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SBM GI > 02-17 PATH: Mouth & Esophagus > Flashcards

02-17 PATH: Mouth & Esophagus Flashcards

● Discuss the common infections of the oral cavity and of the esophagus ● Describe the premalignant and malignant lesions of the oral mucosa ● Memorize the pathologic features of the three most common tumors of the salivary glands ● Define the pathologic features of the most important lesions of the esophagus: congenital anomalies, esophagitis, Barrett's, carcinoma

1
Q

HSV Infection

  • What cell is infected?
  • interpret this slide
  • other H&E Findings?
  • Path Dx?
A

—epithelial cells infected

—slide on other side shows the loss of cohesion and intercellular edema in the epidermis that leads to herpetic ulcers

—Other H&E findings: surrouding area will have squamous hyperplasia; smudgy/steel gray intranuclear “Cowdry A” bodies

—Path dx = scraping of an ulcer base to look for Tzanck cells (multinucleated giant cells); epithelial cells with “3 M changes” [see pic here]:

  1. Multinucleated
  2. molding of nuclei and
  3. margination of nuclei
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2
Q

CMV Infection

  • What cell is infected?
  • H&E Findings?
A

—CMV infects endothelial and mesenchymal cells

—H&E findings: Owl’s eye nuclei and cytoplasmic inclusion [pic here]

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3
Q
  • Dx here?
  • DDx?
  • Histo appearance?
A
  • Dx = candidiasis (most often C. albicans)
  • DDx = leukoplakia
    • can scrape candida off; can’t scrape leukopl.
  • Histo budding yeast w/ pseudo-hyphae (i.e. not septate) + inflammatory infiltrate
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4
Q
  • Dx?
  • Describe organism?
  • Pathogenesis?
  • Common species that cause infection?
A

Dx = Aspergillus

  • Septate hyphae with parallel walls45° branching
  • Angioinvasive
  • Common pathogenic species A. niger A. fumigatus A. flavus
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5
Q

What are pseudohyphae?

A

“distinguished from true hyphae by their method of growth, relative frailty and lack of cytoplasmic connection between the cells” [Wiki]

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6
Q

Mucormycosis

  • Describe appearance under microscope
  • Pathogenesis?
  • Example spp?
A
  • Broad, bulbous, non-septate hyphae w/ 90° branching
  • Angioinvasion
  • Technically caused by any fungus in the order Mucorales
  • Mucor*, *Rhizopus* and *Absidia genera are most commonly implicated genera
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7
Q

Dx?

  • Expected H&E findings?
A

Pyogenic granuloma

  • -Lobular capillary hemangioma with surface ulceration -Inflammation is secondary
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8
Q

Dx?

  • Describe the lesion
A

Dx = Aphthous ulcer

  • painful, shallow ulcer w/ erythematous ring
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9
Q

Dx?

  • DDx
  • Where else can this be seen?
  • Clinical course
A

Leukoplakia - a clinically descriptive term, not a specific diagnosis

  • Candidiasis (this will not scrape off vs. candidiasis)
  • Can be seen anywhere in the oral cavity
  • CIinical course: 5-25% progress to cancer
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10
Q

Dx?

  • DDx
  • Where else can this be seen?
  • Clinical course
  • Findings on H&E
A

Hairy Leukoplakia ≠ Leukoplakia

  • Candiasis (this will not scrape off)
  • Seen usu. only on lateral tongue
  • Clinical course: caused by EBV in immunocompromised (80% HIV)
    • benign vs. leukoplakia
  • H&E: Hyperkeratosis, acanthosis, and “balloon” cells (see image here)
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11
Q

Dx?

  • Clinical course
  • Findings on H&E
A

Dx = Erythroplakia

  • more ominous/↑er risk of transformation > leukoplakia
  • H&E: atypical epithelial cells
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12
Q

Dx?

  • Where else can this be seen?
  • Clinical course
  • Findings on H&E
A

Squamous Cell Carcinoma

  • Most commonly under tongue
  • 50% caused by HPV
    • series of additive mutations e.g. p16 → p53 (loss tumor supp) → cyclin D mutation (immortalized)
  • hypercellular/malignant looking epithelia
    • show here: mod dysplasia → CIS → SCC
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13
Q

What % of tumors in each of the 3 types of salivary glands are malignant?

