Oral cavity

Question 1

Common superficial hyperemic, shallow mucosal ulceration covered by thin exudate and rimmed by narrow zone of erythema 40% pop
Painful recurrent usually first two decades of life
Assoc with celiac, IBD, behcet’s
Resolve spontaneously in 7-10d

Answer 1

Aphthous ulcer canker sore

Question 2

Most common oral fungal infection
Normal oral flora

May be pseudomembranous (thrush), erythematous and hyperplastic

Arise from altered oral microbiota, immunosuppresion

Answer 2

Oral candidiasis

Question 3

Submucosal nodular fibrous tissue mass formed due to chronic irritation resulting in reactive CT hyperplasia
Occur on buccal mucosa along the bite line

Tx: excision

Answer 3

Fibroma

Question 4

Pedunculated mass on gingiva of children, young adult and pregnant
Richly vascular, ulcerated red to purple
Dense proliferation of immature vessels similar in granulation tissue

Tx: excision

Answer 4

Pyogenic granuloma

Question 5

White patch or plaque that cannot be scraped off
5-25% premalignant becoming SCC
Precancerous

Answer 5

Leukoplakia

Question 6

Red, velvety eroded flat or depressed area relative to surrounding mucosa
Greater risk of malignant transformation
40-70 years M 2:1

Answer 6

Erythroplakia

Question 7

Most common rf for leukoplakia and erythroplakia

Answer 7

Smoking

But multifactorial

Question 8

Hyperkeratosis over thickened acanthotic orderly mucosal lesion
Marked dysplasia merging with carcinoma-in-situ
Lymphocyte and mac infiltration

Answer 8

Leukoplakiap

Question 9

95% of cancers in oral cavity
6th mc neoplasm
Additional primary tumor linked to “field cancerization”
Raised, firm pearly plaque irregular, roughened verrucous mucosal thickening developing from dysplastic precursor
Well-differentiated keratinizing neoplasm to anaplastic sarcomatoid tumor

Answer 9

SCC of oral cavity

Question 10

Oral SCC two distinct pathways

Answer 10

1 TP53, P63 and NOTCH I mutations (alcohol, betel nut and smoking)
2 HPV-16 associated overexpress p16 kinase inh (tonsillar, base of tongue)

HPV + tumors have better prognosis

Question 11

Most common location of oral SCC

Answer 11

ventral surface of tongue
floor of mouth
lower lip
soft palate
gingiva

Question 12

SCC most common site of metastasis

Infiltrates before metastizing

Answer 12

cervical LN
mediastinal LN
lungs
Iiver

Question 13

Ulceration and induration

Numerous nests and islands of malignant keratinocyte invading underyling connective tissue stroma

Answer 13

oral scc

Question 14

Dry mouth
20% in >70 yrs
Major feature of Sjogren (dry eyes) and also from radiation, anticholinergics, antidepressant, antipsychotic, diuretic, antiHTN
dry mucosa, atrophy of papillae of tongue, fissuring and ulceration
inflammatory enlargement of salivary glands
Inc dental caries, candidiasis, dysphagia

Answer 14

Xerostomia

Question 15

Inflammation of salivary glands by trauma, virus, bacteria, autoimmune
Mc: mumps

Answer 15

Sialadenitis

Question 16

Most common inflamm lesion of salivary gland from blockage or rupture of salivary duct and saliva leak to CT stroma
Toddler, young adult, aged fluctuant swelling of lower lip
Cystlike lined by inflamm granulation, fibrous CT filled with mucin, inflamm cell mac
Tx: excision

Answer 16

Mucocele

Question 17

Infects submandibular gland by staph and strep viridans
Antecedent to infection: sialolithiasis
Long term phenothiazine therapy suppresing saliva

Answer 17

Bacterial sialadenitis

Question 18

65-80% arise in parotid
15-30% in parotid are malignant
70-90% sublingual tumors are malignant
40% submand 50% minor are malignant

Answer 18

Malignant salivary gland tumor is inversely proportional to the size of gland

Question 19

Most common benign salivary gland tumor

Answer 19

Pleomorphic adenoma 50%
Warthin tumor 5% 
Oncocytoma
Cystadenoma
Basal cell adenoma

Question 20

Most common malignant salivary gland tumor

Answer 20

Mucoepidermoid carcinoma 15%
Acinic cell carcinoma 6% 
Adenocarcinoma 6% 
Adenoid cystic carcinoma 4%
Malignant mixed tumor 3%

Question 21

Painless, slow-growing mobile discrete mass
60% of tumors in parotid
May contain myxoid, hyaline, chondroid, osseous (mesenchymal) or epithelial

Recur 25% if not completely excised

Also called

Answer 21

Pleomorphic adenoma

Mixed tumor

Question 22

Pleomorphic adenomas overexpress tf

Answer 22

PLAG1

Question 23

Transformation of pleomorphic to carcinoma ex pleomorphic adenoma

If present for 5 years

If present for 15 years

Answer 23

2%

10%

Most aggressive of salivary tumor

Question 24

Heterogenous
Epithelial cell resembling ductal acini, irregular tubules, strands dispered with mesenchymal bg of loose myxoid tissue containing chondroid

Answer 24

Pleomorphic adenoma

Question 25

Mucoepidermoid carcinoma is assoc with chromosome rearrangement of

Answer 25

MAML2 gene encoding signaling protein Notch pathway

Question 26

Cords, sheets, cysts lined by squamous mucus or intermediate cell Latter is hybrid cell type with both squamous features and mucus filled vacuoles detected with mucin stain Low grade invade locally recur in 15% but rarely metastasize and afford 5 yr survival of 90% High grade invasive difficult excision recur in 25-30%

Answer 26

Mucoepidermoid carcinoma

Question 27

Epithelial and mesenchymal Squamous and mucous

Answer 27

Pleomorphic Mucoepidermoid

Question 28

Cyst around crown of unerupted tooth resulting from degeneration of dental follicle Unilocular lesion assoc with impacted third molar (wisdom) Stratified squamous assoc with dense chronic inflammatory infiltrate within CT Tx: curative

Answer 28

dentigerous cyst

Question 29

Occur in 10-40 years Male, posterior mandible Locally aggressive high recurrence rate Well defined unilocular multilocular radiolucency Thin layer of parakeratinized or orthokeratinized stratified squamous epi with basal cell layer and corrugated epithelial surface Tx: removal

Answer 29

Odontogenic keratocyst

Question 30

Odontogenic keratocyst occur in nevoid basal cell carcinoma

Answer 30

Gorlin syndrome

Question 31

Inflammatory lesions on tooth apex from long-standing pulpitis by caries Periapical granuloma Tx: removal and restoration of tooth

Answer 31

Periapical cyst

Question 32

Odontogenic epithelium without chondroid or serous differentiation Slow growing cystic locally invasive indolent

Answer 32

Ameloblastoma

Question 33

Most common type of odontogenic tumor from epithelium extensive deposition of enamel and dentin Tx: excision

Answer 33

Odontoma