EXAM 2 Flashcards
1
Q
leiomyomas are most common in ? (3)
A
uterus, GI, skin
2
Q
• Attempts to regenerate and reestablish
innervation of the distal segment;
encounters scar tissue
A
traumatic neuroma
3
Q
Endothelial cell
– Kaposi sarcoma
• Treatment:
A
–Excision for small cosmetically
problematic lesions
–Radiation
–Injections of chemotherapeutic agents
(3)
4
Q
boggy consistency
A
non hodgkin lymphoma
5
Q
• Lymphoreticular
– Langerhans cell histiocytosis
• Radiographic features:
affects where?
how many?
may ?
A
–Any bone affected but skull, mandible,
ribs, vertebrae most frequent –Solitary or multiple –May break out of bone
6
Q
oral invovlement seen in leukemia? (2)
A
Diffuse gingival enlargement
• “Granulocytic sarcoma” - focal
proliferation of leukemic cells at one soft tissue site
7
Q
• Sjögren syndrome
– Primary (sicca syndrome)
is what? (2)
A
• Xerostomia and keratoconjunctivitis sicca
(dry eyes)
8
Q
–Most common hematologic
malignancy in black persons in the U.S.
A
multiple myeloma
9
Q
laangerhaan cell histiocytosis prefers F
A
False
no gender predilection
10
Q
gender preference of congenital epulis?
A
female
11
Q
canalicular adenoma occurs when?
A
7th decade, 65 avg
12
Q
Mucoepidermoid carcinoma makes up what % of major gland
A
10%
13
Q
adenoid cystic carcinoma represents ____ of all salivary gland neoplasms?
A
5%
14
Q
A
adenoid cystic carcinoma
15
Q
Sjogren syndrome secondary is what?
A
Sicca syndrome plus any other autoimmune disease (e.g. rheumatoid arthritis, SLE, Hashimoto’s thyroiditis, mixed connective tissue disease, etc.)
16
Q
–Pathologic fractures (due to tumor
destruction of bone)
A
multiple myeloma
17
Q
Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Treatment: (3)
A
- Targeted therapies for several types • Localized disease
- Radiation ± chemotherapy • Generalized disease
- Chemotherapy
18
Q
during what period of life do salivary gland neoplasms arise?
A
adulthood
19
Q
collection of lymphoid tissue, often shows germinal centers
A
Papillary cystadenoma lymphomatosum “Warthin tumor”
20
Q
–Immunohistochemical studies show
monoclonal light chain restriction (kappa or lambda) of the lesional cell population (Similar finding of monoclonal gammopathy on serum protein immunoelectrophoresis
A
multiple myeloma
21
Q
Salivary Gland Neoplasms • Carcinoma ex-pleomorphic adenoma – Treatment:
A
• Usually wide excision • ± lymph node dissection • ± radiation
22
Q
A
aids related karposi sarcoma
23
Q
what types of cells are found in canalicular adenoma?
A
cuboidal to columnar cells
24
Q
–Importance is potential to cause
airway obstruction, especially if secondarily infected
A
cystic hygroma
25
population affected in hodgkin lymphoma?
• Bimodal age distribution:
• Teenagers and young adults, 2nd-
3rd decades • \> 50 yrs old
26
–HHV-8 positivity in endothelial cells and
some spindle cells
Kaposi Sarcoma
27
Papillary cystadenoma lymphomatosum “Warthin tumor” Prognosis (2)
• Good; low recurrence rate (5%) • Recurrence may represent metachronous lesion
28
histogenesis “Warthin tumor” Papillary cystadenoma lymphomatosum
salivary duct epithelium entrapped in parotid lymph nodes during development
29
• Fibrous
– Fibrosarcoma
• Treatment:
–Wide to radical surgical excision
–Little to no response to radiation or
chemotherapy
30
Salivary Gland Neoplasms • Prevalence of malignancy major glands: (4) + %
– Parotid 15-32% – Submandibular 37-45% – Sublingual 70-90% – Minor 45-50%
31
neurofibroma locations (4)
–Skin (most common location) –Mucosa (oral lesions not uncommon)
• Tongue
• Buccal mucosa
32
– Common cause of oral mucosal swelling
mucocele ranula
33
• Acute/Chronic Sialadenitis
– Clinical features:
• Diffuse, painful and tender, unilateral
swelling • Pain, especially around meal times
34
pyogenic granuloma
35
name 3 reactive lesions
pyogenic granuloma
peripheral giant cell granuloma
peripheral ossifying fibroma
36
– Neurilemoma (schwannoma)
• Clinical features:
(5)
–Most in adults –Slow-growing –Solitary –Encapsulated –Rubbery-firm
–Non-tender
37
pleomorphic adenoma • Predilection of minor gland sites: (3) + %
–Palate – 54% –Upper lip – 18% –Buccal mucosa – 11%
38
fiboma
39
• Not a true neoplasm; reactive
proliferation of nerve tissue after damage of the nerve bundle
– Traumatic neuroma
40
melanotic neuroectodermal tumor of infancy prognosis? (3)
–Good
–Sporadic reports of aggressive behavior
–Clinical f/u is prudent
41
• Lymphoreticular
– Multiple myeloma
• Prognosis:
–Varies among patients, unlikely to be
cured –Younger age better –Worse for pts with widespread disease or
comorbidities –Survival rate 6 – 7 yrs after Dx
42
malignancy of fibroblastic
differentiation
fibrosarcoma
43
melanotic neuroectodermal tumor of infancy
44
• May be a vascular hamartoma
(overgrowth of tissue normally present in the site) rather than a neoplasm
hemangioma
45
langerhans cell histiocytosis
46
Benign Mesenchymal Tumors • Nerve
– Neurofibroma - central
• Radiographic features:
–Radiolucent
• Unilocular
• Multilocular
47
hodgkin lymphoma
48
• Fluctuant to hard on palpation
mucoepidermoid carcinoma
49
pleomorphic adenoma
50
acinic cell adenocarcinoma?
2th-7th decade ( mid 40s to early 50s)
51
canalicular adenoma occurs more often where?
minor glands, esp. labial mucosa
52
• Lymphoreticular
– Multiple myeloma
• Treatment (5)
to control disease and keep pt.
comfortable): • Chemotherapy • Bone marrow transplant • Radiation only as palliative treatment • Bisphosphonates help prevent fracture
53
lipoma clinical features (6)
–Adult patients
–Slow-growing
–Non-tender
–Soft, doughy
–Common in head and neck;
occasionally found intraorally
–Yellow if close to the surface
54
Canalicular adenoma occurs where?
minor and major salivary gland
55
Warthrin tumor
56
massive, pendulous known as
plexiform neurofibroma
57
leukemia
58
59
necrotizing sialometaplasia shows what on surface epithelium?
pseudoepitheliomatous hyperplasia
60
retrocuspid papilla
61
sites of involvement of salivary gland neoplasms for benign and malignant (4)
Parotid Submandibular Sublingual Minor
62
also known as benign mixed tumor
pleomorphic adenoma
63
granular cell tumor (clinical features) 4
–Slow-growing –Demarcated submucosal –Non-tender –Most \< 1 cm
64
most common intraoral site of rhabdomyosarcoma
palate
65
most common location of necrotizing sialometaplasia
posterior hard
palate/anterior soft palate
66
• Endothelial cell
– Kaposi sarcoma
• Prognosis: for all 4
```
1. Classic – fair; pts usually die of
something else (MI, CVA, etc.) 2. Endemic lymphadenopathic – poor 3. Iatrogenic – fair to poor 4. AIDS-related - fair
```
67
clinical features of neurofibroma (5)
soft
non-tender
dome shaped papule or nodule
demarcated
unencapsulated
68
AKA neurogenic sarcoma, or neurofibrosarcoma
Malignant peripheral nerve sheath tumor
| (MPNST)
69
lymphangioma
70
traumatic neuroma
71
laangerhaan cell histiocytosis radiographic features are radioopaque.
False
Radiolucent
72
–Diffuse infiltration and destruction of
the normal host tissue by sheets of poorly differentiated cells with either myelomonocytic characteristics or lymphoid features
leukemia
73
inflammatory papillary hyperplasis may have what condition with it?
superficial candidiasis
74
• Squamous metaplasia of the ductal
epithelium – confined to the normal
boundaries of the gland
• Necrotizing sialometaplasia
75
• Muscle
– Rhabdomyosarcoma
• Treatment: (3)
–Wide excision
–Multiagent chemotherapy
–Post-op radiation
76
what % of cardiac rhabdomyomas are associated with tubular sclerosis?
