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OP - Yield > 10: Epithelial Pathology > Flashcards

10: Epithelial Pathology Flashcards

1
Q

papilloma HPV types

A

6, 11

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2
Q

RRP what is

A

Recurrent respiratory papillomatosis

6, 11

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3
Q

sinonasal papilloma HPV types

A

6, 11

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4
Q

focal epithelial hyperplasia aka

A

Heck disease, HPV 13, 32

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5
Q

heck disease what is

A

focal epithelial hyperplasia, HPV 13, 32

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6
Q

oropharyngeal SCC HPV type

A

16

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7
Q

conjunctival papilloma HPV type

A

6, 11, 16

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8
Q

verruca vulgaris aka

A

common wart, HPV 2

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9
Q

verruca plana HPV type

A

3, 10

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10
Q

palmoplantar wart HPV type

A

1, 4

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11
Q

butchers wart HPV type

A

2, 7

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12
Q

condyloma acuminatum aka

A

venereal wart, types 6, 11

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13
Q

veneral wart aka

A

condyloma acuminatum types 6, 11

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14
Q

cervical SCC HPV types

A

16, 18

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15
Q

papillomatosis HPV and association

A 
HPV 6 and 11
nevus unius lateris
acanthosis nigricans
focal dermal hypoplasia (Goltz Gorlin)
Down syndrome
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16
Q

RRP what is

A

reucrrent repiratory papillomatosis
larynx –> hoarsenss
juvenile onset 2/2 maternal genital warts
adult onset

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17
Q

sinonasal papilloma how common, location, variants

A

10-25% of all sinonasal tumors
1/2 in lateral nasal wall
remainder in maxillary and ethmoid

inverted papilloma most common variant, greatest potential for malignancy

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18
Q

inverted papilloma

A

most common variant of sinonasal papilloma

greatest potential for malignancy

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19
Q

greatest potential for malignancy in sinonasal papillomas

A

inverted papilloma

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20
Q

cutaneous horns in which entities

A 
SCC
BCC
verruca vulgaris
Seb K 
actinic keratosis
trichoep
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21
Q

molluscum contagiosum cause, location, histo, prognosis

A

pox virus
skin of necj, face (particularly eyelid), trunk, genitals
Henderson-Paterson bodies – Molluscum bodies
most cases spontanesous remission

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22
Q

henderson paterson bodies

A

molluscum bodies

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23
Q

patterson kelly aka

A

= Plummer Vinson Syndrome
 Iron def
 Esophageal webbing = fibrous scar
 Malignant transformation

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24
Q

plummer vinson syndrome aka

A

paterson kelly
 Iron def
 Esophageal webbing = fibrous scar
 Malignant transformation

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25
Q

 Iron def
 Esophageal webbing = fibrous scar
 Malignant transformation

A

plummer vinson

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26
Q

verruciform xanthoma histo and IHC

A

xanthoma cells: PAS+, diastase resistant granules

CD68+ (KP1), cathepsin

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27
Q

seborrheic keratosis aka

A

senile wart, basal cell proliferation

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28
Q

Dermatosis papulosa nigra:

A

Variant of seb k found in blacks above zygoma and eyelids.

Seb k are adenoid and acantholytic type

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29
Q

Variant of seb k found in blacks above zygoma and eyelids

A

Dermatosis papulosa nigra:

Seb k are adenoid and acantholytic type

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30
Q

Leser-Trelat sign:

A

Sudden appearance of multiple Seb k indicates malignancy

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31
Q

Sudden appearance of multiple Seb k

A

Leser-Trelat sign: indicates malignancy

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32
Q

Inverted follicular keratosis of Helwig

A

= Irritated seb K

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33
Q

= Irritated seb K

A

Inverted follicular keratosis of Helwig

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34
Q

types of seb k

A

1- Acanthotic (solid)
2- Hyperkeratotic (papillomatosis)
3- Reticulated ( adenoid)
4- Clonal : intraepidermal nests of basaloid cells resembling Borst-Jadassohn
phenomenon
5- Irritated: heavy inflammatory cell infiltrate and lichenoid features

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35
Q

: intraepidermal nests of basaloid cells resembling Borst-Jadassohn
phenomenon seb k

A

clonal

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36
Q

heavy inflammatory cell infiltrate and lichenoid features seb k

A

irritated

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37
Q

mutations in seb k and where else?

A

= FGFR3 + PIK3CA

also in actinic lentigo

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38
Q

actinic lentigo mutations and where else?

A

= FGFR3 + PIK3CA

also in seb k

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39
Q

bowenoid actinic keratosis histo

A

Full epithelial thickness of dysplasia

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40
Q

Oral submucous fibrosis presentation

A

 Trismus

 Stomatopyrosis: intolerance to spicy food

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41
Q

trismus and intolerance to spicy food

A

Oral submucous fibrosis

 Stomatopyrosis: intolerance to spicy food

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42
Q

ephelis aka and genetics

A

(freckle): MC1R gene

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43
Q

MC1R mutation

A

Ephelis (freckle):

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44
Q

FGFR3 + PIK3CA

A

Seb K and actinic lentigo

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45
Q

ephelis clinical

A

 Increase in melanin deposition

 Color changes with sun exposure

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46
Q

ephelis vs melanocytic nevus

A

ephelis no elevation above skin

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47
Q

ephelis vs lentigo simplex

A

ephelis not as dark

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48
Q

ephelis vs lentigo simplex

A

ephelis no elongation of rete ridges

lentigo pigmented hockey sticks/dirty socks

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49
Q

actinic lentigo aka

A

Lentigo solaris ; Age spot; liver spot; senile lentigo

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50
Q

liver spot aka

A

Actinic Lentigo; Lentigo solaris ; Age spot; liver spot; senile lentigo

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51
Q

actinic lentigo where, who (age sex), related entities, histo

A

 Occurs on skin not mouth
 White older men >70 yrs
 Freckles are more prone to develop Actinic Lentigo
 Maybe a precursor to Seb K
 No change in color intensity with UV light exposure
 Elongation of rete ridges

