Oral Cavity Pathology

Question 1

What is this?

Answer 1

Aphthous ulcers (canker sores)

Question 2

Describe canker sores

Answer 2

More common in the first two decades of life, are extremely painful, and are typically recurrent

Question 3

What are some associations of canker sores?

Answer 3

Tend to be familial, and may be associated with celiac disease, IBD, and Behcet Disease

Question 4

What is this?

Answer 4

HSV lesions. Most people harbor HSV-1 latently and asymptomatically, but the virus can eb reactivated to form ‘cold sores’

Question 5

What things can cause a herpes reactivation?

Answer 5

trauma, allergies, UV light (Sunburn), URTI, pregnancy, extremes of temperature

Question 6

What is the most common fungal infection of the oral cavity?

Answer 6

Candidiases (candida albicans is a normal component of the oral flora and only produces disease under certain circumstances)

Question 7

What are the main forms of oral candidiasis?

Answer 7

-pseudomembranous (below) aka thrush

erythematous

hyperplastic

Question 8

What is this?

Answer 8

erythematous candidiasis

Question 9

Describe candidiasis

Answer 9

Usually associated with superficial, curdlike, gray to white inflammatory membranes that are friable

Question 10

What is this?

Answer 10

Oral fibromas, submucosal nodular fibrous tissue masses formed when chronic irritation results in reactive CT hyperplasia.

They are most common on the buccal mucosal

Question 11

How are oral fibromas handled?

Answer 11

surgical excision

Question 12

What is this?

Answer 12

Pyogenic granulomas, pedunculated masses usually found in children, young adults, and pregnant women. These tend to grow quickly but are benign

Question 13

What is leukoplakia?

Answer 13

white patches or plaques that CANNOT be scraped off and cannot be classified clinically or pathologically as any other disease

Question 14

What is the prognosis of oral leukoplakia?

Answer 14

Until proved otherwise, all leukoplakia must be considered precancerous to SSC (although only 5-25% are)

Question 15

What is erythroplakia?

Answer 15

red, eroded areas of the mouth that are usually flat or depresses and are associated with a much greater risk of malignant transformation than leukoplakia

Question 16

What pts commonly get leuko- and erythroplakia?

Answer 16

ages 40-70

-tobacco users

Question 17

How is leukoplakia look histologically?

Answer 17

hyperkeratosis with loss of cell maturation

Question 18

Approximately 95% of cancers of the oral cavity are ________

Answer 18

SCCs (with the remaining being adenocarcinomas)

Question 19

Overview of OSCC

Answer 19

• agressive with a 5yr survivial of only 50%
• those with singular lesions at diagnosis are likely to have others or develop one within 5 yrs (secondary tumors are often deadly- surveillance is CRITICAL)

Question 20

How do OSCCs arise?

Answer 20

two pathways:

• persons who are chronic alcohol and tobacoo users (and betal quid and paan chewing in Asia) get p53, p63, and NOTCH1 mutations
• occurs in the tonsillar crypts or the base of the tongue are harbor oncogenic HPV-16 and overexpress p16, a cyclic-dependent kinase inhibitor

Question 21

T or F. The prognosis for pts. with HPV-positive tumors is better than for those with HPV-negative tumors

Question 22

OSCC

Answer 22

OSCC

Question 23

Question 24

Xerostomia is most common in which pts?

Answer 24

20% 70+ yo

Question 25

What drugs typically cause xerostomia?

Answer 25

anticholinergics antidepressants, antipsychotics antiHTNs like CCBs sedatives analgesics antihistamines

Question 26

What is Sialadenitis?

Answer 26

inflammation of the salivary glands

Question 27

What is the most common cause of viral sialadenitis?

Answer 27

mumps, a paramyxovirus (mainly enlarges the parotids)

Question 28

What is this?

Answer 28

A mucocele, the most common inflammatory lesion of salivary glands resulting from either blockage or rupture of salivary ducts with leakage of saliva into surrounding CT stroma. These tend to swell, especially around meals

Question 29

What are the most common causes of bacterial sialadenitis?

Answer 29

most commonly affects the submandibular glands and is caused by Staph aureus and Strep viridans

Question 30

T or F. The likelihood that a salivary gland tumor is malignant is inversely proportional to the size of the gland

Answer 30

T. In the parotid gland only 15-30% are malignant while 70-90% are in the sublingual glands (the smallest)

Question 31

What is the most common benign tumor of the salivary glands?

Answer 31

Pleomorphic adenomas- painless, slow-growing, mobile masses common in the parotids

Question 32

Pleomorphic adenomas tend to overexpress \_\_\_\_\_

Answer 32

the transcription factor PLAG1

Question 33

What is the prognosis of pleomorphic adenomas?

Answer 33

good but they tend to recur if not completely excised. Note that carcinomas can rarely arise from these are termed carcinomas ex pleomorphic adenoma or malignant mixed tumors- more likely the longer the tumor grows and these are extremely agressive

Question 34

What is this?

Answer 34

Pleomorphic adenoma, marked by a rounded, well-demarcated mass that are mostly encapsulated

Question 35

What is the most common malignant salivary tumor?

Answer 35

Mucoepidermoid carcinomas, occuring mostly in the parotids

Question 36

What mutation is common with mucoepidermoid carcinomas?

Answer 36

MAML2

Question 37

How do mucoepidermoid carcinomas behave?

Answer 37

they are circumscribed but lack capsules allowing for infiltration and clinical course depends on the histologic grade

Question 38

What is a dentigerous cyst?

Answer 38

these form around the crown of an unerupted tooth and are thought to be the result of a degeneration of the dental follicle (primordial tissue that makes the enamel surface of teeth). These occur at the **third molar**