50%
77
rhabdomyoma age preference
middle-age and older males
78
– Kaposi sarcoma
• 4 clinical presentations (con’t)\<
–Classic
usually appear where?
• Usually appears on the lower
extremities of elderly pts, most
often male
79
list lymphocytic leukemia conditions and numbers seen yearly
–Acute lymphocytic leukemia (4,000)
–Chronic lymphocytic leukemia (10,000)
80
sialothiasis
81
• Also known as denture papillomatosis –
maxillary complete denture
– Inflammatory papillary hyperplasia
82
Benign Mesenchymal Tumors • Muscle
– Rhabdomyoma
• Histopathologic features: (3)
–Round to polygonal cells
–Granular eosinophilic cytoplasm
–Multiple vacuolated cells, many with
“spider web” appearance
83
tx of pleomorphic adenoma depends on
location
84
oral cavity is the inital site of presentation in what and what %
AIDS related Karposi sarcoma 22%
85
–Vesicular surface similar to “frogs
eggs” or tapioca pudding
lymphangioma
86
Lymphoreticular
– Lymphoma
• Hodgkin lymphoma
–Prognosis (3)
• Fairly good today (1,300 deaths in
2011) • Low stage with chemo/rads ~ 100%
5-yr survival rate • Before modern cancer therapy 5-
year survival rate only 5%.
87
three features of “Warthin tumor” Papillary cystadenoma lymphomatosum
• Non-tender • Slow-growing • Freely moveable
88
– Kaposi sarcoma
• 4 clinical presentations (con’t)\<
–Iatrogenic (transplant-associated)
• Affects
skin amd mucosa
89
acute disseminated histiocytosis
90
• Hodgkin lymphoma
–Clinical features (con’t)
Category a
no systemic signs
91
• Nerve
– Melanotic neuroectodermal tumor of infancy
• Treatment:
–Conservative excision usually curative
92
cystic hygroma can affect where?
Neck, mediastinum, axilla, oral cavity (4)
93
–Renal failure (due to circulating light
chain proteins)
multiple myeloma
94
• Concentric laminations that may surround a
nidus of amorphous debris
sialothiasis
95
(acellular zones made of reduplicated basement membrane and cytoplasmic processes)
verocay bodies
96
rhabdomyosarcoma
97
BLEL could be isolatd or from?
Sjogren syndrome
98
– Most common salivary gland malignancy in children
Mucoepidermoid carcinoma
99
```
–Soft tissue mass or centrally as an
intrabony lesion (2)
```
–Slow-growing
–Pain is a late feature
fibrosarcoma
MPNST
100
Fibrous
– Inflammatory fibrous hyperplasia
• Also known as
(3)
–denture epulis –epulis fissuratum –denture-induced fibrous hyperplasia
101
tubules and narrow trabecular cords with appearance of channels or “canals”
canalicular adenoma
102
Parotid gland involvment benign and malignant makes up what percent of salivary gland neoplasms?
64-80%
103
• Painless cervical, supraclavicular
lymphadenopathy
% ? and seen in what condition
70-75% of hodgkin lymphoma
104
port wine stains occur where?
anywhere on the body
105
gender preference of Papillary cystadenoma lymphomatosum “Warthin tumor”
males
106
neurilemomma can occur centrally \_\_\_\_\_\_
within bone
107
most common locations of salivary gland neoplasms in minor glands + %.
Palate -50% Lips 20% Buccal Mucosa 15%
108
• Acute/Chronic Sialadenitis
– Prognosis:
• Can range from excellent to poor if gland
must be removed
109
–Lesional tissue mingles with adjacent
normal tissue
neurofibroma
110
adenoid cystic carcinoma accounts for \_\_% of submandibualr gland tumors?
11-17%
111
PLGA – Clinical features (con’t): (4)
• Slow-growing • Firm, painless swelling • ± ulceration • Well-demarcated initially, later becomes infiltrative
112
Blood
– Vascular malformations
• Treatment: (3)
–Depends on severity –Port wine stain
• Pulsed dye laser
113
prevalence of "Warthin tumor or papillary cystadenoma lymphomatosum
Comprises 5% of all salivary gland neoplasms and 5-14% of parotid gland neoplasms
114
tx of pleomorphic adenoma in the parotid
remove lesion w/involved lobe
115
what are laangerhaan cells?
are related to monocytes
and serve as antigen-presenting cells
116
when should you wait to tx hemangioma?
if the lesion impairs vision, ASAP
otherwise, wait until child is at least 6 yrs
117
Benign Mesenchymal Tumors • Nerve
– Traumatic neuroma
• Prognosis:
(3)
–Good –Pain may persist or return at a later
date –Recurrence is not common
118
peripheral giant cell granuloma
119
how many cases of hodgkin lymphoma in 2015?
9000
120
periorbital amyloid deposits in pts with multiple myeloma
121
necrotizing sialometaplasia
122
– Granular cell tumor
• Treatment:
–Conservative excision usually curative
123
–Sheets of large, pale histiocytic-appearing
cells are what and seen where?
neoplastic langerhans cells
langerhans cell histiocytosis
124
• Sjögren syndrome
– Prognosis:
• Fair
–Patients with Sjögren Syndrome have a
44x increase in lymphoma compared to age- and sex-matched population
125
what % of AIDS-related KS will develop
oral lesions
70%
126
• Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Radiographic features:
• Early changes subtle or nonexistent • “moth-eaten” or ill-defined
radiolucency • Expansion; can perforate and “break
out” of bone into the soft tissue
127
histopathologic features of peripheral giant cell granuloma
–granulation tissue with numerous
benign multinucleated giant cells
128
–Spindle-shaped, with cigar-shaped nuclei,
eosinophilic cytoplasm
leiomyoma
129
neurofibromas are seen where? (4)
• Tongue, gingiva, bone • Enlargement fungiform papillae
reported, but specificity for NF1
unknown
130
prognosis of peripheral ossifying fibroma
15% recur
131
–Many poorly defined vascular slits
Kaposi Sarcoma
132
• Lymphoreticular
– Multiple myeloma
• Radiographic features:(5)
–Widespread lytic lesions of bone
–Any bone can be affected
–“punched-out” non-corticated
radiolucencies, especially skull –May appear as osteomyelitis –Mandible involved ~ 30% of cases
133
Papillary cystadenoma lymphomatosum “Warthin tumor” has a strong association with what?
smoking, 8x greater risk
134
Malignant Mesenchymal Tumors and Lymphoreticular Malignancies
• Lymphoreticular
(6)
– Langerhans cell histiocytosis
– Leukemia
– Lymphoma
• Hodgkin lymphoma • Non-Hodgkin lymphoma
– Plasmacytoma/Multiple myeloma
135
parallel calcifications probably represent the calcified walls of abnormal blood vessels)
tram-
line” calcifications seen on skull film
136
• Oral considerations port wine stain:
| (4)
– Hemorrhage may be encountered
• Flossing and dental prophylaxis may be
difficult • Caution with surgical procedures
– Lasers may be helpful in removing
hyperplastic lesions
137
pleomorphic adenoma are proliferation of
ductal and myoepithelial cells
138
small, innocuous growth easily diagnosed clinically, usually no treatment is necessary.
frenal tag
139
• Lymphadenopathic – esp. young
children, visceral tumors
Endemic (African Kaposi Sarcoma)
140
• Mucocele/Ranula
– Histopathologic features: (3)
• Extravasated mucin, granulation tissue
and variable numbers of inflammatory
cells
141
Inflammatory fibrous hyperplasia prognosis
excellent if appropriately tx
142
– Langerhans cell histiocytosis
• Eosinophilic granuloma
seen in what population
teenagers, young adults
143
mucocele/ranula occurs where?
