2- pathology of mouth & oesophagus

Question 1

what is acute oesophagitis - is it common? what are 2 causes?

Answer 1

inflammation of oesophagus = rare

causes:
- chemical ingestion
- infectious agents like candidiasis, herpes, cytomegalovirus (in immunocompromised people)

Question 2

what do people usually experience with chronic oesophagitis and and how rare is it?

Answer 2

experience heart burn or indigestion - reflux disease (rare causes include crohns disease)
- it’s common

Question 3

what is reflux oesophagitis? what causes it and what effect does it have?

Answer 3

= inflammation of oesophagus due to refluxed low pH gastric content

cause = may be due to defective sphincter mechanism +/- hiatus hernia or because increased abdominal pressure

result = altered abdominal oesophageal motility (the way the muscles tighten + relax in wave like motion) so impaired clearance of contents = more exposure to acid

Question 4

what does reflux oesophagitis look like histologically?

Answer 4

basal zone epithelial expansion, intraepithelial neutrophils, lymphocytes and eosinophils
- also lengthening of papillae

Question 5

what are complications of reflux?

Answer 5

• ulceration (bleeding)
• stricture (restriction)
• barrett’s oesophagus

Question 6

what is barrett’s oeosphagus?

Answer 6

replacement of stratified squamous epithelium by columnar epithelium (metaplasia)
- this can lead to unstable mucosa which means increased risk of developing dysplasia and carcinoma of oesophagus
- it’s a protective response, faster generation

Question 7

what causes barrett’s oesophagus?

Answer 7

can be due to:
- persistent reflux of acid or bile = repeated irritation and body healing response is to chnage normal squamous to columnar
- migration & expansion of columnar epithelium from gastric glands or submucosal glands (as more protective to acid)
- differentiation from oesophageal stem cells (as part of bodies attempt to fix damage)

Question 8

what is eosinophilic oesophagitis?

Answer 8

= different form of chronic inflammation of oesophagus but not due to acid reflux - it’s due to allergic oesophagitis
= chronic atopic reaction within oesophagus
= increased eosinophils in blood

Question 9

what is appearance of eosinophilic oesophagitis?

Answer 9

• looks like cats oesophagus - corrugated or spotty

Question 10

what are benign tumours of mouth & oesophagus?(6)

Answer 10

= very rare and don’t usually don’t cause symptoms
- squamous papilloma
- leiomyomas (smooth muscle)
- lipomas (fat)
- fibrovascular polyps (fibrous & vascular)
- granular cell tumours

Question 11

what are the common malignant tumours of oesophagus?

Answer 11

primary (directly derived from squamous epithelium itself) or secondary (from columnar epithelium somewhere else so glandular)
- squamous cell carcinoma
- adenocarcinoma

Question 12

what are the risk factors for squamous cell carcinoma?

Answer 12

• Vitamin A, Zinc deficiency
• Tannic acid/ Strong tea
• Smoking, Alcohol
• HPV
• Oesophagitis
• Genetic

Question 13

what is adenocarcinoma of oesophagus?

Answer 13

= protective response
- has unstable mucosa
- it can be a progression from barrett’s oesophagus

Question 14

what is the progression form normal to adenocarcinoma?

Answer 14

genetic factors/reflux disease →chronic reflux oesophagitis →barrett’s oesophagus →low grade dysplasia →high grade dysplasia →adenocarcinoma

Question 15

what are the 3 different mechanisms of metastases?

Answer 15

1. direct invasion
2. lymphatic permeation (lymphatic system spread)
3. vascular invasion (haematological spread)

Question 16

what are the clinical presentations of carcinoma?

Answer 16

• dysphagia, due to tumour obstruction
• general symptoms of malignancy = anaemia, weight loss, loss of energy

Question 17

what are the types of oesophagitis?

Answer 17

1. reflux oesophagitis
2. corrosive oesophagitis (chemical agents)
3. infective oesophagitis (in immunocompromised)
4. eosinophilic oesophagitis (allergy response)