ch 10 epithelial pathology Flashcards by David Lawlor

5 papillomas

Squamous papilloma Verruca vulgaris Condyloma accuminatum Verruciform Xanthoma Focal Epithelial hyperplasia

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benign proliferation of stratified squamous epithelium thought to be virally induced (HPV), but not as infective

Squamous papilloma

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Squamous papilloma character

soft painless usually pedunculated exophytic nodule with numerous fingerlike surface projections giving a cauliflower or wartlike look

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Squamous papilloma treatment

Surgery. May remain same if untre

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This is a benign, virus induced (HPV), focal hyperplasia of stratified squamous epithelium

Verruca Vulgaris (common wart)

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Is verruca vulgaris contagious

Yes, can spread around person by autoinoculation

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Age Verruca vulgaris common in, and where is it rarely found

children, rare in mouth

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Verruca Vulgaris treatment

Liquid nitrogen
Cryotherapy
Salicylic or lactic acid (topical keratinolytic agents)

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If untreated, how long will it take for Verruca Vulgaris to resolve

2 yrs

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Extreme accumulation of compact keratin resulting in hard surface projection several millimeters in height found in Verruca Vulgaris

Cutaneous horn/Keratin horn

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Virus induced (HPV) proliferation of stratified squamous epithelium of genitalia, perianal region, mouth, larynx

condyloma accuminatum (Venereal wart)

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Condyloma acuminatum is considered what type of disease

STD

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Condyloma acuminatum age normally diagnosed

Teenagers/young adults

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Condyloma acuminatum occur orally where

labial mucosa, soft palate, lingual frenum

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Histologic indication of Condyloma acuminatum

acanthotic stratified squamous epithelium w/ cover having pynknotic nuclei surrounded by clear zone = KOILOCYTES

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Which 2 HPV are associated with Cancer

HPV 16, HPV 18. Present in urogenital condyloma acuminatum

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Hyperplastic condition of epithelium of mouth, skin, and genitalia with a characteristic accumulation of lipid-laden histiocytes beneath the epithelium

Verruciform Xanthoma

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Is Verruciform Xanthoma an HPV papilloma

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Gender, Age, race for Verruciform Xanthoma

Females
40-70
white

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What is the histology looking for when differentiating for a Verruciform Xanthoma

lipid laden histiocytes under the epithelium

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HPV 13 and HPV 32 induced localized proliferation of oral squamous epithelium

Focal Epithelial Hyperplasia

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Age Focal Epithelial Hyperplasia found

Childhood

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Clinical appearance of Focal Epithelial Hyperplasia

multiple flat or rounded papules which are clustered with normal color (not white)

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What is the hallmark histo for Focal Epithelial Hyperplasia

acanthosis

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What is acanthosis (

diffuse epidermal hyperplasia, increases thickness of stratum spinosum (and possibly bm?)

Treatment for Focal Epithelial Hyperplasia

conservative surgical for diagnosis or esthetics, but will regress spontaneously

Common skin condition of elderly representing axquired benign proliferation of epidermal basal cells, associated with chronic sun exposure.

Seborrheic Keratosis

Clinical appearance of Seborrheic Keratosis

Brown plaque that grows up and appears to be stuck on skin

What is sebhorrheic keratosis identical to when it is a small macule (early stages)

actinic lentigenes

Form of Sebhorrheic keratosis in African Americans

Dermatosis papulosa nigra

Sudden appearance of numerous seborrheic keratoses with pruritis that is associated with internal malignancy

Laser-Trelat sign

Histo feature of Seborrheic Keratosis

deep keratin filled invaginations that look cystic = horn cyst/pseudo-horn cysts

common small hyperpigmented macule of skin that represents a region of increased melanin production

Ephelis (Freckle)

What is the predilection for Ephelis

Blond and red heads

benign brown macule that results from chronic UV light damge to skin. Not seen in mouth, but common on face

Actinic Lentigo

Layman’s term for Actinic Lentigo

Age spots/liver spots

Demographics for Actinic Lentigo

Older whites >70

Does Actinic Lentigo undergo malignant transformation

diffuse hyperpigmentation of the facial skin in pregnant women

Melasma

flat brown mucosal discoloration produced by focal increase in melanin deposition and possibly concomitant increase in number of melanocytes

Oral Melanotic Macule

Is the oral melanotic macule related to the sun

Demographics for Melanotic macule

2:1 Females, can be on vermillion border

Causes/syndromes/demographics associated w/ melanin pigmentation

Racial Peutz-jaghers | Addison’s disease Neurofibromatosis Chronic trauma Smoker’s Melanosis

What drugs can cause melanin pigmentation

Chloroquine/quinine derivatives Phenolphthalein Estrogen AIDS medications

Benign acquired pigmentation characterized by dendritic macrophages dispersed throughout epitherlium

Oral Melanoacanthoma

Oral Melanoacanthoma is found exclusively in what race, common site, and age

Blacks w/ female predilection Buccal mucosa | 3rd-4th decade

Freckle like lesions of the hands, perioral skin, oral mucosa, in conjunction with intestinal polyps

Peutz-Jeghers syndrome

Treatment of Oral Melanoacanthoma

incisional biopsy to rule out melanoma but not treatment indicated

benign, localized proliferation of cells from the neural crest called nevus cells. Represent the most commonly recognized nevus

Acquired melanocytic nevus

Other name for Acquired Melanocytic Nevus

mole

Most common places to have an acquired | melanocytic nevus intraorally

Palate Gingival

Melanoma transformation risk for Acquired melanocytic nevus

1 in 1 million

White lesion that does not rub off and cannot be characterized as any other disease

