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Flashcards in Oral path photos Deck (272)
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1

Odontogenic Myxoma

o   Radiographic feature:  thin septations at right angles to each other.  Thin, wispy septations.

o   Can grow large; resection is difficult as tumor is jelly-like and may send myxoid fingers into surrounding bone, not visible on imaging.

o   Conservative resection necessary.

2

Oral Melanotic Macule

  • 2:1 female predilection

  • tan to brown round macule, usually solitary

  • tx not required, biopsy if unknown etiology

3

Ranula

  • Mucocele on floor of mouth
  • plunging = dissecting through mylohyoid.  May grow large. 
  • DDx
    • Dermoid cyst is in ddx,
    • Cystic Hygroma (neck lymphangioma).

4

Hemangioma (Arterio-venous Malformation)

  • Multilocular RL ddx (if intraosseous).

  • Aspirate prior to biopsy

  • Congenital hemangiomas often spontaneous resolve toward adulthood

5

Erythema  Multiforme

  • Probably autoimmune; 50% pts had other infx
  • EM Minor: Target lesions of skin, assoc w/ HSV
    • Mostly male, 20s-30s, self-limiting (2-6 wks)
    • 20% recurrence, irreg lesions necrose/ulcer
  • EM Major: (Stevens-Johnsons Syndrome)
    • Sick Patients, trigger often a med, 5M/yr
  • Toxic Epidermal Necrolysis (TEN)
    • Old pts, tx in burn unit, sloughing of skin

6

Osteosarcoma

Freq in long bones:  proximal tibia/distal femur, in pubescent boys.  Gnathic osteosarcs = older age, average 35.  X-ray hallmarks of osteosarcoma:  asymm widening of  PDL space; bone formation in soft tissue; bone formation above the alveolar crest.  Spiking root resorption; irregular, ill-defined borders; may be RL to Mixed to RO; “Sun-burst” only in 25% of jaw osteosarcs.  Radical resection is only effective tx.

7

Veruccous Carcinoma

  • A less aggressive, less invasive variant of conventional SCC. 
  • Exhibits a prominent papillary, exophytic growth pattern. 
  • Does not metastasize; if metastatic, likely represents transformation to conventional SCC.

8

Eruption Cyst

o   Overlying soft-tissue impacted tooth, may clinically appear blue or red. 

o   Usually, spontaneous resolution with subsequent eruption of the tooth, no need to make an incision.

9

Wegeners Granulomatosus

  • "Saddle Nose," affects Respiratory/Renal Systems
  • Oral Manifestation = "Strawberry Gingiva"
    • before renal involvement

    • florid, granular hyperplasia (bumpy, hemorrhagic, and friable)

    • bone destruction and tooth mobility

10

Central Giant Cell Granuloma

 

  • Multilocular RL ddx; some may be aggressive.
  • Can be associated with aneurysmal bone cyst   
  • Same histology seen in Cherubism; Brown Tumors of hyperparathyroidism.

 

11

Macule

 

  • A circumscribed flat area, up to 1.0 cm in diameter

 

  • Perceptibly different color from surrounding tissue

12

Papule

  • A circumscribed, solid elevation in skin or mucosa

13

Buccal Bifurcation Cyst

Be familiar with typical clinical presentation

  • associated tooth is vital
  • tx with curettage
  • DO NOT extract tooth.

