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Flashcards in Path slide set 1 Deck (177):
1

Classic SCC is preceded by?

precancerous lesion

2

What salivary tumor occurs much more often in males an perhaps reflects the higher prevalence of smoking amoung men

Warthin tumor

3

What causes caries

focal demineralization of tooth structure by acidic metabolites of fermenting sugars that are produced by bacteria

4

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

5

Salivary glands secrete this for digestion?

Lubrication?

Protection?

-ptalin/salivary amylase

-mucus

-IgA, Lactoferrin, lysozyme

6

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

Leukoplakia

7

intermediate form having characteristics of both leukoplakia and erythroplakia

speckled leukoerythroplakia

8

Major cause of tooth loss before age 35

Caries

9

Theory that multiple independent primary tumors develop as result of years of chronic exposure of the mucosa to carcinogens

"field cancerization"

10

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"

11

50% found in minor salivary glands. . particularly palatine glands

Adenoid cystic carcinoma

12

MECT1-MAML2 fusion gene

mucoepidermoid carcinoma

13

Periodontitis can be associated with what systemic diseases?

-AIDS
-Leukemia
-Crohn disease
-Diabetes
-Down syndrome
-Sarcoidosis
-Syndromes associated with neutrophil defect

14

location for periapical cyst

apex of teeth

15

Are Caries painful

yes to extent it affects daily life

16

Complications of Xerostomia

-increased rates of dental caries
-candidiasis
-difficulty swallowing and speaking

17

Survival with a mucoepidermoid carcinoma depends on what?

Grade dependent

18

Most neoplasms of salivary glands arise where

parotids

19

treatment for irritation fibroma

complete surgical excision

20

Size of salivary tumor when first diagnosed

4 to 6 cm

21

second primary tumors in oral cavity

rate of development higher compared to other malignancies

22

Candidiasis remains superficial unless what? then it invades

immunosuppression

23

Distant metastases of SCC

-mediastinal nodes
-lungs
-liver
-Bones

24

on microscopic exam, there is intracellular and intercellular edema (acantholysis)

HSV

25

When Sjogren syndrome produces dry eyes

keratoconjunctivitis sicca

26

treatment for keratocystic odontogenic tumor

complete removal

27

can be scraped off

Candida albicans

28

describe the inflammatory infiltrate of an aphthous ulcer

at first largely mononuclear but secondary bacterial infection may result in a neutrophilic infiltrate

29

submucosal nodular mass of fibrous connective tissue stroma that occurs primarily on the buccal mucosa along the BITE LINE or the gingiva

-irritation fibroma
-Traumatic fibroma
-focal fibrous hyperplasia

All of these are different names for the same thing

30

Derived from remnants of odontogenic epithelium present within the jaw

Odontogenic cysts and tumors

31

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

32

What can Sialadenitis be induced by?

-trauma
-Viral (mumps)
-Bacterial
-autoimmune disease

33

3 major clinical forms of oral candidiasis

-pseudomembranous
-erythematous
-hyperplastic

34

San Joaquin Valley fever complex

Cocci

35

White patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease

Leukoplakia

36

5 year survival if Tobacco related and late stage SCC

20%

37

Periapical cyst is ______ in origin?

inflammatory

38

What are the 2 malignant neoplasms of salivary glands

-mucoepidermoid carcinoma
-Adenoid cystic carcinoma

39

Painless, slow-growing, mobile discrete mass within the parotid or submandibular areas or in the buccal cavity

Pleomorphic adenoma

40

offenders for nonspecific bacterial sialadenitis

Staph and strep viridans

41

-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

42

epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged

Ranula

43

number of aphthous ulcers

single or multiple

44

Most common primary malignancy of salivary glands

mucoepidermoid carcinoma

45

Periodontitis can be the origin of what systemic diseases

-infective endocarditis
-pulmonary and brain abscesses

46

plaque within areas of active periodontitis contains what bacterial?

