Exam 3 - ST Masses (Infectious/Neoplasms) Flashcards
(123 cards)
1
Q
Name the lesion
Caries, periodontal disease, or trauma. Accumulation of acute inflammatory cells. Associated with a nonvital tooth
Often painful. In the palatal region.
A
Palatal Abscess
2
Q
How to diagnose palatal abscess?
A
“Vitality testing - this rules out nasopalatine duct cyst
Imaging (periapical RL) “
3
Q
How to tx palatal abscess?
A
Treat source of infection (RCT or EXT)
If EXT, submit any soft tissue removed for histo exam
Monitor for improvement
4
Q
Name the lesion
Caries, periodontal disease, or trauma. Inflammatory cells perforate through epithelium and drain through intraoral sinus.
A
Parulis
5
Q
Name the lesion
Yellow-red nodule on gingiva or in vestibule
Associated with non vital tooth
Usually asymptomatic
A
Parulis
6
Q
How to diagnose parulis?
A
Vitality testing
Imaging (PA RL)
7
Q
How to tx parulis?
A
Treat source of infection (RCT or EXT)
If EXT submit soft tissue for histo exam
Monitor for improvement
Can poke gutta purcha in and take a PA the gutta purcha will point to the tooth of origin
8
Q
T/F Tx for parulis and palatal abscess follow same guidelines.
A
True
Treat source of infection (RCT or EXT)
If EXT submit soft tissue for histo exam
Monitor for improvement
9
Q
Name the lesion
Reaction to infection (bacterial, viral, fungi). Enlarged, tender LN
Mobile upon palpation
Accompanying symptoms of infection (fever, sore throat, fatigue).
A
Infectious LAD
10
Q
With Infectious LAD, LN are usually ______. Where as in LAD secondary to malignancy LN are usually _____ and _________.
A
Tender
Firm; Non-tender
11
Q
How to diagnose infectious LAD?
A
Clinical Diagnosis
Lab Tests
Biopsy if persistent
12
Q
How to diagnose LAD 2ndary to malignancy?
A
Imaging
Lab tests - to rule out infection
Biopsy - deep core with needle not done by dentist usually
13
Q
How to tx infectious LAD?
A
Often self limiting (should be gone in 2 weeks), resolved with tx of underlying conditions.
14
Q
How to tx LAD 2ndary to malignancy?
A
Treat underlying malignancy, need to fully describe what you see to primary care so they can be pushed up on the waitlist
15
Q
Name the lesion
Direct spread from a primary cancer (metastasis) or
Lymphoproliferative disorders (lymphoma, leukemia).
Firm-non tender LN
May feel fixed or matted to underlying tissue
Typically unilat
May have B symptoms (Night sweat, fever, weight loss)
A
LAD secondary to malignancy
16
Q
What are the clinical presentations of LAD 2ndary to Malignancy? (4 things)
A
Firm-non tender LN
May feel fixed or matted to underlying tissue
Typically unilat
May have B symptoms (Night sweats, fever, weight loss)
17
Q
What are the B symptoms?
A
Fever
Night sweats
Weight loss
18
Q
What is the demographic for LAD 2ndary to malignancy?
A
Middle age and elderly
19
Q
Name the lesion:
Benign neoplasm derived from schwann cells (mesenchymal)
A
Granular Cell Tumor
20
Q
Name the lesion
Benign tumor of fat
A
Lipoma
21
Q
Name the lesion
Benign vascular tumor
A
Hemangioma
22
Q
Name the lesion
Structural anomaly of blood vessels
A
Vascular malformation
23
Q
Name the lesion
Benign Nerve origin - a lot of different cells.
Can occur in many parts of the body. _____ and ______ mucosa common oral sites
A
Neurofibromma
Tongue; Buccal mucosa
24
Q
Name the lesion
Benign Nerve origin - schwann cells
______ most common oral site
A
Schwannoma
Tongue
25
Demographics for granular cell tumor
Female predilection
Rare in Children.
