2. Premalignant Lesions of Surface Epithelial Origin Flashcards Preview

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Flashcards in 2. Premalignant Lesions of Surface Epithelial Origin Deck (110)
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What is the normal histology of the oral mucosa?

parakeratinized, stratified squamous epithelium


What part of the oral mucosa isn't parakeratinized?

Palate and Gingiva, which is orthokeratinized


Dysplasia involving the entire thickness of the epithelium with: no maturation and no keratin.

CIS - highest grade of dysplasia


What do all grades of dysplasia except CIS show?

Some keratin production on the surface


Why are dysplasia and CIS not considered cancer?

There is no invasion with access to blood and lymphatics


What are the 4 histological architectural changes that occur with dysplasia and CIS?

  • Bulbous or teardrop-shaped rite ridges
  • Loss of polarity
  • Keratin or epithelial pearls
  • Loss of epithelial cell cohesiveness, but intact bm b/c no invasion


What are the 6 histological cytologic changes that occur with dysplasia and CIS?

  • Enlarged cells, nuclei and nucleoli
  • Increased nuclear:cytoplasmic
  • Hyperchromatism
  • Pleomorphism (cellular and nuclear)
  • Increased, altered and displaced mitoses
  • Dyskeratosis (premature keratinization of individual cells)


Where do up to 50% of oral malignancies occur, that are associated with reverse smoking? 

Hard palate

This is an unusual location


How many years after cessation does it take, before your cancer risk is that of non-smokers?

10 years


Risk for what is 2-6x greater than of those that quit smoking after their 1st cancer?

2nd primary UADT Carcinoma 


What is the Clinical Appearance of Smokeless Tobacco Keratosis?

  • A reactive change to placement of the product
  • Gray/white, translucent plaque with rippled appearance and blending borders,
  • Probably isn't a true leukoplakia


What is the presence of dysplasia seen with Smokeless Tobacco?

Infrequently ~3%, compared to 5-25% for Leukoplakia


What in Betel Quid or Paan Quid causes euphoria by enhancing the alkaloids released from the areca nut?

Slaked lime


What is the lifetime risk for developing oral cancer due to betel chew or paan quid use?


Even tobacco-free Paan increases risk 


What is Oral Submucous Fibrosis associated with? 

Habit of Betel Nut Chewing


What is Oral Submucous Fibrosis?

  • A chronic progressive scarring disease of the oral mucosa 
  • High-risk Precancerous Condition


In the pathogenesis of Oral Submucous Fibrosis, what does the areca nut primarily due?

Stimulates Fibrosis 


In the pathogenesis of Oral Submucous Fibrosis?

  • Alkaloid from the areca nut -->
  • Stimulates fibroblasts to synthesize collagen 


In the pathogenesis of Oral Submucous Fibrosis, what effect do high levels of copper have?

increase collagen cross-linking 


What is the initial clinical presentation of Oral Submucous Fibrosis? 

  • Vesicles
  • Petechiae
  • Xerostomia
  • Generalized Oral Burning Sensation (Stomatopyrosis) with Intolerance to spicy foods


What gradually forms as Oral Submucous Fibrosis progresses? (3)

  • Formation of fibrous bands with oral pallor and stiffness
    • Lose depth of the vestibule due to scaring
    • Soft palate has a pale look due to all of the collagen laid down
  • Leading to increasing Trismus
  • Develop Leukoplakic lesions, with dysplasia that have a tendency to undergo malignant transformation


What is the Histology of Oral Submucous Fibrosis?

  • Hyperkeratosis with epithelial atrophy & atypia is seen
  • Pronounced collagen deposition in submucosal CT


What may be used to improve mild cases & severe cases of trismus associated with Oral Submucous Fibrosis?

  • Intalesional corticosteroids
  • Surgical splitting of fibrous bands, with skin grafts & mouth props, physiotherapy 


Does cessation of betel nut habit stop Oral Submucous Fibrosis?

No, but the pt should still d/c betel nut habit

This is in contrast to the cessation of smoking tobacco 



What percent of Oral Submucous Fibrous cases show dysplasia at initial biopsy?


  • All pts should be biopsied to confirm dx & assess for dysplasia
  • Biopsy even if they don't have a Leukoplakia


What percent of Oral Submucous Fibrosis cases undergo malignant transformation to SCCA in a 17 yr period?



How much of an increased risk do Oral Submucous Fibrosis pts have for developing Oral Cancer?



What carcinogens does marijuana release at a 50% higher levels than tobacco?

Polycyclic hydrocarbons & Acetaldehyde like tobacco 


What is a promotor of tobacco, creating a synergistic effect to develop cancer (RR=15)




What is the pathogenesis of alcohol?

  • Ethanol turns to acetaldehyde (carcinogenic)
  • Carcinogenic impurities in alcoholic drinks