells, chronic sun exposure
  • dermatosis papulosa nigra in 30% of blacks
  • numerous seborrheic keratosis with pruritus associated with internal malignancy (laser-trelat sign)
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7
Q

ephelis (freckle)

A
  • most in fair-skinned, blue eyes, red or blond hair
  • less prominent with age
  • sunscreen prevents new and darkening of old
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8
Q

actinic lentigo

A
  • age/liver spot up to 1cm
  • chronic UV damage, not malignant
  • 90% whites over 70
  • no darkening after sun exposure
  • retinoic acid reduces intensity, laser removes
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9
Q

melasma

A
  • mask of pregnancy
  • symmetric hyperpigmentation of sun exposed face/neck
  • topical treatment 3% hydroquinone and tretinoin
  • minimal sun exposure prevents
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10
Q

oral melanotic macule

A
  • flat, brown discoloration
  • not sun related except on labia
  • 2:1 female, 40+ and 33% vermilion zone
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11
Q

melanin pigmentation

A
  • racial/physiologic
  • peutz-jeghers syndrome, addison’s disease, neurofibromatosis
  • chronic trauma, autoimmune disease
  • smoker’s melanosis
  • chloroquine, quinine derivatives, phenolphthalein, estrogen, AIDS meds
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12
Q

oral melanoacanthoma

A
  • benign, no treatment needed
  • characteristic dendritic macrophages throughout epithelium
  • exclusively blacks, mostly female
  • mostly buccal mucosa, 3rd-4th decade
  • grows quickly, biopsy to rule out melanoma
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13
Q

acquired melanocytic nevus

A
  • common mole, 1 in million risk of melanoma
  • neural crest origin
  • most present before 35
  • whites more than asians/blacks
  • intraoral and gingiva
  • junctional, compound, intramucosal
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14
Q

leukoplakia

A
  • white lesion that doesn’t rub off
  • 20% premalignant or malignant at biopsy
  • 85% of all oral precancer lesions
  • 3% white adults, 70% male
  • tobacco, alcohol, sanguinaria, UV, microorganism, trauma
  • average age 60 (same as cancer)
  • high risk in floor of mouth, ventral tongue, soft palate
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15
Q

precancerous leukoplakia changes

A
  • proliferative verrucous leukoplakia usually leads to squamous cell carcinoma within 8 years
  • enlarged, hyperchromatic nuclei
  • pleomorphic nuclei
  • abnormal mitotic figures
  • keratin pearls
  • loss of epithelial cohesiveness
  • progression from thin to homogenous and thick to granular leukoplakia
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16
Q

dysplasia

A
  • mild, moderate, severe, carcinoma-in-situ
  • must breach basement membrane to be cancer
  • can’t metastasize without invasion
  • hyperkeratosis, hyperparakeratosis, hyperorthokeratosis, acanthosis
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17
Q

erythroplakia

A
  • red lesion that does not rub off
  • no known cause
  • 80-90% premalignant or malignant
  • epithelial cells no longer produce keratin
  • usually advanced dysplasia
  • in mixed lesions always biopsy the red!
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18
Q

smokeless tobacco use

A
  • painless loss of gingiva and tissue at site of use
  • caries common
  • smokeless tobacco keratosis in 15% chewing tobacco and 60% snuff users
  • more common in India with use of betal nut, areca nut, slaked lime
  • lesions that remain +6 weeks after cessation must be biopsied
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19
Q

oral submucous fibrosis

A
  • chronic, progressive, scarring, high risk precancerous related to betal quid placement
  • slaked lime releases alkaloid from areca nut causing euphoria
  • causes mucosal rigidity, trismus, pain when when eating spicy food
  • stiffness of subepithelial tissues
  • submucosal fibrous bands on buccal mucosa, soft palate, and lingual mucosa
  • brown-red discoloration, high malignant transformation
  • leukoplakia common
20
Q

actinic cheilitis

A
  • premalignant change in lower lip from UV exposure
  • 10:1 males
  • scaly, peels off and reforms
  • focal ulcerations with smoking
  • sqaumous cell carcinoma 6-10%, preventable cancer
21
Q

squamous cell carcinoma

A
  • 3% of cancers, 3:1 males
  • 65+white men greatest risk, middle age greatest risk in blacks
  • tobacco, alcohol, phenols, radiation, iron/vitmain A deficiency, syphilis, candidiasis, oncogene activation
  • 50% tongue lesions (2/3 posterior lateral border and ventral, 20% anterior lateral border, 4% dorsal tongue)
  • 35% of intraoral cancer in floor of mouth, earlier in females, mostly near midline frenum, most often associated with second primary malignancy
22
Q

SCCa and tobacco smoking

A
  • 80% oral cancer patients smoke
  • 2-6x great chance of 2nd cancer
  • greater risk for pipes/cigars
  • 50% palate cancers from reverse smoking
  • nonsmokers with oral cancer: female, young, mutation of p53/suppresor genes
23
Q

