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Oral candidiasis > 11. Other oral malignancies > Flashcards

11. Other oral malignancies Flashcards

1
Q

What tissue do carcinomas occur in?

A

Epithelial cells

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2
Q

What tissues do sarcomas occur in?

A

Connective tissue
Muscle cells

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3
Q

What tissues do lymphomas and leukaemias occur in?

A

Haemopoeitic and immune system

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4
Q

What is the name for gland tumours?

A

Adenoma
Adenocarcinoma

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5
Q

What is the name for cartilage tumours?

A

Chondroma
Chondrosarcoma

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6
Q

What is the name for fat tissue tumours?

A

Lipoma
Liposarcoma

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7
Q

What is the name for bone cell tumours?

A

Osteoma
Osteosarcoma

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8
Q

What is the name for fibroblastic tumours?

A

Fibromas
Fibrosarcoma

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9
Q

What is the name for smooth muscle tumurs?

A

Leiomyoma
Leiomyosarcoma

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10
Q

What is the name for striated muscle tumours?

A

Rhabdomyoma
Rhabdomyosarcoma

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11
Q

How can secondary tumours spread via?

A

CSF
Implantation
Lymphatic system
Blood stream

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12
Q

What are examples of special diagnostic methods?

A

Histochemical stains, eg. glycogen, melanin
Immunohistochemistry- peroxidase anti-peroxidase
Recombinant DNA techniques- viruses
Next generation sequencing- mutation analysis
Cytogenetic analysis- chromosome abnormalities
Computerised image analysis (morphometry)

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13
Q

What are some examples of structural antigens immunohistochemical markers?

A

Keratin
Vimentin
Desmin
Neurofilaments
Collagens

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14
Q

What are some examples of functional antigens immunohistochemical markers?

A

Lysozyme
Hormones
Immunoglobins

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15
Q

What are lineage antigens immunonohistochemical markers?

A

Neuron-specific enolase
S100 protein
Carcinoembryonic antigen CEA

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16
Q

What does S100A2 stain?

A

The basal layer red in normal epithelium

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17
Q

What is basal cell carcinoma and what is it associated with?

A

Most common skin neoplasm
Associated with long UV light exposure

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18
Q

What genetic diseases is basal cell carcinoma associated with?

A

Basal cell naevus
Bazex syndrome

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19
Q

What is the description of lesion forming in basal cell carcinoma?

A

Slow growing nodules that eventually ulcerate in the centre- rodent ulcer
Do not tend to metastasise

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20
Q

What is the histology of basal cell carcinoma?

A

Cells resemble epithelial basal cells
They have a scanty cytoplasm
No evidence of cellular bridges
The basal cells are more elongated

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21
Q

What is the cause of basal cell naevus syndrome/Gorlin-Goltz syndrome?

A

Autosomal dominant and variable penetrance
Caused by mutation on PTCH gene on chromosome 9

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22
Q

What is the symptoms of Gorlin-Goltz/Basal cell naevus?

A
  1. Multiple odontogenic keratocysts throughout life
  2. Multiple basal cell carcinomas of the skin
  3. Calcium and phosphate metabolic abnormalities- calcification of falx cerebri
  4. Skeletal abnormalities- prognathism, frontal bossing, especially ribs and vertebrae
  5. Other anomalies- palmar pits, ovarian fibromas, medulloblastomas
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23
Q

What are the 4 types of malignant melanoma?

A

Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous

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24
Q

What are the characteristics of superficial spreading melanoma?

A

Commonest-70%
Radial growth
Brown, tan, black
On sun exposed skin

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25
Q

What is nodular melanoma?

A

13% common
Vertical growth
Pink or black
At back of head, neck skin

26
Q

What is lentigo maligna melanoma?

A

10% common
Hutchinson’s melanotic freckle
Occurs in elderly people, sun exposed skin, flat moles, slow growing, non-invasive, melanoma in situ

27
Q

What is acral lentiginous?

A

Melanomas that do not occur in sun-exposed areas such as palms, soles, nail beds, oral mucosa

28
Q

What is the order of most common cancers affecting the skin?

A

BCC>SCC>Melanoma

29
Q

What is the characteristic of lesions in oral malignant melanoma?

A

Usually posterior maxillary alveolar ridge or hard palate
Dark brown/Blue-black lesions
Deeply pigmented
Uneven nodular surface
Ulcerated or haemorrhagic
Progressively increasing in size

30
Q

What are the differentials for oral malignant melanoma?

A

Kaposi sarcoma
Blue nevi
Oral nevi
Addison’s disease
Ephelides

31
Q

What is the treatment for oral malignant melanoma?

