Oral Cavity and Sinuses Flashcards Preview

MODHIII - Unit 3 > Oral Cavity and Sinuses > Flashcards

Flashcards in Oral Cavity and Sinuses Deck (48)
1

Candidiasis (moniliasis, thrush): location, presentation, who

- oral
- white patch clinically, easily removed by scraping
- diabetes or immunocompromised associated

2

Tumor-like conditions

- pyogenic granuloma/lobular capillary hemangioma
- mucoceles

3

Pyogenic granuloma/lobular capillary hemangioma

- benign reactive process
- nodular growth on the mucosal surface
***not a granulomatous process***

4

Mucoceles

- obstruction of oral mucosa mucous glands
- leads to inflammation
- caused by trauma
- cystic dilation of ducts filled with mucin

5

Potentially premalignant lesions

- leukoplakia (white patch)
- erythroplasia (red patch)

6

Leukoplakia (white patch)

- can be benign or dysplastic/carcinoma
- cannot be removed by scraping
- irritation, inflammation can cause leukoplakia reaction
- must always be considered potentially pre cancerous unless proven otherwise (malignancy 1-15%)

7

Erythroplakia (red patch)

- more likely to be associated with malignancy, up to 50%

8

Leukoplakia (white patch): histology of benign disease

- hyperkeratosis
- mucosal epithelial hyperplasia
- orderly maturation
- no distortion of architectural order

9

Leukoplakia or erythroplakia with severe dysplasia

- architectural disorder
- nuclear irregularity
- nuclear pleomorphism

10

Squamous carcinoma of lip/skin: etiology, survival, differentiation

- etiology: sun (UV)
- survival: best
- differentiation: well

11

Squamous carcinoma: floor of mouth, anterior tongue, hard palate: etiology, survival, differentiation

- etiology: ETOH, smoking
- survival: intermediate, poor
- differentiation: variable

12

Squamous carcinoma of oropharynx: etiology, survival, differentiation

- etiology: HPV
- survival: favorable
- differentiation: variable

13

Result of oropharyngeal cancer being associated with HPV

- better survival than non-HPV associated carcinomas
- nearly exclusively seen in men

14

Oral cavity/oropharyngeal squamous carcinoma: treatment

- surgical: surgical margins guided by intra operative frozen sections
- post op radiation/chemoradiation given for metastatic or incompletely resected tumor

15

Salivary gland sialadenitis

- acute and chronic forms
- can be secondary to obstruction of a major excretory duct

16

Chronic sialadenitis

- duct obstruction--inflammation--tissue destruction: acinic atrophy, ductal metaplasia, duct dilation, chronic inflammation (lymphocytes), fibrosis (few cells)

17

Autoimmune sialadenitis

- sjogren's syndrome

18

Sjogren's syndrome

- autoimmune multi organ process
- affects lacrimal and salivary glands
- dry eyes, dry mouth
- pathologic finding: lympho-plasmacytic infiltration

19

Sjogren's syndrome: histologic finding

- inflammatory FOCUS

20

Salivary gland tumors: general info

- uncommon
- large number of types of tumors
- major glands: parotid, submandibular, sublingual
- parotid gland: 85% of salivary gland tumors

21

Salivary gland tumors: facts

- 65-80% of parotid tumors are benign
- smaller the gland, more likely the tumor will be malignant
- most salivary gland tumors are slow growing
- all salivary gland tumors are treated primarily by surgical removal

22

Benign salivary tumors

- pleomorphic adenoma
- warthin's tumor (papillary cystadenoma lymphomatosum)

23

Pleomorphic adenoma: frequency, sit

- frequency: most common tumor
- site: usually parotid, may occur in any salivary gland

24

Pleomorphic adenoma: cell involvement

- mixed tumor: epithelial cells (ducts, acini); mesenchymal cells (myoepithelial, chondroid, myxoid)

25

Salivary gland tumors: treatment

- total excision of parotid gland hampered by facial nerve (separates superficial and deep lobes)
- most pleomorphic adenomas occur in superficial lobe
- facial nerve at risk of surgical treatment of histologically benign process

