Oral Path Marathon II Flashcards Preview

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Flashcards in Oral Path Marathon II Deck (145):
1

Tumefaction is another name for...

Swelling

2

Hyperplasia that can grow quite large but doesn't have unlimited growth potential:

Reactive Tumors

3

Reactive Tumors are not...

Neoplasms

*unlimited growth potential

4

Reactive Lesions make up ____% of Biopsied lesions in the dental office

20%

5

The most common tumor of the Oral Mucosa:

Fibroma

6

Hyperplasia of fibrous connective tissue:

Fibroma

7

Fibroma incidence is higher in the _____ but occurs almost anywhere

Usually ______, smooth surfaced, normal color, asymptomatic

Cheek

Sessile (fixed)

8

2 Fibroma Variants:

Giant cell fibroma

Peripheral odontogenic (ossifying) fibroma

9

Increases incidence in Gingiva, also on the Tongue but to a lesser extent, and children, often confused with Papillomas

Giant Cell Fibroma

10

Giant Cell Fibroma is a fibrous CT tumor containing plump ________ Fibroblasts that are ______ nucleated

stellate

bi/tri

11

Giant Cell Fibroma contains what cells?

Peripheral Giant Cell Granuloma contains what cells?

stellate, multinucleated Fibroblasts

multinucleated Giant Cells

12

Reactive folds of hyperplastic fibrous CT along Border of ill-fitting Denture:

Hyperplastic response of Palatal Mucosa to ill-fitting Denture:

*2 names for each

Inflammatory Fibrous Hyperplasie (Epulis Fissuratum)

Inflammatory Papillary Hyperplasia (Papillomatosis)

13

Papillary hyperplasia + inflammation +/- psudoepitheliomatous hyperplasia =

Inflammatory Papillary Hyperplasia (Papillomatosis)

*ill-fitting denture to Palate

14

Only on Gingiva (more in Anterior), any age, asymptomatic, red/brown/purple

pedunculated or sessile

2:1 female to male

Peripheral Giant Cell Granuloma

15

Peripheral Giant Cell Granuloma is a tumor of well vascularized fibrous CT w/ numerous _______ cells

multinucleated Giant cells

16

The body's basic reparative tissue:

Granulation tissue

(Giant Cells?)

17

red/ulcerated pedunculated/sessile
2-4 decades
Mostly in Gingiva but can occur anywhere (including skin)
"pregnancy tumor"
reactive lesion of granulation tissue

Pyogenic Granuloma

*misnomer

18

Pyogenic Granuloma is a reactive lesion of _______ tissue and often occurs during _______

Granulation

Pregnancy

19

If a Pyogenic Granuloma occurs in extraction sockets it is called...

Epulis Granulomatosa

20

Hyperplastic granulation tissue, Fibroblasts w/ Delicate Collagen

vascularized

Pyogenic Granuloma

21

Occurs anywhere, but if on Gingiva
Odontogenic and Pus

*pulpal/periodontal in origin

Parulis

"Gum Boil"

22

Exclusively 1-2 decades
Female 2:1
Mx 5:1
Papillary w/ edema

Localized juvenile spongiotic gingival hyperplasia

*red/papillary/gingival

23

Localilzed Juvenile Spongiotic Gingival Hyperplasia is red, ______, and gingival

Papillary

24

Overgrowth of Blood Vessels:

Hemangioma

25

Hemangioma is often ________

____% in the Head and Neck

Females __:__



developmental

60%

3:1

26

Rapid proliferation of Endothelial Cells at birth/short after

Most common tumor in infancy (5-10%)

Hemangioma

27

Hemangioma Tx: most of it naturally _______

Laser pulse, excision, sclerosing agents, and what 2 drugs?

involutes

steroids, Systemic Propanolol

28

Sturge-Weber Angiomatosis, aka...