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52
Q

lentigo simplex vs melanocytic nevus

A

single lesion - identical

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53
Q

lentigo simplex what, where, who and how

A 
 Melanocytic hyperplasia
 Skin not exposed to sunlight
 Does not darken with the sun
 Increase in both melanin production and number
 Elongation of rete ridges
 Children
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54
Q

multiple lentigo simplex

A

1-LEOPARD
2-Peutz Jeghers syndrome
3-Lentiginosis profusa

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55
Q

melasma aka and what is

A

Mask of pregnancy; Chloasma
Acquired, symmetrical hyperpigmentation on sun exposed skin of face and neck
Unknown cause
Proliferation of # and production

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56
Q

melanotic macule aka, what, where

A

focal melanosis
Increase in deposition of melanin, perhaps melanocytes
Not affected by the sun
Most common site is the lower lip > BM >gingiva > palate

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57
Q

lesions on skin unexposed to sun

A

lentigo simplex, melanotic macule

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58
Q

melanoacanthoma what is, who, where

A

Benign, acquired pigmentation of dendritic cells

F> M / Most common site BM but can occur anywhere

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59
Q

congenital nevus where, size(s)

A 
Most common trunk and extremities
 15% in H&N
 Small= <1.5 cm
 Medium = 1.5-20 cm
 Large = > 20 cm
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60
Q

developmental nevi

A 
NBCC
Nevus Flammeus
Epidermal nevus
WSN
Nevus sebaceous
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61
Q

congenital nevus genetics

A

NRAS

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62
Q

sutton disease

A

Major aphthous ulcer

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63
Q

halo nevus aka, where, what, why, prognosis

A

Leukoedema Acuisitum Centrifugum ; Sutton Nevus

 Skin of trunk
 Hypopigmentation due to a destruction of the melanocytes by the immune system
 Develops from a recent excision of a melanoma
 Most regress and require no treatment

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64
Q

Hypopigmentation due to a destruction of the melanocytes by the immune system

A

halo nevus

from a recent excision of a melanoma

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65
Q

spitz nevus aka, where, who

A

Benign juvenile melanoma; spindle and epitheliod nevus

 Extremities or face
 Childhood

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66
Q

spitz nevus genetics and histo

A

 HRAS mutation

 Kamino bodies

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67
Q

melanoma aka and genetics

A

acquired nevus, BRAF

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68
Q

congenital nevus genetics

A

NRAS

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69
Q

blue nevus genetics

A

GNAQ

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70
Q

spitz nevus genetics

A

HRAS

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71
Q

BRAF

A

melanoma

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72
Q

NRAS

A

congenital nevus

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73
Q

GNAQ

A

blue nevus

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74
Q

HRAS

A

spitz nevus

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75
Q

blue nevus aka and types

A

Dermal Melanocytoma: Jadasshon-Tieche nevus
1 - common blue nevus
2 - cellular blue nevus

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76
Q

common blue nevus where

A

 2nd most common nevus
 Predilection to dorsa of hand and feet, scalp, face
 Mucosal lesions on palate

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77
Q

cellular blue nevus where

A

 More than 50% arise in sacrococcygeal or buttock region

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78
Q

tyndal effect

A 
long wavelength (red & yellow) tend to be absorbed more by tissue
Short wavelength (blue) tend to be reflected
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79
Q

long wavelength (red & yellow) tend to be absorbed more by tissue

A 
Short wavelength (blue) tend to be reflected
tyndal effect
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80
Q

Keratoacanthoma aka and from where

A

self-healing carcinoma ; Pseudocacinoma ; SCC-KA type

Infundibulum of hair

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81
Q

types of keratoacanthoma

A 
 Abortive KA = Involutes 4-6 wks
 Subungual KA = nail bed
 Mucosal KA = mucosa
 Giant KA = >2-3 cm
 Keratoacanthoma centrifugum marginatum = peripheral growth, central scarring
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82
Q

syndromes with multiple keratoacanthomas

A

 Muir-Torre syndrome: Seb neoplasm + GI malignancy + KA

 Xeroderma pigmentosa: AK + SCC + BCC

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83
Q

Muir-Torre syndrome

A

Seb neoplasm + GI malignancy + KA

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84
Q

Xeroderma pigmentosa

A

AK + SCC + BCC

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85
Q

Seb neoplasm + GI malignancy + KA

A

Muir-Torre syndrome

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86
Q

AK + SCC + BCC

A

Xeroderma pigmentosa

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87
Q

syndromes with early onset of keratoacanthoma

A

 Ferguson-Smith syndrome : nodular lesions / Scottish descents
 Witten-Zak syndrome : variable lesion size

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88
Q

scottish descent with multiple nodular keratoacanthomas

A

Ferguson-Smith syndrome

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89
Q

late onset of keratoacanthoma syndrome

A

Gryzbowski syndrome : hundreds of papules +GI malignancy

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90
Q

Gryzbowski syndrome

A

hundreds of papules keratoacanhtoma +GI malignancy

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91
Q

hundreds of papules keratoacanhtoma +GI malignancy

A

Gryzbowski syndrome

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92
Q

verrucous carcinoma aka

A

; Snuff Dipper’s pouch ; Ackerman’s Tumor

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93
Q

Oral florid papillomatosis

A

previous name for verrucous carcinoma

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94
Q

NUT midline carcinoma mutation

A

Fairly new entity / gene mutation chromosome # 15q14

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95
Q

gene mutation chromosome # 15q14

A

NUT midline carcinoma

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96
Q

Nasopharyngeal Carcinoma (NPC) : location, who, presentation

A

 Most common site is lateral wall of nasopharynx (fossa of Rosenmὕller)
 Asian M
 1
st sign in most cases is an enlarged LN

