Mucosal diseases Flashcards
(36 cards)
Describe linea alba/ traumatic keratosis in terms of:
- Pathogenesis
- Histopathology
Pathogenesis:
• Oral keratoses appear white because the thickened or abnormal keratin becomes hydrated as a result of being bathed by saliva, and then evenly reflects light
• Chronic frictional irritation leads to epithelial thickening and hyperkeratinization
• Appears on the buccal mucosa
Histopathology:
• Hyperkeratosis
• Acanthosis but there is no dysplasia
Describe fordyce granules in terms of:
- Histopathology
- Clinical signs
Histopathology:
• Consist of a number of lobules of sebaceous cells grouped around one or more ducts
Clinical:
• Sebaceous glands in the oral mucosa
• Seen as separate small, yellowish bodies beneath the surface,
• Commonly seen in the mucosa of the upper lip, cheeks, and anterior pillar of the fauces
Describe benign migratory glossitis aka geographic glossitis in terms of:
- Pathogenesis
- Clinical signs (5)
Pathogenesis:
• Inflammatory condition
• The cause of geographic tongue is unknown but geographic tongue occurs more often in patients who have psoriasis
• Not a static condition; there are periods of remission
Clinical:
• Irregular, partially depapillated, red areas on the anterior two-thirds of the tongue surface
• The margins of the lesions are often outlined by a thin, white line or band
• Associated with loss of the filiform papillae
• The fungiform papillae remaining as shiny, dark-red eminences
• Frequently associated with fissured tongue
Describe benign migratory glossitis aka geographic glossitis in terms of:
- Histopathology
Histopathology:
• Parakeratosis
• Epithelium at the edges of the lesions are acanthotic
• Dense, neutrophil leukocyte infiltration
• Munro’s microabscess:
• Vascular ectasia
Describe recurrent aphthous ulceration in terms of:
- Pathogenesis
- Histopathology
Pathogenesis:
• Idiopathic ulcers, which recur frequently
• The aetiology of RAS is unclear, but there is increasing evidence that damaging immune responses are involved
Histopathology:
• The surface of the ulcer is covered by a fibrinous exudate infiltrated by polymorphs
• Lymphocyte infiltrate by basal cells
• Beneath is a layer of granulation tissue with dilated capillaries and oedema
Describe recurrent aphthous ulceration in terms of:
- Clinical signs of minor aphthous ulcers
○ Prodromal symptoms
○ One to five, shallow, round or oval ulcers which affect the non- keratinized areas of the oral mucosa
○ Have a grey/yellow base with an erythematous margin
○ Heal without scarring
○ Common anteriorly
Describe recurrent aphthous ulceration in terms of:
- Clinical signs of major aphthous ulcers
○ Major aphthous ulcers are large greater than 1 cm in diameter
○ They may occur anywhere in the mouth, including the keratinized oral mucosa, especially posteriorly
○ Extend deep and may present as crater-like ulcers with rolled margins which are indurated on palpation because of underlying fibrosis
Describe recurrent aphthous ulceration in terms of:
- Clinical signs of herpetiform aphthous ulcers
○ Multiple, small, pin-head sized ulcers (about 1–2 mm)
○ Can occur on any part of the oral mucosa
○ As many as a hundred ulcers may be present
Describe fibroepithelial polyps in terms of:
- Histopathology
- Fibrous connective tissue
- Core of dense, relatively avascular and acellular fibrous tissue
- The surface of a fibroepithelial polyp is covered by stratified squamous epithelium which may vary in thickness and show areas of hyperkeratosis
- Typically, there is little or no inflammatory cell infiltration
Describe fibroepithelial polyps in terms of:
- Clinical signs
- Arises mainly in the cheeks, particularly along the occlusal line, lips, and tongue,
- Firm, pink, painless pedunculated or sessile polypoid swelling
- A few millimeters to centimeters in size
- Larger lesions often attach to skin by slender stalks
- Ulceration is not a feature unless the patient has bitten into the polyp.
