13. Traumatic and Reactive Lesions Flashcards
• Sessile
○ A bump, mass that’s growing ____ surface of any tissue
○ Removal: go into ____ tissue to excise
• Pedunculated
○ Attached to tissue via ____
under
underlying
stalk
Biospy
Excisional v. incisional
• Surgical technique used to diagnose clinical pathology • Excisional ○ Excise the lesion in \_\_\_\_ • Incisional ○ Remove a \_\_\_\_ of the actual lesion • For excisional, the lesion is \_\_\_\_ and it won't casue morbidity after surgery (only a couple sutures) ○ If 1cm (medium sized), but access surgically is \_\_\_\_ (ant tongue, lower lip) ○ But typically \_\_\_\_-related • Incisional biopsy ○ Worried about \_\_\_\_; leave enough tissue for surgeon afterwards to know how much more to remove ○ Lesion is too \_\_\_\_ to move entirely, would cause too much discomfort ○ Posteriorly located where \_\_\_\_ is difficult (post tongue, soft palate, uvula) ○ Own experience, how \_\_\_\_ you are • \_\_\_\_ and \_\_\_\_ are two important factors
entirety piece small easier size cancer large access confident size surgical access
Incisional Biopsy
• Right: regular scalpel, laser, taking tissue and putting into \_\_\_\_ (diluted formaldehyde) which helps to fix the tissue ○ Tissue remains at state \_\_\_\_ ○ Cells undergoing \_\_\_\_ under microscope bc at time of biopsy it's undergoing division • Left: punch biopsy ○ \_\_\_\_ blade, removing circular tissue to put into bottom to send into analysis ○ Punches have different \_\_\_\_ (2,3 4, 6 and 10mm) • Rest of lesion remains
formalin forever mitosis circular diameter
Differential diagnosis
A process of listing two or more diseases with similar signs and symptoms
– Increase likelihood of establishing correct diagnosis
– Direct diagnostic and therapeutic plans
Initially list ____ possible diagnoses, all with similar signs and symptoms
Use accumulated information to narrow list to no more than ____ diagnoses
* Done with every patient (toothache, aesthetic concern, etc.) * Help inform the testing you will conduct to help further understand the problem
5-7
three
Oral mucosa • \_\_\_\_ epithelium • Connective tissue – \_\_\_\_ (superficial) lamina propria – \_\_\_\_ (deep) lamina propria • Submucosa
• Papillary ○ Less \_\_\_\_ ○ More superficial, below the epithelium • Reticular • Submucosa ○ Lower lip: \_\_\_\_ ○ Tongue: \_\_\_\_ muscle ○ Buccal mucosa: fat, salivary gland and muscle • Attached gingiva and hard palate has no \_\_\_\_
papillary reticular collagenized salivary gland skeletal submucosa
Linea alba
• Chronic friction leading to epithelial ____ and ____
* Technically a \_\_\_\_, but not pathologic * Chronic irritation to buccal mucosal tissue and epithelial cells * Hyperplasia - normal cells, but increased in \_\_\_\_ * Surface of tissue - \_\_\_\_, due to hyperkeratosis
hyperplasia
hyperkeratosis
number
white
Petechiae • \_\_\_\_ bleeding • Causes: – Trauma – Systemic disease – Infection
• Common in \_\_\_\_ of oral cavity (but can get it anywhere) • Systemic disease ○ AIDs • Infection ○ Mononucleosis ○ HIV ○ Measles ○ Streptococcus (strep throat) • Coaggulation disorders are causes because they weaken \_\_\_\_, thus allowing blood to rush into the surrounding tissues. Patients that are pone to bruising, are also susceptible to petechiae. • \_\_\_\_ is one of the most common causes of petechiae that is systemic in nature. It is defines as low \_\_\_\_ count. Thus, do NOT assume that all causes of bruising are \_\_\_\_ in origin.
pinpoint soft palate blood vessels thrombocytopenia platelet traumatic
Purpura • Slightly larger than \_\_\_\_ • Causes: – Trauma – Systemic disease – Infection
* Caused by similar things to \_\_\_\_ * Slightly larger area of \_\_\_\_
pinpoint
petechiae
hemorrhage
Ecchymosis
• ____ accumulation
• Greater than ____ cm
• Following \_\_\_\_ of tooth * Typically caused by \_\_\_\_ * Can be more prone to ecchymosis due to coagulation disorder (\_\_\_\_)
hemorrhagic
2
extraction
trauma
hemophilia
Hematoma
• Accumulation of blood resulting in ____ mass
This is a boy who was chewing on a pen and then it went through his palate.
This is a ____ mass. It will heal, and will go through the same evolution as any bruise on a skin. It will go from purple, to blue, to green, to brown/yellow, and the resolution.
You wouldn’t ____ this because it is a bruise
Chin trauma from ____
Over a few hours, bruises will ____. This is clotted blood being squeezed out by doctor to relieve pressure.
Not necessary to biopsy but if you do biopsy a bruise, all you will see is ____ and ____ (clotted blood).
You will not see ____ cells. However, as a few days pass, you will see some ____ & other cells, because the ____ response will kick in.
palpable
raised
biopsy
car accident
clot
blood fibrin inflammatory macrophages wound healing
Non-specific ulcer
• Non-specific histology
• If no resolution after ____ weeks then MUST biopsy
• Happens to \_\_\_\_ • Has non-specific histology ○ Acute inflam ○ Chronic inflam ○ Granulation tissue within lam prop ○ Vascularity - wound healing response • Common cause: \_\_\_\_ ○ Will go away on their own • 2 weeks ○ Non-healing ulceration, warranting a biopsy ○ Cause: trauma, cancer, and by infection \_\_\_\_, or \_\_\_\_*
epithelium
trauma
Tb
histoplasmosis
Non-specific ulcer
• Above patient did not resolve • Ulceration: loss of \_\_\_\_ • Surface of ulceration ○ \_\_\_\_ exudate* § Microscopically: lots of fibrin, neutrophils embedded, chronic inflam cells and dead cells § \_\_\_\_-rich • Wound healing = \_\_\_\_ tissue ○ Highly vascularized ○ Myofibroblasts § Help \_\_\_\_ the tissue back together ○ Fibroblasts produce collagen (with myo) ○ \_\_\_\_/\_\_\_\_ inflam and macrophages clean up debris
epithelium fibrinous protein granulation contract
Eosinophilic ulcer
• Has distinct ____
• ____ most common site
* Cause of \_\_\_\_, but microscopically distinct * Anywhere on the tongue it can occur
histology
tongue
trauma
Eosinophilic ulcer
• Look into lamina propia ○ \_\_\_\_, lots of them ○ Larger cells: \_\_\_\_ § Big nuclei ○ Smaller, blue: \_\_\_\_ § T cells (cannot tell from slide) • \_\_\_\_ - B cell marker • \_\_\_\_ - T cell marker
eosinophils fibroblasts lymphocytes CD20 CD3
Eosinophilic ulcer
* \_\_\_\_ induced, resolves on its \_\_\_\_ * Continue to return until complete resolution * Follow patient's at regular intervals, routinely, until completely resolved (can be via phone call)
traumatically
own
