10 Epithelial Pathology Flashcards
1
Q
squamous papilloma
A
- benign proliferation, may be viral
- low infectivity and virulence
- usually <1/2cm
2
Q
verruca vulgaris
A
- HPV virus, frequent in kids
- infrequent in oral cavity, usually <5mm
- cutaneous horn form = keratin accumulation
- cryotherapy, surgery, 2/3 will disappear in 2 years
3
Q
condyloma acuminatum
A
- viral, considered STD
- teens, young adults
4
Q
verruciform xanthoma
A
- whites, 40-70yrs old, females
- 50% gingiva and alveolar mucosa
- most <2cm
- hyperplastic epithelium, accumulation of lipid laden histiocytes
- papillary lesion, unknown cause
5
Q
focal epithelial hyperplasia
A
- viral proliferation of squamous cells
- multiple flat rounded papule clusters (not white)
- hallmark is considerable acanthosis
- spontaneous regression after months to years
6
Q
seborrheic keratosis
A
- skin condition of elderly, hereditary tendency
- benign proliferation of epidermal basal cells, chronic sun exposure
- dermatosis papulosa nigra in 30% of blacks
- numerous seborrheic keratosis with pruritus associated with internal malignancy (laser-trelat sign)
7
Q
ephelis (freckle)
A
- most in fair-skinned, blue eyes, red or blond hair
- less prominent with age
- sunscreen prevents new and darkening of old
8
Q
actinic lentigo
A
- age/liver spot up to 1cm
- chronic UV damage, not malignant
- 90% whites over 70
- no darkening after sun exposure
- retinoic acid reduces intensity, laser removes
9
Q
melasma
A
- mask of pregnancy
- symmetric hyperpigmentation of sun exposed face/neck
- topical treatment 3% hydroquinone and tretinoin
- minimal sun exposure prevents
10
Q
oral melanotic macule
A
- flat, brown discoloration
- not sun related except on labia
- 2:1 female, 40+ and 33% vermilion zone
11
Q
melanin pigmentation
A
- racial/physiologic
- peutz-jeghers syndrome, addison’s disease, neurofibromatosis
- chronic trauma, autoimmune disease
- smoker’s melanosis
- chloroquine, quinine derivatives, phenolphthalein, estrogen, AIDS meds
12
Q
oral melanoacanthoma
A
- benign, no treatment needed
- characteristic dendritic macrophages throughout epithelium
- exclusively blacks, mostly female
- mostly buccal mucosa, 3rd-4th decade
- grows quickly, biopsy to rule out melanoma
13
Q
acquired melanocytic nevus
A
- common mole, 1 in million risk of melanoma
- neural crest origin
- most present before 35
- whites more than asians/blacks
- intraoral and gingiva
- junctional, compound, intramucosal
14
Q
leukoplakia
A
- white lesion that doesn’t rub off
- 20% premalignant or malignant at biopsy
- 85% of all oral precancer lesions
- 3% white adults, 70% male
- tobacco, alcohol, sanguinaria, UV, microorganism, trauma
- average age 60 (same as cancer)
- high risk in floor of mouth, ventral tongue, soft palate
15
Q
precancerous leukoplakia changes
A
- proliferative verrucous leukoplakia usually leads to squamous cell carcinoma within 8 years
- enlarged, hyperchromatic nuclei
- pleomorphic nuclei
- abnormal mitotic figures
- keratin pearls
- loss of epithelial cohesiveness
- progression from thin to homogenous and thick to granular leukoplakia
16
Q
dysplasia
A
- mild, moderate, severe, carcinoma-in-situ
- must breach basement membrane to be cancer
- can’t metastasize without invasion
- hyperkeratosis, hyperparakeratosis, hyperorthokeratosis, acanthosis
17
Q
erythroplakia
A
- red lesion that does not rub off
- no known cause
- 80-90% premalignant or malignant
- epithelial cells no longer produce keratin
- usually advanced dysplasia
- in mixed lesions always biopsy the red!