Encephalotrigeminal angiomatosis

29

Nonheriditary developmental, congenital
Vascular proliferation brain/face
Large purplish lesions identical to port-wine stains
Ipsilateral Common

Sturge-Weber Angiomatosis

(encephalotrigeminal angiomatosis)

30

Sturge-Weber and port wine stains are due to somatic activation mutations in _______- which encodes _______

This is a member of the ____ class of ____ protein alpha that mediates G-protein to downstream receptors

(difference is when mutation occurs)

GNAQ, G-alpha-q

q class, G protein

31

Leptomingeal angioma of cerebral cortex

Sturge-Weber

32

Developmental overgrowth of Lymphatic Vessels:

Lymphangioma

33

Tx for Lymphangioma

b/c the don't ______

Excision

Involute

34

Head and Neck
0-5 yrs
Tongue
pebbly if superficial, more diffuse deeper
called a Cystic Hygroma if large/deep/neck

Lymphangioma

35

Pathologic new growth of tissue - Uncontrolled - no regression if caused by stimulus and the stimulus was removed

Neoplasm

36

T/F
You can usually differentiate if a Neoplasm is epithelial/mesenchymal or benign/malignant

True

37

2 kinds of Epithelial Neoplasms (etiologies):

HPV etiology

Keratoacanthoma

38

3 Types of HPV derived Epithelial Neoplasms:

Papilloma (soft palate)

Verruca vulgaris (common wart - HPV 2)

Condyloma Acuminatum (veneral - HPV 6/11)

39

Exophytic, pedunculated, pink/white Epithelial Neoplasm w/ HPV etiology on the Palate:

Papilloma

40

Sun Exposed areas will create Reactive (not Neoplastic) tumor

increased in older patients with ___% on the lips

Natural History is involution/healing

Keratocanthoma

10%

41

Neoplasms can be ______ or ________

Epithelial

Mesenchymal

42

3 types of Mesenchymal Neoplasms:

CT

Muscle

Nerve

43

Most _____ Neoplasms look identical clinically and present as asymptomatic, slowly growing Submucosal Masses

Mesenchymal

44

3 CT derived Mesenchymal Neoplasms:

Fibroma

Lipoma

Verruciform xanthoma

45

A benign neoplasm of fat

yellowish, very common in skin, less Orally

Lipoma

46

Reactive lesion, often in Hard Palate or Gingiva

Oral, but can be in skin/genitals

Irregular

Pink to White

Verruciform Xanthoma

47

Papillary hyperplasia in which CT papiiae contain phagocytic cells that have engulfed Lipid

Verruciform Xanthoma

xanthoma = engulfed lipid cells

48

Benign neoplasm of Smooth Muscle, common in the Uterus

*rare orally, red to purple

Leiomyoma

(angioleiomyoma, vascular leiomyoma)

49

Benign neoplasm of Skeletal Muscle, often in the Heart, rare orally (but in tongue)

Rhabdomyoma

50

Once thought to originate from Muscle, but now Nerve (possibly sheath)

Tongue

Fixed

Granular Cell Tumor

*Myoblastoma

51

Granular Cell Tumors have large ____ cells with granular cytoplasm

1/2 cause overlying epithelium to react, stimulating Carcinoma, this is called?

polygonal

pseudoepitheliomatous hyperplasia (PEH)

52

Congenital Tumor of the Anterior Alveolar Ridge

Congenital Epulis of the newborn

53

Congenital Epulis of the Newborn occurs 2:1 in the _______ and F:M _:_

Mx

10:1

54

Identical Cells to Granular Cell Tumor but no Nerve markers

No PEH (pseudoepitheliomatous hyperplasia)

May regress if incompletely excised

Congenital Epullis of the Newborn

55

Aberration of healing following Trauma to Nerve (not real Neoplasm)

Lateral/Anterior ______, lower lip, mental foramen,

Palpation produced ______

Traumatic Neuroma

Tongue

Pain

56

Benign Neoplasm in Nerve composed of Schwann Cells, Axons, and Fibrous Tissue

Most are _____ but can occur anywhere

Neurofibroma

asymptomatic

57

Developmental form of Neurofibromatosis, can affect Pigmentation, central/peripheral NS....

Von Recklinghausens Disease of the Skin

58

Von Recklinghausen's Disease of the Skin can cause what skin pigmentation?

