ch 10 epithelial pathology Flashcards
squamous papilloma
- Benign prolif, thought to be viral induced
- low infectivity and virulence
- any age and usually <1/2 cm
- tx surgical removal, if left may remain the same
Verruca Vulgaris
- virus induced (HPV)
- frequent in children
- common on skin and infrequent in oral cavity
- usually < 5 mm
- cutaneous horn form extreme accumulation of keratin
what virus is associated with Verruca Vulgaris?
HPV
what is the tx for verruca vulgaris?
- skin lesions treated by liquid nitrogen, cryotherapy, surgical or topical keratinolytic agents
- oral lesions sergical laser, cryotherapy or electrosurgery
- if untreated 2/3s will disappear in two years
- viral induced (HPV)
- considered sexually transmitted
- teenagers and young adults
- Koilocytes (pyknotic nuclei surrounded by a clear zone)
Condyloma Acuminatum
what different epithelial lesions are assoicated with HPV?
- Verruca Vulgaris
- Condyloma Acuminatum
- Verrucous Carcinoma
- Whites between 40-70 with female predilection
- Favor gingiva and alveolar mucosa (50%)
- Most
Verruciform Xanthoma
- Viral induced localized proliferation of squamous cells
- Usually multiple flat or rounded papules which are usually clustered with normal color (not white)
- Childhood condition
Focal epithelial hyperplasIa
- considerable acanthosis is hallmark
- spontaneous regression reported months to years
- conservative surgical for diagnostic or esthetic
focal epithelial hyperplasia
common skin condition in elderly and represents and axquired b9 proliferation of epidermal basal cells
- chronic sun exposure with hereditary tendency
- Brown plaque that appears to be “stuck on” skin
Seborrheic Keratosis
what disease is associated with the “laser-Trelat sign” (numerous ___with pruritus associated with internal malignancy)
Seborrheic Keratosis (SK)
seborrheic keratosis like but in blacks
‘Dermatosis papulosa nigra’ occurs in 30% blacks with Autosomal Dominant pattern
what is the histologic finding in Seborrheic Keratosis?
horn and pseudo-horn cysts and melanin pigmentation in the basal cell layer
-Skin discoloration is produced by excess of melanin deposition in the epidermis; blond and red hair
ephelis (freckle)
-genetic predilection, Autosomal Dominant
-Age spot; liver spot
- Chronic UV light damage; rare
before 40 and 90% whites > 70
-No change in color intensity after exposure to UV light
-Typically multiple; tan/brown
-May reach 1cm; most
Actinic Lentigo
-does not undergo malignant transformation
treatment for actinic lentigo (liver spots)
-topical retinoic acid can reduce intensity and completely destroyed with Q-switched ruby laser
- “mask of pregnancy”
- Symmetric hyperpigmentation of sun exposed skin of face and neck
- Topical tx with 3% hydroquinone and tretinoin
- Prevented by minimizing sun exposure
Melasma
-Flat brown discoloration caused by focal increase in melanin deposition (maybe increased malanocytes)
-Not related to sun
-May want to separate Labial MM
which probably has sun association
-2:1 female; average age 43 and 33% vermilion zone of lip
Oral melanotic macule
- Racial or physiologic; P-J syndrome; Addison’s disease and Neurofibromatosis
- Chronic trauma; Chronic AI disease
- Smokers melanosis
- Drugs; chloroquine or other quinine derivatives; Phenolphthalein; estrogen; AIDS-related medications
Melanin Pigmentation
- Benign acquired pigmentation characterized by dendritic macrophages dispersed throughout epithelium
- Exclusively in Blacks with F predilection
- BM most common site; 3rd-4th decades
oral melanoacanthoma
- Alarming growth rate; can reach several cm in a few weeks
- Incisional biopsy to r/o melanoma
- No treatment indicated
- Several instances spontaneous resolution after biopsy
- Alarming growth rate; can reach several cm in a few weeks
- Incisional biopsy to r/o melanoma
- No treatment indicated
- Several instances spontaneous resolution after biopsy
oral melanoacanthoma
- Common mole/nevus
- Neural crest origin
- Most present before 35
- Whites have more nevi than Asians or blacks
- Intra-oral palate and gingiva
acquired melanocytic nevus
-the cells have a “pear” shape(?)
what are the types of acquired melanocytic nevus?
- Junctional
- compound
- intramucosal
Leukoplakia
- White lesion that does not rub off
- 20% premalignant or malignant on initial biopsy
- High risk FOM, VT and SP
- Risk of malignant transformation is greater than the risk associated with unaltered mucosa
- 1/3 of oral cancers have leukoplakia in close proximaty
- Most common oral precancer representing 85% of lesions
- Common and may affect 3% of white adults (70% male)
Leukoplakia
different etiologies for leukoplakia
- Tobacco
- Alcohol
- Sanguinaria
- Ultraviolet radiation
- Microorganisms
- Trauma
prevalence of Leukoplakia as age increases
prev increases, ave age 60 is the same ave age for cancer
precancerous changes
- Enlarged hyperchromatic nuclei with prominent nucleoli
- Increased nuclear-to-cytoplasmic ratio
- Pleomorphic nuclei and cells
- Dyskeratosis and increased mitotic activity
- Abnormal mitotic figures
- Bulbous or teardrop shaped rete ridges
- Keratin pearls
- Loss of epithelial cohesiveness
to be classified as cancer, it needs to…
breach the basement membrane
the technical term for cheek chewing
Morsicatio Buccarum
- Red lesion that does not rub off
- No known cause
- 80-90% premalignant or malignant
Erythroplakia
- Represents sites in which epithelial cells are so immature or atrophic they no longer produce keratin
- Pattern that frequently reveals advanced dysplasia upon biopsy
- Biopsy red in mixed lesions!
