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Flashcards in Pathology3 Deck (94):
1

A dental granuloma and a radicular cyst can be differentiated:
• based on symptoms
• radiographically
• histologically
• by an electric pulp tester

histologically and only histologically!

2

This inflammatory cyst derives its epithelial lining from ? within the periodontal ligament

proliferation of small odontogenic epithelial residues (rest of Malassez)

3

A 37-year-old patient comes into your office with the complaint of a slowly growing, painless swelling of his lower left jaw. A panoramic shows a multilocular radiolucency with well-defined and sclerotic margins along the left mandibular molar-ramus area. All teeth test as vital. A biopsy is conducted and shows odontogenic epithelium. What is the most likely diagnosis for the most aggressive type of this tumor?
• solid (multicystic or polycystic)
• unicystic
• extraosseous (peripheral)

solid (multicystic or polycystic)
ameloblastoma is the most common epithelial odontogenic tumor

4

Malignant behavior by ameloblastoma is ? encountered. These lesions occur in a younger age group (30s) and appear in the ? more frequently. Malignant lesions have been divided into two subtypes?

• rarely
• mandible
• the malignant ameloblastoma and ameloblastic carcinoma

5

A 30-year-old patient comes into your office complaining of a painless swelling of his lower left jaw. A panoramic radiograph shows a well-circumscribed multilocular radiolucency with a "honeycomb" pattern at the location of the lower left molars. The teeth have been displaced. The pathology report calls this an odontogenic myxoma. This tumor:
• is composed of large polyhedral, neoplastic, epithelial cells
• is composed of neoplastic epithelium and mesenchyme
• arises from follicular connective tissue resembling pulp tissue
• is composed of spindle-shaped mesenchymal cells and aggregates of multinucleated giant cells

arises from follicular connective tissue resembling pulp tissue

6

for odontogenic myxoma ? are the rule

• cortical expansion (rather than perforation)
• root displacement (rather than resorption)

7

The calcifying epithelial odontogenic (Pindborg) tumor is composed of ?

large polyhedral, neoplastic, epithelial cells

8

The ameloblastic fibro-odontoma and ameloblastic fibroma are composed of ?

neoplastic epithelium and mesenchyme

9

The central giant cell granuloma is composed of a proliferation of spindled fibroblasts in a stroma containing variable amounts of collagen. ? cells are present throughout the connective tissue stroma

Multinucleated giant cells

10

The cementoblastoma is more often seen:
• in the mandible than in the maxilla, and more often in the posterior than in the anterior regions
• in the mandible than in the maxilla, and more often in the anterior than in the posterior regions
• in the maxilla than in the mandible, and more often in the posterior than in the anterior regions
• in the maxilla than in the mandible, and more often in the anterior than in the posterior regions

in the mandible than in the maxilla, and more often in the posterior than in the anterior regions (also known as the true cementoma)

11

To distinguish cementoblastoma from condensing osteitis ?

in condensing osteitis you can distinguish the root outline

12

Periapical cemental dysplasia has:
• a predilection for persons younger than 20 years old
• a predilection for middle-aged caucasian men
• a predilection for middle-aged black women
• no age, racial, or sex predilection

a predilection for middle-aged black women

13

The most common location for a Pindborg tumor (calcifying epithelial odontogenic tumor (CEOT) is the:
• tuberosity area
• maxillary anterior area
• mandibular premolar area
• molar— ramus area

molar— ramus area

14

The ameloblastic fibroma and ameloblastic fibro-odontoma appear to be variations of the same process. These neoplasms occur predominantly in:
• adults with a mean age of 40
• elderly people with a mean age of 75
• young adults with a mean age of 25
• children and young adults

children and young adults (Except for the presence of an odontoma, the two lesions are the same, Radiographically, are well circumscribed and are usually surrounded by a sclerotic margin and may be associated with the crown of an impacted tooth)

15

An ? appears within the ameloblastic fibro-odontoma owing to the presence of an odontoma. This lesion, therefore, presents as a combined lucent-opaque lesion; the ameloblastic fibroma is ?

• opaque focus
• completely lucent

16

• a compound odontoma looks ?
• a complex odontoma ?