1/2 inherited as ______ trait, the other 1/2 _____ mutations

Most on Chromosome _____

cafe-au-lait spots

autosomal dominant, somatic

17


*Remember, this is a neurofibroma

59

Von Recklinghausen's Disease of the Skin causes freckling, cafe au lait spots, or defects in the iris called...

___% of pts develop malignancy in their neurofibromas

Lisch spots

1-5%

60

Benign encapsulated neural neoplasm arising withing the sheath of a peripheral nerve

Painless, often Freely Moveable

Neurilemmoma (Schwannoma)

61

Antoni A Neurilemmoma, _____ areas of replicated basement membrane material surrounded by ______ nuclei

Antoni B Neurilemmoma, haphazardly arranged _____ Schwann cells in loose _____

Acellular, Schwann cell

spindled, stroma

62

Neural Crest Tumor in Jaws (rarely extragnathic)

Melanotic Neuroectodermal tumor of Infancy

63

Melanotic Neuroectodermal Tumor of Infancy is mostly Congenital and occurs where?

Rapidly growing, pigmented, Radiolucent, produces _____ in serum/urine

Tx is aggressive _______

___% recur

Anterior Jaws, Mx

VMA - vanilymandelic acid

curettage

10-20%

64

MEN3:

Multiple Endocrine Neoplasia Type 3

65

Multiple Endocrine Neoplasia Type 3, 95% of pts have mutation on the _____ gene

This is a ProtoOncogene on chromosome _____

50/50 autosomal dominant/_____

RET

10

somatic

66

3 Examples of MEN3 neoplasms:

*remember, this is a Mesenchymal neoplasm of the Nerve

Mucosal neuromas

Medullary carcinoma of thyroid

Pheochromocytoma of adrenal medulla

67

Pigmented lesions we focus on are _____ lesions

melanocytic

68

Common mole, aka...

Nevi (nevus)

69

Nevus cells are pigmented lesions that migrate from _____ to skin and occasionally mucous membranes

Neural Crest Cells

70

Nevi can be congenital: _% of newborns

Acquired: genetic influence, avg person has about ____

1%

15

71

4 types of Nevi:

Junctional

Intradermal

Compound

Blue

72

Junctional Nevus: flat macule, in the ____ epithelium at junction btwn epithelium/CT

Intradermal Nevus: Nodule (+/- hair) in the dermis or ______

Compound Nevus: nodule, combo of...

Blue Nevus: ____ nevus in deep _____

Basal Epithelium

Lamina Propria

Junctional/Intradermal

Dentritic, CT

73

Reactive proliferation of intraepithelial dentritic melanocytes

*increased in blacks, cheeks

*resolves if irritant removed

Melanocanthoma

74

Freckle:

Ephelis

75

Localized overproduction of Melanin of flat macules, increased in Head and Neck

Ephelis

76

T/F
Freckles (Ephelis) are an increase number of cells

False

*increased overproduction of Melanin

77

From Chronic UV damage, not seen intraorally
increases after 40, 90% of elderly have them
Flat, evenly discolored, multiple

Actinic/Senile Lentigo

*aka Age Spots, Liver Spots

78

A big freckle that isn't sun related:

female:male = _:_

avg size:

Melanotic Macule

2:1

6.8 mm

79

Melanotic Macule occurs ___% in the Lower Lip

also common in palate and ______

___% multiple

33%

gingiva

15%

80

A malignancy of melanin-producing cells

Malignant Melanoma

81

Malignant Melanomi is the ____ most common skin cancer
but incidence in increasing

3rd

82

The likelihood of a White person developing Malignant Melanoma is less than 1 in 100 throughout life

True

83

Malignant Melanoma happens ___% in the Head and Neck

___% in the extremities

__% Intraorally

25%

40%

less than 1%

84

Risk factor for Malignant Melanoma:

Sun exposure

85

Clinical Features of Malignant Melanoma A:

B:

C:

D:

Asymmetry

Borders

Color - red/tan/brown/black

Diameter (growth, greater than 6mm)

86

2 Biologic Growth phases Malignant Melanoma:

Radial

Vertical

87

% of Radial Malignant Melanoma:

