Flashcards in Path slide set 1 Deck (177):
Classic SCC is preceded by?
What salivary tumor occurs much more often in males an perhaps reflects the higher prevalence of smoking amoung men
What causes caries
focal demineralization of tooth structure by acidic metabolites of fermenting sugars that are produced by bacteria
How does herpetic stomatitis differ from acute herpetic gingivostomatitis?
it occurs at the site of primary inoculation or in adjacent mucosa associated with the same ganglion
Salivary glands secrete this for digestion?
-IgA, Lactoferrin, lysozyme
histologically; spectrum of epithelial changes ranging from hyperkeratosis overlying a thickened acanthotic but orderly mucosal epithelium to lesions with markedly dysplastic changes sometimes merging into carcinoma in situ
intermediate form having characteristics of both leukoplakia and erythroplakia
Major cause of tooth loss before age 35
Theory that multiple independent primary tumors develop as result of years of chronic exposure of the mucosa to carcinogens
The granular appearance of the cytoplasm of the upper layer of cells in a warthin tumor is due to presence of numerous what?
mitochondria . . "oncocytic"
50% found in minor salivary glands. . particularly palatine glands
Adenoid cystic carcinoma
MECT1-MAML2 fusion gene
Periodontitis can be associated with what systemic diseases?
-Syndromes associated with neutrophil defect
location for periapical cyst
apex of teeth
Are Caries painful
yes to extent it affects daily life
Complications of Xerostomia
-increased rates of dental caries
-difficulty swallowing and speaking
Survival with a mucoepidermoid carcinoma depends on what?
Most neoplasms of salivary glands arise where
treatment for irritation fibroma
complete surgical excision
Size of salivary tumor when first diagnosed
4 to 6 cm
second primary tumors in oral cavity
rate of development higher compared to other malignancies
Candidiasis remains superficial unless what? then it invades
Distant metastases of SCC
on microscopic exam, there is intracellular and intercellular edema (acantholysis)
When Sjogren syndrome produces dry eyes
treatment for keratocystic odontogenic tumor
can be scraped off
describe the inflammatory infiltrate of an aphthous ulcer
at first largely mononuclear but secondary bacterial infection may result in a neutrophilic infiltrate
submucosal nodular mass of fibrous connective tissue stroma that occurs primarily on the buccal mucosa along the BITE LINE or the gingiva
-focal fibrous hyperplasia
All of these are different names for the same thing
Derived from remnants of odontogenic epithelium present within the jaw
Odontogenic cysts and tumors
histolgically, Dentigerous cysts are lined by what?
What else is found?
a thin layer of stratified squamous epithelium
often there is a dense chronic inflammatory cell infiltrate in connective tissue stroma
What can Sialadenitis be induced by?
3 major clinical forms of oral candidiasis
San Joaquin Valley fever complex
White patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease
5 year survival if Tobacco related and late stage SCC
Periapical cyst is ______ in origin?
What are the 2 malignant neoplasms of salivary glands
-Adenoid cystic carcinoma
Painless, slow-growing, mobile discrete mass within the parotid or submandibular areas or in the buccal cavity
offenders for nonspecific bacterial sialadenitis
Staph and strep viridans
-small, poorly encapsulated, infiltrative, gray-pink lesions
histology: small cells having dark, compact nuclei and scant cystoplasm. spaces bt tumor cells are often filled with hyaline material . . excess basement membrane
Adenoid cystic carcinoma
epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged
number of aphthous ulcers
single or multiple
Most common primary malignancy of salivary glands
Periodontitis can be the origin of what systemic diseases
-pulmonary and brain abscesses
plaque within areas of active periodontitis contains what bacterial?
anaerobic and microaerophilic gram-negative
-Aggregatibacter (Actinobacillus) Actinomycetemcomitans
-encapsulated but capsule not fully developed
-cut surface is gray-white with myxoid and blue translucent areas of condroid
-epithelial elements dispersed within mesenchyme-like background of loose myxoid tissue
do aphthous ulcers run in families
What do patients with mucocele report
history of changes in size of the lesion, especially in association with meals
HSV viral reactivation is called what?
cough, choriza, conjunctivitis in a child
organism for Scarlet fever
Group A beta hemolytic strep
What are the two benign neoplasms of salivary glands
-Warthin tumor (Papillary Cystadenoma Lymphomatosum)
results from either blockage or rupture of a salivary gland duct, with consequent leakage of saliva into the surrounding connective tissue stroma
Acute Herpetic gingivostomatitis is accompanied by what other symptoms?
lack well defined capsules and often infiltrative at margins
histo: cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells
age for leukoplakia/erythroplakia
Bony, hard protrusion on roof of mouth. Can also be on mandible
Most common fungal infection of the oral cavity
Is gingivitis reversible
HSV treks along regional nerves and eventually becomes dormant in what ganglion
anatomic sites of origin for HPV associated SCCs of oropharnx
-base of tongue
Age for gingivitis
any age but most prevalent and severe in adolescence
chromosomal rearrangement of PLAG1
psuedocysts with cyst-like spaces lined by inflammatory granulation tissue or by fibrous connective tissue. cystic spaces filled with mucin and inflammatory cells, particulcarly macrophages
Must be differentiated from other odontogenic cysts because of its aggressive behavior
odontogenic keratocyst (OKC) also called keratocystic odontogenic tumor
If a dental plaque is not removed, what happens?
it becomes mineralized to form calculus (tartar)
inflammation of salivary glands is called
Molcular biology of HPV related SCC
-p16 overexpression encoded by CDKN2A
-E6 and E7
Primary HSV infections typically occur in children b/t what ages?