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97
Q

most common skin cancer

A

BCC

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98
Q

most common overall cancer

A

BCC

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99
Q

BCC aka and genetics

A 
rodent ulcer
1- Hedgehog signaling pathway (PTCH = 9q22)
2- SMO
3- TP53
4- BER-EB4 = positive BCC
negative in peripheral ameloblastoma
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100
Q

BCC vs ameloblastoma

A

BER-EB4 = positive BCC

negative in peripheral ameloblastoma

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101
Q

merkel cell tumor cause, origin, IHC, symptoms, who gets it

A 
Polyomavirus
Merkel cells are mechanoreceptors
CD20 perinuclear dot
AEIOU
o Asymptomatic
o Expanding rapidly
o Immunosuppression
o Old age
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102
Q

CD20 perinuclear dot

A

merkel cell tumor

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103
Q

polyomavirus tumor

A

merkel cell

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104
Q

most common type of BCC

A

Solid/Nodular (noduloulcerative) 70% cases

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105
Q

sclerosing BCC what is

A

(Morpheaform): insidious lesion mimics scar tissue / Invasion has occurred

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106
Q

metatypical BCC

A

mixed features with basaloid and squamous

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107
Q

mixed features with basaloid and squamous

A

metatypical BCC

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108
Q

morpheaform BCC

A

insidious lesion mimics scar tissue / Invasion has occurred

aka sclerosing

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109
Q

BCC on skin of trunk with threadlike margins

A

superficial BCC

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110
Q

most common melanoma

A

superficial

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111
Q

melanoma with greatest vertical grwowth

A

nodular

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112
Q

lentigo maligna where, who, aka

A 
(Hutchinson freckle)
o Radial growth 15 yrs
o Sun exposed areas
o Melanoma in situ
o Elderly
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113
Q

hutchinson freckle aka

A 
entigo maligna
o Radial growth 15 yrs
o Sun exposed areas
o Melanoma in situ
o Elderly
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114
Q

most common oral melanoma

A

Acral lentiginous melanoma (mucosal lentigenous melanoma)

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115
Q

most common melanoma in black people

A

Acral lentiginous melanoma (mucosal lentigenous melanoma)

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116
Q

Acral lentiginous melanoma (mucosal lentigenous melanoma) location in mouth

A

80% in palate and maxillary alveolus

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117
Q

Acral lentiginous melanoma (mucosal lentigenous melanoma) location generally

A

Feet, subungual area, mucous membrane

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118
Q

sign of melanoma on hands

A

nail pigmentation

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119
Q

NUT midline Carcinoma genetics

A

15q19 BRD4-NUT

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120
Q

15q19

A

NUT midline Carcinoma BRD4-NUT

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121
Q

BRD4-NUT

A

15q19 NUT midline Carcinoma

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122
Q

9q22

A

PTCH BCC

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123
Q

PTCH Ca

A

9q22 BCC

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124
Q

BRAF-MAPK pathway

A

melanoma

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125
Q

melanoma genetics

A

BRAF-MAPK pathway

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126
Q

Seb K & Actinic lentigo genetics

A

FGFR3 and PIK3CA

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127
Q

FGFR3 and PIK3CA

A

Seb K & Actinic lentigo

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128
Q

papilloma HPV

A

6 and 11

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129
Q

papillomatosis how presents

A

extensive coalescing papillary lesions

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130
Q

extensive coalescing papillary lesions

A

papillomatosis

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131
Q

oral papillomatosis associations

A

acanthosis nigricans, Goltz-Gorlin, nevus unius lateris

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132
Q

types of laryngeal papillomatosis

A

juvenile onset (aggressive) and adult onset

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133
Q

verruca vulgaris hpv

A

2, 4, 6, 40

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134
Q

cutaneous horn present in which entities

A

verruca vulgaris, seb ker, actinic keratosis, SCC

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135
Q

condyloma acuminatum hpv

A

2, 6, 11, 53, 54

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136
Q

multifocal epithelial hyperplasia aka and why

A

heck disease, HPV 13 and 32

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137
Q

HPV 13

A

heck

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138
Q

HPV 32

A

Heck

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139
Q

sinonasal papillomas kinds and causes

A

fungiform (6 and 11), inverted (low HPV), cylindrical (low HPV)

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140
Q

highest malignancy among sinonasal papillomas

A

inverted, up to 25%

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141
Q

inverted papilloma IHC

A

CD44+

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142
Q

risk factors for prolonged molluscum contagiosum

A

HIV, atopic dermatitis, Dariers disease

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143
Q

molluscum bodies aka and what is

A

henderson paterson, bloated keratinocytes with viral inclusions

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144
Q

henderson paterson aka and what is

A

molluscum bodies

bloated keratinocytes with viral inclusions

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145
Q

bloated keratinocytes with viral inclusions

A

molluscum bodies, henderson paterson

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146
Q

verruciform xanthoma seen in association with what

A

lichen planus, lupus, pemphigus, warty dyskeratoma, GVHD, dysplasia, SCC

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147
Q

VX histo and IHC

A

granules are PAS+ diastase resistant, CD68+ and cathepsin B+

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148
Q

AD seb ker - who, where, histo type

A

dermatosis papulosa nigra, black people, zygoma and periorbital; adenoid and acantholytic

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149
Q

seb ker genetics

A

FGFR3 and PIK3CA

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150
Q

types of seb ker

A

acanthotic, hyperkeratotic, adenoid

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151
Q

inverted follicular keratosis of helwig what is and special histo

A

seb ker altered by trauma

whorled epithelium due to metaplasia of lesional cells – squamous eddies

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152
Q

squamous eddies what is

A

whorled epithelium due to metaplasia of lesional cells

inverted follicular keratosis of helwig (irritated seb ker)