• like a tooth
• does not look (it is a disorganized arrangement of tubular dentin, enamel, and thin layers of cementum)

17

A 45-year-old African-American female presents to your office for a routine exam. Periapicals of the mandibular incisors show multiple radioopacities with radiolucent rims. Teeth #23 through #26 test as vital. There is no pain on percussion or palpation. Treatment for these lesions should be:
• do nothing (observe)
• RCT treatment for teeth #23 through #26
• surgical excision of lesions
• none of the above

do nothing (observe) (Periapical cemental dysplasia formerly known as cementoma) The term "cementoma" is a misnomer as the opacities are not cementum but bone

18

Three stages of periapical cemental dysplasia :

1.Osteolytic stage: radiolucency appears on radiograph.
2. Osteoblastic stage: beginning of calcification in the radiolucent area (mixed radiolucent and radiopaque appearance).
3.Mature (Sclerotic) stage: radiopacity appears on radiograph with a thin radiolucent line around the area

19

A 5-year-old boy presents with his mother for his first dental exam. Your exam reveals a normally developing dentition, but you notice multiple "freckles" on his lower lip and on the buccal mucosa. What condition should you be concerned about?
• gorlin-goltz syndrome
• gardner syndrome
• peutz-jeghers syndrome
• cleidocranial dysplasia

peutz-jeghers syndrome (refer for intestinal polyposis, signs and symptoms of abdominal pain, rectal bleeding, and diarrhea)
There is a strong tendency for these multiple polyps of the colon to undergo malignant change

20

? is the most common oral pigmented lesion. The tattoo has been mistaken for ?

• An amalgam tattoo
• a melanin-pigmented lesion

21

Attempt to locate amalgam on x-ray if tattoo is suspected; if you can not locate any amalgam, ? may be needed to rule out a melanocytic neoplasm

a biopsy

22

Focal (frictional) keratosis: common white lesion caused by chronic friction on the mucosa. Important: Differentiated from ? because cause is known

idiopathic leukoplakia

23

Linea alba: a type of ? that appears as a linear white line in buccal mucosa

frictional keratosis

24

The most common location for an intraoral congenital nevi (moles) (birthmark) is the:
• buccal mucosa
• tongue
• hard palate
• alveolar mucosa

hard palate (greater than 10 cm) have a higher incidence of malignant transformation (as opposed to acquired nevi)

25

? are much more common than congenital nevi both intraorally and extraorally.

Acquired nevi

26

? are both characterized by having numerous large, pigmented atypical nevi that have a high risk for developing malignant melanoma

• The B-K mole syndrome
• the dysplastic nevus syndrome

27

Which of the following conditions demonstrate pigmentation of the intraoral mucous membranes. Select all that apply.
• addison disease
• albright syndrome
• cushing syndrome
• peutz-jeghers syndrome

• addison disease
• albright syndrome
• peutz-jeghers syndrome

28

Addison disease results from ?. It is characterized by ?. Oral signs consist of ?. Although cutaneous pigmentation will most likely disappear following therapy, pigmentation of the oral tissues tends to persist

• hypofunction of the adrenal cortex
• bronzing of the entire skin
• diffuse pigmentation of the gingiva, tongue, hard palate, and buccal mucosa

29

There is an increased incidence of ? seen with polyostotic fibrous dysplasia.

osteosarcoma

30

Peutz-Jeghers syndrome is characterized by having ?

multiple intestinal polyps and intraoral melanin pigmentations

31

A 40-year-old patient presents to his physician with complaints of muscle weakness and loss of appetite. He has noticed a loss of weight and also that his skin has started to "bronze". His labs show lowered blood glucose and sodium and increased potassium. One condition likely to be causing this is:
• peutz--jeghers syndrome
• cushing syndrome
• addison disease
• albright syndrome

addison disease (Clinical features do not begin to appear until at least 90% of glandular tissue has been destroyed)

32

The main concern when performing dental procedures on a patient with Addison disease is that the adrenal cortex has ? to stress

no capacity to put out extra cortisol as a response

33

Focal melanosis is a common circumstance in which brownish areas of pigmentation occur in the oral cavity. Once properly diagnosed:
• surgical excision is required
• radiation is required
• no treatment is necessary
• antibiotics are required

no treatment is necessary (its etiology is developmental)

34

The intraoral nevus is usually a/an:
• intradermal nevus
• compound nevus
• junctional nevus
• blue nevus
• intramucosal nevus

intramucosal nevus (rare in the oral cavity. When found intraorally they most frequently occur on the hard palate)

35

If a pigmented lesion shows ?, a biopsy should be performed—this may indicate transformation into a malignant melanoma.

ulceration, an increase in size, darkening in color, etc.

