Pathology Mental Dental] Flashcards by Michael McMahan

Benign but Aggressive
Classic DDx for multilocular RL in post mand is _______, KCOT, CGCG, COF
Tx: wide excision or resection, high reccurence if too conservative

Ameloblastoma

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RL with driven snow calcification (white flecks)
Amorphous pink amyloid with concentric calcifications termed Liesegang rings
Tx: excision, good prog

CEOT: Pinborg tumor

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Contains epithelia duct-like spaces and enameloid material
Mostly in anterior max and over impacted canine
Tx: surg excision, good prog

AOT

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Myxomatous connective tissue= slimy stroma
Messy RL with unclear borders and honeycomb pattern
Tx: surgical excision, moderate recurrence

Odontogenic Myxoma

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Dense collagen strands of epithelium
Central: bone, well defined multilocular RL
Mostly in post mand

Central odontogenic fibroma

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Well-circumscribed RO mass
Ball of cementum and cementoblasts replacing tooth root
Tx: surg excision and TE

Cementoblastoma

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Occurs in children and teens
Mostly seen in post mand
Myxomatous connective tissue
Called different name is odontoma is also present
Tx: surg excision

Ameloblastic fibroma

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RO lesion composted of dental hard tissues
Can block eruption
Compound: mostly anterior and toothicles
Complex: posterior, conglomerate mass
Garder syndrome: multiple odontomas and intestinal polyps

Odontoma

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COmposed of fibroblastic stroma in which goci of mineralized products are formed
Central: bone, well-circumscribed RL
Juvenile= aggressive variant, rapid growth, younger population
Similar in appearance and behavior to cementifying fibroma
Tx: surg excision

Central ossifying fibroma

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Ground glass appearance
Usually stops growing after puberty
McCune-Albright Syndrome; polyostotic fibrous dysplasia, cutaneous cafe au lait spots, endocrine abnormalilites like precocious puberty

Fibrous dysplasia

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Reactive process of unknown orgin
Most common at apices of mand anterior teeth
Most common in middle aged black femals
Teeth are vital
Lucent to opaque
No tx

Periapical cemento-osseous dysplasia

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Circumscribed opaque mass of bone and osteoblasts
Tx: surg excision

Osteoblastoma

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Composed of firbroblasts and multinucleated giant cells
Anterior mand favored
Central= bone RL with thin wispy septations
Tx Excisiton

Central giant cell granuloma

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Pseudocyst composed of blood filled spaces
ML RL
Expansile
Post mand favored
Tx Excision: Apsiration biopsy

Aneurysmal bone cyst

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Causes multiple bone lesions resulting from excessive levels of PTH
Brown tumor= due to excess osteoclast activity
Elevated alkaline phosphatase due to too much breakdonw of bone
Von Recklinghhausen’s disease of bone= the result of this condition

Hyperparathyroidism

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Austomsomal dominant
Symmetical bilateral swelling, expansile bilateral multilocular RLs
Stops growing after puberty
Giant cell lesion

Cheubism

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Rare type of cancer
Langerhan cells are normally found in the skin as antigen presenting cells, but can cause damage if they buildup in certain parts of the body
Discrete punched out ice cream scoop RLs that lead to floating teeth
Tx: excision, radiation, chemo

Langerhans cell ds

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Progressive metabolic distrubance of many bones causing symmetrical enlargement
Usually adults over 50
Elevated alkaline phosphatase due to breakdown of bone
Cotton wool appearance
Dentures and hats become too tight
Tx: bisphosphonates and calcitonin

Paget’s ds

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Approx 1 in 1000 birth
Unilateral (80%) or bilateral (20%)
Lack of fusion between medial nasal process and max process

Cleft lip

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Approx 1 in 2000 births
Lack of fusion of palatal shelves

Cleft palate

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Invaginations at commissures or near midline
Van der Woude Syndrome= clefts and pits

Lip pits

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Ectopic sebaceous glands

Fordyce Granules

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White or whitish-gray edematous lesion of buccal mucosa
Dissipates when cheek is stretched

Leukoedema

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Thryoid tissue mass at midline base of tongue
Located along embryonic path of thyroid descent

