1. Benign Epithelial Neoplasms, Melanocytic Lesions Flashcards
Etiology of Squamous Papilloma
HPV 6, 11
Histo of Squamous Papilloma
Epithelial projections, each with fibro-vascular CT cores
Differential Diagnosis of Squamous Papilloma (5)
- Verruca Vulgaris
- Condyloma Acuminatum
- Heck Ds - Focal Epithelial Hyperplasia
- Verrucous Carcinoma
- Cowden Sx
Children who bite nails or suck fingers with warts
Verruca Vulgaris
Etiology of Verruca Vulgaris
HPV 2
Histo of Verruca Vulgaris
Young lesions have kiolocytes - clusters of clear cells with shrunken raisin-like nuclei in the granular cell layer
- Kiolocytes = virally infected cells
Etiology of Condyloma acuminatum
HPV 6, 11, 16, 18
History of oral sex with a partner having venereal warts
Condyloma acuminatum
Histology of Condyloma Acuminatum
- 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
Etiology of Heck Disease (Multifocal Epithelial Hyperplasia)
- 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
- A slow growing squamous carcinoma characterized by exophytic papillary growth
- Much larger than any papilloma
Verrucous Carcinoma
Describe Cowden Syndrome - Multiple Hamartoma Sx (7)
- 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
- Benign lesion that imitates SCCA clinically and histologically, but spontaneously resolves
- Firm fleshy epithelial growth with a central keratin plug
Keratoacanthoma
How long does a cycle of a Keratoacanthoma take?
4 weeks to 1 year
Histo of Keratoacanthoma
- Arises from hair follicle epithelium
- Seen on upper and lower lips
- Pseudoepitheliomatous Hyperplasia - looks similar to SCCA
Appearance of multiple Keratoacanthomas is seen in several inherited syndromes and is associated with what?
Internal Malignancies
Describe Seborrheic Keratosis (4)
- Skin only - never oral cavity
- Soft, sessile, waxy friable growth - can be partially scraped off
- Common after age 40
- Never becomes malignant
Etiology of Seborrheic Keratosis
- Autosomal Dominant
or
- Somatic mutation due to UV light
Sign of Leser-Trelat
- A sudden shower of Seborrheic Keratosis
- Indicator of undiagnosed internal malignancy (usually stomach cancer)
Micro of Seborrheic Keratosis
Exophytic growth of basal cells showing hyperkeratosis, acanthosis, papillomatosis
- Shows increased melanin in basal layer (epidermis) with no increase in melanocytes
- Darkens with UV light
Ephelis (Freckle)
- Flat, brown, macule on lip, gingiva, or palate, no larger than 7mm
- Histo looks like a freckle but Not UV activated
- No malignant potential
Oral Melanotic Macule
- 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
Actinic Lentigo (Liver Spot)
- 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
Nevus (Mole)
Junctional Nevus
- Theques of nevus cells are confined to the junction of the epithelium and CT - intraepithelial
- Always present as a macule
Compound Nevus
- Nevus cells are present along the junctional area-epithelium and within the CT
Intradermal / Intraoral Nevus
- Nevus cells are found only within the CT
- Presents as a papule
- 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
Where do you see Racial Pigmentation?
- Attached gingiva
- Fungiform papillae of tongue
What do Cafe-au-lait Spots resemble in Neurofibromatosis?
Smooth borders like the coast of California
What do Cafe-au-lait Spots resemble in Albright Syndrome?
Margins are very irregular like the coastline of Maine
- 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
- Adrenal cortical deficiency stimulates pituitary production of ACTH (trying to stimulate the decreased cortisol production)
- ACTH stimulate melanocytes causing hyperpigmentation
Addision Disease
- 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
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
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)
Which are Autosomal Dominant?
- Cowden Sx
- Seborrheic Keratosis
- Peutz-Jeghers Sx
Which mimic Child Abuse?
- Conyloma acuminatum
- Blue Nevus
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
What is the most common location for Verruca Vulgaris?
skin of hands
When Verruca Vulgaris is found in the mouth where is it located?
Anterior Region (where you put your hands)
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
What is the location of oral lesions from Condyloma Acuminatum?
- Labial mucosa and lingual frenum
- Soft palate
What is the clinical appearance of an oral lesion of Condyloma Acuminatum?
- Soft, pink, exophytic mass with short blunted surface projections
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,
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
What is the tx for Heck Disease?
- Resolve Spontaneously
- VV, and KA
What is the clinical appearance of KA?
- Firm, fleshy epithelial growth with Central Keratin Plug (black or white center)
How do you differentiate KA from SCC?
- KA grows faster than SCC, usually gone within 6 months