36

Radiographically, traumatic bone cysts present as a:
•well-defined unilocular or multilocular radiolucency with scalloping around the roots
• poorly circumscribed radiopaque lesion which may have a "ground-glass" appearance
• saucer-shaped radiopaque lesion
• poorly defined multilocular radiolucency with a "pear-shaped" appearance between the maxillary central incisors

well-defined unilocular or multilocular radiolucency with scalloping around the roots (are non-cysts (referred to as pseudocysts))

37

Which of the following statements are true concerning the aneurysmal bone cyst. Select all that apply.
• it is an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood-filled cystic lesions
• most aneurysmal bone cysts occur in patients under 20 years of age, and it is uncommon after the age of 30
• it commonly involves the jaws
• the lesions are usually tender or painful, particularly upon motion of the bone affected
• upon entering the lesion surgically, excessive bleeding is encountered

• it is an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood-filled cystic lesions
• most aneurysmal bone cysts occur in patients under 20 years of age, and it is uncommon after the age of 30
• the lesions are usually tender or painful, particularly upon motion of the bone affected
• upon entering the lesion surgically, excessive bleeding is encountered
(The aneurysmal bone cyst commonly involves the proximal humerus, femur, tibia, and pelvis. It is not as common in the jaws, but it does appear here as well)

38

The aneurysmal bone cyst (ABC) is classified as a pseudocyst because it appears radiographically as a cyst-like lesion but microscopically ?

exhibits no epithelial lining

39

A patient presents with an asymptomatic, elongated, erythematous patch of atrophic mucosa of the mid-dorsal surface of the tongue due to a chronic Candida albicans infection. The most likely diagnosis is:
• thyroglossal duct cyst
• lymphangioma
• hemangioma
•median rhomboid glossitis

median rhomboid glossitis (devoid of filiform papillae, no treatment is necessary, however, topical or systemic antifungal drugs to manage the predisposing factors may be helpful)

40

Most patients who develop burning mouth syndrome are:
• children
• teenagers
• postmenopausal women
• middle-aged males

postmenopausal women (it is a "diagnosis of exclusion" and the lining of the mouth clinically appears normal)

41

A 13-year-old patient presents with his father to your dental clinic for a routine examination. From the health history, you gather that the patient has frequent nosebleeds, just like his father. Upon intraoral examination, you notice multiple red spots on the patient's lower lip and tongue. The father states that he has these same marks on his tongue, palate, and also his hands and eyes.
• wegener granulomatosis
• rendu-osler-weber syndrome
• sturge-weber syndrome
• juvenile nasopharyngeal angiofibroma

rendu-osler-weber syndrome (also known as hereditary hemorrhagic telangiectasia)

42

Carcinoma in situ exhibits all of the histologic characteristics of malignancy (pleomorphism, hyperchromatism, abnormal mitoses, anaplasia, etc.) but ?

does not show invasiveness or extension into adjacent structures

43

A clinical term defined as a red patch that cannot be clinically or pathologically diagnosed as any other condition is called:
• leukoedema
• psoriasis
• erythroplakia
• white sponge nevus

erythroplakia (like the term "leukoplakia," has no histologic connotation. It is a clinical diagnosis. Almost all true erythroplakias exhibit a microscopic picture of epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma. Note: Biopsy is mandatory.)