Lingual thyroid

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Midline neck swelling Located along embryonic path of thyroid descent

Thyroglossal duct cyst

White annular (ringed) lesions surrounding central red islands that migrate over time Occasionally hurt and burn Tx: none

Geographic tongue

Folds and furrows of tongue dorsum Melkersson-Rosenthal Syndrome= fissured tongue + granulomatous chelitis + facial paralysis

Fissured tongue

Tumors of blood vessels or lymph vessels

Angioma

Congential focal proliferation of capillaries Most undergo involution but persistent lesions are excised

Hemangioma

Congential focal proliferation of lymph vessels Oral are very rare purple spots on tongue Called cystic hygroma when occurs in the neck Sturge Weber syndrome: angiomas of leptomeninges (arachnoid and pia mater) + skin along th distribution of the trigeminal nerve

Lymphangioma

Mass in midline floor of mouth if about mylohyoid Mass in upper neck if below mylohyoid Contains adnexal structures like hair and sebaceous glands Doughy consistency

Dermoid cyst

Lateral neck swelling Epithelial cyst within lymph node of neck

Branchial cyst

Epithelial cyst within lymphoid tissue of oral mucosa Palatine and lingual tonsils are common regions

ORal lymphoepithelial cyst

RL in post mand below mand canal Due ot lingual concavity of jaw

Stafne defect

Heart shaped RL in nasopalatine canal Caused by cystification of canal remnants Tx: excision

Nasopalatine duct cyst

Large RL scalloped around roots No epithelial lining in mand of teens Tx: aspiriate to Dx just monitor

Traumatic bone cyst

White line in buccal mucosa Type of focal hyperkeratosis due to chronic friction on mucosa

LInea alba

Red dots are inflamed salivary duct openings ONly premalignant if related to reverse smling

Nicotine stomatitis

Traumatic implantation of amalgam particles into mucosa Tiny RO particles in xray

Amalgam tattoo

Benign hyperpigmenation in mucous membranes Basicallly a freckle of mucosa Peutz-Jehgers: freckles and intestinal polyps

Melanotic macule

Elongated FILIFORM papilllae

Hairy tongue

Related to surfactant ingredient SLS

Dentrifice Assc sloughing

Primary: pan oral self limiting and childhood Latent in Trigemial gang Recurrent: keratinized mucosa only Labilalis and recurrent intraoral Whitlow: fingers Gladiatorum: head Acyclovir in prodromal period

HSV

Primary: chihckenpox, slef-limiting and childhood Latent in trigemianl Recurrent: shingles Ramsay Hunt Syn: herp zoster in geniculate gang affecting CN 7 and 8 resuling in facial paralysis, vertico , deafness Tx: acyclovir

Varicella zoster virus

Hand foot and mouth disease Herpangina: posterior oral cavity

Coxsackie virus

Koplik's spots (buccal mucosa dot ulcers) precede skin rash Primary: self limiting and childhood

Measles (rubeola)

Caused by several strains of HPV Benign epithelial pedunculated or sessile proliferation on skin or mucosa

Papilloma (wart)

Caused by several strains of HPV Common skin wart

Verruca vulgaris

Caused by HPV 6 and 11 Genital wart or from oral sex with somone with genital warts Tx: excision with high recurrence

Condyloma acuminatum

Caused by EBV White patch on lateral tongue that does not wipe off Opportunistic infection associated with HIV Associate with Burkitt's lymphoma

Oral hairy leukoplakia

Caused by contact with Treponema pallidum Primary: chancre Secondary: oral mucous patch, conyloma latum, maculopapular rash Tertiary: gumma, CNS involvement, CV involvement Congenital: Hutchinson's triad (notched incisors and. mulberry molars, deafnenss, ocular keratitis

Syphillis

Cuased by Mycobacterium tuberculosis Oral nonhealing chronic ulcers follow lung infection Primary: Ghon complex( inhaled bacteria surrounded in a granuloma that undergoes caseating necrosis and infected hilar lymph node draining the first lesion) Secondary: more widespread lung infection with cavitation Miliary: systemic spread HIV pts are at high risk of getting progressive ds Tx: multidrug