 

14

McCune-Albright Syndrome

  • Polyostotic Fibrous Dysplasia
  • Cafe-au-lait (Coast of Maine)
  • Endocrinopathies (early menses in Females)
  • Hockey Stick deformity to Femur

15

Squamous Papilloma

  • HPV subtypes 6 & 11 found in 50% of squamous papillomas
  • tongue, lips; most common soft tissue mass of soft palate
  • cauliflower appearance, finger-like projections
  • Papilloma Ddx= Squamous Papilloma, Verruca Vulgaris, Condyloma Acuminata, Heck's Disease

16

HSV-1

  • Cold sores...not the same as Canker sores/apthae
  • Typically initially presents in Kids, crusting mouth, low fever
  • Rarely initial presentation in adults, high fever, pharnyx

17

Erythema  Multiforme

Probably autoimmune; 50% pts had other infx

EM Minor: Target lesions of skin, assoc w/ HSV

  • Mostly male, 20s-30s, self-limiting (2-6 wks)
  • 20% recurrence, irreg lesions necrose/ulcer

EM Major: (Stevens-Johnsons Syndrome)

  • Sick Patients, trigger often a med, 5M/yr

Toxic Epidermal Necrolysis (TEN)​

  • Old pts, tx in burn unit, sloughing of skin

18

Osteoma

  • Benign neoplasm; multiple seen in Gardner’s syndrome. 
  • Primarily craniofacial distribution.

19

Amelanotic Melanoma

  • 20% of oral melanomas are non-pigmented
  • Oral are of the Acral Lentiginous variety 
  • Rarely ulcerate

20

Epulis Granulomatosum

  • histologically identical to pyogenic granuloma
  • occurs within the socket of a recently extracted tooth
  • hyperplastic growth of granulation tissue

21

Fibrous Dysplasia

Developmental; post-zygotic mutation of GNAS1 gene.  Monostotic (late mutation), Polyostotic (intermediate mutation), Syndromic (early mutation). 

  • Polyostotic may affect just craniofacial bones.
  • “Ground glass” radiopaque appearance to bone expansion.  Ill-defined borders.
  • Syndromes: 
    • McCune-Albright (FD, café au lait pigmentations (coast of Maine), endocrinopathies)
    • Jaffe-Lichtenstein (FD, café au lait pigmentations).
  • Growth often continues through adolescence, then slows/stops in adulthood.  Lesions may need to be debulked periodically.

22

Cherubism

  • presents in Kids
  • multiple quadrants of CGCL
  • often resolves in adulthood, sometimes not. 

23

Thyroglossal Duct Cyst

o   Midline of neck, anywhere from foramen cecum (base of tongue) down to thyroid.

o   Usually attached to hyoid bone; cyst moves when patient swallows.

o   Surgical procedure is Sistrunk procedure: remove cyst and involved portion of hyoid bone.

24

Epstein Barr

  • HHV-4 

25

Oral Melanoacanthoma

  • Rapid onset and growth
  • Buccal mucosa most common site
  • Dark-brown or black pigmentation
  • Flat or slightly raised
  • Biopsy tends to incite resolution.  
  • Considered reactive, but etiology unknown.
  • Black Females 20s/30s most common

26

Actinic Lentigo (Liver spots)

  • not considered premalignant (no cytologic atypia)
  • UV damaged skin
  • Common in people with light skin (90% of whites over 70 years); Rare under 40 years
  • well-demarcated, irregular borders
  • usually multiple, may coalesce (to form into one)
  • no treatment required (cosmetic)

27

Neurofibroma

  • most common BPNST
  • most percutaneous including facial skin; oral lesions less common
  • young adults, M=F
  • tongue &  buccal; mandible
  • soft painless nodule; unencapsulated bundles of spindle cells
  • Multiple:  concern for neurofibromatosis

28

Angular Chelitis

  • usually related to candidiasis, but may have other cutaneous bacterial microfloral admixed
  • redness, cracking of corners of the mouth
  • often waxes and wanes
  • may require topical or systemic antifungal therapy

29

Mucoepidermoid Carcinoma

  • Malignant.  Most common malignant salivary gland neoplasm.
  • Any location; parotid and palate more common. 
  • Bluish nodule, may be ulcerated.
  • Mucicarmine special stain highlights mucous cells histologically. 
  • Graded:  low, intermediate, high grades. 
  • DDX in the palate:  necrotizing sialometaplasia, MEC, SCC.

30

Giant Cell Fibroma