82% lower lip, also seen buccal mucosa,
ventral tongue floor of mouth (FOM)
144
–Fever (result of neutropenia and
increased susceptibility of infection)
– Multiple myeloma
145
* Sialolithiasis – Prognosis:
* Minor glands:
Major glands:
Good
Good, but morbidity if gland requires
removal
146
147
demographics of necrotizing sialometaplasia
adults, male
148
Salivary Gland Neoplasms • Prevalence of malignancy intraoral minor glands: (6) + %
– Palate 45% – Upper lip 20% – Lower lip 60% – Buccal mucosa 50% – Retromolar region 90% – Tongue 90%
149
• Lymphoreticular
– Leukemia
• Treatment: (3)
–Chemotherapy
–Bone marrow or stem cell
transplantation –Targeted gene therapy – promising e.g.,
imatinib (Gleevec) and several other
tyrosine kinase inhibitors for CML
150
4 clinical features of mucocele/ranula
• Non-tender, soft swelling • May be fluctuant or firm • Color translucent to bluish • May have history of repeated swelling
and resolution
151
adenoid cystic carcinoma accounts for what % of all parotid tumors?
2%
152
Pyogenic granuloma most common sites intraorally
* Gingiva (~80%)
* lips
* tongue
153
– Prognosis: of acinic cell carcinoma • According to Armed Forces Institute of Pathology series: (3)
–35% recurred –16% metastasized via lymphatics –16% dies of disease
154
rhabdomyoma clinical features? (3)
–Non-tender
–Well-circumscribed nodule (may be
multinodular)
–May grow several centimeters
155
• Group of hematologic malignancies
characterized by tumor cells circulating in
the blood
– Leukemia
156
• Lymphoreticular
– Langerhans cell histiocytosis
• Prognosis:
generally better for ?
acute?
chronic?
eosinophilic granuloma?
older patients
poor
guarded
good
157
–Surrounded by plump epithelioid cells
with vesicular nuclei, which produce
melanin
Melanotic neuroectodermal tumor of infancy
158
what percent of neurofibroma are solitary
90%
159
Blood
– Hemangioma
• Clinical features (con’t): (2)
–Most elevated, but macular lesions
seen –Variable size
160
• Acute or chronic sialadenitis of the feeding
gland
sialothiasis
161
most common salivary gland neoplasm
pleomorphic adenoma
162
could be assoc. with
sjogren syndrome
163
Pleomorphic adenoma – Prognosis: (3)
• Will recur if inadequately treated • Parotid lesions have more recurrences than minor glands • 5% undergo malignant transformation if not removed
164
pyogenic granuloma treatment
–Excise, remove irritants
165
• Spectrum of disorders characterized by
proliferation of histiocyte-like cells
accompanied by varying numbers of
eosinophils, lymphocytes, plasma cells and
multinucleated giant cells
– Langerhans cell histiocytosis (LCH)
166
• Axillary or inguinal freckling
type 1 NF1
167
• Lymphoreticular
– Leukemia
• Diagnosis: (2)
–Usually based on finding of increased
numbers of atypical white blood cells in the circulation
–Type of leukemia is determined by
immunohistochemical/cytogenetic studies
168
multiple myeloma accounts for what % of malignancies involving bone
50%
169
– Kaposi sarcoma
• 4 clinical presentations (con’t)\<
–AIDS- related (con’t)\<
• Skin lesions have predilection for
face and lower extremities
170
necrotizing sialometaplasia can be mistaken for what?
SCC or mucoepidermoid carcinoma
171
Fibrous
– Inflammatory papillary hyperplasia
• Clinical features: (4)
–Numerous asymptomatic
red/erythematous papules
–Central region of hard palatal mucosa
* High palatal vault
* Habitual mouth breathers
172
• BLEL
– Histopathologic features:
• Must identify
epimyoepithelial islands,
which probably represent residual ductal
structures
173
174
(a very
large lymphangioma)
cystic hygroma
175
how many cases of mulltiple myeloma are diagnosed yearly?
26,000
176
2nd most common benign tumor of salivary glands
“Warthin tumor” Papillary cystadenoma lymphomatosum
177
neurofibroma
178
Sjogren syndrome usually affects who? and what gender?
• Usually middle-age to older adults, but
has been seen in children
female predilection 9:1
179
• Hodgkin lymphoma develops in the
non-Hodgkin lymphoma mostly arises
lymph nodes
lymph nodes, but can also arise in soft
tissue or bone
180
• May have bluish tinge due to entrapped mucin
• Mucoepidermoid carcinoma
181
• Chronic disseminated histiocytosis (Hand-
Schüller-Christian disease)
seen in ?
older children
182
– Neurofibromatosis • Type I (NF1)
–Treatment
• Remove traumatized neurofibromas
or disfiguring lesions • Genetic counseling • f/u due to potential of malignant
transformation
183
• Pain can be lancing and constant
adenoid cystic carcinoma
184
adenoid cystic carcinoma occurs where?
Can occur in any salivary gland but 40% - 45% are in minor glands
185
found at birth on maxillary ridge, lateral to midline?
congenital epulis
186
– calcified structures that develop within the
salivary ductal system
sialothiasis
187
what type of cell is associated with pleomorphic adenoma?
myoepithelial cells
188
myoepithelial cells in pleomorphic adenoma appear
plasmacytoid spindled
189
Nonspecific reactive hyperplasia of
stratified mucocutaneous epithelia,
which simulates squamous cell
carcinoma
necrotizing sialometaplasia
190
which is more common
non-hodgkin lymphoma or hodgkin lymphoma?
how many cases of the greater one
non-hodgkin lymphoma (70,000)
191
multiple neurofibromas (2)
• Small, discrete • Massive, pendulous known as
plexiform neurofibroma
192
• If something is growing out of a socket (3)
1. Epulis granulomatosa 2. Lymphoma 3. Metastatic disease
193
• Non-Hodgkin lymphoma
–Histopathologic features:
• Varies by type of lymphoma • Need IHC to identify
194
• Acute disseminated histiocytosis (Letterer-
Siwe disease):
is an aggressive malignant course. T/F
true
195
laangerhaan cell histiocytosis clinical features (2)
rare
dull pain or tenderness
196
Muscle
– Rhabdomyosarcoma
• Clinical features: occurs in what population
–Children or adolescents
197
• Effacement of normal nodal
architecture by infiltrate of
inflammatory cells
hodgkin lymphoma
198
• Nerve
– MPNST
• Histopathologic features (2)
–Spindle-shaped cells with wavy nuclei
–Mitoses
199
Site predilection of pleomorphic adenoma (3) + %
–80% - parotid (63% of all parotid tumors) –10% - submandibular (60% of all submandibular tumors) –10% - intraoral minor salivary glands (43% of all minor salivary gland tumors)
200
–Port wine stain in distribution of 1st and
sometimes 2nd or 3rd division of CN V
• Encephalotrigeminal angiomatosis
| (Sturge-Weber syndrome)
201
tumor of smooth muscle
differentiation
Leiomyoma
202
–Collection of mesenchymal cells with
granular-appearing cytoplasm
granular cell tumor
203
what percent of hodgkin lymphoma are relapse free after after 10 years in stage 1 and 2
stage 3/4 show what percentage of survival rate after 10 year
80-90
55-85
204
• Adenoid cystic carcinoma – Clinical features (con’t): (3)
• Variably firm • Usually poorly demarcated on palpation • ± ulceration, more often seen later in the course of the lesion
205
• Low-power - lobular growth pattern infiltrating surrounding tissue
PLGA
206
vascular malformation clinical features (3)
–Port wine stain (capillaries)
–Venous malformation (blue)
–arteriovenous malformation (bruit, thrill)
207
leiomyomas clnical features? (6)
–Well-demarcated –Rubbery firm – ˂ 1 cm diameter
–Reddish-purple color due to vascular
nature –Slow growing
–Usually painless
208
laangerhaan cell histiocytosis is not a neoplastic process T/F
False
209
Benign Mesenchymal Tumors • Fibrous
List 6
– Fibroma
– Inflammatory fibrous hyperplasia
– Inflammatory papillary hyperplasia
– Pyogenic granuloma
– Peripheral giant cell granuloma
– Peripheral ossifying fibroma
210
Lymphoreticular
– Langerhans cell histiocytosis
• Chronic disseminated histiocytosis (con’t)\<
–Classic triad
bone, skin, viscera)
• Exophthalmos • Diabetes insipidus • Bone lesions
211
Mucoepidermoid carcinoma epidemiology
– Wide age range, 2nd to 7th decade
212
– Neurilimoma (schwannoma)
• Histopathologic features: (2)
–Well-developed connective tissue
capsule –Benign proliferation of spindle-shaped
Schwann cells
213
Benign Mesenchymal Tumors • Adipose
– Lipoma
• Treatment:
–Enucleation or conservative surgical
excision
214
• Sialolithiasis
– Radiographic features:
• Soft tissue film shows opaque, lamellated
structure
215
–More than 50% of cases seen in patients
younger than 15 y.o.
