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Oral and Maxillofacial Pathology > Chapter 10 Epithelial Pathology > Flashcards

Chapter 10 Epithelial Pathology Flashcards

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1
Q

What is this?

A

Heck’s disease

Multifocal epithelial hyperplasia

HPV 13, 32

Mucosal colored

No risk of malignant transformation

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2
Q

What is this?

A

Actinic cheilosis

(Actinic keratosis of the lip)

Further progression leads to ulceration and suggest transformation into SCCA

Changes are irreversible, but patients should be instructed to use lip balms with sunscreens to prevent further damage

submitted for biopsy if: Induration (firm to the touch), Thickening (leukoplakia), Ulceration

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3
Q

Treatment of leukoplakia

A

First arrive at definitive diagnosis, therefore biopsy

Long term follow up is important because recurrences are frequent

5% of leukoplakias become SCCA in 2-4 years

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4
Q

What is this?

A

Basal cell carcinoma

Most common of all cancers

80% are found in the H&N

Results from UV radiation

Most common form = nodular (noduloulcerative)

One or more telangiectatic blood vessels are typically seen

Metastasis is extremely rare

Mohs micrographic surgery - Essentially uses frozen-sections to evaluate margins during surgery

98% cure rate

Death is usually result of local invasion into vital structures

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5
Q

What is this?

A

Squamous cell papilloma

Benign proliferation of stratified squamous epithelium

Caused by human papillomavirus (HPV) (DNA viruse of the papovavirus)

Types 6, 11

Extremely low virulence and infectivity rate

Sites of predilection:Tongue, Lips, Soft palate

pedunculated

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6
Q

What are the BANS of melanoma?

A

Interscapular area of the Back
Posterior upper Arm
Posterior & lateral Neck
Scalp

Prognosis for oral melanoma is extremely poor

5-year survival is 15-20%

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7
Q

What is this?

A

Condyloma acuminatum

Venereal wart

Caused by HPV 6, 11, 16*, 18*, 31

*increased risk for malignant transformation to SCCN

Considered a sexually transmitted disease

Short, blunted surface projection

Differential diagnosis is the same as squamous papilloma

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8
Q

List of white lesions that can be scraped off

A

Materia Alba
White coated tongue
Burn (thermal, chemical, cotton roll, etc.)
Pseudomembranous candidiasis
Sloughing from toothpaste

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9
Q

What is this?

A

Oral submucous fibrosis

Linked to chronic placement of betel quid or paan

Seen primarily in the Indian subcontinent

Characterized by mucosal rigidity

First chief complaint = trismus and mucosal pain from eating spicy foods

Most commonly affected sites: Buccal mucosa, Retromolar areas, Soft palate

Lesion does NOT regress with habit cessation

10% undergo malignant transformation

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10
Q

What is this?

A

Nicotine stomatitis

Due to heat

Reverse smoking (lit end in the mouth)

More erythematous, bleeding, ulcerated

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11
Q

What are the 6 etiologies for leukoplakia?

A

Tobacco

Alcohol

Sanguinaria

UV radiation

Microorganisms

Trauma

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12
Q

SCCA staging

A

Clinical staging is a better prognostic indicator than histologic grading

TNM sysytem

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13
Q

Staging classifications

A

I - T1 N0 M0

II - T2 N0 M0

III - T3 N0 M0 or any T, N1, M0

IV - any M, T4, any N3

Clinical stage guides tx for intraoral carcinoma

Tendency toward development of multiple mucosal cancers = *field cancerization

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14
Q

What are all the N’s and their meanings?

A

N1= single ipsilateral node, 3cm or less

N2= ipsilateral or contralateral node or nodes, 6cm or less

N3= any metastasis in a node greater than 6cm

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15
Q

What is this?

A

Blue nevus

Oral lesions are almost always on the palate

Blue color is due to Tyndall effect

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16
Q

What is this?

A

Erythroplakia

True erythroplakias are never completely benign

90% show moderate dysplasia or worse on biopsy

Most common locations: Floor of mouth, Ventral tongue, Soft palate

Biopsy is mandatory for erythroplakia

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17
Q

What is a leukoplakia?

A

An intraoral white plaque that does not rub off and cannot be identified as any well known entity

Considered a premalignant lesion

Comprises 85% of oral precancer

70% are found on: Lower lip vermilion, Buccal mucosa, Gingiva

90% with dysplasia or carcinoma are found: Lower lip vermilion, Lateral/ventral tongue, Floor of mouth

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18
Q

What is this?

A

Actinic lentigo

Benign brown macule resulting from chronic UV light damage to the skin

Well-demarcated but irregular borders

No change in color intensity with UV light exposure (unlike ephelis)

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19
Q

SCCA metastasis

Study These Flashcards
A

Usually through lymphatics

Ipsilateral lymph cervical nodes

Fixed-spread outside capsule

If below clavicles- liver, lungs, and bone

20
Q

What are all of the T’s and their meaining?