75-85%

88

5 types of Melanoma:

Superficial spreading

Nodular

Lentigo maligna

Acral lentiginous

Oral

89

70% of Cutaneous melanomas

more in trunk (28% in head and neck)

Superficial Spreading Melanoma

90

Superficial spreading malanoma has a short ____ phase, develops nodules, goes _____

radial

vertical

91

15% of cutaneous melanoma

(30% head/neck)

Nodular Melanoma

92

Nodular Melanom has almost no _____ growth

it is rarely ______

Radial

amelanotic

93

5-10% of cutaneous melanoma

Lentigo maligna melanoma

94

Lentigo maligna melanoma increases with age (sun) and has an extremely long _____ growth phase

This is called _______ and may last for ____ years

*ultimately develops vertical growth

Radial

Hutchinson's freckle, 15-20 years

95

Small subset of Melanomas affecting palms, soles, sublingual and mucous membranes

Acral lentiginous melanoma

96

Most Oral Melanom has _____ growth (more than 50%)

most often found in what 2 places?

radial

palate, Mx gingiva

97

Excise Malignant Melanoma w/ a minimum of a ___ margin

+/- lymph nodes, chemo, radiation, etc

1 cm

98

Most important factor influencing survival of Malignant Melanomas

survival is ___% over 10 years

Oral melanomas survival is ____ over 5 years

Depth of invasion

79%

less than 20%

*oral much much worse Prognosis

99

T/F
Antimalarials, Antimicrobials, Psychotropics, and Chemotherapeutics can cause Pigmentation

True

100

Multifocal pigmentation includes Addisons, Peutz-Jeghers, McCune Albright, and Smoker's melanosis

True

101

4 Drugs that can cause Multifocal Pigmentation:

Antimalarials

Antiarrythmics (quinidine)

Tranquilizers (thorazine)

cis-platinum

102

Adrenocortical insufficiency that triggers hypothalamus to stimulate ant pit to over-produce ACTH and MSH (Melanin Stimulating Hormone)

Addison's Disease

*multifocal pigmentation

103

Peutz-Jeghers Syndrome is ______ (heritability)

Affects skin, intestine, oral and perioral freckles

autosomal dominant

*multifocal pigmentation

104

Neurofibromatosis and McCune Albright syndroms (polyostotic fibrous dysplasia) cause _____

cafe au lait spots

*multifocal pigmentation

105

Smoker's melanosis is a type of _________

increased on palate/gingiva

multifocal pigmentation

106

melanoma, kaposi's sarcoma, petechiae, ecchymosis, purpura

multifocal pigmentation

107

Odontogenesis starts with _________ growing into the _______ and producing tooth germ, a portion of which is the enamel organ

ectoderm (epithelilum)

dental lamina (jaw)

108

Pathologic Cavity lined by Odontogenic Epithelium and filled with fluid or semisolid material

Odontogenic Cyst

109

Odontogenic can by Inflammatory or not

True

110

2 types of Inflammatory Odontogenic Cysts:

The rest are _______

Radicular cyst, buccal bifurcation cyst

Developmental

111

A cyst arising from degeneration of enamel organ prior to tooth formation.

This aborts odontogenesis resulting in radiolucency in place of a missing tooth

Primordial Cyst

112

Primordial Cysts most often occur in what tooth?

Mn 3M

113

Cyst resulting from the separation of the follicle from around the crown of a developing tooth

Dentigerous Cyst

*aka follicular cyst

114

Dentigerous Cyst happen at any age, most often in the Mandibular ______

and the Maxillary ______

3M

Canines

115

Dentigerous cysts are expansive and symptomatic

False

*asymptomatic, usually no expansion

116

Dentigerous cysts usually are lateral and unerupted crowns, creating a radiolucency where?