26
Demographics for lipoma
Rare in children
27
Demographics for hemangioma
Infancy
Female predilection
28
Demographics for Vascular Malformation
Present at birth but persist and may become more apparent throughout life
29
What two benign Neoplastic ST lesion did we talk about that are rare in children?
Granular cell tumor and Lipoma
30
What is the most common tumor of infancy?
Hemangioma
31
Where is granular cell tumor most likely to be found in the oral cavity (site)?
Dorsal tongue most common oral site but can be anywhere
32
Where is Lipoma most likely to be found in the oral cavity (site)?
Buccal mucosa and buccal vestibule most common.
33
Where is hemangioma most likely to be found?
60% in the head and neck
34
Where is neurofibroma most likely to be found in the oral cavity (site)?
Tongue and buccal mucosa
35
Where is schwannoma most likely to be found in the oral cavity (site)?
Tongue
36
Clinical presentation of granular cell tumor?
Sessile submucosal nodule
Pink sometimes with yellow hue, usually on dorsal tongue
37
Clinical presentation of Lipoma
Soft smooth surfaced nodule
Usually yellow, sometimes pink depends on how much tissue overlay's
buccal vestibule and buccal mucosa most common oral sites
38
Clinical presentation of hemangioma
Bright red to dull/purple nodule
Undergo rapid growth for 6-12 months then involute
90% resolve by age 9
39
Hemangioma: Undergo rapid growth for _____ months then involute
______ resolve by age ____
6-12
90% resolve by age 9
40
Clinical presentation of vascular malformation
Can vary from pink/red macule to blue/purple mass
Presentation varies based on kind of vasculature involve (capillary, venous, av)
Port wine staines (capillary malformations) common on the face
Bruit- "large vessels"
41
How to tx granular cell tumor?
Excisional biopsy
42
How to tx lipoma?
Excisional biopsy
43
How to tx hemangioma?
Varies depending on subtype, location, and size. It does respond to medication
44
How to tx vascular malformation?
Varies depending on subtype, location and size
Does NOT respond to medications
45
What test can be used to determine if a lesion is vascular?
Diascopy
46
Diascopy: Vascular lesion tend to _____ with pressure. Blood displaced.
blanch
47
How can you diagnose
granular cell tumor, lipoma, hemangioma, and vascular malformations?
all biopsy
But vascular malformation can also be diagnosed by aspiration (dx vascular origin) and imaging (angiogram).
Also note Lipoma will float in formula bottle
48
________ will float in formalin bottle.
Lipoma
49
What is the function of lymphoid tissue?
Recognize and process foreign antigens (Bacterial, fungal, and viral)
Respond to antigenic challenges
Lymphoid cells proliferate, causing lymphoid hyperplasia
50
Name the three Lymphoid tissue head and neck locations
A. Cervical lymph nodes (anterior and posterior)
B. Lymphoid tissue of waldeyer’s ring (tonsils)
C. Scattering lymphoid aggregates (oropharynx, soft palate, lateral tongue, floor of mouth) ---- Bilateral +multiple patches good sign it is an scattering lymphoid
51
What is the one benign salivary gland tumor we talked about?
Pleomorphic adenoma
52
What is the most common salivary neoplasm?
Pleomorphic adenoma
53
What are the three malignant salivary gland tumors we talked about? (MPA)
1. Mucoepidermoid Carcinoma
2. Polymorphous adenocarcinoma
3. Adenoid cystic carcinoma
54
What is the most common salivary gland malignancy?
Mucoepidermoid carcinoma
55
What is the most common salivary gland malignancy?
Mucoepidermoid Carcinoma
56
What is the most aggressive salivary gland tumor?
Adenoid cystic carcinoma (perineural invasion)
57
What salivary tumor can recur?
Pleomorphic adenoma
58
T/F Mucoepidermoid Carcinoma and Polymorphous adenocarcinoma are usually low grade salivary tumors.