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153
Q

irritated seb ker

A

inverted follicular keratosis of helwig

whorled epithelium due to metaplasia of lesional cells – squamous eddies

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154
Q

sudden onset of multiple itchy seb kers

A

leser-trelat

internal malignancy

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155
Q

leser trelat sign

A

sudden onset of multiple itchy seb kers

indicates internal malignancy

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156
Q

sebaceous hyperplasia association

A

cyclosporine, corticoids, hemodyalisis, Muir-Torre syndrome

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157
Q

muir torre syndrome what is

A

visceral malignancies, sebaceous adenomas/carcinomas, keratoacanthomas

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158
Q

ephelis what is and genetics

A

MC1R mutation, freckle

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159
Q

MC1R mutation

A

ephelis (freckle)

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160
Q

melasma settings

A

pregnancy, oral contraceptives, hormonal replacement therapy

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161
Q

very large congenital nevus

A

bathing trunk nevus aka garment nevus

162
Q

bathing trunk nevus aka and what is

A

garment nevus

very large congenital nevus

163
Q

risks of congenital nevus

A

increased risk of developing neurocutaneous melanosis (melanotic neoplasms of CNS)
3-15% transformation into melanoma

164
Q

congenital nevus –> melanoma risk

A

3-15% transform

165
Q

most common soft tissue mass of the soft palate

A

squamous papilloma

166
Q

goltz gorlin aka

A

focal dermal hypoplasia – assoc with papillomatosis

167
Q

when is juvenile onset laryngeal papillomatosis aggresive?

A

with HPV 11

168
Q

juvenile onset laryngeal papillomatosis presentation and cause

A

can obstruct airway, related to maternal history of genital warts, hoarseness

169
Q

risks with laryngeal papillomatosis

A

in smokers and history of radiation can progress into SCC

170
Q

prominent granular cell layer, elongated rete ridges converge to center of lesion (cupping effect)

A

verruca vulgaris

171
Q

blunter broader epithalial projections

A

condyloma acuminatum

172
Q

when does anogenital condyloma acuminatum progress into SCC

A

with high risk HPV 16, 18, 31

173
Q

HPV in condyloma acumiatum

A

2, 6, 11, 53, 54

174
Q

heck’s disease HLA

A

DR4

175
Q

HLA DR4 epithelial condition association

A

heck disease

176
Q

mitosoid cell what is and in what

A

cell with altered nucleus that looks like a mitotic figure; in heck

177
Q

where are rete ridges in heck

A

epithelial is acanthotic upward; rete ridges at level of normal epithelium

178
Q

schneiderian papillomas are what

A

sinonasal papillomas

179
Q

aka for fungiform sinonasal papilloma

A

exophytic, everted, septal

180
Q

fungiform sinonasal papilloma where, what, malignant potential

A

HPV 6, 11
nasal septum
no malignant potential

181
Q

inverted sinonasal papilloma where, what, malignant potential

A

most common
HPV 6, 11, 16, 18
lateral nasal wall and sinuses (usually maxillary)
MONOCLONAL! Cd44 + (vs papillary SCC)
most aggressive and up to 25% SCC transformation

182
Q

most common sinonasal papilloma

A

inverted

183
Q

most aggressive sinonasal papilloma

A

inverted
actually monoclonal
25% –> SCC

184
Q

papilloma on nasal septum

A

prolly fungiform

185
Q

papilloma on lateral nasal wall

A

inverted or cylindrical (oncocytic)

186
Q

papillary SCC vs inverted sinonasal papilloma

A

papilloma is CD44+

187
Q

least common sinonasal papilloma

A

cylindrical or oncocyti

188
Q

HPV in cylindrical sinonasal papilloma and aka

A

aka oncocytic

no HPV

189
Q

hybrid or mixed sinonasal papilloma

A

inverted + cylindrical

190
Q

cylindrical sinonasal papilloma aka, where, what, malignant potential

A

aka oncocytic
no HPV assoc
lower aggression/malignant potentil
lateral nasal wall and sinuses (usually maxillary)

191
Q

are sinonasal polyps neoplastic?

A

no; non-neoplastic proliferations composed of epithelial and stromal elements

192
Q

multiple inflammatory sinonasal polyps in children concern for

A

cystic fibrosis

193
Q

multiple inflammatory sinonasal polyps in adults why

A

inflammatory: history of rhinitis, allergy, aspirin intolerance, diabetes

194
Q

inflammatory sinonasal polyps how many and where

A

multiple, bilateral

195
Q

antrochoanal sinonasal polyp where, how many

A

arise in antrum, extend to nasal cavity, 90% single

196
Q

antrochoanal sinonasal polyp vs inflammatory

A

antrochoanal pedunculated, less inflamed

inflammatory - sessile, highly inflamed myxoid/gelatinous stroma, can have charcot-leyden crystals

197
Q

charcot leyden crystals

A

asthma – in inflammatory sinonasal polyps

198
Q

single sinonasal polyp likely what kind

A

antrochoanal

199
Q

molluscum what kind

A

pox, DNA

200
Q

when does molluscum resolve

A

6-9 months

201
Q

how common is dermatosis papulosa nigra

A

30% of black ppl

202
Q

secretory nature of sebaceous glans

A

holocrine

203
Q

sebaceous hyperplasia associations

A

cyclosporing, corticoids, hemodyalisis, Muir_torre syndrome

204
Q

sebaceous hyperplasia vs BCC

A

sebaceous expresses sebum on ceompression

205
Q

rhinopyma what i, who, histo

A

hypertrophy of sebaceous glands of nasal dome
pts with long standing acne rosacea
enlarged bumpy nasal dome
facial flushing with drinking hot liquids, alcohol, spicy foods,
histo: hyperplasia of sebaceous glands