Langerhans cell histiocytosis
216
prognosis of lipoma
–Little or no tendency to recur
–No evidence of malignant
transformation
217
–Calcifications in soft tissue (metastatic
calcifications) caused by hypercalcemia secondary to tumor- related osteolysis
multiple myeloma
218
• Carcinoma ex-pleomorphic adenoma occurs which age?
6th -7th decade
219
Acute Sialdenitis usually affects the?
what is expressed from the parotid papilla
parotid, purulent exudate
220
“Bumps on the gums”
• Fibrous
– “3 P’s”
• Pyogenic granuloma • Peripheral giant cell granuloma • Peripheral ossifying fibroma
221
• Fibrous
– Fibrosarcoma
• Prognosis:
–50% 5-year survival
–Metastasizes via blood
• Lung • Liver • Bone
222
lipoma
223
– Neurilimoma (schwannoma)
• Histopathologic features:
–Patterns seen microscopically:
• Antoni B – (2)
• less organized • sometimes myxoid
224
Benign Mesenchymal Tumors • Muscle (2)
– Leiomyoma – Rhabdomyoma
225
• 10-year survival rates: of mucoepidermoid carcinoma
–Low-grade – 95% –High-grade – 40%
226
• Mucocele/Ranula
– Treatment: (4)
* Microscopic exam to rule-out neoplasm
* Some resolve with no treatment
• Excision of mucous deposit including
involved gland
• Marsupialization – unroofing
227
• BLEL
– Prognosis:
• Good, but malignant transformation of
lymphoid or epithelial components has
been reported
228
• Muscle
– Rhabdomyoma • Treatment:
–Conservative surgical excision
229
peripheral ossifying fibroma
230
Fibrous
– Peripheral giant cell granuloma
• Radiographic features:
–Cupping of underlying bone
sometimes seen
231
–Most common soft tissue sarcoma in
children under 15 y.o.
– Rhabdomyosarcoma
232
laangerhaan cell histiocytosis
233
pleomorphic adenoma develops what age and gender?
4th-6th decade, avg 45 slight female
234
• Circulating unattached light chains filtered
in kidney--\> secreted in urine
bence jone proteins
235
neurilemoma can cause what (2)
expansion and push on other nerves
236
fibrosarcoma affect what population
adult
237
most rhabdomyomas are?
cardiac rhabdomyomas
238
which salivary gland neoplasm is Fairly circumscribed? check for others?
acinic cell adenocarcinoma
239
• Aggregates (foci) of \>50 lymphocytes ±
plasma cells scattered throughout
glandular parenchyma
• Sjögren syndrome
240
tx of fibroma
conservative excision
241
savliary gland disease thought to be related to ischemic necrosis
• Necrotizing sialometaplasia
242
prognosis if peripheral giant cell granuloma
15% recur
243
• Acinar necrosis, but overall architecture
of the involved glands is preserved
• Necrotizing sialometaplasia
244
where is frequently affect in angioma
head and neck
245
ranula occurs where?
– FOM to right or left of midline
246
Salivary Gland Neoplasms • Carcinoma ex-pleomorphic adenoma – Prognosis – related to =(3)
histologic subtype • Guarded –Survival rates • 5-year 25% - 60% • 15-year 10%
247
• Adenoid cystic carcinoma – Prognosis:
• Generally poor; tumor is slow-growing and relentless • Depends on lesion location, grade, anatomic structures involved, presence of tumor at surgical margins
248
granular cell tumor prognosis
excellent
249
what is often the primary site in non-hodgkin lymphoma extra-nodally?
oral
250
• Muscle
– Rhabdomyosarcoma
• 3 types:
1. Embryonal
2. Alveolar
3. Pleomorphic
251
mucocele
252
• Fibrous
– Inflammatory papillary hyperplasia
• Prognosis
good after Tx if patient keeps
denture out and keeps it clean
253
most leiomyomas arise from what?
vascular smooth muscle
254
• Prevalence increased in patients who
have for non-hodgkin lymphoma?
immunologic problems
255
adenoid cystic carcinoma displays what 3 growth patterns
–Tubular – well-differentiated –Cribriform – classic “Swiss cheese” pattern – intermediate –Solid – poorly-differentiated
256
what stage of life does the Papillary cystadenoma lymphomatosum “Warthin tumor occur?
6th – 7th decade (mean age 55 – 60 y.o.)
257
which salivary gland neoplasm is unencapsulated?
adenoid cystic carcinoma
258
• Patients often present with myelophthisic
anemia
leukemia
259
• Lymphoreticular
– Langerhans cell histiocytosis
• Acute disseminated histiocytosis (Letterer-
Siwe disease):
seen in what population
infants
260
what are b signs in hodgkin lymphoma (4)
1. Fever 2. Weight loss 3. Drenching night sweats 4. Generalized pruritus (itching)
261
–Extensive alveolar involvement causes
teeth to appear as if they are “floating in
air”
Langerhans cell histiocytosis
262
what percent of MPNFT are associated with NF1
50%
263
Benign Mesenchymal Tumors • Nerve
– Neurilemoma (schwannoma)
• Prognosis: (2)
–No tendency to recur –Extremely rare malignant
transformation
264
• Plasma cell origin
– Multiple myeloma/Plasmacytoma
265
– Lymphangioma
• Histopathologic features: (3)
–Lymphatic vessels showing mild
dilatation to large cystic spaces
containing fluid, ± red blood cells –Vessels infiltrate soft tissue –Thin endothelial lining
266
Lymphoreticular
– Leukemia
• Prognosis (con’t)\<
–CML: (3)
• Indolent period
• 5-year survival ~80% • Blast transformation (less
differentiated, proliferate wildly) leads to death in 3 – 6 months
267
Papillary cystadenoma lymphomatosum “Warthin tumor” occurs exclusively where?
parotid gland
268
submandibular gland involvement benign and malignant makes up what percent of salivary gland neoplasms
6-11%
269
• Nerve
– Neurilemoma (schwannoma)
• Treatment: (2)
–Conservative excision –Usually “shells out” due to dense
connective tissue capsule
270
• PLGA – Clinical features (con’t): • Almost exclusively + % (3)
in minor salivary glands –Posterior hard/soft palate 62% –Buccal mucosa 15% –Upper lip 10%
271
– Prognosis: PLGA (3)
Excellent –Recurrence 20% –Lymph node metastasis 7% –Dead of disease 2%
272
• May also be found centrally within maxilla or mandible
• Mucoepidermoid carcinoma
273
• Pt may c/o “denture too tight” • Vague pain, discomfort can be
mistaken for toothache
non hodgkin lymphoma
274
• Radiographic features: – Chronic sialadenitis
• Sialography “sausage-link” appearance
of ductal system due to ductal dilatation
275
–Bone pain, especially lumbar spine
| (most characteristic symptom)
multiple myeloma
276
multiple myeloma affects what gender, what age?
race?
–Mean age of 65 years; rare \< 40 years
–2:1 male predilection; black males
affected 2X more than white males
277
• Lymphoreticular
– Langerhans cell histiocytosis
• Acute disseminated histiocytosis (Letterer-
Siwe disease): involves where?
