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2. GI II Flashcards > Chapter 16: Head and Neck > Flashcards

Chapter 16: Head and Neck Flashcards

1
Q

Inflammatory process affecting the supporting structures of the teeth (peridontal lig.), alveolar bone, and cementum?

A

Periodontitis

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2
Q

What are the normal class of bacteria that colonize healthy gingival sites?

A

Facultative gram positives

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3
Q

Which systemic diseases are associated w/ Periodontitis?

A
  • AIDS
  • Leukemia
  • Chron disease
  • DM
  • Down syndrome (high risk for leukemia)
  • Sarcoidosis
  • Dz asso. w/ defect in neutrophils (Chediak-Higashi, agranulocytosis, and cyclic neutropenia)
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4
Q

Which diseases can periodontal infections be the origin for?

A
  • Infective endocarditis
  • Pulmonary and Brain abscesses
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5
Q

Which inflammatory lesion is typically found on the gingiva of children, young adults, and pregnant woman (pregnancy tumor)?

A

Pyogenic granuloma

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6
Q

Which test is diagnostic for Acute Herpetic Gingivostomatitis?

What are you looking for?

A

- Tzanck test, microscopic examination of the vesicle fluid

  • Presence of multinucleate polykaryons (giant cells) or eosinophilic intranuclear viral inclusions
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7
Q

Which infection produces a characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsils and retropharynx?

A

Diptheria

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8
Q

Which infection produces spotty enanthema in the oral cavity often preceding a skin rash; ulcerations on the buccal mucosa about Stensen duct producing Koplik spots (small red lesions w/ blue-white centers)?

A

Measles

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9
Q

Which 3 hematologic disorders may present w/ oral changes?

A

1) Pancytopenia (agranulocytosis, aplastic anemia)
2) Leukemia
3) Monocytic leukemia

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10
Q

Hairy leukoplakia is caused by what virus?

Found where in oral cavity?

A
  • EBV
  • Lateral border of the tongue
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11
Q

Which oral lesion is characterized by a distinct microscopic appearance consisting of hyperkeratosis and acanthsosis with “balloon cells” in the upper spinous layer?

A

Hairy leukoplakia

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12
Q

Until proven otherwise, all leukoplakias must be considered __________.

A

Precancerous

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13
Q

What are the histological changes of the epithelium seen with erythroplakia?

A

Severe dysplasia, carcinoma in situ, or minimally invasive carcinoma

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14
Q

Around 95% of the cancers of the head and neck are of which type?

Remainder largely consists of which type?

A
  • Squamous Cell Carcinoma (SCC) = majority (95%)
  • Adenocarcinomas of salivary gland origin = remainder
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15
Q

In the oropharynx, as many as 70% of SCCs, particularly those involving the tonsils, base of the tongue, and the pharynx, harbor what?

A
  • Oncogenic variants of HPV
  • Particularly HPV-16
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16
Q

What is the prognosis (5-year survival rate) of the “classic” (smoking and alcohol related) early-stage SCC?

Late stage?

A
  • Good (80%)
  • Drops to 20% for late-stage disease
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17
Q

Which observation associated with tumors of the upper aerodigestive tract has led to the concept of “field cancerization?”

A

Development of multiple primary tumors is more common here than any other malignancy

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18
Q

What is the basis of “Field Cancerization?”

A

Multiple individual primary tumors develop independently in the upper aerodigestive tract as a result of years of chronic exposure of the mucosa to carcinogens

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19
Q

Which genetic mutations are commonly associated with the “classic - tobacco/alcohol” SCC subset?

A
  • Frequently involve p53
  • p63 and NOTCH1
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20
Q

What is typically overexpressed in HPV-associated SCC’s?

Other common genetic alterations?

A
  • p16 (cyclin dependent kinase inhibitor) = overexpressed
  • p53 inactivation –> E6
  • RB inactivation –> E7
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21
Q

Change in oral flora —> ________ + ________ = periodontitis

A

Change in oral flora —> anaerobic + microaerophilic G (-) = periodontitis

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22
Q

Apthous ulcers (canker sores) tend to be more prevalent in and associated with what disorders?

A
  • IBD
  • Celiac disease
  • Behcet disease
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23
Q

What is the morpholgy of peripheral ossifying fibroma?