206
Q

hypertrophy of sebaceous glands of nasal dome

A

rhinopyma

pts with long standing acne rosacea

207
Q

long standing acne rosacea presentation

A

rhinopyma

hypertrophy of sebaceous glands of nasal dome

208
Q

age spots on sun exposed skin of older people

A

actinic lentigo

209
Q

actinic lentigo age and where

A

older people, UV damage, sun exposed skin

more common in people with freckles on face

210
Q

multiple simple lentigines what to consider

A

lentiginosis profusa, Peutz Jeghers, and LEOPARD

211
Q

LEOPARD components

A

lentigines (multiple), ECG abnormalities, Ocular hypertelorism, Pulmoary stenosis, Abnormal genitalia, Retarded growth, Deafness

212
Q

lentigo simplex sun or no

A

skin not exposed to sunlight

213
Q

melasma associations

A

pregnancy, oral contraceptives, hormonal replacement therapy

214
Q

oral melanotic macule mechanism and role of sun

A

unrelated to sun

focal increase in melanin and possibly # of melanocytes

215
Q

laugier Hunziker syndrome

A

pigmentation of lips and buccal mucosa an longitudinal melanonychia (linear pigmentation of nail)

216
Q

pigmentation of lips and buccal mucosa and longitudinal melanonychia (linear pigmentation of nail)

A

laugier Hunziker syndrome

217
Q

longitudinal melanonychia

A

(linear pigmentation of nail) laugier Hunziker syndrome

218
Q

(linear pigmentation of nail)

A

longitudinal melanonychia

laugier Hunziker syndrome

219
Q

oral melanoacanthoma race gender cause

A

almost exclusively in black ppl, F predilection

reactive

220
Q

progression of acquired melanocytic nevus

A

junctional (pigmented macule), compount (less pigmented papule), intradermal/intramucosal (papillary, hair, no pigment)

221
Q

can acquired nevus go away

A

yes

222
Q

cells in acquired nevus by depth

A

type A - superficial, epithelioid
B - middle, lymphocyte like
C - deeper, spindle

223
Q

risks of congenital nevus

A

3-15% –> melanoma

224
Q

halo nevus cause

A

hypopigmented halo bc melanocytes destroyed by immune system, seen in pts with recent melanoma excision

225
Q

kamino bodies where what

A

eosinophilic globoid in spitz nevus

226
Q

histo spitz nevus

A

epithelioid and spindle cells, similar to melanoma but young age and small size

227
Q

spitz nevus IHC

A

S100+, NSE+

228
Q

color reflection effect in blue nevi

A

Tyndall

229
Q

combined nevus

A

blue nevus + overlying melanocytic nevus

230
Q

blue nevus + overlying melanocytic nevus

A

combined nevus

231
Q

LAMB syndrome

A

lentigines, atrial and mucocutaneous myxomas, blue nevi (subset of Carney complex)

232
Q

balloon cell nevus histo

A

large, pale, polyhedral balloon cells (clear cells)

233
Q

oculodermal melanocytosis aka, cause, look, distribution

A

aka nevus of Ota
diffuse distribution of proliferating melanocytes
unilateral facial and/or ocular slate-blue pigmentation
follow trigeminal V1/V2

234
Q

unilateral facial and/or ocular slate-blue pigmentation

follow trigeminal V1/V2

A

oculodermal melanocytosis aka nevus of Ota

235
Q

nevus of Ota aka, cause, look, distribution

A

oculodermal melanocytosis
diffuse distribution of proliferating melanocytes
unilateral facial and/or ocular slate-blue pigmentation
follow trigeminal V1/V2

236
Q

dysplastic nevus where, histo

A

light-exposed areas, premalignant, melanocytes show nuclear atypia, may be syndrome associated

237
Q

dysplasia in leukoplakia %

A

5-25%

238
Q

sanguinaria associated keratosis where

A

mx vestibulr or alveolar mucosa

239
Q

leukoplakia ffrom microorganisms

A

syphilis - dorsal tongue leukoplakia; candida, hpv

240
Q

dorsal tongue leukoplakia

A

syphilis

241
Q

leukoplakia progression

A

thin (mild) –> thick (homogeneous) –> nodule/granular –> verrucous

242
Q

PVL look, starting point, demographic, risks and how soon

A

multiple lesions, starts in gingiva and spreads to other areas, non smoking females (4:1)
clinically can become similar to verrucous carcinoma, transforms into SCC withint 8 y

243
Q

erythrileukoplakia why red

A

read areas atrophic and can’t make keratin

244
Q

dysplasias –> SCC risks by grade and how soon

A 
2-4y: 
mild 4%
mod 10%
sev 35%
erythroleuko 47%
245
Q

erythroplakia locations

A

most are FOM, tongue, soft palate

246
Q

smokeless tobacco keratosis progression

A

painless gingival recession, possible with bone destruction

247
Q

smokeless tobacco keratosis mucosa look

A

thin gray white plaque with blending borders on the area where tobacco is placed

248
Q

parakeratin pointed projections above epithelial layers name and in what

what else under basement membrane

A

chevroning in smokeless tobacco keratosis

can have amyloid like areas around BMs and blood vessels

249
Q

which smokeless tobacco/snugg higher risk of SCC

A

dry (vs moist)