True
59
Major glands: The larger the salivary gland the more likely it is to be ________. The smaller the gland the more likely it is to _________.
benign ; malignant
60
Minor glands have almost ____ chance of being malignant.
50/50
61
Parotid Gland ____ of neoplasms
Minor gland _____ of neoplasms
Submandibular gland ____ of neoplasms
Sublingual gland _____ of neoplasms
70
19
10
1
62
What are the common site for minor salivary gland neoplasms?
Hard palate
Soft palate
Upper Lip
63
How do you tx a salivary tumor?
Varies depending on benign vs malignant, location, histopathologic grade and clinical stage
Local surgical excision or wide surgical excision
Superficial parotidectomy, or total gland removal with or without neck dissection
64
What is the most common site for a minor salivary neoplasm?
Hard palate
Soft Palate
Upper Lip
65
Name the lesion
Group of malignancies characterized by overproduction of neoplastic white blood cells
Originates in bone marrow, then spills over into circulation blood and tissues
Leukemia
66
Leukemia is the overproduction of what cells?
Neoplastic WBCs
67
What is the demographic you find leukemia?
Acute -
Chronic -
Acute - children and young adults
Chronic - middle-aged adults
68
What is the clinical presentation of leukemia?
Fatigue, Fever, Dyspnea
Splenomegaly and Hepatomegaly
LAD
Easy bruising and bleeding
Diffuse, boggy, nontender swelling on gingiva with or without ulceration that is asymptomatic
69
What is the difference between acute and chronic leukemia?
Acute - children and young adults
proliferation of immature WBC
more aggressive clinical course
Chronic - middle aged adults
proliferation of mature WBC
Slowly progressive clinical course
70
Name the pathology
middle aged adults
proliferation of mature WBC
Slowly progressive clinical course
Chronic Leukemia
71
Name the pathology
children and young adults
proliferation of immature WBC
more aggressive clinical course
Acute Leukemia
72
How to diagnose leukemia?
Biopsy -you can do this first before sending to ER because at ER may not immediately do bone marrow biopsy, however ER can get results from blood test
Bone Marrow Biopsy will be done in hospital
73
How to tx leukemia? and its oral presentation?
Chemotherapy
Bone marrow transplant
With tx of cancer the oral lesions will heal
74
T/F The diffuse boggy swelling gingiva with or without ulceration that is sometime associated with leukemia is usually asymptomatic.
True - but there are some symptomatic cases
75
A patient with CLL is more likely to be an adult or child?
Adult think chronic = adult
76
What is the most common leukemia?
CLL
77
T/F Leukemia starts in the LN and Lymphoma starts in the bone marrow.
False Leukemia starts in the bone marrow and Lymphoma starts in the LN.
78
Name the Pathology
Group of malignant tumors of LN
Originates in LN then can become more widely disseminated
Lymphoma
79
What is the clinical presentation of lymphoma?
Enlarging, non-tender, discrete mass in LN region
May have weight loss, fever, night sweats (B symptoms)
Pruritus
Oral non tender, diffuse soft tissue swelling, boggy can have ulceration
80
What type of lymphoma most commonly presents with oral manifestations?
Most commonly diffuse large B cell lymphoma
81
How to diagnose lymphoma?
Biopsy - can do a narrow slice but need to go deep
Imaging
82
How to tx lymphoma?
Chemo
83
Which has a more diffuse oral manifestation?
Leukemia or lymphoma
Leukemia usually
84
Name the pathology
Vascular malignancy
Caused by infection with HHV-8
Kaposi sarcoma
85
What is the demographic for kaposi sarcoma?
Most commonly seen in pt with _______.
Classic Form -
Endemic -
Iatrogenic -
Which one male or female more likely?
Most commonly seen in pt with AIDS in US
Classic form seen in the mediterranean, eastern europe, and central africa
Endemic form seen in africa
Iatrogenic form seen in recipient of solid organ transplants
90% in men
86
Kaposi sarcoma is found ____% in ____.