Caused by Neisseria gonorrhoeae Oral pharyngitis rarely seen

Gonorrhea

Caused by actinomyces israelii (not fungal) Opportunistic infection chronic and granulomatous PA: jaw infections Cervicofacial: head and neck infectoins Sulfur granules in purulent exudate Tx Long term high dose penicillin

Actinomycosis

Caused by strep group A (strep pyogenes This when strep throat becomes a systemic infection Strawberry tongue: white coated tongue with red inflamed FUNGIFORM papillae Tx Pen

Scarlet fever

Pseudomembranous: white plaque that rubs off Atrophic: red Median rhomboid glossitis: loss of lingual papillae Angular chelitis: corner of mouth Tx: antifungal

Candidiasis

Canker sore Nonkeratinized Minor: heal without scarring Major heal with scarring Sutton ds: another name for major form Behcet's syndrome: multisystem vasculitis that causes apthous-type ulcers of oral and gential and inflammation of ete Tx: corticosteroids for Behcet's

Aphthous ulcer

Often on lips but can occur anywhere on skin and mucosa Minor: herpes simplex hypersensitivity Major: drug sensitivity Stevens-Johnson Syndrome: another name for major form

Erythema Multiforme

Allergic reaction to drug or food contact Diffuse swelling of lips neck or face Mediated by mast cell release of IgE and histamines Tx: antihistamines

Angioedema

Allergic reaction to inhaled antigen Strawberry gingivitis Tx: corticosteroids and cyclophosphamide

Wegner's granulomatosis

T lymphocytes target and destroy basal keratinocytes Basal zone vacuolizatoin and sawtooth rete pegs secondary to this destruction is observed histologically Reticular: wickham striae, more common Erosive: wickham striae with red ulceration Tx: corticosteroids

Lichen planus

Discoid chronic type Disc like lesions on facial skin Oral lesions mimic erosive lichen planus Systemic acute type Multiple organ involvement Butterfly rash over bridge of nose Austoantibodies (ANA test) Tx: corticosteroids

Lupus Erythematosus

Hardening of skin and connective tissue Restricted opening and uniform widening of PDL space

Scleroderma

Suprabasilar Autoantibodies against desmosomes Multiple painful ulcers preceded by bullae Postivie Nikolsky's sign Tx: corticosteroids

Pemphigus vulgaris

Subasilar Autoantibodies agaisnt basement membrane (hemidesmosomes) POstivie Nikolsky's sign

MMP

Clinical description not a Dx White patch that does not rub off Tx: biopsy mandatory

Leukoplakia

Recrrent and warty May be assc with HPV 16 and 18 High risk of malignant transformation to SCC or verucous carcinoma

Proliferative Verrucous Leukoplakia

Clincial description not Dx Red patch Higher risk than leukoplakia Tx: Biopsy mandatory

Erythroplakia

Tobacco and HPV 16 and 18 are causes Slow-growing malignancy Tx: excision

Verrucous carcinoma

Caused by oncogenes or inactivation of tumor suppressor genes Increased incidence of oropharyngeal SCC assc with HPV 16 and 18 5-survival is about 50% Plummer-Vinson Syndrome: mucosal atrophy, dysphagia, iron deficiency anemia, increased risk of oral cancer Tx: excision or radiation

SCC

Sue to sun damaged Very rarely metastasizes Tx: surg

Basal cell carcinoma

Malignancy of melanocytes High risk sites are palate and gingiva 5-year survival for skin lesions is greater than 65% but less than 20% for oral lesions

Oral melanoma

Calcium channel blockers Dilantin Cyclosporine Tx: gingivectomy and discontinue drug is possible

Gingival hyperplasia

Entangled submucosal mass of neural tissue Caused by injury to nerve MOst common at mental foramen Multiple Endocrine Neoplasia (MEN 2B)+ multiple neuromas and medullary thyroid cancer and pheochromocytoma of the adrenal gland

Traumatic neuroma

Hyperplasia of capillaries: red Caused by chronic trauma or irritation Common in gingiva