2 and 4
Decreases salivary secretions caused by dehydration may lead to the development of bacterial suppurative parotitis in who?
elderly patients with a recent history of major thoracic or abdominal surgery
What virus is associated with erythro/leukoplakias
distinctive oral lesion on lateral border of the tongue that is usually seen in immunocompromised patients
what is required for therapy of mucocele
complete excision and its accompanying minor salivary gland
what predisposed to oral candidiasis
dirty white, fibrinosuppurative, tough inflammatory membrane over the tonsils and retropharynx
shallow, hyperemic ulcerations covered by a thin exudate rummed by a narrow zone of erythema
in the oropharynx, as many as 70% of SCCs, particularly thoses involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of what?
Until proven otherwise by means of histologic evalulation, all leukoplakias must be considered what?
Severe oral infections in the form of gingivitis, pharyngitis, tonsillitis; may extend to produce cellulitis of the neck (Ludwid angina)
Pancytopenia (agranulocytosis, aplastic anemia)
Age and gender and location for keratocystic odontogenic tumor
between 10 and 40 and most common in males within posterior mandible
mucoceles most often found where and are result of what
lower lip and trauma
Can Hairy leukoplakia be scraped off
Sticky, colorless, biofilm that collects b/t and on the surface of teeth
predisposing influence for SCC of lower lip
Actinic radiation (sunlight) and particularly pipe smoking
Raspberry or strawberry tongue
appear as solitary or multiple white patches or plaques, often with sharply demarcated borders
Xerostomia is a major feature of what autoimmune disorder and is usually accompanied by what other symptome
epithelial elements dispersed throughout the matrix along with varying degrees of myxoid, hyaline, chondroid (cartilaginous), and even osseous tissue
Salivary gland tumors are mobile on palpation except in what case
neglected malignant tumors
superficial gray to white inflammatory membrane
What leads to accumulation of what?
dental plaque and calculus
Radiographically, unilocular lesion, most often associated with impacted third molar (wisdom) teeth
Adenoid cystic carcinomas have a tendency to invade what?
perineural spaces . . so pain is a common symptome
white, confluent pathenes of fluffy, hyperkeratotic thickenings
location of warthin tumor (papillary cystadenoma lymphomatosum)
almost exclusively in the parotid
age for mucocele
all ages but most common in toddlers, young adults, and elderly who are prone to falling
Age for benign salivary gland tumors?
5th to 7th decades
time frame for HSV vesicle
spontaneously clear within 3 to 4 weeks
What are the most common type of inflammatory salivary gland lesion?
most common type of odontogenic tumor that arises from epithelium but shows extensive depositions of enamel and dentin
Favored location for classic SCC
-floor of mouth
-Gingiva (look under dentures)
Develops as a result of long standing inflammation of the tooth (pulpitis), which may be caused by advanced carious lesions or by trauma to the tooth in question
vesicles are first filled with a clear, serous fluid, but rapidly rupture to yield painful, red-remmed, shallow ulcerations
red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed.
Mucicarmine stains this reddish pink
What clinical form of oral candidiasis is most common and what is it also called
pseudomembranous . . also known as thrush
95% of head and neck cancers are what histological type?
squamous cell carcinomas (SCC)
inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum
When multiple keratocystic odontogenic tumors are found, patients should be evaluated for what?
nevoid basal cell carcinoma syndrome (Gorlin syndrome)
Epidermal cells sometimes develop esosinophilic INTRANUCLEAR VIRAL INCLUSIONS, or several cells may fuse to produce MULTINUCLEATED POLYKARYONS
broad based budding yeast
composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells
`Location of mucoepidermoid carcinoma
Mainly parotids but also account for large fraction of salivary gland neoplasms in other glands, particularly the minor salivary glands
compare long term survival of HPV-positive SCC to HPV negative
Reactivation of latent HSV is associated with what?
