1. Benign Epithelial Neoplasms, Melanocytic Lesions Flashcards
1
Q
Etiology of Squamous Papilloma
A
HPV 6, 11
2
Q
Histo of Squamous Papilloma
A
Epithelial projections, each with fibro-vascular CT cores
3
Q
Differential Diagnosis of Squamous Papilloma (5)
A
- Verruca Vulgaris
- Condyloma Acuminatum
- Heck Ds - Focal Epithelial Hyperplasia
- Verrucous Carcinoma
- Cowden Sx
4
Q
Children who bite nails or suck fingers with warts
A
Verruca Vulgaris
5
Q
Etiology of Verruca Vulgaris
A
HPV 2
6
Q
Histo of Verruca Vulgaris
A
Young lesions have kiolocytes - clusters of clear cells with shrunken raisin-like nuclei in the granular cell layer
- Kiolocytes = virally infected cells
7
Q
Etiology of Condyloma acuminatum
A
HPV 6, 11, 16, 18
8
Q
History of oral sex with a partner having venereal warts
A
Condyloma acuminatum
9
Q
Histology of Condyloma Acuminatum
A
- Large papilloma with koilocytes and keratin filled crypts between projections
-
Acanthotic epithelium forming blunted projections with thin CT cores
- papillary projectes are more blunted and broader than SP and VV
10
Q
Etiology of Heck Disease (Multifocal Epithelial Hyperplasia)
A
- HPV 13, 32
- Producing multiple acanthotic papules
- Inside of lips, cheeks, and sides of tongue
- Mostly in Native American Children
- Also in immunosuppressed HIV pts
- Tends to resolve
11
Q
- A slow growing squamous carcinoma characterized by exophytic papillary growth
- Much larger than any papilloma
A
Verrucous Carcinoma
12
Q
Describe Cowden Syndrome - Multiple Hamartoma Sx (7)
A
- Multiple papules on gingiva, tongue, buccal mucosa
- Multiple small hair follicle tumors
- Macrocephaly
- Intestinal polyps, don’t become malignant
- Keratosis of palms and soles
- Early development of malignant tumors of breast and thyroid
- Autosomal Dominant
13
Q
- Benign lesion that imitates SCCA clinically and histologically, but spontaneously resolves
- Firm fleshy epithelial growth with a central keratin plug
A
Keratoacanthoma
14
Q
How long does a cycle of a Keratoacanthoma take?
A
4 weeks to 1 year
15
Q
Histo of Keratoacanthoma
A
- Arises from hair follicle epithelium
- Seen on upper and lower lips
- Pseudoepitheliomatous Hyperplasia - looks similar to SCCA
16
Q
Appearance of multiple Keratoacanthomas is seen in several inherited syndromes and is associated with what?
A
Internal Malignancies
17
Q
Describe Seborrheic Keratosis (4)
A
- Skin only - never oral cavity
- Soft, sessile, waxy friable growth - can be partially scraped off
- Common after age 40
- Never becomes malignant
18
Q
Etiology of Seborrheic Keratosis
A
- Autosomal Dominant
or
- Somatic mutation due to UV light
19
Q
Sign of Leser-Trelat
A
- A sudden shower of Seborrheic Keratosis
- Indicator of undiagnosed internal malignancy (usually stomach cancer)
20
Q
Micro of Seborrheic Keratosis
A
Exophytic growth of basal cells showing hyperkeratosis, acanthosis, papillomatosis
21
Q
- Shows increased melanin in basal layer (epidermis) with no increase in melanocytes
- Darkens with UV light
A
Ephelis (Freckle)
22
Q
- Flat, brown, macule on lip, gingiva, or palate, no larger than 7mm
- Histo looks like a freckle but Not UV activated
- No malignant potential
A
Oral Melanotic Macule
23
Q
- Benign, brown macule that is considered a hallmark of photodamaged skin
- No change in color intensity is seen after UV light
- No malignant transformation
- Linear increase in melanocytes
A
Actinic Lentigo (Liver Spot)
24
Q
- Benign localized proliferation of melanocytes
- Symmetrical brown or flesh colored (differentiate from melanomas)
- Intraoral lesions are uncommon but the sites the can be seen are - palate, buccal mucosa, gingiva, lips
- Diameter of < 6mm
- Most regress slowly with age
A
Nevus (Mole)
25
Junctional Nevus
* Theques of nevus cells are confined to the junction of the epithelium and CT - **intraepithelial**
* Always present as a **macule**
26
Compound Nevus
* Nevus cells are present along the junctional area-**epithelium** and within the **CT**
27
Intradermal / Intraoral Nevus
* Nevus cells are found only within the **CT**
* Presents as a **papule**
28
* Uncommon, benign proliferation of melanin producing **spindle cells** within the **dermis**
* Common on skin of Black and Asain children - **Mongolian Spot**
* Located on butt or lower back
* Mimics bruise of **child abuse**
* Oral lesions almost always found on the **hard palate**
* small, symmetrical blue macule or papule
Blue Nevus
29
Where do you see Racial Pigmentation?