field cancerizaion
once you have cancer, you are more likely to get other cancers
smokeless tobacco keratosis is more prevalent in India due to…
longer contact and tobacco leaves combined in a quid with betal leaves, area nuts and slaked lime
oral submucous fibrosis
Chronic, progressive, scarring, high risk precancerous condition related to chronic placement of betal quid (areca nut and slaked lime) or paan and found in .4% indian villagers
-Produces mucosal rigidity
-Trismus and mucosal pain
when eating spicy foods
-Blotchy marblelike pallor and a progressive stiffness of subepithelial tissues
-Tongue immobile if involved
submucosal fibrous band on BM, SP and LM
Oral submucous fibrosis
“betal chewer’s mucosa”
- brownish-red discoloration
- oral submucous fibrosis
Premalignant alteration of the LL that results from long-term excessive exposure to uv component of sunlight
! A person with chronic sunlight exposure and compromised immunity has increased risk
! Males 10:1
actinic cheilosis
-May report scaly material that can be peeled off with some difficulty, only to reform in a few days
! With further progression, chronic focal ulceration especially in areas of mild trauma from cigarettes or pipe stems
! SCCa 6-10% cases; seldom before 60; preventable cancer
if a person does reverse smoking and gets cancer, where in the oral cavity would the cancer most likely be located?
on the palate
if a person gets oral cancer and they are a non-smoker, what is a general characteristic of that patient?
Female, young and have mutations of p53 and other suppressor genes
effect of alcohol on cancer contraction
Significant potentiator or promoter
! 15 fold increase in oral Ca if combined with smoking
! Cirrhosis of liver found in 20% of male patients with oral cancer
effect of Phenols in oral cancer contraction
Increased Ca in wood products industry (exposed to certain chemicals especially phenoxyacetic acid)
! Also wood workers at increased risk for nasal and nasopharyngeal carcinoma
Plummer-Vinson Syndrome associated with > risk of SCCa of esophagus, oropharynx and posterior mouth
! Malignancies develop at earlier age with (this)
iron deficiency
iron deficiency
Impaired cell mediated immunity and iron is essential for normal functioning of epithelial cells of upper digestive tract
! Esophageal webs susceptible to malignant transformation (fibrous bands of scar tissue)
Vitamin A deficiency
Produces excessive keratinization
! Vitamin A may play a preventative role in precancer and cancer
! Betacarotene and retinoic acid therapy associated with regression in severity of dysplasia
Leutic glossitis
syphilis
when ‘staging’ oral cancer, what are the different letters used and what do they classify?
T=size of primary tumor
N=involvement of lymph nodes
M=distant metastasis
Carcinoma of the tongue is more likely to have metastasized when located on which portion of the tongue?
Posterior 1/3 (80% metastasized and 20% local0
anterior 2/3 (80% local and 20% metastasized)
cancer of maxillary sinus
Elderly and 80% cases advanced
! Symptoms include unilateral stuffiness, ulceration or mass of hard palate or alveolar bone
! If 2nd division of trigeminal involved, intense pain of midface or maxilla
! Teeth in area loosened and “motheaten” appearance on X-ray
! Superior displacement protrusion of eyeball
Skin Melanoma are more likely if you have what physical characteristics?
- Redder your hair
- Fairer your skin
- Bluer your eyes
- Sun exposure
what are the four clinicopathologic types of melanoma?
- superficial spreading melanoma
- nodular melanoma
- Lentigo malignant melanoma
- Acral lentiginous melanoma
Most common form of melanoma
! 70% cutaneous lesions
! Interscapular region of males and back of legs in females
! Invasion indicated by appearance of surface nodues or induration; usually 1 year after precursor macule
! Satellite macules or nodules around primary lesion
superficil spreading melanoma
- 15% of cutaneous melanomas
- Begins almost immediately in vertical growth phase and appears as nodular elevation and rapidly invades connective tissue
- Number of cases so undifferentiated to lack pigment (amelanotic)
nodular melanoma
- 5-10% cutaneous melanomas
- Develop’s from precursor lesion called lentigo maligna (Hutchinson’s freckle)
- Sun-exposed skin of elderly in midface;melanoma-in-situ in purely radial growth phase
- 15 year radial growth phase
lentigo malignant melanoma
-Most common form of melanoma in blacks and most common form of oral melanoma
! Palms of hands, soles of feet, sublingual area and mucous membranes
! Oral melanoma is often nodular at time of diagnosis; 6-7th decades; 2/3 male; 4/5 HP or maxillary alveolus
Acral Lentigerous melanoma
when looking at a melanoma, what are the four things to analyze?
- Asymmetry
- Border irregularity
- color variation
- Diameter (> 6 mm)
what areas of the skin have a worse prognosis for melanomas?
“BANS”, Back, posterior upper Arm, posterior and lateral Neck, and Scalp
