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Neville and Damm > Ch10 Epithelial > Flashcards

Ch10 Epithelial Flashcards

1
Q

What type of virus is HPV? (RNA? DNA? DS? SS?) oral HPV infection is present in approximately __ to __% of normal, healthy individuals.

A

Double stranded DNA virus….5-12%

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2
Q

Oral HPV infection is prevelent in children under what age?

A

1 year

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3
Q

What is the bimodal age range for oral HPV infection?

A

30-34 yrs and 60-64 years

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4
Q

What is the range of incubation for benign HPV disease?

A

3 weeks to 2 years

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5
Q

When HPV stays in a basal cell of the epithelium, what is the name of its circular form?

A

episomal

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6
Q

What are the 4 high risk HPV strands?

A

16,18,31,33

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7
Q

What are the 2 low risk HPV strands?

A

6,11

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8
Q

What HPV strands are vaccinated against in the bivalent (Carvarix) vaccine?

A

16,18

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9
Q

What HPV strands are vaccinated against in the quadravalent (Guardasil)?

A

6,11,16,18

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10
Q

What are the two HPV strands most associated with oral squamous papillomas?

A

6,11

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11
Q

What are the two HPV strands most associated with recurrent respiratory papillomatosis?

A

6,11

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12
Q

What are the two HPV strands most associated with Focal Epithelial Hyperplasia

A

13,32

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13
Q

What HPV strand is most associated with oropharyngeal SCC?

A

16

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14
Q

What HPV strand is most associated with verruca vulgaris? What are two main histological features that help distinguish a VV from a squamous papilloma?

A

HPV strand 2

VV = “cupping” (converging) effect” of the rete ridges

VV= prominent granular cell layer

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15
Q

What HPV strands are most associated with condyloma acuminatum (genital warts)?

A

6,11

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16
Q

What 6 HPV strands are most associated with intraepithelial neoplasia?

A

6,11,16,18,31,33

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17
Q

What at HPV strands are most associated with cervical SCC?

A

16,18

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18
Q

What is the MOST COMMON soft tissue mass arising from the soft palate?

A

Papilloma

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19
Q

What 5 syndromes have multiple papillomas (papillomatosis) associated with them?

A
  1. nevus unius lateris, 2. acanthosis nigricans, 3. focal dermal hypoplasia (Goltz-Gorlin) syndrome, 4. Down syndrome 5. Recurrent Respiratory Papillomatosis
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20
Q

What is the recurrence for papillomas?

A

“unlikely”

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21
Q

Which HPV strain is known for exceptionally aggressive behavior in benign papillomas?

A

11

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22
Q

What % of verrucae resolve on their own within 2 years?

A

2/3

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23
Q

What % of condyloma acuminatum are caused by HPV 6,11? Can they be co-infected?

A

90%..yes, 6 and 11 can be coinfected with 16/18 etc

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24
Q

What is the incubation period for condyloma acuminatum?

A

1-3 months

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25
Q

What distinguishes an oral condyloma acuminatum from a squamous papilloma?

1 clinical feature

2 histological features

A

Clinical: CA tend to be double the size of a SP

Histo: CA papillary projections are MORE BLUNTED and BROADER than SP or VV

CA tend to have less koilocytosis than SP or VV

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26
Q

Anogenital condylomata infected with _______ are associated with an increased risk for malignant transformation to squamous cell carcinoma, but such transformation has not been demonstrated in oral lesions

A

HPV 16 or 18

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27
Q

Fungiform sinonasal papilloma usually arises where? Gender predilection? Recurrence?

A

nasal septum…2:1 male to female…20-30% (pretty high!)

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28
Q

sinonasal papillomas location?

A

majority on lateral wall of nasal cavity…however - fungiform are mostly found on the nasal septum

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29
Q

basophilic viral inclusions in molluscum contagiosum

A

Henderson-Paterson bodies

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30
Q

What are the 2 variants of Heck Dz? Which one is more common?

What is the characteristic histo feature in multifocal epithelial hyperplasia (Heck Dz)?

A
  1. Papulonodular (more common - buccal/labial mucosa)
  2. Papillomatous (less common - gingiva/tongue)

Mitosoid cell

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31
Q

form of SebK in blacks

A

Dermatosis papulosa nigra

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32
Q

sudden appearance of many SebKs with pruritus= a sign of internal malignancy

A

Leser-Trelat sign

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33
Q

irritated SebK is AKA

A

Inverted follicular keratosis of Helwig

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34
Q

description of sebaceous hyperplasia in the oral cavity

A

“Cauliflower appearance”

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35
Q

freckle (no increase in # of melanocytes) is AKA

A

Ephelis

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36
Q

Nevus cells are derived from _______ origin

A

neural crest

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37
Q

superficial nevus cells in small round aggregates

A

Theques

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38
Q

solitary or coalescent eosinophilic globules within the epidermis or at the epidermal dermal junction in spitz nevus

A

Kamino bodies

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39
Q

creates the blue color of a blue nevus- interaction of light with particles in colloidal suspension

A

Tyndall effect

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40
Q

Epithelial dysplasia is found in up to ____% of oral leukoplakias

A

25%

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41
Q

Malignant transformation rate for mild dysplasia?