–Skin rash, splenic, hepatic and marrow
involvement
278
oral findings are seen in what percent of NF1
72-92%
279
Benign Mesenchymal Tumors • Fibrous
– Inflammatory papillary hyperplasia
• Histopathologic features:
–Papillary surface –Edema
280
Muscle
– Leiomyoma
• Clinical features (con’t):
–Most common sites of mouth:
* Upper lip
* Tongue
* Palate
* Buccal mucosa
281
can include neurological deficits
• Encephalotrigeminal angiomatosis
| (Sturge-Weber syndrome)
282
tx of pleomorphic adenoma in the hard palate
remove lesion, including overlying mucosa down to periosteum
283
• Sjögren syndrome
– Treatment: (5)
• Artificial tears and artificial saliva • Sialogogues - pilocarpine (Salagen
Tablets) or cevimeline (Evoxac) • Daily topical fluorides for natural teeth
• Anti-fungal agents for candidiasis, prn • For secondary Sjögren syndrome,
appropriate therapy should be given the
other autoimmune process as well
284
• One or more non-tender, palpable
rubbery-firm, enlarging lymph nodes
hodgkin lymphoma
285
• Autoimmune process attacks lacrimal and
salivary glands
Sjogren syndrome
286
–Rare lesion of undetermined
histogenesis
congenital epulis
287
• Lymphatics
– Prognosis: (3)
• Good for most patients
• Relatively high recurrence rate – up to
40% in some series • Large tumors of the head and neck may
result in airway obstruction and death
288
peripheral giant cell granuloma (3) clinical features
–Painless –Dusky purple-red –Only on gingiva of alveolar ridge,
including edentulous ridge
289
lymph node involvment accounts for what percent of adenoid cystic carcinoma?
5%
290
Canalicular adenoma is tender.
F
291
• BLEL
– Treatment: (3)
• Varies:
–Do nothing
–Low-dose radiation
–Corticosteroid therapy
292
Salivary Gland Neoplasms • Adenoid cystic carcinoma – Prognosis - Routes of metastasis –Most metastasize via and other sites? (4)
blood 1. Lung 2. Brain 3. Bone 4. Liver
293
• Parotid swelling (BLEL) may or may not
be dramatic
Sjogren syndrome
294
–Usually develops in the 1st year of life
| (only 9% of cases seen after 12 mos. old)
Melanotic neuroectodermal tumor of infancy
295
what percent of non hodgkin lymphoma are extranodal
30% - 40%
296
chronic sialadenitis usually affects?
submandibular gland
297
gender prefernence of PLGA
• 2:1 female predilection
298
pts with sjogren syndrome tend to have elevated (3)
sedimentation rate, elevated levels of
ANA and
polyhypergammaglobulinemia
299
Prognosis of mucocele/ranula
– Excellent
– Occasionally recur if involved gland not
excised
300
mucoepidermoid carcinoma represents what percent of minor salivary glands?
13-23%
301
ranula
302
Lymphatics
– Lymphangioma • Treatment:
| (3)
–Depends on size of lesion –Surgical excision is the treatment of
choice –More difficult to treat than hemangioma
because it is often difficult to discern the
borders of the tumor
303
Birbeck bodies are seen where?
cytoplasm of langerhan cells in langerhans cell histiocytosis
304
• After 15 yrs. post-tx mortality due
more in hodgkin lymphoma due to what?
secondary malignancy or
cardiovascular disease
305
neurofibroma
306
what can help regression of kaposi sarcoma in iatrogenic (transplant associated)
• Reducing degree of immune-
suppression may cause regression
of KS
307
fibromas are located where?
buccal mucosa, tongue ( any mucosal surface)
308
– Benign tumor of Schwann cell origin
| (surround axons of peripheral nerves)
– Neurilemoma (schwannoma)
309
• Highlighted by S100 protein –Mast cells
neurofibroma
310
what percent of malignant neuroectodermal tumor of infacny are malignant?
7%
311
– Ductal obstruction, retrograde infection -
associated with xerostomia, may follow general anesthesia
• Acute/Chronic Sialadenitis
312
• Carcinomatous elements which arise in areas of benign pleomorphic adenoma
• Carcinoma ex-pleomorphic adenoma
313
encapsulated salivary gland neoplasms? (3)
pleomorphic adenoma papillary cystadenoma lymphomatosum canicular adenoma
314
polystotic laangerhaan cell histiocytosis is seen in \_\_\_\_\_
monostotic laangerhaan cell histiocytosis is seen in\_\_\_\_\_\_\_
teenagers
adults
315
Lymphoreticular
– Langerhans cell histiocytosis
• Eosinophilic granuloma
occupies what locations?
–Intrabony only; no visceral involvement
316
• Solid organ transplants (0.5% of
renal transplants)
iatrogenic (transplant associated) karposi sarcoma
317
acinic cell carcinoma
318
Benign Mesenchymal Tumors • Fibrous
– Peripheral giant cell granuloma
• Treatment:
–Excise, remove irritants
319
Benign Mesenchymal Lesions • Fibrous
– Inflammatory fibrous hyperplasia:
• Clinical features:
(2)
Flange of ill-fitting denture –May have central fissure/ulcer
320
tumor of striated muscle
differentiation
Rhabdomyoma
321
pain and tenderness develops in half of the cases
acinic cell adenocarcinoma
322
arises from sublingual gland
ranula
323
hogdkin lymphoma has no gender preference. T/F
F. male
324
Mucoepidermoid carcinoma – Histopathologic features: • 2 distinct cellular elements:
–Mucous cells –Epidermoid cells
325
frequently occurs during pregnancy
pyogenic granuloma
326
• Prior to advent of HIV/AIDS was
already recognized in sub-Saharan
Africa
Endemic (African)
327
list lymphreticular malignancies
Lymphoreticular
* Langerhans Cell Histiocytosis
* Leukemia
• Lymphoma
– Hodgkin
– Non-Hodgkin • Multiple Myeloma/
Plasmacytoma
328
– Congenital epulis
• Histopathologic features: (3)
–Benign proliferation of cells with
granular cytoplasm –No PEH –Does not stain for neural
differentiation with IHC
329
• Frequently associated with pain or tenderness, which may be an early finding
adenoid cystic carcinoma
330
pt may die ___ years after diagnosis of adenoid cystic carcinoma
20 years
331
what medications cause xerostomia (4)
–Antihistamines
–Antidepressants
–Sedatives and anxiolytic agents
–Antihypertensive agents
332
myoepithelial cells in pleomorphic adenoma produce (4)
myxoid stroma hyaline material cartilaginous material osteoid
333
benign mesenchymal tumors of blood (4)
Blood
– Hemangioma – Vascular malformations
• Port wine stain
• Encephalotrigeminal angiomatosis
(Sturge-Weber anomaly, Sturge-Weber syndrome)
334
AIDS related KS can invade bone. T/F
T
335
what is the most common intraoral site in lymphangioma? which can result in ?
tongue
macroglossia
336
Benign Mesenchymal Tumors • Nerve
– Traumatic neuroma
• Treatment:
–Surgical excision, including a small
portion of the proximal nerve
bundle
337
granules) • Dark, eccentrically place nucleus
acinic cell carcinoma
338
– Neurofibromatosis • Type I (NF1)
–Prognosis:
• Fair to guarded
• If malignant transformation occurs,
prognosis is poor (usually a malignant peripheral nerve sheath tumor)
339
List benign salivary gland neoplasms (4)
– Pleomorphic adenoma – Papillary cystadenoma lymphomatosum “Warthin tumor” – Monomorphic adenoma • Canalicular adenoma
340
• Caused by infection with HHV-8
Kaposi Sarcoma
341
inflammatory papillary hyperplasia
342
what can occur centrally within bone?
neurilemma
neurofibroma
343
Inflammation of the salivary gland
Acute/Chronic Sialadenitis
344
BLEL
– Histopathologic features:
remants of what?
ductal epithelium
"epimyoepithelial islands"
345
extraoral symptoms associated with leukemia (4)
–Fatigue, shortness of breath (SOB),
pallor (decreased R’s) –Easy bruising (decreased platelets) –Infection (decreased W’s)
346
congenital epulis
347
slight female predilection (4)
salivary gland tumors pleomorphic adenoma PLGA adenoid cystic carcinoma
348
neurilemomma (schwannoma)
349
neurilemoma occur in what age group?
adults
350
rhabdomyoma prognosis
–Good
–Recurrence has been reported but is
not common (may be due to incomplete removal)
351
involves deeper soft tissue and meninges and brain
• Encephalotrigeminal angiomatosis
| (Sturge-Weber syndrome)
352
what percent of lymphangioma are present at birth?
50%
353
sialothiasis typically affects what?