SCCa and smokeless tobacco

A
  • 1:1.5 male to female

- 50% of cancer at site of use

24
Q

SCCa and betal quid

A
  • slaked lime enhances absorption of molecules
  • lifetime risk 8%
  • 200 million + users
25
Q

SCCa and alcohol

A
  • significant promoter
  • 15x increase when combined with smoking
  • liver cirrhosis found in 20% male oral cancer patients
26
Q

SCCa and phenols

A
  • increased risk in wood products industry from chemical exposure
  • also increased risk of nasal and nasopharyngeal cancers
27
Q

SCCa and radiation

A
  • UV radiation and lip cancer
  • radiation decreases immune reactivity and causes chromosome changes
  • fibrosis and difficulty in diagnosis
28
Q

SCCa and iron deficiency

A
  • plummer-vinson syndrome associated with SCCa of esophagus, oropharynx, posterior mouth
  • earlier malignancies with iron deficiency
  • impaired cell-mediated immnunity
  • fibrous bands of scar tissue forms in esophagus
29
Q

SCCa and vitamin A deficiency

A
  • excessive keratinization
  • vitamin A may be preventative for cancer
  • betacarotene and retinoic acid associated with dysplasia regression
30
Q

SCCa and syphilis

A
  • leutic glossitis
  • tertiary stage associated with dorsal tongue cancer
  • arsenic and heavy metals used for treatment before antibiotics may be cause
31
Q

SCCa and candidiasis

A
  • associated with and probably superimposed

- produces carcinogenic nitrosamines

32
Q

SCCa and oncogenes

A
  • HPV implicated in many cancers

- not enough evidence to link HSV

33
Q

oropharyngeal cancer

A
  • 3/4 in tonsillar area or soft palate, rest at base of tongue
  • initially pain and dysphagia
34
Q

cancer staging

A

T - size of primary tumor
N - lymph node involvement
M - distant metastisis

35
Q

oral cancer prognosis

A

lip cancers - 95% 5 yr survival
anterior 2/3 tongue cancers - 80% local, 20% metastasized
posterior 1/3 tongue cancers - 80% metastasized, 20% local

36
Q

verrucous carcinoma

A
  • possible HPV 16 association
  • associated with smokeless tobacco
  • leukoplakia and tobacco pouch keratosis may also be present
  • may arise from proliferative verrucous leukoplakia
  • less aggressive than SCCa
37
Q

maxillary sinus cancer

A
  • elderly, 80% of cases are advanced
  • unilateral stuffiness, ulceration or mass of hard palate
  • intense facial pain if trigeminal nerve invovled
  • loose teeth, ‘motheaten’ appearance on radiographs
  • protrusion of eyeball
38
Q

basal cell carcinoma

A
  • 85% on skin of head and neck
  • incidence increasing 3-7% per year, and with age
  • adult, whites, fair complexion
  • does not metastasize
  • nevoid basal cell carcinoma syndrome
39
Q

melanoma

A
  • UV, but not as important as with BCCa or SCCa
  • acute damage more important than chronic exposure
  • 2-8x increase with family history
  • red hair, fair skin, blue eyes = increased risk
  • history of painful, blistering sunburns or congenital/dysplastic nevi
  • 3rd most common skin cancer, rare orally
40
Q

melanoma types

A
  • superficial spreading melanoma
  • nodular melanoma
  • lentigo malignant melanoma
  • acral lentiginous melanoma
41
Q

superficial spreading melanoma

A
  • most common form
  • 70% cutaneous lesions
  • interscapular region in males, posterior legs in females
  • appearance of surface nodules or induration after precursor macule
  • satellite macules around primary lesion
42
Q

nodular melanoma

A
  • 15% of cutaneous melanomas
  • appears as nodular elevation (vertical growth phase) and rapidly invades connective tissue
  • may lack pigment (amelanotic)
43
Q

lentigo maligna melanoma

A
  • 5-10% cutaneous melanomas
  • precursor lesion called lentigo maligna (hutchinson’s freckle)
  • purely radial growth phase melanoma-in-situ
  • sun exposed skin of elderly
44
Q

acral lentigerous melanoma

A
  • most common form in blacks
  • most common oral melanoma
  • palms of hands, soles of feet, mucous membranes
  • oral melanoma often nodular, mostly hard palate or maxillary alveolus
  • 2/3 male, 6-7th decades
45
Q

ABC’s of melanoma

A
  • asymmetry - because of uncontrolled growth
  • border irregularity - often notching
  • color veriegation - brown, black, white, red and blue
  • diameter - 6+mm (pencil eraser)
46
Q

melanoma prognosis

A
  • oral melanoma 20-45% 5 yr survival
  • level of tumor invasion is important
  • worse prognosis for lesions on back, posterior upper arm, lateral neck, and scalp

Oral Pathology (16 decks)

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