44

a fast-growing reactive proliferation of endothelial cells which is commonly found on the gingiva and usually forms in response to chronic irritation. The most likely diagnosis is?

pyogenic granuloma (The term "pyogenic granuloma" is somewhat of a misnomer in that it is not pus-producing, as "pyogenic" implies. It is, however, a "tumor" of granulation tissue, as "granuloma" implies)

45

Pregnant patients are prone to ? (sometimes called "pregnancy tumor").

pyogenic granuloma

46

Peripheral giant cell granulomas are seen exclusively in:
• buccal mucosa
• alveolar mucosa
• bone
• gingiva

gingiva

47

Generally, Peripheral giant cell granulomas is clinically indistinguishable from ?. will provide definitive results.

a pyogenic granuloma

48

benign vascular tumors composed of cells that normally line the blood vessels (endothelial cells). They are the most common tumor of childhood, occurring in up to 10% of infants

Hemangiomas

49

One of the earliest signs of Rendu-Osler-Weber syndrome is ?

epistaxis (nosebleeds) (syndrome is characterized by numerous spider like telangiectasias on the face, neck, chest, lips, gingiva, buccal mucosa and tongue)

50

How to distinguish between a hemangioma and a hematoma ?

hemangioma (inflammatory lesions) will blanch on diascopy, hematomas and nevi do not blanch

51

the most common tumor of major and minor salivary glands?

Pleomorphic adenoma (benign)

52

Tumors of the salivary glands are:
• uncommon and represent 2-4% of head and neck neoplasms
• common and represent 75-80% of head and neck neoplasms
• uncommon and represent 25-30% of head and neck neoplasms
• common and represent 95-98% of head and neck neoplasms

uncommon and represent 2-4% of head and neck neoplasms

53

almost exclusively a parotid neoplasm?

Warthin tumor

54

• The most common site of intraoral minor salivary gland neoplasms is ?
• The most common site of intraoral major salivary gland neoplasms is ?

• the palate
• the parotid

55

Which lesion below presents itself as a deep-seated palatal ulcer with clinical and histologic features mimicking those of a malignant neoplasm?
• white sponge nevus
• lichen planus
• necrotizing sialometaplasia
• focal hyperkeratosis

necrotizing sialometaplasia (lesion of the minor salivary glands) (in the past misdiagnosed as a squamous cell carcinoma)

56

The initiating event of necrotizing sialometaplasia is believed to be related to ?. Infarction of the salivary gland follows, presumably due to compromise of the vascular supply

ischemia, secondary to alteration of local blood supply

57

Following biopsy and the establishment of the diagnosis of necrotizing sialometaplasia, further treatment generally ?

is not recommended since healing usually occurs within 6-10 weeks.

58

In a small Amish community, there is an infectious outbreak. Multiple children are coming down with symptoms including fever and malaise. Commonly, there is swelling of the parotid glands. Given that this community does not receive vaccinations, what is a likely diagnosis for the condition?
• measles
• mumps
• rubella
• chicken pox

mumps
• 90% of the cases occur before 14 years of age
•A major sign is sudden salivary gland swelling without purulent discharge from the duct
Orchitis (inflammation of the testis) and epididymitis can occur in postpubertal males. *** May cause sterility

59

in nonvaccinated individuals, ? is still a cause of acute nonsuppurative salivary adenitis

mumps

60

The Stafne bone cavity is a developmental anomaly represented by a bone concavity usually containing:
• parotid gland tissue
• submandibular gland tissue
• sublingual gland tissue
• all of the above

submandibular gland tissue (The posterior mandible region, particularly at the angle and below the mandibular canal, is the most common location)

61

in Stafne bone cavity
• the radiographs show ?.
• histologically, ? is found,
• treatment ?

• a small, circular, corticated radiolucency below the level of the mandibular canal
• normal submandibular salivary gland tissue
• no treatment is required except routine radiographic follow-up.

62

A 53-year-old woman comes into the dental clinic with bilaterally enlarged parotid glands. It was discovered that she had recently been to the African continent and had contracted tuberculosis. What is the name of the autoimmune disease associated with enlarged salivary glands in association with a secondary disease?
• sjogren syndrome
• mikulicz disease
• gorlin-goltz syndrome
• pierre robin syndrome
• apert syndrome

mikulicz disease (also called benign lymphoepithelial lesion", the etiology is unknown, however, there is increasing evidence that both Mikulicz disease and Sjogren syndrome are both actually autoimmune diseases in which the patient's own salivary gland tissue becomes antigenic.)