Specific examples

anaerobic and microaerophilic gram-negative

-Aggregatibacter (Actinobacillus) Actinomycetemcomitans
-porphyromonas gingivalis
-prevotella intermedia

47

-well demarcated
-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

pleomorphic adenoma

48

do aphthous ulcers run in families

Yes

49

What do patients with mucocele report

history of changes in size of the lesion, especially in association with meals

50

HSV viral reactivation is called what?

Herpetic stomatitis

51

cough, choriza, conjunctivitis in a child

measles

52

organism for Scarlet fever

Group A beta hemolytic strep

53

What are the two benign neoplasms of salivary glands

-Pleomorphic adenoma
-Warthin tumor (Papillary Cystadenoma Lymphomatosum)

54

results from either blockage or rupture of a salivary gland duct, with consequent leakage of saliva into the surrounding connective tissue stroma

Mucocele

55

Acute Herpetic gingivostomatitis is accompanied by what other symptoms?

-lymphadenopathy
-fever
-anorexia
-irritability

56

lack well defined capsules and often infiltrative at margins

histo: cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells

mucoepidermoid carcinoma

57

age for leukoplakia/erythroplakia

males 2:1

58

Bony, hard protrusion on roof of mouth. Can also be on mandible

Torus Palatinus

59

Most common fungal infection of the oral cavity

Candida Albicans

60

Is gingivitis reversible

yes

61

HSV treks along regional nerves and eventually becomes dormant in what ganglion

trigeminal

62

anatomic sites of origin for HPV associated SCCs of oropharnx

-tonsillar crypts
-base of tongue
-oropharynx

63

Age for gingivitis

any age but most prevalent and severe in adolescence

64

chromosomal rearrangement of PLAG1

Pleomorphic Adenoma

65

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

Mucocele

66

Must be differentiated from other odontogenic cysts because of its aggressive behavior

odontogenic keratocyst (OKC) also called keratocystic odontogenic tumor

67

If a dental plaque is not removed, what happens?

it becomes mineralized to form calculus (tartar)

68

11:19 transolcation

mucoepidermoid carcinoma

69

inflammation of salivary glands is called

Sialadenitis

70

Molcular biology of HPV related SCC

-p16 overexpression encoded by CDKN2A
-p53
-RB
-E6 and E7

71

Primary HSV infections typically occur in children b/t what ages?

2 and 4

72

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

73

What virus is associated with erythro/leukoplakias

HPV

74

distinctive oral lesion on lateral border of the tongue that is usually seen in immunocompromised patients

Hairy Leukoplakia

75

what is required for therapy of mucocele

complete excision and its accompanying minor salivary gland

76

what predisposed to oral candidiasis

immunosuppression

77

dirty white, fibrinosuppurative, tough inflammatory membrane over the tonsils and retropharynx

Diptheria

78

shallow, hyperemic ulcerations covered by a thin exudate rummed by a narrow zone of erythema

aphthous ulcers

79

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?

HPV-16

80

Until proven otherwise by means of histologic evalulation, all leukoplakias must be considered what?

precancerous

81

Severe oral infections in the form of gingivitis, pharyngitis, tonsillitis; may extend to produce cellulitis of the neck (Ludwid angina)

Pancytopenia (agranulocytosis, aplastic anemia)

82

Age and gender and location for keratocystic odontogenic tumor

between 10 and 40 and most common in males within posterior mandible

83

mucoceles most often found where and are result of what

lower lip and trauma

84

Can Hairy leukoplakia be scraped off

no

85

Sticky, colorless, biofilm that collects b/t and on the surface of teeth

Dental plaque

86

predisposing influence for SCC of lower lip

Actinic radiation (sunlight) and particularly pipe smoking

87

Raspberry or strawberry tongue

Scarlet fever

88

appear as solitary or multiple white patches or plaques, often with sharply demarcated borders

leukoplakias

89

Xerostomia is a major feature of what autoimmune disorder and is usually accompanied by what other symptome

