7 Benign/Premalignant Epithelial Lesions Flashcards
(61 cards)
1
Q
HPV
- # of subtypes?
- # of type identified in lesions affected the head and neck?
- # of genuses of the family
- 2 major groups:
- basic structure?
A
- 200 subtypes
- ~24 that affect head/neck
- 5 genuses of the Papillomaviridae family
- 2 groups: cutaneous and mucosal
- circular dsDNA
2
Q
most common sexually transmitted infection in the US, but not all are sexually transmitted
A
HPV
3
Q
How does HPV infects cells?
A
Virus is epitheliotropic –> enters through wounds/abrasion and infects basal cells (only actively dividing cells in the epithelium)
4
Q
low risk HPV
A
- viral genome remains separate in the host nucleus
- replication of the viral genome occurs in parallel with host genome replication
- stable viral copy number distributed among daughter epithelial cells
5
Q
low risk HPV types
A
6, 11 (squamous papilloma, condyloma aacuminatum)
6
Q
benign papillary proliferation of squamous epithelium, all ages, any location
A
squamous papilloma
7
Q
Clinical findings: -
- “wart-like”
- exophytic
- soft
- pedunculated or sessile
- finger-like projections
- pink or white
A
squamous papilloma and verruca vulgaris
8
Q
tx of squamous papilloma
A
surgical removal
9
Q
aka common wart
A
verruca vulgaris
10
Q
benign papillary proliferation of squamous epithelium, any location but skin is most common
A
verruca vulgaris (common wart)
11
Q
single papillary lesion (2)
A
squamous papilloma
verruca vulgaris
12
Q
clinical findings: exophytic, soft, pedunculated or sessile, rough papillary surface, can see multiple lesions, pink or white
A
verruca vulgaris
13
Q
tx for verruca vulgaris
A
surgical removal (oral), cryotherapy (skin)
14
Q
any age but most commonly adolescents and young adults, multiple lesions
A
condyloma acuminatum
15
Q
incubation period of condyloma acuminatum
A
1-3 months from time of sexual contact
16
Q
caused by HPV 6, 11
A
squamous papilloma
condyloma acuminatum
17
Q
causes 90% of genital warts
A
condyloma acuminatum
18
Q
Clinical findings: more likely sessile, pink, well-demarcated, nontender exophytic mass, short, blunted surface projections (cauliflower like
A
condyloma acuminatum
19
Q
tx of condyloma acuminatim
A
surgical excision
20
Q
tx for all intraoral warts
A
- recommend surgical removal
- laser ablation has been used (airborne secretions of HPV possible)
- some lesions may resolve on their own
- recommend removal given risk of spread (discuss risk of spread with patients)
- not routinely evaluated by the pathologist for the presence of high-risk HPV genotypes
21
Q
caused by HPV 13, 32
A
multifocal epithelial hyperplasia (Heck’s disease)
22
Q
initially reported in Native Americans and Innuits
A
multifocal epithelial hyperplasia (Heck’s disease)
23
Q
age group affected by multifocal epithelial hyperplasia (Heck’s disease)
A
children most common
24
Q
most common sites affected by multifocal epithelial hyperplasia
A
labial, buccal, and lingual mucosa
25
Clinical findings:
- 3-10 mm lesions
- multiple, usually clustered
- coalescing (merge together)
- soft
- nontender
- flattened or rounded papules
- color of normal mucosa
- spontaneous regression after months or years
- rarely seen in adults
multifocal epithelial hyperplasia (Heck's disease)
26
tx for Heck's disease
biopsy for dx, monitor, remove lesions subject to recurrent trauma, remove for aesthetic purposes
27
HPV vaccine
Gardasil 9-9vHPV
28
Gardasil
- Age given recommended?
- Age range given?
- Expanded age range?
11-12 yo
9-26 yo
27-45
29
CDC guideline for the decision on whether or not to give the gardasil vaccine to pts 27-45
shared clinical decision making
30
benign OR premalignant
smokeless tobacco keratosis
31
formation of a white plaque where the mucosa directly contacts the tobacco product
smokeless tobacco keratosis
32
appearance is wrinkled, fissured, or rippled ("sand on a beach at ebbing tide")
smokeless tobacco keratosis
33
state that uses the most smokeless tobacco
West Virgina
Wyoming
Mississippi
34
Smokeless tobacco contains ____ carcinogens.