A
  • Parotid – 30%
  • Submandibular – 40%
  • Sublingual – 80%
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14
Q

Dx this sample from a salivary gland mass

  • Benign or malignant?
  • Cell types seen?
  • Most commonly occurs where?
A

Pleomorphic adenoma, accounts for 50% of benign salivary gland tumors

  • Benign but w/ low but definite risk of malignant transformation (“Carcinoma ex pleomorphic adenoma”)
    • 2% at 5 yrs; 10% at 15 yrs.
  • Cell types: Biphasic tumor w/ ductal (epithelial) and myoepithelial cells
  • More common in parotid than in submandib/subling glands
    • 60% of parotid tumors are mixed tumors
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15
Q

Dx this salivary gland mass

  • Benign or malignant?
  • Gross appearance?
  • Cell types seen?
  • Most commonly occurs where?
A

Warthin tumor, 5-10% of benign salivary gland tumors

  • Gross: tumors w/ motor-oil cysts
  • Two components
    1. Epithelial (oncoctyic) component – dense, eosinophilic, granular cytoplasm (mitochondria) [see photo here w/ arrow pointing to oncocytic cell
    2. Lymphoid component
  • Almost always in the parotid – 10% bilateral

Other FYI benign tumor mentioned: Oncocytoma (1%)

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16
Q

Dx this sample from a salivary gland mass

  • Benign or malignant?
  • Cell types seen?
  • Subtypes + there clinical course?
A

Mucoepidermoid carcinoma, causes 15% of malignant salivary gland tumors

  • Two components
    • Mucus-secreting cells
    • Squamous cells
  • Subtypes
    • Low Grade - mucous cells predominate, 15% recurrence; 90% 5-year survival (shown here w/ Mucicarmine stain)
    • High Grade - squamous cells predominate, greater atypia • 25% recurrence; 50% 5-year survival (shown on front w/ H&E stain)

**other malignant tumors that were mentioned as an FYI:

  • Adenoid cystic carcinoma (5%)
  • Acinic cell carcinoma (5%)
  • Malignant mixed tumors (3-5%)
17
Q

Name this esophageal deformity associated w/ dysmotility.

A

Zenker’s Diverticulum

18
Q

Name this esophageal deformity associated w/ dysmotility.

A

Achalasia

19
Q

Name this esophageal deformity associated w/ dysmotility.

A

Hiatal hernia (sliding)

20
Q

Name this esophageal deformity associated w/ dysmotility.

A

Hiatal Paraesophageal Hernia (rolling)

21
Q

Which tracheoesophageal malformation is most common? How would a baby present?

Next most common?

A

esophageal atresia w/ tracheoesophageal fistula [pic here]

  • this accounts for ~85% of Congenital Anomalies of the esophagus
  • babies have rapidly distending abdomens + choking and regurg when feeding
  • next most common (4%) is tracheoesophageal fistula (just a small lateral fistula between both full length lumens
22
Q

Esophageal Webs

  • Occur where in esophagus?
  • Which demographic most commonly?
  • What is a syndromic cause?
A
  • Upper Esophagus
  • Women over 40 yrs of age
  • Syndromic Cause = Plummer-Vinson Syndrome
    • Web
    • Iron deficiency anemia
    • Glossitis
    • Cheilosis
    • Risk for carcinoma of upper esophagus
23
Q

Esophageal Rings

  • List the two types
  • Clinical presentation?
A
  • “A” ring: in lower esophagus above the GE junction
  • “B” (Schatzki’s) ring: at the GEJ, usu above a HH
  • Clinical presentation with episodic dysphagia, only when you eat too quickly/eat something too big that get stuck on the “shelf” made by ring
24
Q

Mallory-Weiss Tear

A

A laceration at GEJ caused by forceful vomiting

25
Q

Boerhaave Syndrome

A

A catastrophic esophageal rupture from vomitting

  • “56% of oesophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraoesophageal surgery.[1] In contrast, the term Boerhaave’s syndrome is reserved for the 10% of oesophageal perforations which occur due to vomiting” [Wiki]
26
Q

Dx this specimen from pt w/ heartburn

A

Reflux esophagitis

  • Giveaway = eosinophils, seen up close here:
27
Q

What’s going on in this autopsy specimen from a deceased patient w/ alcoholism?

A

Esophageal Varices

  • Causes
    • Develop in 90% of cirrhotic patients
    • Consequence of portal HTN
  • Major cause for bleeding in these patients
28
Q

Epidemiology of esophageal cancer

  • What is most common type worldwide? Causes? Occurs in which part of esophagus?
  • Most common in U.S.? Causes? Occurs in which part of esophagus?
A

Squamous cell carcinoma (90% Esophageal Ca worldwide)

  • Alcohol, tobacco, fungus-derived carcinogens, nitrosamines
  • More common in African-Americans
  • More common in mid-esophagus

Adenocarcinoma (50% of esophageal carcinoma among non-African Americans in USA)

*Squamous Cell – More common in African-Americans

  • Incidence of adenocarcinoma is rapidly increasing
  • Vast majority of adenoCA arises in Barrett’s
  • Most arise in lower third of esophagus
29
Q

Official definition of Barrett’s Esophagus

A

• Endoscopic evidence of columnar epithelium in the distal esophagus

AND

• Intestinal metaplasia (i.e. goblet cells) on a mucosal biopsy from this segment [seen here]

30
Q

Dx this esophageal specimen?

A

adenocarcinoma

associated w/ Barrett’s metaplasia

31
Q

This slide shows low grade dysplasia in Barrett’s (metaplastic) esophagus. How would high grade dyplasia in BE look histologically?

A
  • increase cytosol to nucleus ratio
  • cytological atypia
  • architecture is dysplastic

SBM GI (29 decks)

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