```
submandibular gland (80%),
but can affect parotid or minor glands
```
354
• Nerve
– Traumatic neuroma
• Clinical features: (2)
–Smooth-surfaced –Dome-shaped papule or nodule,
usually \< 1 cm
355
Papillary infoldings lined by a double row of cuboidal and columnar oncocytes (altered ductal epithelial cells) project into the cystic spaces
“Warthin tumor” Papillary cystadenoma lymphomatosum
356
• Unilateral or bilateral, firm, non-tender
swelling of the parotid area
BLEL
357
• Atypical neoplastic lymphoid cell –
reed sternberg cell
358
– Congenital epulis
• Clinical features:
| (3)
–Smooth surface –Often pedunculated –Vary in size
359
Fibrous
– Peripheral ossifying fibroma
• Treatment:
Excise, remove irritants
360
mucocele/ranula appears in what demographic
children, young adults but all ages
361
• Previously thought to be myoblastoma
(immature muscle cells) but immunohistochemistry (IHC) shows neural differentiation
granular cell tumor
362
• Primarily HIV-infected adult male
homosexuals (other types of KS seen
in both genders; children in endemic)
– Kaposi sarcoma
• 4 clinical presentations (con’t)\<
–AIDS- related:
363
minor gland involvement benign and malignant makes up what percent of salivary gland neoplasms
9-23%
364
prognosis of fibroma
recurrence is rare
365
\_\_\_\_\_\_ of mucoepidermoid carcinoma have excellent prognosis
\< 2.5 cm
366
• Fibrous
– Inflammatory papillary hyperplasia
• Has been attributed to (3)
–Ill-fitting denture –Poor denture hygiene –Wearing the denture 24/7
367
Benign Mesenchymal Tumors • Nerve
– Neurofibroma
• Treatment:
–Conservative excision
368
Kaposi Sarcoma clinical presentations (5)
* Painless • Purple – red • Macules plaques tumors • Do not blanch on pressure
* Slow-growing
369
what are oncocytes
altered ductal epithelial cells
370
histopatholgic features of peripheral ossifying fibroma
–Cellular fibrous connective tissue,
variable amounts of calcification
371
• Periductal inflammation
sialothiasis
372
what patterns are seen histopathologically in neuriiloma (schwannoma)
Antoni A
Antoni B
373
PLGA can be confused with? (2)
adenoid cystic carcinoma or carcinoma ex-pleomorphic adenoma
374
Benign Mesenchymal Tumors • Fibroma
– Histopathologic features:
• Nodular mass of dense fibrous
connective tissue
375
frenal tag
376
• Xerostomia
– Treatment:
| (4)
Artificial saliva/lubricants • Sialogogues, sugar-free lemon drops
–Salagen (pilocarpine) or Evoxac
(cevimeline) • 1% neutral sodium fluoride gel or
toothpaste nightly • Antifungal therapy as needed
377
– Deposition of calcium salts around nidus of
debris in lumen
sialothiasis
378
• Begins in the bone marrow with
malignant transformation of one of the
stem cells, which proliferates and
eventually overflows into the peripheral
blood
leukemia
379
– Encephalotrigeminal angiomatosis
(Sturge-Weber syndrome)
• Radiographic feature:
“tram-
line” calcifications seen on skull film
380
–Petechial hemorrhages of skin and oral
mucosa (if platelet production affected)
multiple myeloma
381
• Lymphoreticular
– Leukemia
• Prognosis depends on:
–Type of leukemia
–Age of patient
–Cytogenetic alterations
382
list 4 clinical features of pleomorphic adenoma?
• Slow-growing • Painless • Moveable • Rubbery-firm on palpation
383
what is myelophthisic anemia?
normal bone marrow cells
replaced by leukemic cells)
384
Much less common than pleomorphic adenoma, it is characterized by a proliferation of one cell type
monomorphic adenoma
385
a portion of Benign lymphoepithelial lesion (BLEL)
of the infiltrate is \_\_\_\_, perhaps representing \_\_\_\_\_\_
monocolonal
low grade lymphoma in situ
386
Lymphoreticular
– Leukemia
• Prognosis (con’t)\<
–CLL:
• Incurable, but highly variable course
of disease, 2 – 10 years
387
how much of oral traumatic neuromas are painful
1/4-1/3
388
with the
salivary component of Sjögren syndrome
• \>1 focus/4 mm2
389
could be from?
xerostomia
390
– Neurilemoma (schwannoma) - central
• Radiographic features: (3)
–Radiolucent
• Unilocular
• Multilocula
391
tx of pleomorphic adenoma in the submandibular gland
remove lesion and the involved gland
392
• Benign tumor of adipose tissue (fat)
lipoma
393
–Sarcoma botryoides is associated with
rhabdomyosarcoma
394
–Collection of spindle-shaped cells with
wavy nuclei
neurofibroma
395
Salivary Gland Neoplasms • Acinic cell adenocarcinoma – Treatment:
surgical excision
396
most common intraoral site of hemangioma?
tongue
397
• Nerve
– Traumatic neuroma
• Histopathologic features:
–Tangled mass of peripheral nerve
fibers in a collagenous background
398
• Mild tenderness to burning severe
radiating pain
traumatic neuroma
399
• Basophilic granular cells (zymogen granules)
acinic cell adenocarcinoma
400
Extracardiac rhabdomyomas have striking
predilection
for H/N
401
what percent of neurofibroma are multiple and associ with?
10% neurofibromatosis
402
bilateral papular lesions on the gingiva lingual to the mandibular canines
retrocuspid papilla
403
–Cellular spindle cell tumor within the
connective tissue, extravasated blood
Kaposi sarcoma
404
• Muscle
– Rhabdomyosarcoma
• Prognosis: (2)
–Depends on type
–Much improved compared to 40 yrs ago.
Prior to 1960 more than 90% patients died
405
• Often appear pseudoencapsulated
acinic cell adenocarcinoma
406
most common location of rhabdomyosarcoma
head and neck
407
clinical features peripheral ossifying fibroma (5)
–Painless –Firm –Coral-pink
–May be ulcerated
–Found only on the gingiva
408
–Mucocele-appearing lesion of retromolar area should be considered
mucoepidermoid carcinoma until proven otherwise!!
409
PLGA
410
• Atypical neoplastic lymphoid cell –
Reed-Sternberg cell
hodgkin lymphoma
411
clinical features of necrotizing sialometaplasia
• Swelling ± pain, paresthesia
• After ~ 2 weeks patient usually reports,
“a piece of my palate fell out”
• Sharply demarcated ulcer, non-elevated
margins
• Minimal peripheral erythema
412
Canalicular adenoma – Treatment:
enucleation
413
• Von Recklinghausen disease of the
skin • Majority of neurofibromatosis cases
Type 1 (NF1)
414
– Congenital epulis • Treatment: (2)
–Conservative excision –Some reports of spontaneous
resolution without surgery
415
\_\_\_\_\_\_ of all minor salivary gland adenoid cystic carcinomas are in palate
50%
416
• Sialography: “blossoms on a tree"
pattern of punctate sialectasis is often
observed
BLEL
417
• Sjögren syndrome
– Diagnosis
–Nuclear autoantibodies: Anti-SS-A
(anti-Rho) and anti-SS-B (anti-La) may
be found in ~ 50% of these patients
418
prognosis of pyogenic granuloma
15% recur
419
Tend to grow as solid masses
lymphoma
420
Type 1 (NF1) occurs how often? AD or AR, what % new mutations
– ~ 1 in 3000 live births – Autosomal dominant – ~ 50% new mutations
421
demographics of BLEL
female predilection, middle aged or older
422
–Bence Jones proteins
• Found in urine of
30-50% of cases multiple myeloma
423
– Most common salivary gland malignancy
Mucoepidermoid carcinoma
424
Papillary cystadenoma lymphomatosum “Warthin tumor” – Treatment:
surgical excision
425
myelomonocytic leukemia seen yearly?
and two types
• Myelomonocytic: (AML and CML)
–Acute myeloid leukemia (12,000)
–Chronic myeloid leukemia (4,700)
426
• Plexiform neurofibroma - feels
like “a bag of worms” • Pathognomonic for NF1
Type 1 NF1
427
focal
proliferation of leukemic cells at one soft tissue site
“Granulocytic sarcoma”
428
–Oral involvement most often in
what forms of leukemia
myelomonocytic forms
429
etiology of salivary gland neoplasms
unknown
430
• Patients often complain of dry, gritty
feeling in eyes and a dry mouth
Sjogren syndrome
431
• Adipose
– Lipoma
• Histopathologic features:
–Demarcated or encapsulated collection of mature fat cells
432
–Clonal proliferation of one specific
immunoglobulin type that is not normal or functional disease
multiple myeloma/plasmacytoma
433
oncocytes are associated with
“Warthin tumor” Papillary cystadenoma lymphomatosum
434
adenoid cystic carcinoma occurs what age?