28
35
forms of smokeless tobacco
Chewing tobacco
Snuff- dry or moist, fire cured
Snus- steam pasteurized
36
consequences of smokeless tobacco use
- caries due to high sugar levels
- gingival recession/bone loss
- staining of teeth
- halitosis
- cardiovascular disease
- oral cancer increases with long term use
37
ADA reports ___x greater risk for oral cancer for those who use smokeless tobacco than never users
4x
38
Which is better? wet or dry snuff
wet snuff
39
histo: hyperkeraotic, acanthotic (thickened, hyperplastic) epithelium, fibrosis of CT, dysplasia may be seen
smokeless tobacco keratosis
40
tx for smokeless tobacco keratosis
- counsel pt to quit
- if unwilling, have them move product to different site
- lesion should resolve in 2-6 weeks following cessation
- biopsy if lesion persists after 6 weeks without tobacco use
41
What does a severe biopsy look like?
intensely white, sharply defined borders, verrucous surface, ulceration, erythematous appearance, induration (palpable mass under the surface) or mass
42
High risk sites for premalignant/malignant lesions:
What percentage of all oral cancers occur in these location?
lateral/ventral tongue, roof of mouth, soft palate/oropharynx (lower lip also but develops from UV exposure so very different behavior)
90% of oral cancers occur in these locations!!
43
- white plaque that cannot be diagnosed clinically as another entity
- cannot be wiped off
- has a risk to develop into cancer
- more commonly has sharply defined borders
- a clinical term only, have to biopsy to know what it is (may be benign, premalignant, or malignant)
leukoplakia
44
cannot be wiped off
leukoplakia
45
average age of leukoplakia
60
46
Patients at increased risk for cancer development within a leukoplakia include:
- female patients
- nonsmokers
- persistent lesion over several years
- lesion on the floor of mouth or ventral tongue
47
After biopsy, leukoplakia may be:
- hyperkeratosis
- atypia (atrophy, acanthosis, hyperplasia)
- mild, moderate, or severe dysplasia
- carcinoma in-situ
- SCC
48
What does normal squamous look like?
- cells above the basal layer show progressive flattening of the cell body
- nuclear condensation as the cell differentiates/matures
- mitoses are almost never seen above the basal layer
49
histo appearance of dysplasia
- enlarged nuclei and cells
- large and prominent nucleoli
- increased nuclear-to-cytoplasmic ratio
- hyperchromatic nuclei (darkly staining)
- pleomorphic nuclei and cells
- dyskeratosis- premature keratinization
- increased mitotic activity
- abnormal mitotic figures
- mitotic figures above the basal layer
- bulbous (teardrop) shaped rete ridges
- lack of maturation toward surface
50
mild vs moderate vs severe vs full thickness dysplasia
Mild = extends to basilar 1/3 of the epithelium
Moderate = extends to basilar 1/2 of the epithelial thickness
Severe = extends beyond 1/2 of the epithelial thickness but not full thickness
Full thickness = carcinoma in-situ, almost cancer or "intra-epithelial neoplasm"
*The closer the cellular changes are to the surface, the worse the dysplasia
51
intra-epithelial neoplasm
carcinoma in-situ (or almost cancer)
52
histo: tissue with dysplastic epithelial cells that extend from the basal layer to the epithelial surface, "top-to-bottom" change, no invasion has occurred yet, basement membrane is intact
carcinoma in-situ
53
entire epithelial thickness exhibits dysplastic changes, basement membrane is intact
carcinoma in-situ
54
- persistent red patch that cannot be classified as anything else
- sharply demarcated borders
- frequently asymptomatic
- less common than leukoplakia
- biopsy for definitive diagnosis
- final tx dictated by microscopic diagnosis
erythroplakia (erythroleukoplakias)
55
~90% are severe dysplasia, carcinoma in-situ, or SCC
erythroplakia
56
- an aggressive form of oral leukoplakia
- persistent
- often multifocal, slowly spreading plaques
- rough surface projections
- high risk of recurrence
- high risk of malignant transformation
proliferative verrucous leukoplakia
57
etiology unknown, not associated with tobacco, alcohol, HPV, or other virus
PVL/PL
58
management of pts with PVL/PL
- photographs at every visit and submitted with biopsy specimens
- reassess every 3-6 months
- if biopsy shows hyperkeratosis, atrophy, or acanthosis --> followed
- if biopsy shows mild/moderate dysplasia --> excised
- severe dysplasia or CIS --> complete excision
59
management protocol for pts with diagnosed oral premalignancy
- removal of precancer
- discontinue tobacco and/or heavy alcohol
- upper aerodigestive tract evaluation
- clinical re-evaluation every 3-6 months
- repeat biopsy if clinically indicated
60
leukoplakia vs PVL/PL
Leukoplakia
- single site
- men > women
- 5th decade and beyond
- higher correlation with tobacco and alcohol
- ~40% have dysplasia at first biopsy
- moderate rate of malignant transformation (3-15%)
PVL/PL
- multifocal
- women > men
- 6th-8th decades
- lower correlation with tobacco and alcohol
- < 10% have dysplasia on first biopsy
- high rate of malignant transformation (70-100%)
61
malignant transformation potential from high to low
```
PVL
erythroplakia
erythroleukoplakia
granular leukoplakia
actinic chelitis
smooth thick leukoplakia
smokeless tobacco
smooth thin leukoplakia
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