Peak incidence in whom?

Treatment of choice?

A
  • Red, ulcerated and nodular lesions of gingiva
  • Increased incidence in young/teenage females
  • Complete surgical exicison down to periosteum
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24
Q

Which form of Oral Candidiasis (Thrush) is the most common?

How does it appear in the oral cavity?

A
  • Pseudomembranous form
  • Superficial, gray to white inflammatory membrane, that can be readily scarped off
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25
Q

What is the typical age of onset and sex most affected by leukoplakia and erythroplakia?

A
  • Age 40-70
  • M:F (2:1)
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26
Q

Actinic radiation (sunlight) and pipe smoking are known predisposing factors for what type of oral cancer?

A

SCC of the lower lip

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27
Q

How does an HPV (+) vs. HPV (-) SCC affect the prognosis?

A
  • HPV (+) = BETTER prognosis if p16+
  • HPV (-) = worse prognosis
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28
Q

How does the progression of oral SCC differ from that of cervical cancer?

A
  • Oral SCC may invade underlying CT stroma before progression to full-thickness dysplaisa (carcinoma in situ)
  • In cervical cancer, carcinoma in situ, develops before invasion
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29
Q

What are the 5 favored locations in the oral cavity for the development of SCC?

A
  • Ventral surface tongue
  • Floor of mouth
  • Lower lip (associated w/ sun exposure and pipe smoking)
  • Soft palate
  • Gingiva
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30
Q

What is the morphology of oral SCC in the early stage?

A

Raised, firm, pearly plaques or irregular, roughened or verrucous areas of mucosal thickening –> may look like leukoplacia

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31
Q

What are the favored sites for local metastasis of SCC?

Favored sites for distal metastasis?

A
  • Local —> cervical LN’s
  • Distal —> mediastinal LN’s, lungs, liver, and bones
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32
Q

Which type of cyst is defined as originating around the crown of an unerupted tooth and is thought to be the result of fluid accumulation between the developing tooth and dental follicle?

A

Detingerous cyst

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33
Q

Radiographically, dentigerous cysts are seen as what type of lesions and most often associated with which teeth?

Treatment?

A
  • Unilocular lesion
  • Impacted third molar (wisdom) teeth
  • Complete removal = curative
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34
Q

What is the significance of Keratocystic Odontogenic Tumors (OKC’s)?

A

Must be differentiated from other cysts due to its aggressive behavior

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35
Q

Keratocystic Odontogenic Tumors (OKC’s) are most often diagnosed between what ages and which sex is more commonly affected?

Where do they most often arise within the oral cavity?

A
  • Ages 10-40 yo; most often in males
  • Posterior mandible
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36
Q

Multiple Keratocystic Odontogenic Tumors (OKC’s) occuring in a patient should prompt evaluation for what?

A

Nevoid basal cell carcinoma (Gorlin syndrome)

37
Q

Nevoid basal cell carcinoma (Gorlin syndrome) is associated with mutations in what gene and on what chromosome?

A
  • PTCH (tumor suppressor gene)
  • Cr. 9
38
Q

Periapical, Residual, and Paradental cysts of the oral cavity are classified how (inflammatory or developmental cysts)?

A

Inflammatory cysts

39
Q

Periapical cysts are common lesions found where in the oral cavity?

A

Apex of teeth

40
Q

What are the common causes of Periapical cysts (Periapical Granulomas)?

A
  • Long-standing inflammation of a tooth (pulpitis)
  • May be due to advanced carious lesions or trauma to the tooth
41
Q

Ameloblastoma arises from ___________ and shows no _____________

A

Ameloblastoma arises from odontogenic epithelium and shows no ectomesenchymal differentiation

42
Q

What is the most common Odontogenic tumor?

A

Odontoma

43
Q

Where do Odontomas arise from?

Show extensive deposition of?

A
  • Arise from epithelium
  • Extensive deposition of enamel and dentin
44
Q

Odontomas are more likely __________ rather than true neoplasms

A

Hamartomas

45
Q

What is the inheritance pattern of Rendu-Osler-Weber syndrome?

