Ch. 16 Flashcards

Question

The development of SCC is driven by...

Answer 1

accumultion of _mutations & epigenetics_ changes --\> alter expression & fxn of oncogenes & tumor suppressor genes --\> cancer hallmarks --\> cell death, increased prolif, induce angiogenesis and ability to invade/metastasize genetic alterations have molecular consistency of **tobacco carcinogen induced cancers (DNA adducts)** -freq involve p53 path & proteins responsible for squamous differntiation **p63 & NOTCH1**

Answer 2

TP63 --\> instructions for making a p63 =**TF - attaches to certain region of DNA and controls the activity of particular genes** present in leukoplakia & SCC

Answer 3

pseudohyphae - chain of budding yeast cells joined end to end at constrictions

Answer 4

dental caries! -focal demineralization of enamel & dentin by acidic metabolities of fermented sugar produced by bacteria

Answer 5

underlying systemic conditions

Answer 6

**malignancy = inversely proportional to size of gland** NO RELIABLE clinical criteria to diff btn benign and malignant - have to Bx

Answer 7

surface = ulcerate, red-purple; growth may be rapid (worry about malignancy) histologically - highly vascular proliferation of organizing granulation tissue

Answer 8

produce saliva - digestion (ptyalin/salivary amylase) - lubrication for swallowing protection (IgA, lactoferrin, lysozome)

Answer 9

health-associated streptococci --\> [poor oral hygiene, high sugar diet, salivary/immunologic/microbial factors] --\> 1. S. mutans- glucan production, biofilm formation, acid tolerant/producing 2. late colonizers - acid tolerate & producing --\> dental caries (picture also lists how to prevent!)

Answer 10

AIDs HIV (\*if pt present w/ candida and no obv cause -test for HIV!) **DM** newborns kids on **oral steriods** for asthma organ/BM transplant **pregnant** **broad spectrum ABx**

Answer 11

young/teenage females = red, ulcerated & nodular lesions of _gingiva_ complete surgical excision down to the periosteum

Answer 12

wet mount - vaginal discharge Candida vaginitis - DM women, or on OC =intense itching, thick, curdlike discharge

Answer 13

hyperkeratosis & acanthosis w/ **"balloon cells"** in upper spinous layer

Answer 14

red, velvety, eroded areas w/i oral cavity that usually remains level w/ or may be slightly depressed in relation to surrounding mucosa **less common but _more ominous bc almost always associated w/ dysplasia/carcinoma in situ_** (CIS = has not broken basal membrane yet)

Answer 15

predisposition to opportunistic oral infxn, particulary herpes virus candida kaposi sarcoma hairy leukoplakia

Answer 16

pemphigus - vesicles & bullae prone to rupture, leaving hyperemic erosions covered w/ exudates bullous pemphigoid - orally look like pemphigus lesions- _need to differentiate via histology_

Answer 17

Viridans group strep -microaerophilic also cause endocardititis --\> so life threatening!

Answer 18

SCC = 95% = 6th MC neoplasm in the world (have high rate of multiple primary tumors)

Answer 19

spotty exanthema before skin rash koplik spots = made by ulcerations on buccal mucosa about stensen duct (cough, coryza, conjunctivitis)

Answer 20

great heterongenity epithelial elements in ductal formations, acini, irregular tubules, strands or sheets mesenchymal foci of cartilage, bone, fat in myxoid stroma

Answer 21

= protein required for progression thru _G1 phase_ of cell cycle; in _G1-phase -made rapidly and accumulated in nucleus_ and is _degraded as the cell enters S-phase_ **= regulatory subunit of CDK4 & CDK6** expressed in both leukoplakia and SCC

Answer 22

virulent microorganisms with ability to damage or penetrate the epidermis/mucosal epithelium **transfer via contact (direct/indirect), resp route, fecal-oral, sex, vertical transmission, insect/arthropod vectors** infxn if virulence factros overcome host defense or if _host is compromised_

Answer 23

pain - affects daily living wt. loss/nutritional probs loss of self confidence/esteem potential life-threatening

Answer 24

pleomorphic adenoma =well demarcated mass (vary in size) benign tumor that consists of mixture of ductal (epithelial) & myoepithelal cells (histologically = mixed tumor) parotid \> submandibular \>\>\> minor RF = ionizing radiation reoccur is not completely excised invasive to acini - malignancy arise as long as they are untreated **PLAG1** gene rearrangement- overexpression

Answer 25

due to **trauma** **=cyst of sublingual gland** - usually intra-oral but can bulge out Tx: excise completely - if not may reoccur

Answer 26

ALL BENIGN!