Describe lichen planus in terms of:
- Pathogenesis
- Lichen planus is aT cell-mediated autoimmune disorder in which inflammatory cells attack an unknownproteinwithin the skin and mucosalkeratinocytes.
- Affects stratified squamous epithelium
- Present in different forms
Describe lichen planus in terms of:
- Histopathology
- Lymphocyte infiltrate beneath, killing epithelial cells (particularly, basal cells)
- If basal cells die, thickness of epithelium is reduced (atrophy), thus erythema
- Epithelium is indistinct from connective tissue
Describe lichen planus in terms of:
- Oral signs (3)
- Systemic signs (4)
Oral:
• White reticular/ network pattern of striae, bilateral, presents on checks
• Red, swollen tissues
• Open sores
Systemic: • Purplish lesions/ bumps on skin • May be itchy • Blisters • Thin, white lines over rash
Describe squamous cell papilloma:
- Pathogenesis
- Histopathology
- Clinical
Pathogenesis:
• Small benign (non-cancerous) growth that begins insquamous cells
• 50% associated with human papillomavirus
Histopathology:
• Proliferatingsquamousepithelia shown as finger like projections
• May be hyperkeratosis
Clinical:
• White-pink cauliflower-like surface projections
Describe oral submucous fibrosis in terms of:
- Pathogenesis
- Premalignant condition because it is often associated with epithelial atrophy and dysplasia
- Characterized by inflammation and progressivefibrosisof thesubmucosaltissues
Describe oral submucous fibrosis in terms of:
- Histopathology
- Hyalinization (necrosis) of the subepithelial connective tissue
- Very few fibroblasts present
- Blood vessels narrowed or totally obliterated by the fibrosis
- Lymphocytes and plasma cells are scattered throughout the hyalinized tissue
- No rete ridges
Describe oral submucous fibrosis in terms of:
- Clincal signs
- Blanched, marble appearance, often with palpable bands of fibrous tissue
- Increased stiffening of the oral mucosa associated with progressive underlying fibrosis
- Difficulty in opening the mouth and to a binding down of the tongue
Describe capillary haemangioma in terms of:
- Pathogenesis
- “Birth mark”. Non cancerous growths of numerous small capillaries which are close to the skin
- Oral lesions occur most commonly in the lips, tongue, cheeks, or palate
- May regress
Describe capillary haemangioma in terms of:
- Histopathology
- Lobules separated by thin septa containing clusters of thin walled capillaries
- Capillaries lined by a single layer of epithelium
Describe capillary haemangioma in terms of:
- Clinical signs (5)
- Bright red in colour
- Soft consistency
- Smooth, flat or raised, sometimes globular lesion of the mucosa
- Blanch on pressure
- Some may have a nodular consistency on palpation
Describe cavernous haemangioma in terms of:
- What it is
- Clinical signs
What it is:
• Made up of larger blood vessels that are dilated
• The blood vessels are not as closely packed as in a capillary haemangioma, and the spaces (or “caverns”) between them are filled with blood
Clinical signs:
• Same as capillary, except they are dark in colour
Describe cavernous haemangioma in terms of:
- Histopathological signs
- Large spaces containing blood
- Spaces lined by single layer of endothelium
Define and describe neoplasia
- Neoplasms are a new and abnormal growth of tissue in a part of the body, especially as a characteristic of cancer. It continues to grow even after the cessation of the stimuli that evoked the change
- Can be malignant or benign
- Malignant lesions metastasise
- Pathologically, benign lesions can be clinically malignant and cause death (might be compressing a vital structure or releasing hormones)
Differentiate hyperplasia from neoplasia
- Hyperplasia is the growth of tissue by increase in the size of the cells
- It can be reversible response to injury, stops upon removal of stimulus
- All cells grow, not just single clones
- Example: Fibrous epulis
- Example: Hypertrophy of muscles with exercise