A

<5%

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42
Q

Malignant transformation rate for moderate dysplasia?

A

up to 11%

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43
Q

Malignant transformation rate for severe dysplasia?

A

up to 46%

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44
Q

tobacco pouch keratosis - 3 histologic features

A
  1. Intracellular vacuolization 2.parakeratin chevrons 3. amorphous eosinophilic material in subjacent CT
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45
Q

generalized oral burning is aka and is seen in WHAT condition?

A

Stomatopyrosis…oral submucous fibrosis

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46
Q

Bowenoid actinic keratosis is histologically equivalent to:

A

full thickness dysplasia

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47
Q

Characteristic acute angle formed between the normal adjacent epithelium and a KA on histology

A

“Buttress”

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48
Q

4x increased risk of DORSAL tongue carcinoma in ________ patients

A

tertiary syphilis

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49
Q

Tongue carcinomas account for __% of intraoral cancers

A

50%

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50
Q

Old name for PVL

A

oral florid papillomatosis

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51
Q

Parakeratin on the surface of verrucous carcinoma

A

“Parakeratin clefts”

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52
Q

Spindle cell carcinoma presents as a ________ polypoid mass

A

pedunculated

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53
Q

Adenosquamous carcinoma may just be high grade _________

A

mucoepidermoid carcinoma

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54
Q

Which sinus is the most common site for carcinoma of the paranasal sinuses?

A

Maxillary

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55
Q

“SNUC” = _______….. The cell of origin may be the ________ membrane or olfactory epithelium

A

sinonasal undifferentiated carcinoma….schneiderian

56
Q

Nasopharyngeal carcinoma is most common in what geographic region and gender? What virus is a risk factor? Where is the PRIMARY lesion usually located?

A

southern Chinese men…EBV…lateral nasopharyngeal wall

57
Q

Old name for nasopharyngeal carcinoma =

A

lymphoepithelioma

58
Q

3 histologic types of nasopharyngeal carcinoma

A
  1. Keratinizing SCC 2. Differentiated nonkeratinizing carcinoma (EBV associated) 3. Undifferentiated non keratinizing carcinoma (EBV associated)
59
Q

Most common of all cancers =

A

BCC

60
Q

Intraoral BCC may look like _________…… The _______ surface protein expressed in cutaneous BCC helps differentiate

A

peripheral ameloblastoma…. Ber-EP4

61
Q

Cell of origin for merkel cell carcinoma = Pluripotent ______ or ______ stem cells

A

epidermal or dermal

62
Q

AEIOU of Merkel cell carcinoma

A

Asymptomatic, rapidly Enlarging, Immunosuppression, Old age, UV exposure

63
Q

HPV type: recurrent respiratory papillomatosis

A

6/11

64
Q

HPV type: verruca vulgaris

A

2

65
Q

HPV type: condyloma accumenatum

A

6/11 (also sometimes high risk 16/18)

66
Q

HPV type: multifocal epithelial hyperplasia

A

13/32

67
Q

HPV type: Fungiform type of sinonasal papillomas

A

6/11

68
Q

HPV type: some inverted sinonasal papillomas

A

6/11, 16/18

69
Q

What are the 5 conditions with multifocal squamous papillomas (papillomatosis)

A
  1. Nevus unius lateris 2. Acanthosis nigricans 3. Focal dermal hypoplasia (Goltz-Gorlin) syndrome 4. Down syndrome 5. Recurrent respiratory papillomatosis (HPV 6/11)
70
Q

Patients with Darier disease and atopic dermatitis are at risk for a severe or prolonged form of which infection?

A

molluscum contageosum

71
Q

What are the 3 components of Muir-Torre syndrome?

A
  1. Visceral malignancies 2. Sebaceous adenomas / carcinomas 3. Keratoacanthomas
72
Q

Lentigo simplex is found in what 3 conditions?

A
  1. lentiginosis profusa 2. Peutz-Jeghers syndrome 3. LEOPARD
73
Q

What is the rare, potentially fatal congenital syndrome with multiple congenital nevi, melanotic neoplasms of the CNS, leptomenengial melanosis and melanomas?

A

Neurocutaneous melanosis

74
Q

What 3 conditions are more susceptible to actinic cheilosis?

A
  1. xeroderma pigmentosum 2. Albinism 3. Porphyria cutanea tarda
75
Q

What 2 conditions show EARLY ONSET of KAs?