Answer 27

= _raspberry tongue_ --\> **scarlet fever** could present w/ white coated tongue through which hyperemic papillae project (_strawberry tongue_) (group A beta hemolytic - strep pyogenes)

Answer 28

**predisposing factor: immunosuppression** histoplasma, blastomycosis, coccidiodomycosis aspergillosis cryptococcosis zygomycetes - mucor, absidia, rhizopus

Answer 29

HPV - tropism for lymphod assocaited structures of the oropharynx (including palatine & lingual tonsils) in oropharynx- HPV gains access to _basal kertinocyte progenitors via fenestrations_ in retuculated epithelium of tonsil crypts infxn of tonsillar epithelium --\> **aberrant basal cell differntiation, dysplasia, carcinoma in situ & invasive carcinoma**

Answer 30

_HSV-1_ (but HSV-2 possible) primary infxn MC in _kids 2-4_ (often asymptomatic)

Answer 31

dirty white, fibrinosuppurative, tough, inflam membrane over the tonsils & retropharynx

Answer 32

almost always _parotid_ _M \> F_ 10% multifocal & _10% bilateral_ _=smokers 8x greater risk_ _distinctive double layer of neoplastic epithelial cells resting on a dense lymphoid stroma, sometimes bearing germinal centers_

Answer 33

single ulceration w/ an erythematous halo around a yellowish fibropurulent membrane =_aphthous ulcer (canker sore)_- single/multiple shallow, hyperemic ulceration covered by thin exudate & rimmed w/ narrow zone of erythema painful, superficial oral mucosal ulceration of UNKNOWN ETIOLGY; resolves spontaneously in 7-10 days

Answer 34

aka focal fibrous hyperplasia =submucosal nodular mass of fibrous CT stroma on **bucal mucosa** along bite line or gingiva (could be sessile or pedunculated) =reactive prolif bc of trauma remove w/ complete surgical excision

Answer 35

70% OPSCC (esp of _base of tongue, tonsils, and pharynx_) = associated w/ **HPV-16** (oncogenic varient) highest risk: _35-55 yo, non-smoking, white male_ **greater survival rate than HPV-neg tumors**

Answer 36

they can regress, mature into dense fibrous masses and form peripheral ossifying fibromas -complete surgical excision is the definitive Tx

Answer 37

1. (agranulocytosis, aplastic anemia) --\> severe infxn - gingivitis, pharyngitis or tonsillitis ; may spread to neck = cellulitis (ludwig angina) 2. (see above) -similar bc neutropenia 3. leukemic infiltration & enlargement of gingivae w/ periodontitis

Answer 38

HSV 1 & 2 herpes zoster EBV (mono, nasopharyngeal carcinoma, lymphoma) CMV Enterovirus (herpangina, HFM dz, acute lymphodocular pharyngitis rubeola

Answer 39

increase risk w/ age - 20% pt \>70 yo etiology 1. due to **meds** (anticholingerics, antidepressant/antipsychotics, diuretic, antiHTN, sedative, M relaxant, analgesics, antihistamines) 2. **sjogrens syndrome** 3. **radiation therapy** **complication -** burning mouth syndrome - may also suggest HYPOfxn of PNS

Answer 40

**_HPV_**: **E6 --l p53 --\> p53 degrades** E7 --l RB HPV is integrated into host genome

Answer 41

SJS/TEN = widespread blisters predom on the trunk & face = erythematous or pruritic macules epidermal detachment

Answer 42

= _superficial_, gray-white inflam membrane made of matted organisms enmeshed in _fibrinosuppurative exudate_- **can be scraped off** to reveal underlying erythematous inflam base (remain superficial EXCEPT in compromised pt - organ/bone marrow transplant, neutropenia, chemo pt, AIDs, **DM)**

Answer 43

=disordered growth -**loss of uniformity & loss of architectural orientation** may **exhibit considerable pleomorphism** - often have hyperchromatic nuclei w/ high nuclear-to-cytoplasm ratio more abundant **mitotic figures** & seen in all layers

Answer 44

p16 = tumor supressor protein encoded by CDKN2A surrogate marker bc p16 overexpressed in HR-HPV-(+) OPSCC