Sjogren syndrome

Dry eyes

90

epithelial elements dispersed throughout the matrix along with varying degrees of myxoid, hyaline, chondroid (cartilaginous), and even osseous tissue

Pleomorphic Adenoma

91

Salivary gland tumors are mobile on palpation except in what case

neglected malignant tumors

92

superficial gray to white inflammatory membrane

thrush

93

What leads to accumulation of what?

dental plaque and calculus

94

Radiographically, unilocular lesion, most often associated with impacted third molar (wisdom) teeth

Dentigerous cyst

95

Adenoid cystic carcinomas have a tendency to invade what?

perineural spaces . . so pain is a common symptome

96

white, confluent pathenes of fluffy, hyperkeratotic thickenings

hairy leukoplakia

97

location of warthin tumor (papillary cystadenoma lymphomatosum)

almost exclusively in the parotid

98

age for mucocele

all ages but most common in toddlers, young adults, and elderly who are prone to falling

99

Age for benign salivary gland tumors?

Malignant?

5th to 7th decades

Later

100

time frame for HSV vesicle

spontaneously clear within 3 to 4 weeks

101

What are the most common type of inflammatory salivary gland lesion?

Mucocele

102

most common type of odontogenic tumor that arises from epithelium but shows extensive depositions of enamel and dentin

Odontoma

103

Favored location for classic SCC

-ventral tongue
-floor of mouth
-lower lip
-soft palate
-Gingiva (look under dentures)

104

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

periapical cyst

105

vesicles are first filled with a clear, serous fluid, but rapidly rupture to yield painful, red-remmed, shallow ulcerations

HSV

106

red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed.

erythroplakia

107

Mucicarmine stains this reddish pink

mucoepidermoid carcinoma

108

What clinical form of oral candidiasis is most common and what is it also called

pseudomembranous . . also known as thrush

109

95% of head and neck cancers are what histological type?

squamous cell carcinomas (SCC)

110

inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum

periodontitis

111

When multiple keratocystic odontogenic tumors are found, patients should be evaluated for what?

nevoid basal cell carcinoma syndrome (Gorlin syndrome)

112

Epidermal cells sometimes develop esosinophilic INTRANUCLEAR VIRAL INCLUSIONS, or several cells may fuse to produce MULTINUCLEATED POLYKARYONS

HSV

113

broad based budding yeast

Blasto

114

composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells

Mucoepidermoid carcinoma

115

`Location of mucoepidermoid carcinoma

Mainly parotids but also account for large fraction of salivary gland neoplasms in other glands, particularly the minor salivary glands

116

compare long term survival of HPV-positive SCC to HPV negative

greater

117

Reactivation of latent HSV is associated with what?

-trauma
-allergies
-UV light exposure
-URI
-pregnancy
-menstruation
-immunosuppression
-exposure to temperature extremes

118

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

119

inflammation of oral mucosa surrounding teeth

gingivitis

120

Arises from odontogenic epithelium and show NO ectomesenchymal differentiation

Ameloblastoma

121

The likelihood of a salivary gland tumor being malignant is inversely proportional to what?

size of the gland

122

Gingivitis is result of what?

poor oral hygiene

123

What glands are affected by mumps

major ones particularly parotids

124

Bats, birds, caves

histo

125

2 subtypes of odontogenic cysts

inflammatory or developmental

126

if a ranula becomes so large that it has dissected through the connective tissue stroma connecting the two bellies of the mylohyoid muscle

plunging ranula

127

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

128

inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women

pyogenic granuloma (pregnancy tumor)

129

Decreased secretory function may also predispose to secondary bacterial invasion, as sometimes occurs in patients receiving what?

long term phenothiazines

130

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

Dentigerous cyst

131

What during delivery predisposes infant to oral thrush

vaginal yeast infections

132

Therapy for gingivitis

aimed at reducing the accumulation of plaque and calculus via regular brushing, flossing, and dental visits

133

virus that causes hairy leukoplakia

EBV

134

Gland for pleomorphic adenoma

60% of the parotid tumors and less common in submandibular and rare in minor glands

135

Most common pathogenic factor for leuko/erythroplakias

tobacco . . alcohol also contributes

136

50% of adenoid cystic carcinomas disseminate where decades after primary tumor removal

bone, liver, brain

137

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

Warthin tumor

138

5 year survival for early stage and tobacco related SCC

80%

139

gene and chromosome for Gorlin syndrome?