90% in men
87
What type of infection causes kaposi sarcoma?
HHV-8
88
What sites in the oral cavity does kaposi sarcoma have a predilection for?
Hard palate, gingiva, and tongue but can be at other sites as well
89
Describe the clinical presentation of kaposi sarcoma
Multiple blue-purple macules, plaques and nodules on the face and oral mucosa
Predilection for Hard palate, gingiva, and tongue but can be at other sites as well
90
How to diagnose Kaposi Sarcoma?
Biopsy
91
T/F For all the ST Neoplasms we talked about take a biopsy.
True
92
How do you tx kaposi sarcoma?
Varies, but usually involves management of the underlying AIDS (if applicable) and possibly chemotherapy
93
What type of kaposi sarcoma is the most common?
Endemic
Iatrogenic
AIDs related
Classic
AIDs related
94
Describe metastatic tumor.
Spread of malignancy
Middle aged and older adults with cancer
95
For MEN what are the most common metastatic tumors that metastasize to the oral cavity?
Lung, kidney, melanoma
96
For WOMEN what are the most common metastatic tumors that metastasize to the oral cavity?
Lung, kidney, breast, genitalia
97
What is the clinical presentation for metastatic tumors the metastasis to the oral cavity?
Nodular soft tissue mass resembling hyperplastic or reactive growth, 50% on the gingiva
98
Where are you most likely to find (site) the metastasizes of a metastatic tumor to the to the oral cavity?
50% on the gingiva
99
How to dx and tx metastatic carcinoma?
Incisional biopsy and manage primary malignancy (poor prognosis)
100
In _____ of pt with oral metastasis they do not know about the primary malignancy yet.
25%
101
Thyroid gland enlargement etiology (5 things)
Goiter (most common)
Thyroid adenoma (benign)
Thyroid carcinoma (malignant)
Graves disease - more likely symptomatic
Hashimoto's thyroiditis - more likely symptomatic
102
What is the most common thyroid gland enlargement
Goiter
103
What are the two neoplasms that can cause thyroid gland enlargement?
Thyroid adenoma (benign)
Thyroid carcinoma (malignant)
104
An enlarged thyroid + symptoms is most likely _________ ________ or ________ ____________. (autoimmune conditions)
Graves disease
Hashimoto's thyroiditis
105
Hyperthyroidism clinical Presentation (7 things)
Diffuse thyroid enlargement
Weight loss despite increased appetite
Tachycardia
Excessive perspiration - sweating
Warm, smooth skin
Tremors
Exophthalmos
106
T/F Generalized enlargement is more likely to be goiter, graves or hashimoto's vs a discrete nodule which is more likely to be a neoplasm.
True
107
Hyperthyroidism - Graves disease Clinical Presentation (7 things)
1. Diffuse thyroid enlargement
2. Weight loss despite increased appetite
3. Tachycardia
4. Excessive perspiration - sweating
5. Warm, smooth skin
6. Tremors
7. Exophthalmos
108
Match the pathology to the correct category.
Graves disease
Hyperparathyroidism or Hypoparathyroidism
Hyperparathyroidism
109
Match the pathology to the correct category.
Hashimoto's thyroiditis
Hyperparathyroidism or Hypoparathyroidism
Hypoparathyroidism
110
Hypothyroidism - Hashimoto's thyroiditis Clinical presentation (7 things)
1. Lethargy
2. Dry coarse skin
3. Swelling of face and extremities
4. Huskiness of voice
5. Constipation
6. Bradycardia
7. Hypothermia
111
How to diagnose thyroid enlargment?
Fine needle aspiration (FNA)
Imaging
Blood work
112
Name the pathology
Soft tissue mass of the gingiva
Odontogenic neoplasm: Peripheral ameloblastoma
Peripheral calcifying epithelial odontogenic tumor, ETC"
Peripheral odontogenic cyst/tumors
113
How to diagnose and tx Peripheral odontogenic cyst/tumors?