Study These Flashcards
A

Tis= carcinoma in situ

T1= 2cm or less

T2= >2 but <4

T3= >4

T4a= resectable no involvment of major anatomy

T4b= non resectable involement of major anatomy

21
Q

What are the M’s and their meanings?

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A

M0= not present

M1= present

22
Q

What is this?

Study These Flashcards
A

Melasma

mask of pregnancy

melanocyte stimulating hormone

No risk of malignant transformation

23
Q

What is this?

Study These Flashcards
A

Ephelis

Freckle

Increased melanin production without increase in number of melanocytes

Become more pronounced with sun exposure

24
Q

What is this?

Study These Flashcards
A

Acquired melanocytic nevus

mole

localized proliferation of cells from the neural crest

most common of all adult tumors

25
What is this?
Lentigo simplex increase in number of melanocytes color intensity does not change with sunlight
26
What is this?
Halo nevus
27
What is this? Big arrow
Verriciform Xanthoma Characterized by lipid-laden histiocytes Differential diagnosis is same as squamous papilloma No risk of malignant transformation
28
What is this?
Squamous cell carcinoma Oral cancer accounts for 3% of cancers Contributors: tobacco, alcohol, betel quid, phenolic, radiation, iron deficiency, Vit-A deficiency, oncogenic viruses, immunosuppression, oncogenes, tumor suppressor genes. Most common site is the tongue, Posterior lateral, Ventral Second most common site: floor of mouth Third: soft palate Fourth: Gingiva Of all intraoral SCCA, it is least associated with tobacco use and is more common in females
29
What is this?
Dermatosis Papulsa Nigra occurs in 30% of African Americans AD inheritance Found scattered around the zygomatic and periorbital region
30
What is this?
Melanoma ABCDE's Acute sun exposure is significant 2-8x with family hx 3rd most common skin cancer but account for the most deaths Radical and veritcal growth Ulceration is an adverse prognostic indicator for cutaneous melanomas Excision 3-5 cm margin
31
What is this?
Erythroleukoplakia
32
What is this?
Verruca vulgaris ## Footnote Caused by HPV: 2, 4, 6, 40 Contagious Oral lesions are almost always white Maximum size is about 5 mm Differential diagnosis is same as squamous papilloma No chance of malignant transformation
33
What is the differential diagnosis for squamous cell papilloma?
Verruca vulgaris Condyloma acuminatum Verruciform xanthoma (Lipid laden macrophages)
34
What is the TNM system
T=size of primary local tumor in centimeters N=Involvment of local lymph nodes M=distant metastasis
35
What is this?
Tobacco pouch keratosis ## Footnote Gingival recession may be accompanied by destruction of facial surface of alveolar bone A brown-black extrinsic tobacco stain on the teeth is common Halitosis Appears fissured or rippled A lesion remaining 6 weeks after habit is stopped requires biopsy
36
What is this?
SCCA oropharyngeal pt is usually unaware of its presence Therefore when it is discovered, there are more likely to be metastasis 80% of posterior oropharyngeal wall lesions have metastasized or extensively involved surrounding structures at the time of diagnosis
37
What is this?
Molluscum Contagiosum ## Footnote DNA poxvirus Contains molluscum bodies, aka Henderson-Paterson bodies Spontaneous remission occurs in 9 months
38
What is this?
Verrucous carcinoma Most common sites of involvement: Mandibular vestibule, Gingiva Has a “deceptively benign” microscopic appearance Adequate sampling is important because up to 20% have an SCCA developing within the verrucous carcinoma
39
What is this?
Actinic keratosis Common cutaneous premalignant lesion Caused by cumulative UV radiation Keratotic scale peels off but will recur 10% of actinic keratoses will progress to SCCA in 2 years
40
What is the order of cancer risk with the plakias? Least to most
Leukoplakis, erythroleukoplakia, erythroplakia, and proliferative verrucous leukoplakia
41
What are the three types of sinonasal papillomas?
Fungiform, Inverted and Cylindrical Cell
42
What is this?
Seborrheic Keratosis looks like a raisin on the skin Does not occur in the mouth Sudden appearance of numerous seborrheic keratoses with pruritus has been associated with internal malignancy - Called Leser-Trélat sign
43
What are the different types of dysplasia and what do they mean?
Mild dysplasia-alterations are limited to the lower 1/3 Moderate dysplasia-alterations are limited to the lower ½ Severe dysplasia-alterations are present above the lower ½ Carcinoma in situ-alterations are present throughout epithelium
44
What is this?
Oral melanoacanthoma ## Footnote Acquired pigmentation of the oral mucosa Appears to be a reactive process due to trauma Buccal mucosa is the most common site of occurrence Lesions increase rapidly in size Incisional biopsy is indicated to rule out melanoma
45
What is this?
Congenital melanocytic nevus Birth mark hypertrichosis (excess hair)
46
What is this?
Oral melanotic macule ## Footnote Oral counterpart to the ephelis Most common site = vermilion zone of the lower lip (labial melanotic macule) No malignant transformation potential but cannot distinguish clinically from early melanoma; therefore, biopsy is mandatory

Oral and Maxillofacial Pathology (13 decks)

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