PTCH on chromosome 9

140

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

141

What does a dental plaque contain?

mixture of bacteria, salivary proteins, and desquamated epithelial cells

142

time for herpetic stomatitis

7 to 10 days

143

Nonspecific bacterial sialadenitis is usually secondary to what?

Ductal obstruction produced by stones (Sialolithiasis)

144

Radiographically, well-defined unilocular or multiolcular radiolucencies

keratocystic odontogenic tumor

145

Acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane; enlargement of lymph nodes in neck; palatal petechiae

infectious mononucleosis

146

A lack of salivary secretions is a major complication of what therapy

Radiation

147

Classic pathogenesis for squamous cell carcinomas

tobacco and alcohol

148

What immunologic disorders may aphthous ulcers be associated with

-Celiac disease
-IBD
-Behcet disease

149

color for mucocele

blue translucent hue

150

smoking and Warthin tumors

8 times greater risk

151

Benign tumor that consist of a mixture of ductal (epithelial) and myoepithelial cells and therefore show both epithelial and mesenchymal differentiation

Pleomorphic adenoma

152

Local expansion of SCC

submandibular glands and cervical nodes

153

age for leukoplakia/erythroplakia

any age but usually 40 to 70

154

intercellular bridges and cytokeratin positive

SCC

155

common, often recurrent, exceedingly painful, superficial oral mucosal ulcerations of unknown etiology

Aphthous ulcers (canker sores)

156

Koplik spots

Measles

157

Painful enlargement and sometimes a purulent ductal discharge and UNILATERAL involvement of a single gland

Nonspecific sialadenitis

158

Erythroplakia compared to Leukoplakia

-risk of malignant transformation much higher
-less common
-more ominous

159

Resolution of an Aphthous ulcer

typically spontaneously in 7 to 10 days

160

Xerostomia

dry mouth

161

Rarely show orderly epidermal maturation. Virtually all show SEVERE dysplasia, carcinoma in situ, or minimally invasive carcinoma

Erythroplakia

162

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

163

describe growth and invasion of ameloblastoma

commonly cystic, slow growing, and locally invasive but has an indolent curse in most cases

164

What likely contributes to the reddish clinical appearance of erythroplakia

an intense subepithelial inflammatory reactions with vascular dilation

165

What cures a dentigerous cyst

complete removal

166

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

167

Leukoplakias may occur anywhere in oral cavity but favor what locations

-buccal mucosa
-floor of mouth
-ventral surface of tongue
-palate
-gingiva

168

Molecular biology of classic SCC

-TP53 on chromosome 7
-NOTCH
-p63 protein

169

What drug can cause striking fibrous enlargement of the gingivae?

phenytoin (dilantin) . . for siezures

170

Age and gender for salivary gland neoplasms

usually adults and slight female predominance

171

Age for aphthous ulcers

first 2 decades

172

Tzanck test

HSV

173

microscopically: hyperparakeratosis and acanthosis with "balloon cells" in upper spinous layers

Hairy leukoplakia

174

oral SCC in individuals younger than 40 with no known risk factors like smoking and alcohol?

HPV

175

Nonspecific bacterial sialadenitis most often involves what glands

major, particularly submandibular

176

What increases the risk of pleomorphic adenomas

Radiation

177

what drugs can eliminate or alter the normal bacterial flora of the mouth and can result in oral candidiasis

broad spectrum antibiotics or steroid inhalers