1. Oral, Esophagus

Question 1

Name oral infections and Describe Leukoplakia

Answer 1

Bacteria
Virus: HSV, HFMD
Fungi: Candidiasis

Pre-cancerous
- Leukoplakia - thickened keratotic hyperplastic squamous mucosa w white appearance (25% pre-malignant)

Question 2

Can Crohn’s Disease present as oral ulcers?

Answer 2

Yes.

Question 3

Name 2 oral neoplasms (Benign and malignant) and describe appearance + association w (HPV + Leukoplakia)

Answer 3

Benign
- Squamous Cell Papilloma - papillary appearance w fibrovascular core; associated w HPV

Malignant
SCC
- Most keratinizing - HPV negative;
- Associated w Leukoplakia dysplasia

• HPV positive better prognosis, minimal keratin, not related to risk factor of alcohol, smoking; Sex contact is important; Note HPV is an STV

Question 4

Rate the prevalence of salivary gland neoplasms and their malignancy. What are minor glands?

Answer 4

Frequency: Parotid, Submandibular, SL, Minor
Malignancy: Minor > Major Glands

Minor glands are seromucinous glands in O, OP mucosa.

Question 5

Name and Describe common benign salivary gland tumours [2]

Answer 5

Pleomorphic Adenoma (most common parotid gland/ salivary gland tumor)
- Pleomorphic - diff component, mixed of gland, epithelial, myoepithelial, chondromyxoid; whitish cut surface

Warthin Tumor (papillary)

• Parotid only
• Cystic spaces, double epithelial cell layer, abundant lymphocytes, lymphoid stroma, germinal center. Cystic spaces w papillary infoldings.

Question 6

What is achalasia?

Answer 6

Lower LES cannot be relaxed

Question 7

What can cause Esophageal Varices and what is the anastamosis?

Answer 7

Cirrhosis - Portal Hypertension

Left Gastric Vein to Esophageal Veins

• LGV was going into HPV
• Esophageal was going into Azygos

Question 8

What is Hiatus Hernia and name Cx [2]

Answer 8

When stomach herniates through the diaphragm

• Reflux Esophagitis - heartburn
• Barrett’s Esophagus - dysplasia - adenocarcinoma

Question 9

Name causes of esophagitis [2]

Answer 9

Reflux Esophagitis, caused by
- GERD
- Hiatus Hernia
Cx: BE

Infective Esophagitis

Question 10

GERD Pathophysiology

Answer 10

Acid reflux from LES relaxation;
In response, Squamous cells elicit inflammation
- can lead to BE

Question 11

Barrett’s Esophagus

• Description, cause and Presentation
• Cx

Answer 11

Distal squamous esophageal mucosa replaced w INTESTINAL columnar mucosa (hence have goblet cells) - metaplasia

• red, velvet mucosa
• now SCJunction is proximal to GEJ

Cx:
- dysplasia and Adenocarcinoma

Cause:
- chronic GERD/ reflux esophagus

Question 12

Esophagus Cancers [2]

Answer 12

SCC (majority)

Adenocarcinoma, lower third, associated w BE

Question 13

Describe Warthin’s Tumor

Answer 13

Papilloma of Parotid Gland

• Cystic spaces of double layered epithelium
• Lymphatic inflitrate, germinal centre