A

Radicular surgery including block removal of the jaws, lymphadenectomy

32
Q

What can amelanotic melanoma stain for?

A

They do not contain a lot of melanin as they have differentiated so much.
S100+
HMB45+

33
Q

What are lymphomas and what broad 2 types can they be?

A

Involve cells of the lymphoreticular system
Present as nodal or extra-nodal lesions

34
Q

Where do malignant lymphomas commonly affect most?

A

Uncommon in head and neck disease
Either part of a disseminated disease
Or primary lesions- cervical lymph nodes or lymphoid structures of Waldeyer’s ring

35
Q

What is Hodgkin’s lymphoma presentation?

A

Nodular
Presents in young adults
Most often causes cervical node enlargement
Painless
Progressive

36
Q

What are the 4 types of Hodkin’s lympohma?

A

Lymphocyte rich
Lymphocyte depleted
Mixed cellularity
Nodular sclerosing

37
Q

What is the histology of Hodgkin lymphoma?

A

Reed Sternberg cells
Multi bi-lobed, bi-nucleated giant cells
Owl eye or mirror appearance
Prominent eosinophilic nuclei

38
Q

What is the treatment for Hodgkin lymphoma?

A

Chemotherapy is successful in 50-70%

39
Q

What cells does Non-Hodgkin lymphoma affect?

A

B-cells
T-cells
Natural killer cells
Can be low or high grade

40
Q

Where does Non-Hodkin lymphoma affect?

A

Can be nodular and affect MALT tissues
Can be diffuse and affect jaw bones, salivary gland and oral soft tissues

41
Q

Where is the oral lesion for Non-Hodgkin lymphoma often seen?

A

In the palate- produces a red, purple, rubbery mass

42
Q

What are 2 types of malignant lymphomas that may occur in the mouth?

A

Burkitt’s lymphoma
Lethal midline granuloma

43
Q

What is Burkitt’s lymphoma?

A

Endemic in Africa
Due to EBV and malaria infection
Causes proliferation of B-cells
Commonly occurs as jaw tumour

44
Q

What is the histology of Burkitt’s lymphoma?

A

B-cells form starry sky pattern

45
Q

What is lethal midline granuloma?

A

T-cell
Occurs in nose/paranasal sinuses

46
Q

What are oral malignant lymphomas often confused with?

A

Chronic apical process

47
Q

What do oral malignant lymphomas have an increased incidence and risk with?

A

Sjogren syndrome
Pt’s with HIV and AIDS

48
Q

What is a vascular tissue neoplasm called?

A

Angiosarcoma

49
Q

How do you classify sarcomas?

A

Difficult to classify even using markers
Microscopic examination is necessary as even the clinical characteristics are too vague

50
Q

What is MEN2B? What gene does it involve?

A

Autosomal dominant condition
RET gene on chromosome 11

51
Q

What are the 5 symptoms of MEN2B?

A
  1. Neurofibromas- benign oral, submucosal tumours
  2. Skeletal features- tall, Marfanoid posture, thin, elongated face
  3. Low muscle mass
  4. Protruding, blubbery lips
  5. Endocrine malignancies
52
Q

What endocrine malignancies are associated with MEN2B?

A

Medullary thyroid cancer
Phaeochromocytoma- adrenal gland tumour

53
Q

What are metastatic tumours?

A

Tumours that originated elsewhere but have spread through the body
Make up 1% of all malignant oral tumours

54
Q

What is the presentation of metastatic tumours?

A

Asymptomatic
Pain
Paraesthesia
Tooth extruded
Tooth loosening
Swelling/expansion
Pathological fracture

55
Q

What do the metastatic tumour oral lesions appear like on a radiograph?

A

Often Radiolucent
Can be radiopaque, eg, if come from breast or prostate

56
Q

In oral metastatic tumours how can you see where the primary tumour is?

A

Scintigraphy- uses radioactive chemical to produce pictures of where there is cancer cells in the body

57
Q

Where are oral metastatic tumours most often found in the oral cavity?

A

The cancer cells usually spread by blood, so most are found in red marrow rich locations such as mandible molar area, gingiva, soft palate and tongue

58
Q

Where do the oral metastatic tumours most often come from in the body?

A

Breast> Lung > Kidney > Prostate/thyroid/colon

59
Q

What are oral metastatic tumours often mistaken with?

A

Juxtaoral organ of Chievitz
Looks like a tumour but it is not
The origin is unknown- could be vestigial salivary tissue or neuro-epithelial receptor
Marks NSE+, S100+

60
Q

What are the treatments for malignancies?

A

Surgery
Radiotherapy
Cytotoxic chemotherapy
Immunotherapy
Combinations of the above

Oral candidiasis (18 decks)

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