63

A 33-year-old patient comes into your office for a routine maintenance appt. While doing an intraoral exam, the hygienist discovers a bluish lesion of the lower lip. The patient relates a history of biting this area last week when he had a sinus infection. What is the most likely diagnosis of this lesion?
• ranula
• infectious sialadenitis
• maxillary sinus retention cyst
• mucocele

mucocele

64

• mucocele
• mucus retention cyst

• related to mechanical trauma to the minor salivary
gland excretory duct, mucus pool surrounded by granulation tissue, less common, bluish hue
• regarded as a cyst because it is lined by an epithelium, results from obstruction of salivary flow, often without previous injury, normal color

65

What is the most probable diagnosis for a lesion that presents as a translucent, bluish, well-rounded, smooth-surfaced bulge that protrudes from one side of the floor of the mouth?
• adenoid carcinoma
• squamous cell carcinoma
• a ranula
• a lymphangioma

a ranula

66

Ranula is a clinical term used to designate ? that occurs specifically in the floor of the mouth, associated with the duct system of ?

• a mucocele
• the sublingual salivary glands
increased size just before or during a meal, and a decrease in size between meals

67

A patient comes to your office complaining of pain when eating and even sometimes when thinking about food. Your intraoral exam reveals a small, hard swelling in the floor of the mouth. A mandibular occlusal radiograph shows a pea-sized radiopacity with "onion-skin" thickening lingual to the right: mandibular border. Name the likely diagnosis:
• sialometaplasia
• sialadenitis
• sialolith
•sialosis

sialolith

68

sialoliths are seen incidentally on periapical radiographs, in which case they may be misdiagnosed as ?

osteosclerosis

69

Of the neoplasms affecting the major or minor glands, the ? is the most common.
• basal cell adenoma
• sebaceous adenoma
• pleomorphic adenoma
• ductal papilloma

pleomorphic adenoma (the majority are found in the palate)

70

Which of the following disorders should be included in your differential diagnosis of parotid gland enlargement.
Select all that apply.
• sarcoidosis
• mikulicz disease
• sjogren syndrome
• hypothyroidism
• diabetes mellitus
• malnutrition/starvation
• dehydration
• cystic fibrosis

• sarcoidosis
• mikulicz disease
• sjogren syndrome
• diabetes mellitus
• malnutrition/starvation
• dehydration
• cystic fibrosis

71

Sjogren syndrome: is an autoimmune disorder affecting ?

lacrimal and salivary glands which causes decreased moisture in glands

72

The acinic cell carcinoma is derived from serous acinar cells and is found almost exclusively in the:
• submandibular gland
• parotid gland
• minor glands of the palate
• sublingual gland

parotid gland (Treatment of acinic cell carcinoma includes surgical excision. This tumor is generally regarded as a low-grade malignancy)

73

? is the most common salivary gland malignancy and makes up between 5 % and 9% of all salivary gland neoplasms.
• adenoid cystic carcinoma
• mucoepidermoid carcinoma
• acinic cell carcinoma
• polymorphous low-grade adenocarcinoma

mucoepidermoid carcinoma (most often the parotid and palate)

74

Adenoid cystic carcinoma (ACC) accounts for approximately 23% of all salivary gland carcinomas. Microscopic appearance is described as ?. It is often referred to as ?. It is ?

• cribriform (most easily recognizable)
• the "Swiss cheese" pattern
• slow-growing but relentless

75

Which autoimmune disease is associated with the increase in caries?
• lupus erythematosus
• sjogren disease
• sarcoidosis
• crohn disease

sjogren disease (rampant caries)

76

The histological features of the salivary gland lesions in both Sjogren syndrome and ? are identical.

the "benign lymphoepithelial lesion" (also called Mikulicz disease)

77

It is important to remember that ? develop in some patients who have been diagnosed with Sjogren syndrome. This mandates close follow-up of the patients

• malignant lymphomas
• pseudolymphomas

78

Oral lesions of Discoid lupus erythematosus mimic ?

