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GI 2 > Pathology of GI Tract Ch 16 Robbins > Flashcards

Pathology of GI Tract Ch 16 Robbins Flashcards

1
Q

What are dental carries and what causes them?

A
  • Tooth decay caused by focal demineralization of enamel and dentin by acidic metabolites of fermenting sugars produced by bacteria
  • one of most commmon diseases worldwide
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2
Q

What is Gingivits?

A
  • Inflammation of oral mucosa surrounding the teeth as a result of poor oral hygiene leading to the accumulation of plaque and calculus
  • Reversible
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3
Q

What is a dental plaque? Who is it most prevalent in?

A
  • sticky colorless biofilm that collects between and on the surface of the teeth
    • contains mix of bacteria, saliva, and desquamated epithelial cells
  • Adolescence
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4
Q

What is Periodontitis?

A
  • Inflammatory process affecting the supporting structures of the teeth, alveolar bone, and cementum
  • Results in eventual loss of teeth
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5
Q

What type of bacteria colonizes periodontitis?

A
  • facultative gram positive colonize healthy gingival sites while plaques contain anaerobic and microaerophiolic gram negative floura
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6
Q

What are the systemic diseases that periodontal disease can be a component of?

A
  • AIDS
  • Leukemia
  • Chron dz
  • DM
  • Down syndrome
  • Syndromes with Neutrophil defects
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7
Q

Periodontal infections can be the origin of important systemic diseases such as ___, ___ , and ____.

A
  • Infective endocarditis
  • Pulmonary abscess
  • Brain abscess
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8
Q

What is an Apthous ulcer?

A

Canker sore

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9
Q

Describe an apthous ulcer.

A
  • Common in first two decades of life
  • Common recurrent very painful superficial oral mucosal ulcerations
  • Unknown etiology
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10
Q

What immunologic disorders are Apthous ulcers assoc. with?

A
  • Celiac
  • IBD
  • Behcet
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11
Q

How do Apthous ulcers look?

A
  • Single or multiple shallow hyperemic ulcerations covered by a thin exudate rimmed with narrow zone of erythema
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12
Q

Describe the underlying inflammatory inflitrate in a canker sore?

A
  • Initially largely mononuclear
  • Secondary bacterial infections result in neutrophilic invasion
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13
Q

Describe an irritation fibroma grossly, cause of it, and treatment?

A

Aka Traumatic fibroma and focal fibrous hyperplasia

  • Submucosal noduoalr mass of fibrous connect tissue stroma that occurs primarily on buccal mucosa along bite line
  • Believed to be reactive proliferation caused by repetitive trauma
  • Surgical excision
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14
Q

What is a pyogenic granuloma:

  • Who is it found in commonly
  • Gross appearance
  • Cause
  • Prognosis
A
  • Inflammatory lesion found of gingive of children, young adults, and pregnant women
  • Ulcerated ret to purple lesion with alarmingly rapid growth
  • Histologically they have high vascular proliferation with organizing granulation tissue
  • Regress, mature into dense fibrous mass, or devellop into peripheral ossifying fibroma
  • Complete surgical resection
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15
Q

What is a peripheral ossifying fibroma? How does it arise, and gross appearance?

A
  • Common fingival growth most likely reactive in nature rather than neoplastic
    • may arise from chronic pyogenic granuloma OR
    • denovo from cells of periodontal ligament
  • Red ulcerated and nodular lesions onf gingiva
  • Young kids and females
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16
Q

Periphreal ossifying fibroma treatment?

A

High recurrence so excision down to periosteum is tx

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17
Q

What ype of herpes causes orofacial heerpetic infections? What age does it typically occur?

A

HSV 1 ages 2-4

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18
Q

What symptoms accompany acute herpetic gingivostomatitis?

A
  • Lymphadenoathy
  • fever
  • anorexia
  • irritabiltiy
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19
Q

In adults, reactivation of HSV 1 is associated with what factors?

A
  • Trauma
  • Allergies
  • UV exposure
  • URI
  • Pregnancy
  • Menstruation
  • Immunosuppression
  • Temp extremes
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20
Q

How do herpetic labial lesions appear

A

small groups of vesicles on lips nasal orifices buccal mucosa gingiva and hard palate resolving in 7-10 days

  • immunocompromised persist and may need systemic antivirals
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21
Q

What is the most common fungal infection of the oral cavity?

A

Candida

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22
Q

What are the three major forms of oral candidiasis?

A
  • Psuedomembranous
  • Erythematous
  • Hyperplastic
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23
Q

Gross appearance of thrush?