A

Autosomal Dominant

46
Q

Which disorder is associated w/ multiple congenital aneurysmal telangiectasias beneath mucosal surfaces of the oral cavity and lips?

A

Rendu-Osler-Weber syndrome

47
Q

Irritation fibroma (aka traumatic fibroma) typically arise where in the oral cavity?

A

Buccal mucosa along the bite line or the gingiva

48
Q

Xerostomia is a major feature of?

A

Sjorgren Syndrome

49
Q

Complications of Xerstomia include increased rates of?

A
  • Dental caries
  • Candidiasis
  • Difficulty swallowing and speaking
50
Q

What is the most common type of salivary gland lesion?

A

Mucoceles

51
Q

What is the most common form of viral sialadenitis?

Which major salivary is most commonly affected?

A
  • Mumps
  • Parotids b/l = most common
52
Q

Which glands may be affected w/ a mumps infection?

A
  • Parotids b/l
  • Testes - orchitis
  • Pancreas
53
Q

Mucoceles are caused by what?

Most commonly found where in oral cavity and due to what?

A
  • Blockage/rupture of the salivary gland duct w/ leakage of saliva into CT stroma
  • Most often LOWER LIP due to TRAUMA
54
Q

How do Mucoceles present clinically (i.e., how do they look on examination)?

Patients often report what in regards to the size of the lesion?

A

- Fluctuant swellings of lower lip that have a blue translucent hue

  • Often report hx of changes in size in assoc. w/ meals
55
Q

What is the histological characteristics of Mucoceles?

Most common inflammatory cell present?

A
  • Pseudocysts w/ cyst-like spaces lined by granulation tissue or fibrous CT
  • Cystic spaces filled w/ mucin and most often MACROPHAGES
56
Q

What is the Tx for Mucoceles?

A

Complete excision of the cyst and its accompanying minor salivary gland

57
Q

What is a Ranula?

A

Epithelial-lined cysts that arise when duct of sublingual gland has been damaged

58
Q

Bacterial sialadenitis, most often involves the __________ glands and is a common condition secondary to ___________

A

Bacterial sialadenitis, most often involves the submandibular glands and is a common condition secondary to sialolithiasis

59
Q

What are the 2 most common organisms responsible for sialolithiasis leading to sialadentitis?

Unilateral or bilateral process?

A

1) S. aureus
2) S. viridans
- UNILATERAL

60
Q

A patient presenting with unilateral, sialadentitis with overt suppurative necrosis and abscess formation should raise suspicion of?

A

Sialolithiasis causing sialadentitis, likely due to S. aureus or S. viridans

61
Q

The likelihood of a salivary gland tumor being malignant is more or less ___________ proportional to the size of the gland

A

Inversely

*Smaller the gland = higher risk of malignancy

62
Q

Majority of salivary gland tumors arise where?

A

Parotid gland

63
Q

What is the most common tumor of the salivary gland and is it benign or malignant?

A

Pleomorphic adenoma (60%) – benign

64
Q

Pleomorphic adenomas contain a mixture of _________ and _________ cells

A

Pleomorphic adenomas contain a mixture of ductal (epithelial) and myoepithelial cells

*MIXED tumor

65
Q

Exposure to what increases risk for Pleomorphic Adenomas?

Associated with what genetic mutation?

A
  • Radiation
  • PLAG1overexpression –> Increased cell growth
66
Q

How do pleomorphic adenomas present clinically (i.e., mass where, any pain, and rate of growth)?

A

Painless, slow-growing, mobile, discrete masses within the parotid or submandibular areas or in the buccal cavity

67
Q

A carcinoma arising in a pleomorphic adenoma is referred to as a?

A

Carcinoma ex pleomorphic adenoma or malignant mixed tumor

68
Q

What type of tumor is shown here and how can you tell?

A
  • Pleomorphic adenoma
  • Well-demarcated tumor w/ epithelial cells and myoepithelial cells within a chondroid matrix = DOMINANT histological features
69
Q

What is the prognosis of a malignant pleomorphic adenoma (i.e., carcinoma ex pleomorphic adenoma)?

A
  • Most aggressive of all salivary gland tumors
  • Mortality rates of 30-50% at 5 years
70
Q

Which benign tumor is virtually restricted to the parotid gland?