26

Pleomorphic adenoma: behavior

- conservative surgical therapy, recurrence if not completely removed
- rarely, epithelial or both epithelial/mesenchymal cells become malignant

27

Pleomorphic adenoma: malignant transformation

- carcinoma ex pleomorphic adenoma: epithelial malignancy
- carcinosarcoma: epithelial & mesenchymal malignancy

28

Warthin's tumor (papillary cytadenoma lymphomatosum): frequency, site, microscopic, behavior

- frequency: second most common salivary gland tumor, older population usually men SMOKERS
- site: parotid, maybe bilateral; arise from epithelial cells in parotid LNs
- microscopic: epithelial (oncocytes) overlie lymphoid follicles
- behavior: no recurrence but may have multiple or new tumors

29

Herpetic stomatitis (cold sore)

- HSV type I
- oral cavity, lips
- virus survives in dormant state in nerves
- can become more extensive with involvement of brain in immunosuppressed patients

30

Malignant salivary gland tumors

- mucoepidermoid carcinoma
- adenoid cystic carcinoma
- acinic cell carcinoma

31

Mucoepidermoid carcinoma: site, microscopic

- site: parotid & minor salivary glands
- microscopic: mucus cells & squamous epithelial cells

32

Mucoepidermoid carcinoma: how to tell it involves squamous cells

- intercellular bridges

33

Mucoepidermoid carcinoma: special stain

- mucicarmine stain: stains for mucus

34

Mucoepidermoid carcinoma: differentiation epithelial cell atypia

- high epithelial cell atypia = high grade tumor

35

Mucoepidermoid carcinoma: behavior

- depends on degree of differentiation
- low grade >90%, 5 years; high grade 20-40%, 5 years

36

Adenoid cystic carcinoma: site, microscopic, behavior

- site: major and minor gland, myoepithelial cells participate
- microscopic: cribiform pattern, "swiss cheese", **perineural invasion**
- behavior: indolent course often marked by recurrence

37

Adenoid cystic carcinoma: treatment

- surgical removal, with attention to free margins and negative margins of nerves
- indolent course marked by recurrence, tumor is often fatal, but fatalities may occur 15-20 years after initial presentation
***recurrences related to PERINEURAL invasion***

38

Acinic cell carcinoma: site, microscopic

- site: parotid
- microscopic: recreates salivary gland acinus

39

Acinic cell carcinoma: histological features

- no duct structures
- Zymogen granules

40

Acinic cell carcinoma: treatment, behavior

- treatment: surgical removal, attention to free margins
- behavior: slow growing, 80-90% 5 years

41

Paranasal sinus: inflammatory reaction

- allergic rhinitis

42

Allergic rhinitis (hay fever)

- many allergens responsible, pollens
- IgE mediated
- repeated exposure--thick mucosa, nasal/sinus polyps

43

Nasal sinus - fungal diseases

- invasive fungal sinusitis
- allergic fungal sinusitis
- fungus ball

44

Invasive fungal sinusitis

- aspergillus or mucorales (BAD) species
- seen in immunocompromised, hematologic malgnancies, diabetic ketoacidosis
- vascular invasion by fungi common resulting in necrosis and hemorrhage

45

Invasive fungal sinusitis: course, treatment

- course: fatal infection many times b/c of extension into brain
- treatment: immediate surgical removal of infected tissue

46

Allergic fungal sinusitis: definition, presentation, histology

- altered immune response to fungal agents (atopic)
- rhinorrhea, pressure in sinus, headaches
- histology: mucin, EOSINOPHILS, degenerated epithelial cells

47

Allergic fungal sinusitis: organisms

- Aspergillus
- Dematiaceous: alternaria, bipolaris, curvularia (ABC-D)

48

Fungus ball

- unilateral sinus obstruction and pain
- masses of fungal organisms in sinus (aspergillus species)
- treatment: removal of fungal mass