• Most 5th decade, but wide age range (mean 55 y.o.)
435
light brown
macules, smooth borders “coast of California”
seen where?
cafe au lait
Type 1 NF1
436
– Rhabdomyosarcoma
• linical features (3)
–Usually painless
–Rapidly growing
rare
437
–“scooped-out” appearance of superficial
bone, esp. posterior mandible
– Langerhans cell histiocytosis
438
congenital epulis prognosis
–Excellent, no tendency to recur
439
describe fibroma? 6 characteristics
smooth or slightly papillary surface
dome shaped
sessile or pedunculated
\<1.5 cm or 1.5
–May ulcerate if traumatized –Asymptomatic unless traumatized
440
BLEL histopathologic features
shows destruction of what and replacement with
• Destruction of the normal parotid
parenchyma with replacement by a
diffuse lymphocytic infiltrate
441
canalicular adenoma prognosis
• Excellent – no tendency to recur
442
carcinoma ex-pleomorphic adenoma
443
– Leukemia
• Broadly divided types (4)
–Lymphocytic
–Myelomonocytic
–Acute
–Chronic
444
gradual involution percentages of hemangioma
* 50% resolve by age 5
* 90% are resolved by age 9
445
benign lymphoepithelial lesion
446
list malignant mesenchymal tumors? (4)
Mesenchymal • Fibrous • Nerve • Endothelial cell (Kaposi
sarcoma) • Muscle
447
neurofibroma prognosis (2)
–Generally good, especially small,
superficial lesions –Uncommonly transform to malignant
peripheral nerve sheath tumor
448
sublingual gland benign and malignant involvement makes up what percent of salivary gland neoplasms?
\<1%
449
• Fibrous
– Inflammatory papillary hyperplasia
• Treatment: (3)
–Topical or systemic antifungal therapy
–Removal of the denture may allow the
erythema and edema to subside
–Excise hyperplastic tissue before
fabricating a new denture (various
surgical methods have been used)
450
Lymphoreticular
– Leukemia
• Prognosis (con’t)\<
–AML: (2)
• \<60y.o. 40% 5-yr survival • \>60 y.o. less than 10% survival
451
• Sjögren syndrome
– Clinical features (con’t):
(5) seen in mouth
• Cervical caries, often rampant • Increased prevalence of oral candidiasis • Burning feeling on tongue • Angular cheilitis • Atrophy of dorsal tongue papillae
452
• Adenoid cystic carcinoma – Treatment:
• Wide surgical excision followed by radiation
453
list two examples of fibroma
• Frenal tag • Retrocuspid papilla
454
If the associated duct also is removed, then
it often demonstrates squamous metaplasia
sialothiasis
455
• Uncommon reaction to the sectioning of
a nerve
– Traumatic neuroma
456
what age does PLGA occur
• 6th – 8th decade (mean 56 y.o.), but wide age range 23 – 94 y.o.
457
what is the most common malignancy in the submandiublar gland tumors
adenoid cystic carcinoma
458
salivary gland neoplasms represent ___ of all H/N neoplasms
3%
459
Mucoepidermoid carcinoma – Clinical features: (4)
• Well-demarcated or infiltrative • Non-tender • Usually non-ulcerated, but can be • Ulceration and pain may develop as lesion progresses
460
canalicular adenoma
461
• Fibrous
– Pyogenic granuloma • Clinical features: (6)
–Rapid growth –Painless –Red –Often ulcerated
–Any body surface –Bleeds easily
462
sites of initial involvment in hodgkin lymphoma?
Head
Neck
463
–If port wine stain involves entire
distribution of V1, the risk for neurologic and ocular involvement is
78%
464
–Pseudoepitheliomatous hyperplasia
seen in what two conditions
granular cell tumor
necrotizing sialometaplasia
465
manifestations of Type 1 (NF1) (4)
– Highly variable gene expression (mild
to severe) –Cutaneous manifestations –Oral manifestations –Ocular manifestations
466
how many new cases of salivary gland neoplasms are diagnosed yearly?
4000
467
• Blood
– Hemangioma
• Treatment:
–“watchful neglect” unless problematic
or life-threatening –β- blocker, steroids, cryotherapy,
embolization, lasers or use of
sclerosing agents if cosmetically
unacceptable, surgical excision rarely
468
–Iatrogenic (transplant-associated) Kaposi Sarcoma
• Affects
skin and oral mucosa
469
what major glands are affected in adenoid cystic carcinoma
parotid and submandibular, equally
470
471
developmental
hamartoma of lymphatic vessel
differentiation, rather than true
neoplasm
Lymphangioma
472
cause of mucocele/ranula
Cause: rupture of salivary gland duct,
spillage of mucin into surrounding tissues
473
May be helpful in determining whether a
red lesion is due to extravasated blood or to
blood that is contained within vessels
diascopy
474
\_\_\_\_ % “Warthin tumor” Papillary cystadenoma lymphomatosumcases are synchronous or metachronous lesions
10%
475
–Iatrogenic (transplant-associate (2)
• Solid organ transplants (0.5% of
renal transplants) • Several months – years after
transplant
476
age range of endemic (African) kaposi sarcoma
wide age range esp. young adults
477
Lymphoreticular
– Leukemia
• Prognosis (con’t)\<
–ALL (2)
• Children ~90% considered cured
after tx • Adults ~80% initial remission, lower
5-year survival rate
478
–Rapid growth (endothelial cells) –Gradual involution
hemangioma
479
Muscle
– Rhabdomyosarcoma
• Histopathologic features: (2)
–Small round cells, hyperchromatic nuclei
–May see strap-shaped rhabdomyoblasts
with cross striations
480
cause of sialothiasis
– Cause unclear, may be promoted by chronic
sialadenitis and partial duct obstruction
481
early stages of necrotizing sialometaplasia are what?
lobular ischemic
necrosis
482
Previously known as histiocytosis X
Langerhans cell histiocytosis
483
amyloid deposits seen in what % of patients who have mutliple myeloma?
10-15
484
means frogs belly
ranula
485
–Monotonous sheets of atypical plasma
cells –Varying stages of differentiation
multiple myeloma
486
palisaded nuclei arranged
around Verocay bodies
Antoni A in schwannoma
487
MPNST mean age with NF1
29 years
488
classic kaposi sarcoma
489
• Acinic cell adenocarcinoma – Clinical features: • _____ of all salivary gland tumors • ____ in parotid • ____ minor salivary glands –Especially \_\_\_\_\_(3).
2% 90% 10% buccal mucosa, lips, and palate
490
Lymphadenopathic – esp. young
children, visceral tumors
karposi sarcoma endemic (African)
491
– Melanotic neuroectodermal tumor of infancy
• Radiographic features: (2)
–Radiolucency anterior maxilla –Deciduous maxillary incisor pushed
labially appearing as “tooth floating in
space”
492
• Lymphoreticular
– Lymphoma
• Hodgkin lymphoma
–Treatment depends on
stage:
• Multiagent chemotherapy • Radiation for later stages
493
–Most not associated with other
abnormalities, but some seen in rare syndromes, i.e., encephalotrigeminal angiomatosis (Sturge-Weber)
vascular malformation
494
–Collagen deposition secondary to trauma
fibroma
495
List 8 Salivary Gland Diseases
• Mucocele/Ranula • Sialolithiasis • Acute and Chronic Sialadenitis • Xerostomia • Benign lymphoepithelial lesion (BLEL) • Sjögren syndrome • Necrotizing sialometaplasia • Salivary gland neoplasia
496
• Benign tumor of infancy
hemangioma
497
necrotizing sialometaplasia heals in how many weeks
4-6 weeks
498
– Kaposi sarcoma
• 4 clinical presentations:
1. Classic
2. Endemic (African)
3. Iatrogenic
(transplant-associated) 4. Epidemic (AIDS-related)
499
• Lymphoreticular
– Langerhans cell histiocytosis
• Treatment:
–Depends on form of LCH
acute?
chronic?
eosinophilic granuloma?
chemotherapy
radioation/chemotherapy
curettage/radiation
500
MPNST mean age without NFT
46 years
501
gender preference of salivary gland neoplasms
slight F
502
tx of pleomorphic adenoma soft palate, labial and buccal mucosa
enucleation
503
what growth patterns do you see in PLGA
- Solid, trabecular, cribriform-like, ductal and spindle-cell areas
504
Non-hodgkin lymphoma affects younger patients compared to HL
False
Older age group than HL
505
mucoepidermoid carcinoma
506
3 clinical features of MPNST
may be spontaneous
may have pain
may have nerve deficit
507
two forms of lymphoma
hodgkins and non hodgkins
508
• Benign tumor of neural fibroblast origin
neurofibroma
509
• Mucoepidermoid carcinoma – Treatment – depends on
grade: • Low-grade – wide surgical excision • High-grade – wide surgical excision plus radiation
510
adenoid cystic carcinoma survival rates
–10-year survival 50% –20-year survival 25%
511
Benign Mesenchymal Tumors
tissue of origin: soft tissue (list 6 areas)
* Fibrous • Adipose • Nerve
* Blood • Lymph • Muscle
512
hemangioma usually arise by what age?