A
  • superficial gray to white inflammatory membrane
  • made of matted organisms in a fibrinosuppurative exudate
  • readily scraped off
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24
Q

Infections of candidia usually remain superficial except in the case of what?

A
  • Immunosuppression
  • bone marrow/organ transplant
  • neutropenia
  • chemo induced immunosuppression
  • AIDS
  • DM
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25
Q

Scarlet fever oral lesion?

A
  • Fiery red tongue with prominent papillae
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26
Q

Measels oral lesion?

A

Koplik spots

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27
Q

Mono oral changes?

A
  • Acute pharyngitis and tonsillitis that may cause coating with grey white exudative membrane
  • Enlargement of lymph nodes in neck
  • Palatal petechiae
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28
Q

Diptheria oral changes?

A
  • dirty white fibrinosuppurative tough inflammatory membrane over tonsilis
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29
Q

What is a distinctive oral lesion on the lateral border of the tongue typically seen in immunocmpromised patients? What causes this lesion?

A

Hairy Leukoplakia

EBV

30
Q

What does hairy leukiplakia look like

A
  • white confluent patches of flufffy hyperkeratotic thickenings
  • Cannot be scraped off
31
Q

What does the microscopic appearnce of hairy leukoplakia look liek?

A
  • hyperparakeratosis and acanthosis with balloon cells in upper spinous layer
32
Q

All leukoplakias must be considered ____.

A

Precancerous

33
Q

Whath is erythroplakia?

A
  • Uncommon, high risk malignant transformation
  • Red velvety eroded area within oral cavity that may be slightly depressed din relation to surrounding mucosa
34
Q

What fungal infections have a predilection ofr oral cavity and head/neck region? In what kind of patient?

A
  • histoplasmosis
  • Blastomycosis
  • Cocidiodomycosis
  • Cryptococcosis
  • Zygomycosis
  • Aspergillosis

Immunocompromised patient

35
Q

Histological changes in erythroplakia?

A
  • rarely demonstarte orderly epidermal maturation
  • Most 90% have severe dysplasia
  • Carcinoma in situ
  • Minimally invasive carcinoma
  • Usually see intense supepithelial inflammatory reaction with vascular dilation
    • contributes to the reddness
36
Q

Leukoplakia and erythroplakia are common in what ages and sex?

A
  • 2:1 male to female
  • 40-70
37
Q

What type of cancer is 95% of the neck and head cancers?

A

SCC with the remainder being adenocarcinomas of salivary gland

38
Q

What type of HPV is assoc. with SCC? Why will HPV assoc.SCC of the oral cavity surpass cervical HPV cancer?

A
  • HPV 16
  • There are no screenings for SCC of mouth AND no precursor lesions
39
Q
A
40
Q

HPV assoc. SCC has mutations in what?

A

P16 overexpression

E6 and E7 expresssion inactivating p53 and RB paths

41
Q

What is a Dentigerous cyst?

A
  • cyst that orioginates around crown of un erupted tooth and is result of fluid acucmulation btw developing tooth and dental follicle
42
Q

What is an Odontogenic keratocyst aka Keratocystic odontogenic tumor? Who are they in and where

A
  • MUST be differentitated from other odontogenic cysts bc it is aggessive
  • Diagnosed btw 10 and 40
  • Occur in males more in posterior mandible
43
Q

What do OKC’s look like radiographically? Histologically?

A
  • well defined unilocular or multilocular radiolucencies
  • cyst lining made of thin keratinized stratified squamous epithelium with prominent basal cell layer and corrugated epithelial surface
44
Q

How do you treat OKC’s?

A

Complete removal bc they are lcoally aggressive and recurrencec rates for inadquately removed OKC’s are high

45
Q

Multiple OKC’s occur in 20% of patients. These patients should be evaluated for what syndrome?

A

Gorlin syndrome/nevoid BCC syndrome which is assoc. with PTCH mutations on 9q22

46
Q

What is a branchial cyst?

A
  • arises from remnants of second branchial arch
  • Seen in young adults btw 20-40 yo
  • Upper lateral aspect of neck along SCM muscle
47
Q

Thyroglossal Duct cyst?

A
  • Remnant of developmental tract for thyroid development.
  • lined by strat squam or psuedostrat column
  • locatd midline
48
Q

Xerostomia?

A

dry mouth

49
Q

What autoimmune syndrome has xerostomia associated with it?

A

Sjogren syndrome

50
Q

What is xerostomia frequently a side effect from?

