What is the more common name for an aphthous ulcer?
What causes them?
What ages are aphthous ulcers most likely to present?
What is the treatment?
First two decades of life
spontaneously resolve in a week or two
What causes Herpes Stomatitis?
How is it transmitted?
What is the common name?
Herpes Simplex Virus 1
How is herpes stomatitis diagnosed?
How is it treated?
Diagnosed by a Tzanck stain (multinucleated, marginization of chromatin, and molding seen)
It's not! It lays dormant and reactivates when immunocompromised or stressed.
What organism causes thrush?
How does it present clinically?
White plaque in the mouth that can be scraped off
What are some conditions associated with thrush?
Dentures Diabetes Steroids Antibiotic therapy Cancer Immunosuppression
What is a squamous papilloma?
What conditions is it associated with?
Benign Epithelial hyperplasia
HPV 11 and 6 infection
Where can a squamous papilloma occur?
What ages are most likely to get a squamous papilloma?
Lingual, Buccal, Laryngeal, Labial mucosa
Affects ages 30-50
What is the difference between laryngeal nodules and laryngeal polyps?
Location and number
Nodules are bilateral and on the vocal cord
Polyps are singular and in the ventricle or Reinke's space
What causes laryngeal polyps/ nodules?
Who is most likely to get them?
Do they increase the risk of cancer?
Smoking, overuse of vocal cords
What does a polyp look like on histology?
Normal sqamous epithelium with large amounts of edema and keratin build-up (large pink, swirly swatches)
Distinguish between leukoplakia and erythroplakia (appearance and significance)
Leukoplakias are white patches that cannot be scraped off.
Erythroplakias are reddened, granular areas.
Erythroplakias are more likely to result in epithelial dysplasia & cancer.
Recall the normal progression to an epithelial carcinoma.
Describe the appearance of such a carcinoma.
Hyperplasia > Dysplasia > Carcinoma in Situ > Invasive carcinoma
Proliferation of basal cells, loss of cell polarity, mitotic figures & hyperchromasia.
What is the most common oral cancer?
Describe its usual demography.
Squamous cell carcinoma.
Usually older adults, male prevalence.
What risk factors are associated with oral squamous cell carcinoma?
Tobacco & alcohol (synergistic)
Erythro > Leukoplakia
Describe the prognosis and sites of metastasis of oral SCC.
Survival is decent if caught early stage, dismal if not.
Lung, liver, bone. (lymph nodes too, of course)
Where is the most common site of laryngeal carcinoma?
Why are subglottic laryngeal carcinomas detected later? How are they usually detected?
On the glottis.
These do not cause voice hoarseness like glottal carcinomas do. They are only detected when they spread enough to cause hemoptysis/dysphagia.
How are laryngeal carcinomas treated?
Contrast its outlook with oral SCCs.
Laryngectomy is an option, but radiation is standard.
Lower survival in earliest stage, better in later stage--that is, less extreme decline in prognosis with stage.
Where do nonkeratinizing squamous cell carcinomas usually develop?
How do HPV 16/18 promote carcinogenesis?
In Waldeyer's ring: Tonsil, base of tongue...
These high-risk serotypes express proteins E6 and E7, which inhibit the function of tumor suppressors Rb and p53.
Describe the normal nasal composition.
Anteriorly is squamous, posteriorly is respiratory epithelium.
Submucosum is rich with seromucinous glands and vessels.
Nasal septum comprised of cartilage and lamellar bone.
Virus, allergy, obstruction.
Edema, enlarged turbinates, thickened basement membranes and inflammatory infiltrates.
What tumors can affect the oral cavity?
What tumors can affect the nasal cavity?
Squamous cell carcinoma (keratinizing vs not; laryngeal?)
Schneiderian papilloma, olfactory neuroblastoma, nasopharyngeal carcinoma.
What are the subtypes of schneiderian papillomas?
How do they present?
Are they benign? What associations do they have?
Exophytic, Endophytic, and Cylindrical
Generic nasal symptoms: Obstruction, epistaxis, rhinorrhea, facial pressure & headache.
Benign but often recurrent. HPV 6/11
What cells proliferate in olfactory neuroblastoma?
How can you identify these cells?