Biopsy, Excisional Biopsy
114
How would you diagnosis infectious ST masses?
Reactive LAD:
LAD 2ndary to malignancy:
Palatal Abscess:
Parulis:
Reactive LAD:
Clinical Diagnosis
Lab Tests
Biopsy if persistent
LAD 2ndary to malignancy:
Imaging
Laboratory tests - to rule out infection
Biopsy - deep core with needle not done by dentist usually
Palatal Abscess:
Vitality testing - this rules out nasopalatine duct cyst
Imaging (periapical RL)
Parulis:
Vitality testing
Imaging (PA RL)
115
Demographics for.....
Reactive LAD:
LAD 2ndary to malignancy:
Palatal Abscess:
Parulis:
Reactive LAD: Broad
LAD 2ndary to malignancy: Middle age elderly
Palatal Abscess: Broad
Parulis: Broad
116
How would you diagnose ST Neoplasms?
Granular cell tumor, Lipoma, Hemangioma, Vascular Malformation, Neurofibroma, Schwannoma, Salivary Gland Tumors
You would take a biopsy for all.
For vascular malformations you would also aspirate to see if vascular origin, do imaging (angiogram).
117
How would you tx ST Neoplasms?
Granular cell tumor
Lipoma
Hemangioma
Vascular Malformation (developmental)
Neurofibroma
Schwannoma
Salivary Gland Tumors
Granular cell tumor - Excisional Biopsy
Lipoma - Excisional Biopsy
Hemangioma - Varies depending on subtype, location, and size and response to medication
Vascular Malformation - Varies depending on subtype, location, and size... NO response to medication
Neurofibroma - excisional biopsy
Schwannoma - excisional biopsy
Salivary Gland Tumors - Varies depending on benign vs malignant, location, histopathologic grade and clinical stage local surgical excision, wide surgical excision, superficial parotidectomy, or total gland removal with or without neck dissection
118
Demographics
Granular cell tumor
Lipoma
Hemangioma
Vascular Malformation (developmental)
Neurofibroma
Schwannoma
Salivary Gland Tumors
Granular cell tumor:
Female predilection
Rare in Children
Lipoma:
Rare in children
Hemangioma:
Female predilection.
Most common tumor of infancy
Vascular Malformation: (developmental)
Present at birth but persist and may become more apparent throughout life
Neurofibroma: didnt say
Schwannoma: didnt say
Salivary Gland Tumors: didnt say
119
Site
Granular cell tumor
Lipoma
Hemangioma
Vascular Malformation (developmental)
Neurofibroma
Schwannoma
Salivary Gland Tumors
Granular cell tumor-
Dorsal tongue most common oral site but can be anywhere
Lipoma -
Buccal mucosa and buccal vestibule most common
Hemangioma -
60% in head and neck
Vascular Malformation (developmental)
Neurofibroma -
Can occur in many parts of the body. Tongue and buccal mucosa common oral sites
Schwannoma -
Tongue most common oral site
Salivary Gland Tumors -
Common sites for minor salivary gland neoplasm Hard palate, soft palate, upper lip
120
________ ________ found 90% in men
Kapoks sarcoma
121
What type of malignant salivary gland tumor is not found in major salivary glands?
Polymorphous adenocarcinoma
122
What is the vascular malignancy we talked about?
Kaposi Sarcoma
123
Site to find:
Salivary gland neoplasm
Leukemia
Lymphoma
Kaposi Sarcoma
Metastatic tumors
Peripheral odontogenic cyst/tumor
Minor salivary gland neoplasm: Hard palate (most common), soft palate, upper lip
Leukemia: gingiva
Lymphoma: Posterior hard palate, gingiva, buccal vestibule
Kaposi Sarcoma: Predilection for hard palate, gingiva and tongue
Metastatic tumors: More than 50% on the gingiva
Peripheral odontogenic cyst/tumor: Soft tissue mass of the gingiva