erosive lichen planus

79

The parotids are the salivary glands most often affected by tumors. Most of the tumors that grow in the parotid glands are:
• malignant
• mixed (benign and malignant)
• carcinoma in situ
• benign

benign (although tumors of the sublingual glands are rare, almost all of them are malignant. In contrast, only about 25% of parotid gland tumors are malignant)

80

Oncocytomas are ? tumors that constitute about ? of benign epithelial salivary gland neoplasms.
• common; 50%
• common; 75%
• rare; 2%
• rare; 15%

rare; 2% (the same as Basal cell adenomas which is rare and 3%)

81

A 65-year-old patient comes to your office complaining of a slowly growing enlargement of the jaw. You palpate the angle of his right ramus and find an encapsulated mass that is nontender and firm. Your oral pathologist defines it as a glandular and cystic tumor lined by a bilayered (inner columnar oncocytic and outer basal) epithelium with a lymphoid stroma. Name this second most common benign neoplasm of the parotids.
• pleomorphic adenoma
• warthin tumor
• fibroadenoma
• monomorphic adenoma

warthin tumor

82

? are the most common parotid tumor. It grows slowly and is benign. It begins as a painless lump at the back of the jaw, just below the earlobe. These are more common in women

Pleomorphic adenomas

83

A 40-year-old female presented with a subcutaneous nodule on the right lateral surface of her tongue. The nodule was nontender, soft, movable and had been slowly growing for about 2 years. The nodule was excised. Its cut surface was yellow and lobulated. What is the clinical significance of the nodule being movable and slow-growing?

these are characteristics of a benign neoplasm
General characteristics of malignant neoplasms:
• Immovable
• Rapid growth
• Metastasis

84

• Paresthesia is suggestive of ?
• ? is the most important characteristic that distinguishes malignant from benign

• metastatic disease
• Metastasis

85

A developmental defect characterized by an overgrowth of tissues NORMAL to the organ in which it arises is a:
• teratoma
• choristoma
• hamartoma
• none of the above

hamartoma

86

• a malignant epithelial neoplasm?
• a malignant mesenchymal (connective tissue) neoplasm

• Carcinoma
• Sarcoma

87

• a mass of histologically normal tissue in an abnormal location
• a neoplasm composed of multiple tissues foreign to the organ in which it arises; may be benign or malignant

• Choristoma
• Teratoma

88

Malignant neoplasms range from well-differentiated to undifferentiated. Malignant neoplasms composed of undifferentiated cells are said to be:
• metaplastic
• hyperplastic
• anaplastic
• dysplastic

anaplastic

89

Metaplasia most commonly occurs by replacement of ? by ?.
• cuboidal cells; columnar cells
• columnar cells; stratified squamous epithelium
• columnar cells; pseudostratified columnar cells
• cuboidal cells; stratified squamous epithelium

columnar cells; stratified squamous epithelium (in response
to stress)

90

Dysplastic cells exhibit considerable ? and often possess ?, which are abnormally large for the size of the cell. When dysplastic changes are marked and involve the entire thickness of the epithelium, the lesion is considered a preinvasive neoplasm and is referred to as ?

• pleomorphism (variation in size and shape)
• deeply stained (hyperehromatic) nuclei
• carcinoma in situ.

91

Recurrent aphthous major: heal often with ?, more common in ?

• scarring
• HIV patients

92

A 25-year-old dental student has been cramming for his dental physiology and pharmacology final exams. He is sleep deprived but otherwise healthy. When flossing, he notices a 3-mm ulceration on the inner surface of his lower lip. He can find no other instances of this lesion and remembers that he had one a long time ago in undergraduate clinic, which went away. What is the most likely diagnosis?
• recurrent aphthous minor
• recurrent aphthous major
• recurrent herpetiform aphthous
• recurrent herpetic stomatitis

recurrent aphthous minor also called canker sores

93

name all three classifications present ?

• recurrent aphthous minor
• recurrent aphthous major
• recurrent herpetiform aphthous
all are painful recurrent ulcers

94

Herpetic lesions are preceded by ? and are more likely to be found on ?

• vesicles
• keratinized tissue