250
Q

when would smokeless tobacco keratosis resolve after cessation

A

2 week s

251
Q

oral submucosal fibrosis demographic and look

A

pale and marble like stuff mucosa – betel quid users

252
Q

betel quid other name

A

areca nut

253
Q

oral submucosal fibrosis chief complaint

A

trismus and pain when eating spicy foods

more in BM, SP and retromolar are

254
Q

trismus and pain when eating spicy foods indicator of

A

oral submucosal fibrosis

255
Q

betel chweres mucosa look and risk

A

brown red but not precanceorus

256
Q

nicotine stomatitis resolves how soon

A

within 1 month after discontinuation

257
Q

actinic keratosis risk factors

A

sun damage in light skinned persons

immunosuppresion, albinism, xeroderma pigemtosum, Cockayne sundrome, Bloom syndrome, Rothmund-Thompson syndrome

258
Q

full thickness dysplasia in actinic keratosis name

A

bowenoid actinic keratosis

259
Q

bowenoid actinic keratosis

A

full thickness dysplasia

260
Q

risks with actiniv keratosis

A

10% progress to SCC

261
Q

dysplasia in oral submucous fibrosis how often and what other risks/how often

A

dysplasia in 10-15% of cases

near 8% progress into SCC

262
Q

actinic cheilitis occupation

A

outdoor – farmers, sailors

263
Q

actinic cheilitis risks

A

6-10% SCC progression

264
Q

keratoacanthoma causes

A

UV(95% on sun exposed skin), HPV (26 or 37), tar, immunosuppression, trauma

265
Q

HPV in keratoacanthoma

A

26 or 37

266
Q

keratoacanthoma phases and when

A

growth 6 wks
stationary 6 wks
involution 6-2 months

267
Q

how soon does keratoacanthoma involute

A

6-12 months

268
Q

ferguson smith

A

multiple non involutin keratoacanthomas, earli life, hereditary (AD 9q22-31)

269
Q

multiple non involutin keratoacanthomas, earli life, hereditary

A

ferguson smith

270
Q

9q22-31

A

ferguson smith

multiple non involutin keratoacanthomas, earli life, hereditary

271
Q

eruptive grzybowski

A

100s of small keratoacanthomas in skin and upper digestive tract; sign of internal malignancy

272
Q

100s of small keratoacanthomas in skin and upper digestive tract

A

eruptive grzybowski

sign of internal malignancy

273
Q

keratoacanthoma histo

A

center of lesion is crater like and keratin filled; surrounding epithelium constricts neck of the lesion. downward proliferation isehs adjacent tissues and its extent is regular (inverted cup)

274
Q

center of lesion is crater like and keratin filled; surrounding epithelium constricts neck of the lesion. downward proliferation isehs adjacent tissues and its extent is regular (inverted cup

A

keratoacanthoma

275
Q

plummer vinson aka

A

paterson kelly – increased risk of SCC of esophagus, oropharynx, and posterior mouth

276
Q

SCC gender , deaths per year, new cases per year, % of all cancers in US

A

8th M/15th F
5300 deaths
35k new cases
3% of all cancers

277
Q

esophageal webs are

A

intertwining fibrous bands of scar in esophagus, higher malignancy rate

278
Q

increased risk dorsal tongue scc which infection

A

tertiary syphilis

279
Q

HPV SCC of oropharynx types

A

16, 18, 31, 33

280
Q

locations for SCC in mouth

A

tongue, FOM, soft palate, gingiva, cheek, labial mucosa, hard palate

281
Q

gingival SCC where and who

A

posterior md, similar to PG or IFH, least associated with tobacco,, most common in F

282
Q

SCC distant met sites

A

lung, liver, bones

283
Q

desmoplasia aka and what is

A

scirrhous change; dense fibrosis in CT induced by SCC cells

284
Q

dense fibrosis in CT induced by SCC cells

A

desmoplasia

285
Q

orall SCC risks for what else

A

synchronous (33%) or metachronous (66%, within 3years) cancers of upper aerodigestive tract, esophagis, stomacj, lunh

286
Q

verrucous carcinoma aka

A

ackermans tumor

287
Q

verrucous carcinoma associations and from what

A

smokeless tobacco, may arise from PVL

288
Q

verrucous carcinoma survival

A

90% with surgery without neck dissection

289
Q

papillary SCC location and look

A

oropharynx, hypopharynx, larynx, sinonasal tract-worst prognosis
exophytic, looks like papilloma with fibrovascular cores
DYSPLASTIC epithelium

290
Q

papillary SCC histo and causes

A

looks like CIS, not hyperkeratotic, not highly invasive

HPV 6, 11, 16, 18

291
Q

spindle cell carcinoma aka

A

pseudosarcoma, sarcomatoid SCC

292
Q

ackermans tumor aka

A

verrucous carcinoma

293
Q

spindle cell ca which component is invasive

A

spindle

294
Q

spindle cell ca location

A

oral cavity and larynx

295
Q

spindle cell ca reason

A

dysfunctional cadherin-catenin complex

1/3 develop as recurrence after RT for well-diff SCC (dedifferentiation)

296
Q

spindle cell ca IHC

A

CK+ (AE1/AE3, CAM 5.2)

297
Q

spindle cell ca predictor of prognosis

A

depth of invasion, not size

298
Q

adenosquamous ca location

A

posteriorly

299
Q

adenoid squamous cell carcinoma why the look and where

A

acantholysis – not true glandular structures

mostly on lip

300
Q

basaloid SCC where

A

larynx, pyriform sinus, base of tongue

301
Q

basaloid SCC histo look

A 
superficial SCC (well diff or in situ) + basaloid epithelium
comedonecrosis common
302
Q

comedonecrosis which SCC, which Ca

A

basaloid SCC, SNUC (sinonasal undifferentiated carcinoma)

