Flashcards in Oral & oesophageal pathology Deck (29):
Which type of oesophagitis is more common?
What is reflux oesophagitis?
Inflammation of the oesophagus due to refluxed low pH gastric content.
What are the causes of reflux oesophagitis?
May be due to defective sphincter mechanism ± hiatus hernia.
Abnormal oesophageal motility.
Increased intra-abdominal pressure (pregnancy).
What happens during reflux oesophagitis on a microscopic level?
Basal cell hyperplasia - basal zone epithelial expansion and lengthening of papillae.
(Increased proliferation to compensate for increased cell desquamation)
What are some complications of reflux?
Stricture (abnormal narrowing of lumen)
Barrett's oesophagus (replacement of stratified squamous epithelium by columnar epithelium)
What causes Barrett's oesophagus?
Chronic inflammation due to persistent reflux of acid or bile.
May be due to differentiation from oesophageal stem cells.
What is Barrett's oesophagus?
A protective response where the stratified squamous epithelium of the oesophagus is replaced by columnar epithelium - goblet cells.
What are some microscopic signs of Barrett's oesophagus?
Red velvety mucosa in lower oesophagus - columnar lined mucosa with intestinal metaplasia.
What is the name for the disease in which there would be a spotty or corrugated (feline) oesophagus?
Allergic / eosinophilic oesophagitis
Who is more likely to be affected by allergic oesophagitis?
Males > females
Personal/family history of allergy
What test can differentiate GORD from eosinophilic oesophagitis?
pH probe is negative for reflux in allergic oesophagitis
How can eosinophilic oesophagitis be differentiated from eosinophilic gastritis?
The gastric & duodenal tissues are affected in EG no EO.
What is a typical presentation of allergic oesophagitis?
Intermittent dysphagia (particularly solids).
The solid food can cause chest pain, which can mimic a MI.
Some sort of allergy, e.g. asthma, eczema, hay fever.
What are the 2 types of malignant carcinomas of the oesophagus?
Squamous cell carcinoma
What are risk factors for oesophageal squamous cell carcinomas?
smoking & alcohol
comments in lower 1/3rd of oesophagus - Barrett's oesophagus
Which type of malignant cancer does Barrett's mainly predispose to?
Increased risk of developing dysplasia then adenocarcinoma of the oesophagus.
Pathogenesis of adenocarcinoma?
Genetic factors / reflux disease -> Chronic reflux oesophagitis -> Barrett's oesophagus -> low grade dysplasia -> high grade dysplasia -> adenocarcinoma.
What are the mechanisms of metastases of oesophageal carcinomas?
What are some clinical presentations of oesophageal carcinoma?
Dysphagia - due to obstruction
General symptoms of malignancy - anaemia, weight loss, fatigue.
Which type of carcinoma is 90% of all oral cancers?
squamous cell carcinoma (SCC)
How can oral cancer present?
White / red / speckled / ulcer / lump
Where are the most high risk sites of cancer in the mouth?
Floor of mouth
Lateral border of ventral tongue
Reto molar pad / tonsillar pillars
Where are the rarer sites of oral cancer?
dorsum of tongue
How are SCC graded?
By degree of differentiation:
Well-differentiated tumour cells very obviously squamous with 'prices' and keritinization.
Poorly differentiated, may be difficult to identify tumour cells as epithelial
What are some histopathological features relating to the prognosis of SCC?
1. tumour diameter
2. depth of invasion
3. pattern of invasion
4. lymphovascular invasion
5. neural invasion by tumour
6. involvement of surgical margins
7. metastatic disease
8. extra-capsular spread of lymph node metastases
What does TMN stand for?
T = diameter of primary tumour (+) structures invaded
N = lymph node status
M = metastases
What would cause more difficulty swallowing liquids than solids?
Neuromuscular conditions that cause abnormal peristalsis of the oesophagus = oesophageal dysmotility.
underlying cause - achalasia
What is the classical picture a barium swallow would show of achalasia?