A
  • major complication of radiaiton therapy
  • anticholinergics
  • Antidepressants/psychotics
  • diuretic
  • antihypertensive
  • sedative
  • mm relaxer
  • analgesic
  • antihistamine
51
Q

How will xerostomia present grossly?

A
  • Atrophy of papilla
  • Dry mouth
  • Fissuring and ulcerations of tongue
  • Increased dental caries and difficulty swallowing and speaking and candidias
52
Q

Sialadentitis?

A
  • induced by trauma, viral, bacterial , or autoimmune diseases
53
Q

What is a mucocele?

A
  • common lesion of salivary gland resulting from blockage or rupture of saliva into surrounding CT stroma
  • common on lower lip and from trauma
  • all ages
  • Blue translucent hue
54
Q

Rannula?

A
  • epithelial lined cyssts that arise hewn duct of sublingual gland has been damaged
  • Can be so large it develops a plunging ranula
    • goes through CT stroma connecting mylohyoid muscle
55
Q

Nonspecific bacterial sialadentitis cause? What are the bacteria?

A
  • Involves major salivary glands particularly submandibular, secondary to ductal obstruction by stones
  • S. aureus or S. viridans
  • unilateral involvement single gland
    • ​painful enlargement
56
Q

In general salivary gland tumors occur in who?

A
  • Adults with slight female predominance
57
Q

Warthin tumors occcur in who when? Risks?

A
  • Males more than females
  • Higher prevelance of smoking
  • 50-70 yo
58
Q

What is a pleomorphic adenoma made up of, what is the risk, where are they typically found?

A
  • Benign salivary tumor made of mix of ductal and myoepithelial cells
    • mesenchymal and epithelial differentiation
  • 60% of parotid tumors
  • Radiation exposure increases risk
59
Q

What is the mutation in pleomorphic adenomas?

A

PLAG1 overexpression

60
Q

Pleomorphic adenoma gross appearance and histology?

A
  • Rounded well demarcated mass rarely bigger than 6 cm
  • Grey to white with myxoid and blue translucent areas of chrondroid
  • Histologic feature is Heterogeneity of the tumor
    • epitlelial elements resemble ductal cells or myoepithelial cells arranged in duct formation
    • dispersed within mesenchyme backround of loose myxoid tissue with islands of cartilage
61
Q

How do benign salivary tumors present?

A
  • Slow growing
  • Painless
  • mobile
  • discrete mass
62
Q

What tumor arises exclusively in the parotid gland? When/ who is it common in?

A

Warthin’s Tumor

aka Papillary Cystadenoma Lymphomatosum

More common in men btw 50 and 70 years old

63
Q

Warthin tumor gross appearance and histologic?

A
  • round to oval encapsulated masses, 2-5cm
  • Superficial parotid gland, transection shows pale gray surface with narrow cleft like spaces wih mucinous/serous secretions
  • Spances lined bdy double layer of neoplastic epithelial cells resting on dense lymphoid stroma looking like germinal center
  • Palisading columnar cells abundant finely granular eosinophilic cytoplams
64
Q

What are mucoepidermoid carcinomas composed of?

A
  • squamous cells
  • mucus ssecreting cells
  • intermediate cells
  • 15% of all salivary gland tumors occuring mainly in parotids
65
Q

What is the mutation in mucoepidermoid carcinomas?

A
  • balanced (11;19) (q21;p13) transcocation creating fusion gene made of MECT1 and MAML2
66
Q

What is the most common form of primary malignant tumor of the salivary glands?

A

mucoepidermoid carcinomas

67
Q

Gross appearance of mucoepidermoid carcinomas

A
  • 8 cm
  • circumscribed but lack well defined capsules and are infiltrative at margins
  • Pale and grey-white on tarnsection
  • contain small mucin containng cysts
68
Q

Histologic appearance of mucoepidermoid carcinomas

A
  • hybrid cell types have squamous features with small to large mucus filled vacuoles
    • mucin stain
  • highly anaplastic cells
69
Q

Occurence of adenoid cystic carcinioma? Prognosis?

A
  • Relatively uncommon usually found in the minor salivary glands (palatine)
  • Slow growing but can invade perineural spaces and are very recurrent
  • 50% disseminate
70
Q

Adenoid cystic carcinoma gross appearance?

A
  • generally small poorly encapsulated infiltrative gray pink lesions
71
Q

Histologic appearance of adenoid cystic carcinoma?

A
  • small cells with dark compack nuclei and scant cytoplasm
  • tubular solid or cribiform patterns
  • Spaces btw cells have hyaline material

GI 2 (19 decks)

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