18
Q
smokeless tobacco use
A
- painless loss of gingiva and tissue at site of use
- caries common
- smokeless tobacco keratosis in 15% chewing tobacco and 60% snuff users
- more common in India with use of betal nut, areca nut, slaked lime
- lesions that remain +6 weeks after cessation must be biopsied
19
Q
oral submucous fibrosis
A
- chronic, progressive, scarring, high risk precancerous related to betal quid placement
- slaked lime releases alkaloid from areca nut causing euphoria
- causes mucosal rigidity, trismus, pain when when eating spicy food
- stiffness of subepithelial tissues
- submucosal fibrous bands on buccal mucosa, soft palate, and lingual mucosa
- brown-red discoloration, high malignant transformation
- leukoplakia common
20
Q
actinic cheilitis
A
- premalignant change in lower lip from UV exposure
- 10:1 males
- scaly, peels off and reforms
- focal ulcerations with smoking
- sqaumous cell carcinoma 6-10%, preventable cancer
21
Q
squamous cell carcinoma
A
- 3% of cancers, 3:1 males
- 65+white men greatest risk, middle age greatest risk in blacks
- tobacco, alcohol, phenols, radiation, iron/vitmain A deficiency, syphilis, candidiasis, oncogene activation
- 50% tongue lesions (2/3 posterior lateral border and ventral, 20% anterior lateral border, 4% dorsal tongue)
- 35% of intraoral cancer in floor of mouth, earlier in females, mostly near midline frenum, most often associated with second primary malignancy
22
Q
SCCa and tobacco smoking
A
- 80% oral cancer patients smoke
- 2-6x great chance of 2nd cancer
- greater risk for pipes/cigars
- 50% palate cancers from reverse smoking
- nonsmokers with oral cancer: female, young, mutation of p53/suppresor genes
23
Q
SCCa and smokeless tobacco
A
- 1:1.5 male to female
- 50% of cancer at site of use
24
Q
SCCa and betal quid
A
- slaked lime enhances absorption of molecules
- lifetime risk 8%
- 200 million + users
25
Q
SCCa and alcohol
A
- significant promoter
- 15x increase when combined with smoking
- liver cirrhosis found in 20% male oral cancer patients
26
Q
SCCa and phenols
A
- increased risk in wood products industry from chemical exposure
- also increased risk of nasal and nasopharyngeal cancers
27
Q
SCCa and radiation
A
- UV radiation and lip cancer
- radiation decreases immune reactivity and causes chromosome changes
- fibrosis and difficulty in diagnosis
28
Q
SCCa and iron deficiency
A
- plummer-vinson syndrome associated with SCCa of esophagus, oropharynx, posterior mouth
- earlier malignancies with iron deficiency
- impaired cell-mediated immnunity
- fibrous bands of scar tissue forms in esophagus
29
Q
SCCa and vitamin A deficiency
A
- excessive keratinization
- vitamin A may be preventative for cancer
- betacarotene and retinoic acid associated with dysplasia regression
30
Q
SCCa and syphilis
A
- leutic glossitis
- tertiary stage associated with dorsal tongue cancer
- arsenic and heavy metals used for treatment before antibiotics may be cause
31
Q
SCCa and candidiasis
A
- associated with and probably superimposed
- produces carcinogenic nitrosamines
32
Q
SCCa and oncogenes
A
- HPV implicated in many cancers
- not enough evidence to link HSV
33
Q
oropharyngeal cancer
A
- 3/4 in tonsillar area or soft palate, rest at base of tongue
- initially pain and dysphagia
34
Q
cancer staging
A
T - size of primary tumor
N - lymph node involvement
M - distant metastisis
35
Q
oral cancer prognosis
A
lip cancers - 95% 5 yr survival
anterior 2/3 tongue cancers - 80% local, 20% metastasized
posterior 1/3 tongue cancers - 80% metastasized, 20% local
36
Q
verrucous carcinoma
A
- possible HPV 16 association
- associated with smokeless tobacco
- leukoplakia and tobacco pouch keratosis may also be present
- may arise from proliferative verrucous leukoplakia
- less aggressive than SCCa
37
Q
maxillary sinus cancer
A
- elderly, 80% of cases are advanced
- unilateral stuffiness, ulceration or mass of hard palate
- intense facial pain if trigeminal nerve invovled
- loose teeth, ‘motheaten’ appearance on radiographs
- protrusion of eyeball
38
Q
basal cell carcinoma
A
- 85% on skin of head and neck
- incidence increasing 3-7% per year, and with age
- adult, whites, fair complexion
- does not metastasize
- nevoid basal cell carcinoma syndrome
39
Q
melanoma
A
- UV, but not as important as with BCCa or SCCa
- acute damage more important than chronic exposure
- 2-8x increase with family history
- red hair, fair skin, blue eyes = increased risk
- history of painful, blistering sunburns or congenital/dysplastic nevi
- 3rd most common skin cancer, rare orally
40
Q
melanoma types
A
- superficial spreading melanoma
- nodular melanoma
- lentigo malignant melanoma
- acral lentiginous melanoma
41
Q
superficial spreading melanoma
A
- most common form
- 70% cutaneous lesions
- interscapular region in males, posterior legs in females
- appearance of surface nodules or induration after precursor macule
- satellite macules around primary lesion
42
Q
nodular melanoma
A
- 15% of cutaneous melanomas
- appears as nodular elevation (vertical growth phase) and rapidly invades connective tissue
- may lack pigment (amelanotic)
43
Q
lentigo maligna melanoma
A
- 5-10% cutaneous melanomas
- precursor lesion called lentigo maligna (hutchinson’s freckle)
- purely radial growth phase melanoma-in-situ
- sun exposed skin of elderly
44
Q
acral lentigerous melanoma
A
- most common form in blacks
- most common oral melanoma
- palms of hands, soles of feet, mucous membranes
- oral melanoma often nodular, mostly hard palate or maxillary alveolus
- 2/3 male, 6-7th decades
45
Q
ABC’s of melanoma
A
- asymmetry - because of uncontrolled growth
- border irregularity - often notching
- color veriegation - brown, black, white, red and blue
- diameter - 6+mm (pencil eraser)
46
Q
melanoma prognosis
A
- oral melanoma 20-45% 5 yr survival
- level of tumor invasion is important
- worse prognosis for lesions on back, posterior upper arm, lateral neck, and scalp