Pyogenic granuloma

Neoplasm of fibroblasts Easy to eradicate and rarely recurs Tx surgical excision

Nodular fasciitis

Neoplasm of fibroblasts Difficult to eradicate and often recurs

Fibromatosis

Neoplasm of Schwann cells Named such because these tumor cells have a granular cytoplasm Pseudoepitheliomatous hyperplasia (PEH) in this tumor mimics SCC Most common on dorsal tongue Variant on gingiva is congenital epulis of new born

Granular cell tumor

Neoplasm of schwann cells Acellular verocay bodies in Antoni A tissue

Schwannonma (Neurilemmoma)

Neoplasm of schwann cells and fibroblasts Neurofibromatosis type 1/ Non Recklinghausen's ds: multiple neurofibromas and multiple skin freckles and axillary freckles: neurofibromas can neurofibrosarcomas here

Neurofibroma

Malingnat proliferation of fibroblasts

Fibrosarcoma

Malignant proliferation of schwann cells

Neurofibrosarcoma

Malignant proliferation of endothelial cells Caused by HHV8 and most commonly seen as complication of AIDS Purple lesion

Kaposi's sarcoma

Caused by by trauma to salivary duct Mucocele: common in lower lip Ranula when occurs on the floor of the mouth Tx: excision

Mucous extravasation phenomenon

Histologically a true cyst lined by epithelium Caused by blockage of salivary duct by sialolith

Mucous retention cyst

Rapidly expanding ulcerative lesion Usually due to ischemic necrosis of minor salivary glands in response to trauma or local anesthesia Tx: heals on its own in 6-10 wks

Necrotizing sialometaplasia

Caused by blockae of glands in sinus mucosa

Sinus retention cyst

Hyperimmune: granulomas May. be triggered by mycobacteria Primarily pulomonary ds, but also affects salivary glands mucosa Xerostomia Lofgren's syndrome: erythema nodosum and bilateral hilar lymphadenopathy and arthritis Heerfordt syndrome: anterior uveitis and parotid gland enlargement and facial nerve palsy and fever: Tx: corticosteroids

Sarcoidosis

Autoimmune- lymphocyte mediated Affects salivary and tear glands Primary: keratoconjunctivitis sicca and xerostomia Secondary= above plus another autoimmune ds usually RA Tx: symptomatic

Sjogren's syndrome

Composed of mixture of cell types (mixed tumor) Most common benign salivary gland tumor Firm rubbery swelling Most common site is palate for minor salivary gland or ear for parotid gland

Pleomorphic adenoma

Composed of single cell type Includes basal cell adenoma, canalicular adenoma, myoepithelioma, and oncocytic tumor Tx: surgical excision

Monomorphic Adenoma

Composed of oncocytes and lymphoid cells Oncocyte: epithelial cell with excessive number of mitochondria Usually found in the parotid of older men

Warthin's tumor

Most common salivary gland malignancy

Mucoepidermoid carcinoma

Second most common salivary gland malignancy for minor glands

Polymorphous Low-grade Adenocarcinoma (PLGA)

Cribriform or swiss cheese microscopic pattern 5-year survival is 70%, 15 year survival is 10%

Adenoid cystic carcinoma

Reed-sternberg cells = malignant b cells Very rare in the oral cavity Tx: chemo/radio

Hodgkin's lymphoma

Neoplasm of B or T cells Burkitt's lymphoma= type of B cell NHL with bone marrow invovlement, swelling, pain, tooth mobility, lip paresthesia, and halts root development Tx: chemo/radio

Non-Hodgkin's lymphoma (NHL)

Involves neoplasm of antibody-secreting B cells aka Plasma cells Multiple punched out RL usually in skull Amyloidosis due to accumulation of complex amyloid proteins that develop from antibody light chains Tx: chemo, poor prognosis

Multiple myeloma

Neoplasm of bone marrow cells Classification based on cell lineage and where disease is acute of chronic ALL, CML, AML, ALL Three clinical signs are bleeding, fatigue, and infection

Leukemia

MOst common odontogenic cyst RL at apex Always assc with nonvital tooth Necrotic pulp causes PA inflamm Acute: abscess Chronic: granuloma Epithelial Rest of Malassex from hertwigs epithelial root sheath within pocket of inflamm encapsulate the lesion resulting in formation of a cyst