303
Q

wood dusts exposure which ca

A

sinonasal adenoca, intestinal type
more in men
sporadic more in women

304
Q

second most common glandular sinonasal malignancy

A

sinonasal adenoca intestiinal type

after adenoid cystic ca

305
Q

most common glandular sinonasal malignancy

A

adenoid cystic ca

306
Q

sinonasal adenoca intestinal type location

A

ethmoid sinus in menm

nasal cavity and mx sinus in women

307
Q

sinonasal adenoca intestinal type histo

A

glands lined with pleomorphic columnar cells in back to back pattern

308
Q

histo types of sinonasal adenoca intestinal type

A

papillary, colonic, solid, mucinous, mixed

309
Q

sinonasal adenoca intestinal type IHC

A

CD20, CDX2

CK variable

310
Q

glands lined with pleomorphic columnar cells in back to back pattern

A

sinonasal adenoca intestinal type

311
Q

sinonasal adenoca non intestinal type grades and features

A

high hrade: Males, mx sinus, markedly atypical and pleomorphic
low grade - no sex predilection, nasal cavity

312
Q

sinonasal adenoca non intestinal type histo

A

small glands lined with a single layer of uniform cells (seromucinous carcinoma), back to back

313
Q

small glands lined with a single layer of uniform cells but malignant

A

sinonasal adenoca non intestinal type histo

314
Q

sinonasal undifferentiated carcinoma origin, causative associations

A

schneiderian membrane or olfactory epithelium

some cases associated with smoing, EBV, and radiation (weak)

315
Q

sinonasal undifferentiated carcinoma histo

A

nests, trabeculae, ribbons of medium sized polygonal cells with organoid appearance
comedonecrosis common

316
Q

nests, trabeculae, ribbons of medium sized polygonal cells with organoid appearance
comedonecrosis common

A

sinonasal undifferentiated carcinoma histo (SNUC)

317
Q

SNUC IHC

A

sinonasal undifferentiated carcinoma
CD (7, 8, 19)
negative for synapto/chromo

318
Q

olfactory neuroblastoma aka, what age

A

esthesioneuroblastoma
rare <10yo (unlike usual neuroblastoma)
bimodal peaks (15 and 50)
most in adults

319
Q

olfactory neuroblastoma histo

A

nests of round cells separated by fibrovascular septa, may have neurofibrillary stroma

true rosettes (Flexner-Wintersteiner) and pseudorosettes (Homer Wright)

320
Q

Flexner-Wintersteiner

A

true rosettes in olfactory neuroblastoma

321
Q

Homer Wright

A

pseudorosettes in olfactory neuroblastoma

322
Q

olfactory neuroblastoma types

A

A - nasal cavity
B - external to paranasal sinus
C - beyond nose and paranasal sinuses

323
Q

olfactory neuroblastoma IHC

A

CD56, NSE, synapto, chromo

324
Q

neuroendocrine ca aka on location

A

oat cell ca in lung

carcinoid tumor in HI

325
Q

most common non squamous tumor of the larynx and risk factor

A

tobacco related

MDNEC (atypical carcinoid tumor) – Mills scheme

326
Q

Mills scheme types of carcinoids

A

WDNEC - carcinoid tumor
MDNEC 0 atypical carcinoid tymor
PDNEC small cell (small cell undiff)
PDNEC large cell (large cell undiff)

327
Q

salt and pepper nuclei, nuclear moldingm, crush artifact

A

neuroendocrine

328
Q

neuroendocrine IHC

A

NSE+, chromo, synapto

329
Q

nasopharyngeal carcinoma origin, geography

A

from lining epithelium of lymphoid ricj nasopharynx

high incidence in China, intermediate in SE asia, low in US

330
Q

nasopharyngeal carcinoma associated factors

A

EBV, vit C def, salt fish diet (nitrosamines

331
Q

nitrosamines malignancy

A

nasopharyngeal carcinoma

332
Q

middle aged person with recurrent persistent otitis media consider

A

nasopharyngeal carcinoma

333
Q

location for nasopharyngeal carcinoma

A

lateral wall at rosenmullers fossa

334
Q

first sign of nasopharyngeal carcinoma

A

in 60%, first sign is an enlarged metastatic lymph node

335
Q

nasopharyngeal carcinoma types

A

1 - keratinizing, SCC
2 - differentiated, nonkeratinizing
3 - undifferentiated, nonkeratinizing (lymphoepithelioma, lymphoepithelial carcinoma)

336
Q

worst prognosis among nasopharyngeal carcinoma types and why

A

type 1 worse, prolly 2/2 response to radiation

337
Q

lymphoepithelioma what is and types

A

type 3 of nasopharyngeal carcinoma (undifferentiated, nonkeratinizing)

Regaud type: clusters, nests, or aggregates of neoplastic epithelial cells with lymphocytes
Schminke type: dispersed tumor cells forming a syncytial net

338
Q

: dispersed tumor cells forming a syncytial net

A

lymphoepithelioma Schminke type

339
Q

clusters, nests, or aggregates of neoplastic epithelial cells with lymphocytes

A

lymphoepithelioma Regaud type

340
Q

most common cancer

A

basal cell carcinoma

341
Q

why does BCC pop up

A

mainly due to UV

also arsenic ingestion, immunosuppression, PUVA for psoriasis

342
Q

syndromic associations for BCC (6x)

A

Gorlin syndrome, xeroderma pigmentosum, albinism, Rasmussen, Rombo, and Bazex-Christol-Dupre

343
Q

BCC genetics

A

PTCH (9q22) + p53 + SMO

344
Q

PTCH gene location and disease

A

9q22 – BCC

345
Q

clinical patterns of BCC

A

noduloulcerative (most common: telangiectatic vessels, aka rodent ulcer)
pigmented (nodular with melanocytes)
sclerosing (morpheaform – mimics scar)
superficial (multifocal, mimics psoriasis)
syndromic (sun exposed AND non exposed areas)

346
Q

collision tumor of BCC and SCC

A

basosquamous carcinoma

347
Q

merkel cells where and what

A

epidermis; primarily associated with nerve endings

348
Q

risk factors for merkel cell carcinoma

A

UV light and immunisuppression (transplant, HIV, lymphocytic leukemia)
may be caused by the merkel cell polyoma virus