Pericoronal

*from CEJ around crown

117

Stratified Squamous epithelium w/out Keratinization

*originally ameloblast, but now reduced enamel epithellium

Dentigerous Cyst

118

Tx Dentigerous Cyst for Mn3M

for Canine:

Extraction

may be able to decompress and pull orthodontically

119

2 Variants of Dentigerous Cysts:

Eruption

Lateral

120

A Dentigerous Cyst has high Neoplastic Potential

False

*exceedingly rare

121

3 types of the Exceedingly Rare Dentigerous Cyst Neoplasms:

Ameloblastoma

Squamous cell carcinoma

Mucoepidermoid carcinoma

122

2 Types of Periodontal Cysts:

Which most common?

Apical Periodontal Cyst (most common)

Lateral Periodontal Cyst

123

Cyst of Inflammatory Origin secondary to Devitalized Pulp:

Apical Periodontal Cyst

124

Apical Periodontal Cyst is a _____ cyst

2 types:

Radicular

Lateral radicular cyst, Residual cyst

125

Rest or Malassez cystic degeneration

Most often seen on what tooth?

Lateral Periodontal Cyst

Mn Canine/PM

126

Apical Periodontal Cyst

Lateral Periodontal Cyst

Which one is Vital?

Lateral

*apical NOT vital

127

Polycystic, multilocular, recurring variant on a Lateral Periodontal Cyst:

Botryoid Odontogenic Cyst

128

2 Types of Gingival Cysts:

Newborn (dental lamina)

Adult

129

Common, congenital, Gingival Cyst of Newborn are what color?

Tx?

Yellowish elevations

none - will self-marsupialize and heal

130

Adult Gingival Cyst is attached gingiva, arises from a degeneration of glands of _______

Occurs in what tooth?

Similar to _____

Serres (dental lamina)

Mn Canine/PM

mucocele

131

Developmental cyst from the dental lamina:

Odontogenic Keratocyst

132

Odonotogenic Keratocyst are _____ parakeratinized

_____ orthokeratinized

90%

10%

133

Parakeratinized Odontogenic Keratocyst occurs 2:1 in what arch?

They are clinically _______

Mn

aggressive

134

Parakeratinized Odontogenic Keratocyst is unilocular/multilocular _______ and mimics other odontogenic cysts

radiolucency

135

Parakeratinized Odontogenic Keratocyst histologic parakeratotic stratified squamous epithelium lining with well developed _____/______ basal cells

Often daughters of ______ in wall

Tx is conservative, about ____ recur


palisaded/hyperchromatic

microcysts

1/3

136

5% of pts w/ keratocysts have what Autosomal Dominant disorder?

Basal Cell Nevus-Bifid Rib Syndrome

*nevoid basal cell carcinoma syndrome

137

Basal Cell Nevus-Bifid Rib Syndrome is a mutation on the tumor suppressor gene _______

Creates a basal cell carcinoma not to be confused with?

calcification of ______, bone anomalies, multiple OKC's

9q22

sun exposed/elderly

falx cerebri

138

Keratocysts are known for what 3 things?

Clinical aggression

Recurrence

association w/ basal cell nevus-bifid rib syndrome

139

The smaller, less aggressive, minimal recurrence, not associated w/ syndrome odontogenic cyst?

Orthokeratinized odontogenic cyst

140

Asymptomatic Odontogenic cyst, occurs at any age, may be associated with unerupted teeth/odontoma

Calcifying odontogenic cyst

*Gorlin Cyst

141

Calcyfying Odontogenic Cyst (Gorlin Cyst)_ is fully or partially cystic, contains ____ cells which tend to calcify

Tx is conservative and recurrence is ____

ghost

low

142

Glandular Odontogenic Cyst occurs more often in what arch?

may be _____, unilocular or multilocular radiolucency,

Shows _____ differentiation (mucous, columnar w/ cilia, lumina)

Recurrence rate:

Mn

Large

Glandular

30-50%

143

Buccal Bifurcation Cyst, aka...

Paradental Cyst

144

An inflammatory cyst occurring on the buccal of an erupting tooth:

Happens most often in what demographic?

What tooth?

Buccal Bifurcation Cyst

children

Mn 1M

145

Unilocular radiolucency involving furcation of the roots:

This is an inflamed cyst lined by ________

Tx enucleation of cyst, no ______

Buccal Bifurcation Cyst

stratified squamous epithelium

extraction

Decks in Tim's Cards Class (140):