-UV light exposure
-exposure to temperature extremes
histologically, cyst lined with a thin layer of keratinized stratified squamous epithelium with a prominent basal cell layer and a corrugated epithelial surface
keratocystic odontogenic tumor
inflammation of oral mucosa surrounding teeth
Arises from odontogenic epithelium and show NO ectomesenchymal differentiation
The likelihood of a salivary gland tumor being malignant is inversely proportional to what?
size of the gland
Gingivitis is result of what?
poor oral hygiene
What glands are affected by mumps
major ones particularly parotids
Bats, birds, caves
2 subtypes of odontogenic cysts
inflammatory or developmental
if a ranula becomes so large that it has dissected through the connective tissue stroma connecting the two bellies of the mylohyoid muscle
Why is it thought that HPV related cancers of oropharynx will surpass HPV related cervical cancer?
they are not readily accessible or amenable to cytologic screening for premalignant lesions
inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women
pyogenic granuloma (pregnancy tumor)
Decreased secretory function may also predispose to secondary bacterial invasion, as sometimes occurs in patients receiving what?
long term phenothiazines
cyst that originates around the crown of an unerupted tooth and is thought to be the result of fluid accumulation between the developing tooth and the dental follicle
What during delivery predisposes infant to oral thrush
vaginal yeast infections
Therapy for gingivitis
aimed at reducing the accumulation of plaque and calculus via regular brushing, flossing, and dental visits
virus that causes hairy leukoplakia
Gland for pleomorphic adenoma
60% of the parotid tumors and less common in submandibular and rare in minor glands
Most common pathogenic factor for leuko/erythroplakias
tobacco . . alcohol also contributes
50% of adenoid cystic carcinomas disseminate where decades after primary tumor removal
bone, liver, brain
pale gray surface punctuated by narrow cystic or cleftlike spaces filled with mucinous or serous secretions.
on microscope: spaces lined by DOUBLE LAYER of neoplastic epithelial cells resting on dense lymphoid stroma with germinal centers
5 year survival for early stage and tobacco related SCC
gene and chromosome for Gorlin syndrome?
PTCH on chromosome 9
Maculopapular, vesiculobullous eruption that sometimes follows an infection elsewhere, ingestion of drugs, development of cancer, or a collagen vascular disease; when it involves the lips and oral mucosa it's called stevens-johnson syndrome
Erythema multiforme . . . life threatening
What does a dental plaque contain?
mixture of bacteria, salivary proteins, and desquamated epithelial cells
time for herpetic stomatitis
7 to 10 days
Nonspecific bacterial sialadenitis is usually secondary to what?
Ductal obstruction produced by stones (Sialolithiasis)
Radiographically, well-defined unilocular or multiolcular radiolucencies
keratocystic odontogenic tumor
Acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane; enlargement of lymph nodes in neck; palatal petechiae
A lack of salivary secretions is a major complication of what therapy
Classic pathogenesis for squamous cell carcinomas
tobacco and alcohol
What immunologic disorders may aphthous ulcers be associated with
color for mucocele
blue translucent hue
smoking and Warthin tumors
8 times greater risk
Benign tumor that consist of a mixture of ductal (epithelial) and myoepithelial cells and therefore show both epithelial and mesenchymal differentiation
Local expansion of SCC
submandibular glands and cervical nodes
age for leukoplakia/erythroplakia
any age but usually 40 to 70
intercellular bridges and cytokeratin positive
common, often recurrent, exceedingly painful, superficial oral mucosal ulcerations of unknown etiology
Aphthous ulcers (canker sores)
Painful enlargement and sometimes a purulent ductal discharge and UNILATERAL involvement of a single gland
Erythroplakia compared to Leukoplakia
-risk of malignant transformation much higher
Resolution of an Aphthous ulcer
typically spontaneously in 7 to 10 days
Rarely show orderly epidermal maturation. Virtually all show SEVERE dysplasia, carcinoma in situ, or minimally invasive carcinoma
if a carcinoma arises in a pleomorphic adenoma, it is reffered to as what?
carcinoma ex pleomorphic adenoma or a malignant mixed tumor . . . super agressive
describe growth and invasion of ameloblastoma
commonly cystic, slow growing, and locally invasive but has an indolent curse in most cases
What likely contributes to the reddish clinical appearance of erythroplakia
an intense subepithelial inflammatory reactions with vascular dilation
What cures a dentigerous cyst
clinical presentation for HPV type SCC
-no preceding/precancerous lesion
-Non specific symptoms such as sore throat, ear ache, pain on swallowing (odynophagia), weight loss
Leukoplakias may occur anywhere in oral cavity but favor what locations
-floor of mouth
-ventral surface of tongue
Molecular biology of classic SCC
-TP53 on chromosome 7
What drug can cause striking fibrous enlargement of the gingivae?
phenytoin (dilantin) . . for siezures
Age and gender for salivary gland neoplasms
usually adults and slight female predominance
Age for aphthous ulcers
first 2 decades
microscopically: hyperparakeratosis and acanthosis with "balloon cells" in upper spinous layers
oral SCC in individuals younger than 40 with no known risk factors like smoking and alcohol?
Nonspecific bacterial sialadenitis most often involves what glands
major, particularly submandibular
What increases the risk of pleomorphic adenomas