349
Q

which virus in merkel cell carcinoma

A

merkel cell polyoma virus

350
Q

merkel cell carcinoma location and look

A

75% facial skin

dome shaped nodule with smooth surface and telangiectasis (rarely ulcerates)

351
Q

vowel mnemonic for merkel cell carcinoma

A 
AEIOU: 
asymptomatic
expands rapidly
immunosuppressed
older people
UV exposed areas
352
Q

merkel cell carcinoma IHC and special stains

A

CK20+ (perinuclear dot-like)
synapto chromo NSE
TTF1 to exclude lung met
Grimelius stain shows granules

353
Q

Grimelius stain

A

merkel cell carcinoma shows granules

354
Q

risks with merkel cell carcinoma

A

25% of patietns develop additional malignancies (SCC skin, hemato, breast/ovary adenoca)

355
Q

microcystic adnexal carcinoma aka

A

sclerosing sweat duct carcinoma

356
Q

sclerosing sweat duct carcinoma aka

A

microcystic adnexal carcinoma

357
Q

microcystic adnexal carcinoma behavior, location

A

cytologically bland but locally aggressive

plaque-like indurated lesion of upper lip

358
Q

microcystic adnexal carcinoma histo

A 
squamous/basaloid cells
horn cysts in superficial portion
ductal structures in deeper portions
neural/vascular invasion
desmoplastic stroma
359
Q 
squamous/basaloid cells
horn cysts in superficial portion
ductal structures in deeper portions
neural/vascular invasion
desmoplastic stroma
A

microcystic adnexal carcinoma

360
Q

melanoma genetics

A

50-70% BRAF mutation (Ras-Raf-Erk pathway)

361
Q

BRAF mutation what and pathway

A

melanoma!

Ras-Raf-Erk pathway

362
Q

(Ras-Raf-Erk pathway)

A

BRAF - melanoma

363
Q

most common melanoma

A

superficial spreading

364
Q

which melanoma can be amelanotic

A

nodular

365
Q

which melanoma is in situ and from what

A

lentigo maligna – from hutchinson’s freckle

366
Q

most common melanoma in oral cavity

A

acral lentiginous melanoma

367
Q

most common melanoma in black people

A

acral lentiginous melanoma

368
Q

types of melanoma

A

superficial spreading, lentigo maligna, nodular, acral lentiginous

369
Q

superficial spreading melanoma location

A

intercapsular area in males, back of leg in female

370
Q

melanoma IHC

A

HMB45, Melan A, Mart -1 , Fontana-Masson, S100

371
Q

how is melanoma prognosis graded

A

Breslow classification: depth of invasion associated with poorer prognosis for skin lesions

372
Q

Breslow classification

A

for melanoma

prognosis ~ depth of invasion

373
Q

which labs/ presentation associated with poorer melanoma of skin prognosis

A

elevated serum lactic dehydrogenase (LDH) and ulceration

374
Q

which locations associated with poorer prognosis for skin melanoma

A

interscapular Back
posterior and lateral Neck
posterior upper Arm
Scalp

BNAS

375
Q

which demographic etter prognosis for melanoms

A

women and pts <50yo

376
Q

survival for oral melanoma

which is better, which is worse

A

13-22% survival
better for younger
worse for amelanotic

377
Q

how to ddx spitz nevus from melanoma

A

spitz more in childhood, pink, and small size

378
Q

spitz nevus IHC

A

S100+ and NSE+

379
Q

combined nevus

A

blue nevus + melanocytic nevus

380
Q

blue nevus + melanocytic nevus

A

combined nevus

381
Q

pale and marble-like stiff mucosa

A

oral submucosal fibrosis

382
Q

betel chewers mucosa

A

brown red, not pre-cancerous; and lichenoid lesions

383
Q

risk factors for actiic keratosis

A

immunosuppression, albinism, xeroderma pigmentosum, Cockayne syndrome, Bloom syndrome, Rothmund Thompson syndrome

384
Q

bowenoid actinic keratosis

A

actinic keratosis + CIS

385
Q

actinic keratosis + CIS

A

bowenoid actinic keratosis

386
Q

origin of keratoacanthoma

A

from hair follicle infundibulum

387
Q

what arises from hair follicle infundibulum

A

keratoacanthoma

388
Q

multiple keratoacanthomas that don’t involute

A

Ferguson Smith

389
Q

hundrend of keratoacanthomas in skin and upper digestive tract

A

Eruptive Grzybowski; sign of internal malignancy

390
Q

wood and leather exposure predisposes to what and where

A

sinonasal intestinal type adenocarcinoma (maxillary sinus)

391
Q

nasopharyngeal carcinoma arises from

A

lining epithelium of lymphoid-ricj nasopharynx

392
Q

lining epithelium of lymphoid-ricj nasopharynx gives rise to

A

nasopharyngeal carcinoma

393
Q

factors associated with nasopharyngeal carcinoma

A

EBV, vitamin def, salt fish diet (nitrosamines)

394
Q

which BCC is multifocal

A

superficial

395
Q

which BCC is sclerosing

A

morpheaform

396
Q

which BCC is on sun exposed and nonexposed skin

A

syndromic

397
Q

which BCC has melanocytes

A

pigmented

398
Q

which BCC is telangiectatic and ulcerated

A

nodular aka rodent ulcer

399
Q

mohs micrographic surgery

A

uses frozen sections to ensure complete removal of BCC/SCC

400
Q

which surgery uses frozen sections to ensure complete removal of BCC/SCC

A

mohs micrographic surgery

401
Q

which melanoma has no radial phase

A

nodular

OP - Yield (19 decks)

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