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06. Gastrointestinal Pathology > 1. Oral cavity > Flashcards

1. Oral cavity Flashcards

1
Q

Diseases of the oral cavity

A
  1. Inflammatory conditions
    - Viral infection
    - Bacterial infection
    - Fungal infection
  2. Mouth ulcers
  3. Mucosal changes in oral cavity
    - Leukoplakia
    - Erythroplakia
  4. Neoplasms
    - Squamous cell papilloma
    - Squamous cell carcinoma
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2
Q

Viral infections of the oral cavity

A
  1. Herpes simplex 1 (HSV-1)
    - Causes acute herpetic gingivostomatitis, cold sores, recurrent herpetic stomatitis, herpes labialis etc
    - With changing sexual habits, more & more HSV-2 infections of the oral cavity are being seen
  2. Hand-foot-mouth disease (EV71, CA16, CA24)
  3. Others: VSV, EBV, CMV, measles virus
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3
Q

Fungal infections of the oral cavity

A
  1. Candida albicans (Moniliasis)
    - Normal oral flora in 50% of people
    - Causes oral candidiasis (oral thrush) mainly in immunocompromised
    - Oral candidiasis appears as a superficial, curdy grey to white inflammatory membrane composed of matted organisms enmeshed in a fibrinosuppurative exudate that can be scraped off to reveal underlying erythematous inflammatory base
  2. As one of the manifestations of deep fungal infections:
    - Histoplasmosis, blastomycosis, coccidioidomycosis,
    cryptococcosis, zygomycosis, aspergillosis
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4
Q

Causes of mouth ulcers

A
  1. Trauma
  2. Recurrent aphthous ulcers (stress ulcers)
  3. Blood dyscrasias
    - Deficiencies in iron, folic acid or vitamin B12
  4. Gastrointestinal disorders
    - Manifestation of inflammatory bowel disease
  5. Mucocutaneous diseases
    - Lichen planus (a chronic inflammatory dermatosis with occasional oral cavity manifestations as reticulate lace-like white keratotic lesions)
    - Pemphigus vulgaris
    - Erythema multiforme
    - Systemic lupus erythematosus
  6. Cytotoxic chemotherapy
  7. Tumours
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5
Q

Clinical definition of leukoplakia

A

A thickened keratotic hyperplastic mucosa
with dull whitish appearance that cannot be scraped off,
reversed by removal of irritants, or ascribed to another disease

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6
Q

Association & pathogenesis of leukoplakia

A
  1. Prevalence: 0.6-10%
  2. Associated with tobacco, smokeless tobacco, betel
    nut chewing & alcohol
  3. Formed as a response to injury
  4. 0.2-1% of leukoplakia harbor dysplasia, with a 3-17%
    risk of malignancy (especially in betel nut chewing)
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7
Q

Sites of leukoplakia

A
  1. [Usual] Buccal mucosa, alveolar ridge, dorsal tongue
  2. [Thin mucosal sites – high index of suspicion of underlying malignancy] ventral tongue, tonsil, retromolar trigone, hypopharynx
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8
Q

Differential diagnosis of leukoplakia

A
  1. Oral candidiasis
  2. Lichen planus
  3. Epidermal proliferations (85-90%)
    - Squamous hyperplasia (80%)
    - Dysplasia – carcinoma-in-situ (16.5%)
    - Invasive squamous cell carcinoma (3%)
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9
Q

Morphology of leukoplakia

A

Homogenous leukoplakia

  • Thin, flat, smooth & white lesions
  • Low rates of dysplasia, 90% are benign
  • Other forms of leukoplakia may appear thickened, wrinkled patches
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10
Q

Erythroplakia

A
  1. Red, velvety, possibly eroded area within oral cavity that usually remains level with surrounding mucosa
  2. Possesses a higher risk of malignancy than leukoplakia
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11
Q

Associations of squamous cell papilloma

A
  1. Most common benign epithelial neoplasm

2. Human papilloma virus detected in some cases

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12
Q

Common sites of squamous cell papilloma

A

Uvula, palate, tongue, gingiva, lower lips, buccal mucosa

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13
Q

Gross appearance of squamous cell papilloma

A
  1. Exophytic, cauliflower-like lesion

2. May be solitary or multiple

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14
Q

Histological appearance of squamous cell papilloma

A
  1. Papillary architecture lined by mature proliferated squamous epithelium
  2. Projections possess a fibrovascular core
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15
Q

How is squamous cell papilloma treated

A

Local excision

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16
Q

Associations of squamous cell carcinoma

A
  1. Oral cavity malignancies are uncommon (2-4% of all cancers), of which 95% are squamous cell carcinomas
  2. Male preponderance
  3. 50-70 years old
  4. Risk factors: tobacco, betel nut, chronic irritation, HPV, actinic damage by sunlight (more so for lips)
17
Q

Pathogenesis of squamous cell carcinoma

A
  1. Associated with leukoplakia
  2. Follows a hyperplasia → dysplasia → carcinoma-in-
    situ → invasive carcinoma sequence
18
Q

Common sites of squamous cell carcinoma

A

Lower lips > tongue (anterior 2/3, lateral border) > floor of mouth > cheek > palate

19
Q

Histological appearance of squamous cell carcinoma

A

Mostly well-differentiated & keratinizing

20
Q

Spread of squamous cell carcinoma

A

Local infiltration (lymphovascular & perineural space involvement) with metastases to cervical lymph nodes

06. Gastrointestinal Pathology (5 decks)

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