B43. pathology of the lips oral cavity and pharynx

Question 1

What are the congenital malformations of the oral cavity

Answer 1

Cleft lip: Fusion failure of the medial nasal processes and the maxillary process

Cleft palate: Failure of the median palatine process, off the medial nasal prominences, to fuse with the nasal septum or with the lateral palatine process of the maxilla.

Cheilognathopalatoschisis: cleft lip, jaw, and palate.

Question 2

What are the ulcerative lesions of the oral cavity

Answer 2

Apthous ulcers, canker sores. Common, in up to 40% of people. idiopathic, suspected autoimmune cause. Small white/pale ulcers that are extremely painful and self resolve in a few weeks.

HSV-1 infection, oral herpes, may reactivate

Oral candidiasis: scrapable white infection in IC’d patients

Follicular tonsilitis. #1 cause is rhinoviruses, coronaviruses, orthomyxoviruses #2 is Group A strep

Pemphigus. Rare autoimmune disorder, causing destruction of the desmosomes at very specific cell junctions. Most common is pemphigus vulgaris which causes separation of the basal cell layer from the cells immediately above it in the mucosal epithelium. Causes blisters.

Ulcerative Necrotizing Gingivitis. Caused by a few kinds of bacteria, Actinomyces israelii, Prevotella melaninogenicus, Bacteroides fusobacterium, Spirochetes-treponema vincentii.

Kaposi Sarcoma.

• classic KS: skin lesions, red-purple plaques, benign, in old middle eastern and east european men
• Endemic African KS: in young men and women, very aggressive in young children, benign or malignant in adults.
• Transplant KS: associated with immune supproession –> is often in mucosa.
• AIDS KS: large skin and mucosal lesions with rapid dissemination, but rarely fatal because other factors kill the patient first.

Question 3

Benign proliferative disorders of the mouth/pharynx.

Answer 3

Papilloma: The most common benign neoplasm. Caused by HPV 6 or HPV 11. Can also reoccur as papillomatosis.

Fibroma: Submucosal connective tissue hyperplasia from chronic irritation.

Pyogenic Granuloma: in kids and pregnant women. rapidly growing mass on the gums, composed of densely growing immature vessels, may bleed and look concerning, but is totally benign.

Question 4

Malignant neoplasms of the oral cavity/esophagus.

Answer 4

95% are Squamous Cell Carcinoma.

The rest are mostly adenocarcinomas from the salivary gland (next topic)

Question 5

What are the premalignant or precancers of the oral cavity?

Answer 5

Leukoplakia and Erythroplakia

Leukoplakia is a non-scraping white plaque with no other cause. has a 5-25% chance to become s.c.c.

Erythroplakia is a red plaque and has a >50% chance to transform

Question 6

What is oral hairy leukoplakia?

Answer 6

White hairy lesion on the oral mucosa typically on the sides of the tongue, caused by epethelial thickening.

Caused by EBV infection of these epithelial cells in HIV/AIDS patients almost exlusively.

Question 7

What is are the risk factors/causes of oral/esophageal cancer?

Answer 7

Smoking, Tabacco, and Alcohol

and

HPV 16 and HPV 18.

Question 8

What genes are associated with squamous cell carcinoma of the mouth/esophagus?

Answer 8

Smoking related cancers: p53, NOTCH1

HPV related cancers: HPV 16 or 18 infection, and p16 over-expression

HPV related oral cancers have a significantly better prognosis than non-HPV associated.

Question 9

What is the prognosis of oral/esophageal squamous cell carcinoma?

Answer 9

If discovered before lymph node metastases 5yrS is above 90%.

If there is lymph node involvement, about 20%.

Usually they are discovered with lymph node involvement because there are often no symptoms for a long time.

There is a high frequency of new primary tumor development in patients that are treated/cured of their initial tumor. pertaining to the theory of “field cancerization” caused by the smoke.

Question 10

What is the gross morphology of oral scc like?

How does it metastasize?

Answer 10

• Grows out of a precancerous lesion,
• usually on the underside of the tongue, floor of the mouth, lower lip, soft palate, or gums.
• raised firm plaques that may ulcerate and also infiltrate into the mucosa and submucosal tissues.
• Cells can be well-differentiated and keratinizing or highly anaplastic and undifferentiated.
• infiltrates cervical lymph nodes then metstasizes, often to Lungs and Liver.

Question 11

What are the causes of angular cheilitis?

Answer 11

• Candida
• Staph aureus
• Group A strep
• Smoking, irritation
• Malnutrition, vitamin B2 riboflavin deficiency.