Leukoplakia

What type of lesion is Leukoplakia considered

PREMALIGNANT

3 areas high risk for Leukoplakia

Floor of mouth, ventral tongue, soft palate

1/3 of oral cancers have this in close proximity

Leukoplakia

Most common oral precancer

Leukoplakia

Most common etiology for Leukoplakia

tobacco

If patient had UV radiation induced Leukoplakia, where would it appear orally

Lower lip

With Leukoplakia, which is worse: thick or thin

thick=bad

Leukoplakia that is red, representing sites in which epithelial cells are so immature or atrophic they no longer produce keratin

Eryhtroplakia

If have a mixed Leukoplakia/erythroplakia lesion, where do you biopsy

Biopsy the red

4 grades of dysplasia

Mild Moderate | Severe Carcinoma-in-situ

What is carcinoma-in-situ

entire thickness of epithelium involved. At basement membrane but not through

What must be breached to diagnose cancer

Basement membrane

What is the histology of leukoplakia

Hyperkeratosis (thickened keratin layer of surface epithelium), which can be hyperparakeratinized or hyperorthokeratinized. May or may not have thickened spinous layer (acanthosis)

What is orthokeratin versus parakeratin

Parakeratin has nuclei in top layer

``` Diffuse, gray white milky opalescent appearance of the mucosa looking folded or whitish occurring bilaterally that is diagnosed because white appearance disappears when cheek is stretched. African Americans Siversky lecture & book) 51.) Palate Gingival 52.) 1 in 1 million 53.) Leukoplakia Page 4 of 7 ```

Leukoedema

What is the malignant/premalignant risk for | Erythroplakia

)80-90%

.)Soft fissured gray white lesion of lower labial mucosa located in the area of chronic snuff placement

Tobacco pouch keratosis

What is first oral lesion get with dip versus first thing you get with chew

dip get recession, Chew get root caries

What is the Indian form of dip or chew

Betel quic

How long will tobacco pouch keratosis remain if dipping ceases

disappear in 2-6 weeks, >6 weeks biopsy

Chronic, progressive, scarring high-risk precancerous oral condition seen primarily in India du to betel quid/paan

Oral Submucous Fibrosis

Oral Submucous Fibrosis clinical appearance

Feel the fibrous bands with blotchy, marble-like pallor and progressive stiffness of subepithelial tissues. Can be brownish red

Does oral submucous fibrosis have a high malignant transformation rate

yes

Common premalignant alteration of the lower lip vermillion that results from long-term or excessive exposure to UV component of sunlight

Actinic Cheilosis (Actinic Cheilitis)

Gender predilection for Actinic Cheilosis

Males 10:1

Approximately 94% of all oral malignancies are...

Squamous Cell Carcinoma

When are white men at greatest risk for squamous cell carcinoma

>65 years old

In middle age, what race is at greatest risk for squamous cell carcinoma

Blacks

Smoking increases lung cancer, but smoking + _____ increases oral cancer

Smoking + alcohol

Most common site for intraoral carcinoma

tongue, posterior lateral and ventral surfaces most common

What human papilloma virus is associated with intraoral cancers

HPV 16

Is there a link between Herpes Type I and oral cancer

What is the most common site for Squamous Cell | Carcinoma on the floor of the mouth

Midline near frenum. Usually had a leukoplakia or | erythroplakia in the region prior

Location of 2/3 Oropharyngeal carcinomas

tonsillar area of soft palate

How stage oral cancer

``` T = size of primary tumor N= nodal involvement M = distant metastasis ```

If you see a lesion on the the lateral border of the tongue, then feel it and it is not indurated (hard), but soft, what is it likely

Normal Folliate papillae

Carcinoma lesion, frequently associated with snuff, appearing as a well demarcated, painless, thick plaque with papillary or verruciform surface projections

Verrucous Carcinoma

What leukoplakia is a risk for Verrucous Carcinoma

Proliferative Verrucous Leukoplakia

Is verrucous carcinoma more or less aggressive than squamous cell carcinoma

less aggressive

Maxillary sinus carcinomas are classified as

Squamous Cell Carcinoma

Most common skin cancer and the most common of all cancers

Basal Cell Carcinoma

Locally invasive, slowly spreading, primary epithelial malignancy that arises from the basal cell layer of the skin.

Basal Cell Carcinoma

Basal cell carcinoma is a disease of who

white adults with fair complexion

Does Basal Cell Carcinoma metastasize

Malignant neoplasm of melanocytic origin that arises from a benign melanocytic lesion

Melanoma

4 risks for melanoma

Red hair Fair skin | Blue eyes Sun

Most common from of oral melanoma

Acral lentiginous melanoma

Majority of oral melanomas are found where

hard palate or maxillary alveolu

3 most common skin cancers in order

Basal Cell Squamous Cell | Melanoma

4 melanoma types

Superficial spreading melanoma Nodular Melanoma | Lentigo Malignant melanoma Acral Lentiginous Melanoma

Most common form of melanoma found on interscapular of males and back of legs females, and has satellite nodules around primary lesion

Superficial Spreading Melanoma

Melanoma that begins almost immediately in vertical growth phase

Nodular Melanoma

Develops from precursor lesion called Lentigo maligna/Hutchinson’s freckle arising in the midface region of older adults and is a melanoma in situ in purely radial growth phase

Lentigo Malignant Melanoma

Most common form of melanoma in blacks and the overall most common form of oral melanoma

Acral Lentigerous Melanoma

ABCD of Melanoma

A = Assymetry (from uncontrolled growth B = Border (usually notched) C = Color variegation (brown, black, red, blue, none depending on amount of melanin D= diameter >6 mm (size of pencil eraser)

prognosis for oral melanoma

poor 20-45% 5 year survival

Worse prognosis areas for Melanoma

BANS Back | posterior upper Arm posterior and lateral Necki Scalp