Look for round nuclei with scant cytoplasm, Salt & Pepper chromatin, granules and positive staining for synaptophysin & chromogranin.
Distinguish the presentation of an olfactory neuroblastoma from other nasal tumors.
How is its outlook?
You can't, symptoms are still nondescript: Epistaxis, Obstruction, Headache.
Decent 5-year survival (50-70%) despite ready metastasis to lungs.
Describe the demography of nasopharyngeal carcinoma.
What evidence supports an environmental etiology?
Northern Africa, China & SE Asia. (Sattar says: African children and Chinese adults)
Children of first-gen immigrants show a decline in incidence. Etiology probably related to EBV/smoked foods/smoking in old country.
Nasopharyngeal carcinomas, like oral, can be keratinizing or non-keratinizing. What is the name given to an undifferentiated non-keratinizing carcinoma?
(lymphocytic infiltration obscures the tumor epithelium)
Describe the treatment and outlook of nasopharyngeal carcinoma.
50-70% 3-yr survival rate (same as olfactory neuroblastoma)
Treated mainly with radiotherapy (like laryngeal carcinomas)
Describe the 3 major salivary glands.
Parotid: Largest, entirely serous, with abundant adipose tissue, lymph nodes and draining to the parotid duct.
Submandibular: Mid-sized, mostly serous, without lymph nodes and draining to Wharton's duct (watch for sialoliths?)
Sublingual: Smallest, mostly mucous, poorly encapsulated and draining to multiple ducts (Bartholin's?)
Describe the functional physiology of a salivary gland.
What purposes does saliva serve?
Acinus comprised of serous (basophilic) and/or mucinous (clear) cells drain into a duct (intercalated/striated) with the help of myoepithelial cells.
Facilitate mastication, digestion, and protects teeth.
What is the etiology?
How does it present?
Autoimmune; antibodies made against exocrine antigens (SSB, SSA).
Sicca syndrome: Xerostomia, keratoconjunctivitis, swollen glands.
Is Sjogren's usually primary or secondary?
How does it appear on pathology? Where was the biopsy taken?
What is Mikulicz disease?
Usually secondary to another autoimmune disease.
A minor salivary gland biopsy reveals lymphocytic infiltration with gland destruction.
"Benign lymphoepithelial lesion", whatever
Recall the four discussed salivary gland neoplasms.
What is their usual demography and location?
Are they usually malignant or benign?
Pleomorphic adenoma, Warthin tumor, Mucoepidermoid carcinoma, Adenoid cystic carcinoma.
Older patients with a slight female dominance. Usually parotid gland.
Usually benign (sublinguals are usually malignant!)
Describe its appearance and composition.
How common is it? How is its outlook?
Arises mainly in the parotid; mixed tumor of epithelium, myoepithelium, mesenchyme...
Most common salivary tumor. Slow growing and rarely malignant.
Describe its demography.
What gland is affected?
How does it appear on histology?
Male dominance, associated with smoking.
Bilateral parotid glands.
Bilayered oncocytic (PINK) epithelium with lymphocytic (PURPLE) infiltrate.
What is its composition?
Where does it usually occur?
Mixed tumor; squamous, mucous, intermediate cells...
Parotid and minor salivary glands.
Depends on grade, as usual. High-grade about 50% survival.
Adenoid Cystic Carcinoma
Describe the characteristic appearance of this tumor on histology.
Is it more or less common than mucoepidermoid CA?
Adenoid Cystic Carcinoma
Perineural invasion with cribriform architecture.
Less common; only 10% of salivary carcinomas are adenoid cystic.
What is a thyroglossal duct cyst?
How can you identify them on physical exam?
A developmental remnant from the thyroid's migration inferior from the base of the tongue.
They are affixed to the hyoid and should move with swallowing. Some may fistulize to the skin.
Describe the composition of a thyroglossal duct cyst.
lined with respiratory or squamous epithelium, with thyroid tissue in the walls (this can rarely become papillary thyroid carcinoma)
What mass might be found at the anterior border of the SCM? Assume the patient is 20years old.
Describe its composition.
Branchial cleft cyst (cervical lymph node metastasis also looks like this)
Thin-walled (squamous) and filled with "cheesy, mucoid" material. Frequently infected...