A

Warthin Tumor (aka papillary cystadenoma lymphomatosum)

71
Q

When do Warthin tumors usually arise?

Which sex is most affected?

What is a major risk factor?

A
  • 5th to 7th decade of life
  • More common in males
  • Smokers have 8x the risk
72
Q

What are some of the distinct morphological characteristics of a Warthin tumor?

A
  • Round to oval encapsulated mass, 2-5 cm in diameter, in superfical parotid gland
  • Double layer of lining cells resting on dense lymphoid stroma sometimes w/ GERMINAL centers
  • Upper layer = palisading columnar cells w/ abundant, finely granular, eosinophilic cytoplasm
  • Lower layer = cuboidal to polygonal cells
73
Q

What is the reason for the granular appearance of the cytoplasm in the upper layer of cells seen in Warthin Tumors?

A

NUMEROUS mitochondria, feature referred to as “oncocytic”

74
Q

Which genetic mutation (i.e., translocation and gene products) is thought to play a key role in Mucoepidermoid carcinoma?

A
  • Balanced (11;19) translocation
  • Creates fusion gene = MECT1 and MAML2 genes
75
Q

What is the most common primary malignant tumor of the salivary glands?

A

Mucoepidermoid carcinoma

76
Q

What are the histological characteristics of a mucoepidermoid carcinoma?

How large do they grow?

A
  • Grow to 8 cm in diameter and are circumscribed, but lack well-defined capsules and are infiltrative at margins
  • Cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells
77
Q

Which stain helps to visualize a mucoepidermoid carcinoma?

A

Mucin stains

78
Q

What is the prognosis of both low-grade and high-grade Mucoepidermoid Carcinomas?

A
  • Low grade —> 5-year survival of 90%
  • High grade —> 5-year survival of 50%
79
Q

Adenoid cystic carcinoma is most often seen where?

A
  • Minor salivary glands (particularly the palatine glands)
  • May also be seen in major salivary glands (parotid and submandibular)
80
Q

What is the morphology of Adenoid cystic carcinomas?

A
  • Small, poorly encapsulated, infiltrative, gray-pink lesions
  • Small cells w/ dark, compact nuclei and scant cytoplasm
  • Often create a cribiform pattern
81
Q

Adenoid cystic carcinoma of the salivary gland often shows which type of pattern?

A

Cribiform

*Gaps between the cancer cells within the duct, with an appearance similar to the ‘holes in swiss cheese‘ or perhaps ‘ripples‘.

82
Q

Adenoid cystic carcinomas have a tendency to invade which spaces?

Often metastasize to which distant locations?

A
  • Invade perineural spaces
  • Bone, liver, and brain
83
Q

What is the most common and second most common site for Acinic cell carcinoma of the salivary glands?

A
  • Most common = parotids
  • 2nd = submandibular glands
84
Q

What is the morphological hallmark of Acinic cell carcinoma of the salivary glands?

A

Clear cytoplasm

85
Q

What is the prognosis of Acinic cell carcinoma after resection?

A
  • Overall recurrence = uncommon
  • 90% at 5 years and 60% at 20 years = good prognosis
86
Q

Pt presenting w/ a fiery red tongue w/ prominent papillae (raspberry tongue); white-coated tongue through which hyperemic papillae project should raise suspicion of which infection and organism?

A
  • Scarlet Fever
  • Strep pyogenes –> Gram (+)
87
Q

A pt presenting with acute pharyngitis and tonsilitis w/ a gray-white exudative membrane; enlargement of LN’s in the neck and palatal petechiae should raise suspicion of which type of infection and by what?

A
  • Infectious mononucleosis
  • EBV of the Herpeviridae family = dsDNA virus
88
Q

How does the clinical presentation in terms of lesions differ between the classic type and HPV-type of oral SCC?

A
  • Classic-type - lesions can be on ventral tongue, floor of mouth, lower lip, soft palate, gingiva
  • HPV-type - has NO preceding/precancerous lesion. Originate in tonsillar crypts, base of tongue, or pharynx
89
Q

The prognosis and clinical course of Mucoepidermoid Carcinomas are dependent on what?

A

Grade of the neoplasm

2. GI II Flashcards (12 decks)

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