* Attached gingiva
* Fungiform papillae of tongue
30
What do Cafe-au-lait Spots resemble in **Neurofibromatosis**?
**Smooth borders** like the coast of **California**
31
What do Cafe-au-lait Spots resemble in **Albright Syndrome**?
Margins are very **irregular** like the coastline of **Maine**
32
* Freckle like lesions of the hands, perioral skin, and oral mucosa
* **Intestinal polyps** and intussusceptions
* Predispostion for developing **cancer of breast, thyroid, and pancreas**
* **Autosomal Dominant**, but 1/3 are from **new mutations**
Peutz-Jehgers Syndrome
33
* Adrenal cortical deficiency stimulates pituitary production of ACTH (trying to stimulate the decreased cortisol production)
* ACTH stimulate melanocytes causing hyperpigmentation
Addision Disease
34
* Mimics Racial Pigmentation
* Appears mostly in women particularly those on BC
* Body's attempt to protect mucosa against chemicals from smoke by producing extra melanin
* Develops after 1 year of heavy smoking, and resolves 3 years after quiting
Smoker's Melanosis
35
Other causes of Diffuse/Multiple Melanocytic Macules
* Drugs
* Nutritional and GI Disturbances
* Respiratory Disturbances/ Nasal Polyps
* Post-Inflammatory Pigmentation
* any surface lesion can heal with more, less or the same amount of pigmentation
36
Non-Melanotic causes of Pigmented Lesions (Differental Diagnosis)
* Blood Filled Lesions
* Exogenous Pigments (Amalgam Tattoo)
* Heavy Metal Poisoning
* Symmetrical distribution in the free gingiva (racial pig is in the attached gingiva)
37
Which are Autosomal Dominant?
* Cowden Sx
* Seborrheic Keratosis
* Peutz-Jeghers Sx
38
Which mimic Child Abuse?
* Conyloma acuminatum
* Blue Nevus
39
Which are associated with an increased risk for cancer?
* **Condyloma acuminatum**
* Cervical
* **Cowden Sx**
* Breast, Thyroid
* **Keratoacanthoma (~Seb K)**
* Internal malignancies
* **Peutz-Jeghers Sx**
* Breast, Thyroid, Pancreas
40
What is the most common location for Verruca Vulgaris?
skin of hands
41
When Verruca Vulgaris is found in the mouth where is it located?
Anterior Region (where you put your hands)
42
What is the Tx for Verruca Vulgaris
* Same as SP - surgical excision and biopsy
* Without tx 2/3 will disappear spontaneously within 2 years
* Does not transform into malignancy
43
What is the location of oral lesions from Condyloma Acuminatum?
* Labial mucosa and lingual frenum
* Soft palate
44
What is the clinical appearance of an oral lesion of Condyloma Acuminatum?
* **Soft**, **pink**, exophytic mass with **short blunted surface projections**
45
What is the histology of Blue Nevus?
* Collection of **elongated, slender melanocytes** with **dendritic extensions** and numerous **melanin granules**
* Cells align **parallel** to the surface epithelium,
46
What is the histological hallmark of Heck Disease?
* **Abrupt acanthosis** of surface epithelium (thickened papules)
* **Rete ridges** are **widened**, often confluent and sometimes **club shaped**
47
What is the tx for Heck Disease?
* Resolve Spontaneously
* VV, and KA
48
What is the clinical appearance of KA?
* **Firm**, fleshy epithelial growth with **Central Keratin Plug** (black or white center) ****
49
How do you differentiate KA from SCC?
* KA grows faster than SCC, usually gone within 6 months