Radicular cyst

RL attached to CEJ of impacted tooth Most common with canines and 3rd molars Accumulaton of fluid between crown and reduced enamel epithelium Tx: excision but may be source of future odontogenic tumor

Dentigerous cyst

Most common in mand pm region Always assc with vital tooth Tx: excision

Lateral periodontal cyst

Soft tissue conterpart to LPC

Gingival cyst

Bohn's nodules= lateral palate Epsteins pearls: midline palate Rests of dental lamina epithelialize the small lesions

Gingival cyst of newborn

Cyst that develops where a tooth would have formed Most common at mand 3rd molar region Tx: complete removal

Primordial cyst

Aggressive and recurrent Most common in post ascending ramus Thin corrugated parakeratized epithelium Gorlin syndrome: multiple KCOTs, multiple BCCs, calcified flax cerebri, fatal, Tx: aggressive enucleation

Keratocystic odontogenic tumor

Rare and unpredicable Ghost cells: empty space where nucleus was and keratin fills it, can undergo calcification and little RLs detected radiographically

calcifying odontogenic cyst

Most common initiating causes are odontogenic infection and trauma Infection and inflammation usually begins in medullary space involving the cancellous bone and spreads to cortical bone periosteum and soft tissues Symptoms -Deep and intense pain -High or intermittent fever -Paresthesia or anesthesia of IAN -Tooth is NOT loose, this caused by periodontitis Tx: Abx and drainage

Acute osteomyelitis

Diffuse mottled RL Sequestra= piece of dead bone Garre's osteomyelitis: chronic osteomyelitis with proliferative periosteitis Tx: Abx and debridement

Chronic osteomyelitis

Sarcoma of jaws where new bone is produced by tumor cells Sunburst pattern 5 year survival is 25-40% Tx: resection and chemo

Osteosarcoma

Saroma of jaws where new cartilage is produced by tumor cells Same presentation and tx as previous More common involving condyle due to cartilaginous origin

Chondrosarcoma

Sarcoma of long bones involving "round cells" Seldom affects the jaws Affects children Involves swelling

Ewing's Sarcoma

Pain swelling and especially paresthesia Ill-defined changes are noted Breast, lung, kidney, colon, prostate

Metastatic carcinoma

Autosomal dominant Asymptomatic spongy white buccal mucosa

White sponge nevus

Autosomal dominant Olser-Weber-Rendu Syndrome: another name for this disorder Telangiectasia: red macule or papule dilated or broken capillary Abnormal capillary formation on skin, mucosa, and viscera Assc with iron-deficiency anemia Epistaxis is a frequent presenting sign

Hereditary Hemorrhagic Telangiectasia

Autosomal dominant Missing clavicles Supernumerary teeth

Cleidocranial dysplasia

X-linked recessive Missing teeth Hypoplastic hair and nails

Ectodermal dysplasia

AD or AR Albergs-Schonberg ds and marble bone ds Lack of bone remodeling and resorption leads to stone bone

Osteopetrosis

AD, AR, x-linked Intrinsic alteration of enamel All teeth from both dentitions are affected Thin to no enamel, but dentin and pulp are normal Tx: Full coverage

Amelogenesis Imperfecta

AD Intrinsic alteration of dentin All teeth from both dentitions are affected Shorts roots, bell-shaped crowns, and obliterated pulps Bulbous crowns in radiographs due to constricted DEJ Blue sclera Tx: fulll coverage crowns

Dentinogenesis imperfecta

AD Intrinsic alteration of dentin All teeth from both dentitions are affected Chevron pulps and short roots Teeth are not good candidates for restoration

Dentin dysplasia

Quadrant of teeth exhibit short roots, open apices, and enlarged pulp chambers Ghost teeth Tx: extracted affected teeth

Regional odontodysplasia

Two buds merge into one tooth Tooth count is one less tooth than normal

Fusion

One root bud into 2 crowns Tooth count is normal

Gemination

Pathology Mental Dental] Flashcards

(124 cards)