8 weeks
513
neurilemoma (schwannoma) occurs where?
lips, tongue, buccal mucosa
514
Benign Mesenchymal Tumors • Fibrous
– Pyogenic granuloma
• Histopathologic features
–Vascular granulation tissue
515
• Common hereditary condition
neurofibromatosis
516
–Proliferation of small, dark,
neuroectodermal-appearing cells nested
in aggregates
– Melanotic neuroectodermal tumor of infancy
517
tx could include neurosurgery?
Sturge-Weber syndrome
518
Benign Mesenchymal Lesions • Fibrous
– Inflammatory fibrous hyperplasia:
• Treatment:
–Conservative excision –Remake denture
519
traumatic neuromas common intraoral sites (2)
• Tongue
• buccal vestibule, especially mental
foramen area
• Painful when impinged upon by
denture
520
most common tumor of childhood
hemangioma
521
–Fascicles of spindle-shaped cells often
forming a “herringbone” pattern –Variable number of mitoses
fibrosarcoma
522
\_\_\_\_\_ occur in patients \< 15 y.o. in mucoepidermoid carcinoma
15%
523
– Kaposi sarcoma
• 4 clinical presentations (con’t)\<
–Endemic (African) (2)
• Prior to advent of HIV/AIDS was
already recognized in sub-Saharan
Africa • Wide age range esp. young adults
and children
524
which diseases are slow growing (5)
pleomorphic adenoma PLGA Warthrin Tumor adenoid cystic carcinoma acinic cell adenocarcinoma
525
in AIDS related KS what areas of the mouth are affected?
• Hard palate, gingiva, tongue
526
Originally was used to describe tumors demonstrating a more uniform histopathologic pattern
Monomorphic adenoma
527
cystic spaces containing serous fluid
Papillary cystadenoma lymphomatosum “Warthin tumor”
528
Melanotic neuroectodermal tumor of infancy
shows up where? and displays what type of growth
anterior maxilla
rapid growth
529
Mucoepidermoid carcinoma – Prognosis: Depends on
tumor size and histologic grade (low, intermediate, high)
530
• Bland cells, similar to normal acinar cells
acinic cell adenocarcinoma
531
non hodgkin lymphoma mostly arise from where?
lymph nodes
532
– Lymphoma
• Non-Hodgkin lymphoma
–linical features oral (con’t)\<
(3)
• Soft tissue • Centrally in bone • Mandibular involvement may have
“numb chin” sign (paresthesia)
533
Melanotic neuroectodermal tumor of infancy describe color?
brown and black
534
• Pt. usually aware of long-standing, asymptomatic mass which suddenly becomes tender or is associated with paresthesia
• Carcinoma ex-pleomorphic adenoma
535
–Congenital abnormality, not an inherited
or genetic problem –Dermal capillary vascular malformation
affecting superficial and deeper tissues in
region of cranial nerve V
• Encephalotrigeminal angiomatosis
| (Sturge-Weber syndrome anomaly)
536
Lymphoreticular
– Langerhans cell histiocytosis
• 3 clinical presentations: (overlapping
features)
1. Acute disseminated histiocytosis 2. Chronic disseminated histiocytosis 3. Eosinophilic granuloma (monostotic or
polyostotic, i.e., localized to one site
or multiple skeletal sites)
537
• Rare • Neural crest origin
Melanotic neuroectodermal tumor of
infancy
538
• 2nd most common minor salivary gland malignancy
Salivary Gland Neoplasms • Polymorphous low-grade adenocarcinoma (PLGA)
539
–Deposition of amyloid (accumulation of
light chains) in various soft tissues
– Multiple myeloma
540
sites usually affected by amyloid? (2)
Periorbital skin
• oral mucosa, especially tongue
541
lisch nodules of the iris?
type 1 (NF1)
542
Periorbital skin
–Waxy, firm, plaque-like lesions
multiple myeloma
543
• Non-Hodgkin lymphoma
–Clinical features oral:
where?
• Mass soft palate or buccal mucosa
544
• Nerve
– MPNST
• Treatment:
–Surgical resection, radical excision,
amputation – ± radiation
545
Mucoepidermoid carcinoma • Sites minor glands + % (5)
–Palate 28% –Retromolar region 23% –Lips, floor of mouth, tongue uncommon but mucoepidermoid carcinoma is the most common salivary gland carcinoma in those areas
546
• Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Prognosis: (2)
• Variable, depends on grade and stage
(better due to targeted therapies) • ~ 1/3 die of disease each year (19,320
deaths due to disease in U.S. 2011)
547
non hodgkin lymphoma
548
Benign Mesenchymal Tumors • Nerve
| (7)
– Traumatic neuroma – Neurilemoma (schwannoma) – Neurofibroma
• Neurofibromatosis – Melanotic neuroectodermal tumor of infancy – Granular cell tumor
• Discussion of congenital epulis
549
xerostomia causes (5)
• Glandular aplasia or hypofunction • Radiation therapy • Graft vs. host disease • Sjögren syndrome
medications
550
• Chronic Sialadenitis
– Histopathologic features:
• Chronic inflammatory cell infiltrate • Acinar atrophy, ductal dilatation and
fibrosis
551
non hodgkin lymphoma
552
• Sjögren syndrome
– Labial salivary gland biopsy technique: (3)
• Lower labial mucosa, lateral to midline,
uninflamed • 1cm incision, parallel to vermilion zone • Remove at least 5 minor glands through
the incision and place them in routine
10% buffered formalin
553
Xerostomia
– Predisposes to:
| (3)
• Mucosa susceptible to injury due to lack
of lubrication • Oral candidiasis • Increased caries, especially cervical
554
Solitary plasmacytoma is precursor to ?
and confined to
multiple myeloma
bone
555
list malignant salivary gland neoplasms (5)
– Mucoepidermoid carcinoma – Polymorphous low-grade adenocarcinoma – Adenoid cystic carcinoma – Acinic cell carcinoma – Carcinoma ex-pleomorphic adenoma
556
Lesional cells usually bland
PLGA
557
• PLGA – Treatment:
– Wide surgical excision
558
• Fully developed at birth • Does not involute
non-involuting congenital
hemangioma
559
cause of acute/chronic sialadenitits
infectious/non infectious causes
– Bacterial, often penicillinase-producing
staph. Viral, most often mumps
560
• Sialolithiasis – Treatment: (try to name 3)
• Gentle massage to milk toward orifice • Sialogogues or sour sugarless candies • Moist heat
• Increase fluid intake to “flush” • Surgical removal, may include gland if
significant inflammatory damage • Lithotripsy, sialendoscopy with basket
retrieval (major glands)
561
– Langerhans cell histiocytosis
• Incidence in general population ranges from
1-4 million cases
562
• Nerve
– MPNST
• Prognosis:
–With NF1 –
-without NF1-
23% 5 year survival
50% 5 year survival
563
three clinical features of sialothiasis
hard submucosal mass in soft tissue
+/- symptoms
swelling prior/during meals
564
granular cell tumor found where (3)
–Any cutaneous surface –40% occur on the tongue –Also found on buccal mucosa, floor of
mouth