Answer 45

distictive oral lesions on the lateral border of the tongue seen in immunocompromised pts caused by EBV

Answer 46

=white patches/plaques- **canNOT be scraped off** **_&_ canNOT be characterized clinically or pathologically w/ any other dz** 3% world pop **25% of lesions = premalignant**- _until proven otherwise, think of ALL leukoplakia as precancerous_

Answer 47

_=epithelial lined cyst in mandible & maxilla_ need to differentiate from other cysts becuase of its aggressive behavior seen at any age; but MC 10-40 yo Males w/i posterior mandible

Answer 48

hairy leukoplakia - white confluent pathches of "hairy", hyperkarototic thickening - usually on lateral tongue (**canNOT be wiped off**-like in Candida) \*but can have a superimposed candida infxn - contributes to "hairiness"

Answer 49

fibrous enlargement of gingiva (gingival hyperplasia) often due to poor hygiene or side effect of medications (Dilantin- anti-seizure med)

Answer 50

numerous nests & islands of malignant keratinocytes invading the underlying CT stroma and sk. M if HPV related - nonkeratinizing SCC formed by basophillic cells w/ indistinct borders & scanty cytoplasm, w/ strong expression of p16

Answer 51

osler-weber-rendu dz (aka hereditary hemorrhagic telangiectasia- HHT) -_affect **blood vessels** throughout the body - cause vascular dysplasia --\> increase tendency to bleed_ MC presentation = recurrent/severe epistaxis --\> severe anemia - need transfusions

Answer 52

tumor on ventral tongue, floor of mouth, lower lip, soft palate or gingiva **\*look under dentures\*** _premalignant lesions can be heterogenous in presentation_ & present before classic malignancy (EXCEPT HPV-SCC - no premalignant lesion) ==\> **early detection of all premalignant lesions critical for long term survival** = firm, pearly plaques that may ulcerate/protrude w/ irregular borders

Answer 53

15% of all salivary gland tumors _(MC primary malignancy)_ _60-70% occur in parotid_ balanced chromosomal translocation **(11:19)(q21;p13)** produces a fusion gene product **(MECT1-MAML2)** **prognosis dep on grade** = low grade - look normal and tend to grow/spread slowly compared to high-grade 3 diff types of cells - solid epithelial squamous, intermediate celll and mucus producing cells (see on histology w/ mucus stains & cyst like spaces w/ mucus)

Answer 54

poor oral hygiene w/ resultant change in oral flora (anaerobic/gram (-)) --\> **inflam process that affects the supporting structures of the teeth (periodontal ligaments) alveolar bone and cementum** --\> can lead to complete destruction of ligament --\> loosen and lose teeth

Answer 55

relatively uncommon **10% in MINOR salivary glands (palatine gland)= poorer prognosis** slow growing BUT unpredictable 50% _disseminate_ (bone, liver, brain) decades _after_ primary tumor _removal_ _cells = clear cytoplasm but cells someitme solid and other times vacuolated_ **pain bc grow along nerve (perineural)**

Answer 56

10-20% _acute herpetic gingivostomatitis_ = abrupt onset of diffuse oral vesicles w/ ulcerations (esp in gingiva) [also have LAD, fever, anorexia and irritability]

Answer 57

1. upper lip, teeth & submental LN --\> submandibular LN --\> SDC nodes --\>IDC nodes 2. hard palate & lateral tongue --\> submandibular LN --\> SDC nodes --\> IDC nodes 3. soft palate --\> retropharyngeal nodes --\> SDC nodes --\> IDC nodes 4. pharyngeal arches --\> SDC nodes --\> IDC nodes 5. tonsils --\> jugular diagastric nodes 6. lateral lip cross over and tip of tongue cross over --\> submental LN --\> submandibular LN or IDC nodes 7. middle of tongue cross over --\> IDC nodes

Answer 58

= fluid from vessicle on micro slide and stained w/ Wright or Giemsa stain (+) = acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes (_multinucleated polykaryons),_ or eospinophilc _intranuclear viral inclusions_ (+) in 75% of early cases (primary or recurrent)

Answer 59

reticulate, lacelike, white keratotic lesions sometimes ulcerate and rarely form bullae

Answer 60

no, most likely = reactive from pyogenic granuloma or de nova from periodontal ligament cells