A

Ferguson-Smith syndrome, Witten-Zak Syndrome

76
Q

What condition is associated with late onset of KAs?

A

Grzybowski syndrome (hundreds to thousands of KAs on skin and aerodigestive tract

77
Q

What 2 iron def syndromes increase susceptability to SCC?

A

Plummer-Vinson Syndrome, Paterson-Kelly Syndrome

78
Q

What are the 7 conditions associated with BCCs?

A
  1. NBCCS 2.Xeroderma pigmentosum 3.Albinism 4. Rasmussen syndrome 5.Rombo Syndrome 6.Bazex-Christol-Durpe Syndrome 7.Dowling-Meara subtype of Epidermolysis Bullosa Simplex
79
Q

Familial Hecks Disease is related to which allele?

A

HLA-DR4 allele

80
Q

Which variant of Heck’s is more common?

A

Papulonodular (pink, smooth surface)…the less common = papillomatous (white, pebbly)

81
Q

What is the histo buzzword for the rete ridges in Heck’s disease?

A

“club shaped”

82
Q

Inverted papilloma: proteins increased?

A

p63, p21

83
Q

Inverted papilloma: decreased ____ (cell adhesion)

A

CD44

84
Q

Inverted papilloma: Presence of HPV ___ and ___

A

16 and 18

85
Q

Inverted papilloma: what % have malignant trans

A

up to 24%

86
Q

What is the clinical feature of a CYLINDRICAL cell papilloma?

A

BEEFY-RED or brown mass

87
Q

What causes Molluscum?

A

DNA poxvirus called MCV (molluscum contagiosum virus)

88
Q

VX: gene mutation (somatic)

A

3BHSD

89
Q

What stain is positive in VX?

A

PAS-D

90
Q

What are the two somatic mutations in SebK?

A

FGFR3 and PIK3CA

91
Q

What inheritance for dermatosis papulosa nigra (periorbital / zygomatic papules)…up to 77% blacks affected

A

AD

92
Q

What is the gene variation of an ephelis?

A

MC1R

93
Q

Genetic alterations for actinic lentigo?

A

PIK3CA and FGFR3

94
Q

How is lentigo simplex differentiated from a melanocytic nevus?

A

Nevus = BRAF mutation

95
Q

What does LEOPARD stand for?

A

Lentigines, ECG abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnromalities of genitalia, Retarded growth, Deafness

96
Q

Melasma is AKA:

A

mask of pregnancy

97
Q

Gender predilection for melanoacanthoma?

A

female

98
Q

80% of aquired melanocytic nevi have what genetic mutation?

A

BRAF

99
Q

BRAF is a proto oncogene that encodes serine/threonine kinase involved in the ______ pathway

A

MAPK

100
Q

Aquired nevus = maturation pattern…superficial cells arranged in ______ (nested), further down they resemble _______, and deepest more ______ shaped

A

theques….lymphocytes…elongated/spindle

101
Q

Aquired nevi start ______ and then move to ______

A

the epithelium (junctional)….then move to the mucosa/dermis (compound –> intradermal/intramucosal)

102
Q

Congenital nevi harbor _____ mutations

A

NRAS

103
Q

What is the malignant transformation rate of a congenital nevus?

A

2-3%

104
Q

What are the two other names for a Halo nevus?

A

Sutton nevus, leukoderma acquisitum centrifugum (fucking evil name)

105
Q

Genetic mutation in Spitz nevus?

A

HRAS

106
Q

Other names for Spitz nevus?

A

benign juvenile melanoma (wtf?!), spindle and epitheloid cell nevus

107
Q

What age do Spitz nevi show up in?

A

children

108
Q

Genetic mutation in a blue nevus?

A

GNAQ

109
Q

Two alternate names for Blue nevus?

A

dermal melanocytoma, Jadassohn-Tieche nevus

110
Q

What is the most common intraoral melanocytic? 2nd?

A
  1. ? maybe intramucosal nevus? 2.Blue nevus
111
Q

The __________ is probably the most common of all human “tumors,” with an average of 10 to 40 cutaneous nevi per white adult.

A

acquired melanocytic nevus

112
Q

Which KA syndrome occurs in patients of Scottish decent?

A

Ferguson-Smith

113
Q

Where does the SCC go? Lower lip and floor of mouth?

A

submental nodes

114
Q

Where does the SCC go? Posterior mouth

A

superior juggular and digastric

115
Q

Where does the SCC go? oropharynx

A

jugulodigastric or retropharngeal

116
Q

In adenosquamous carcinoma what do both components stain positive for?

A

HMCK

117
Q

SNUC is positive for which 2 stains?

A

CK and EMA

118
Q

What gene is associated with NBCCS? (you better get this)

A

PTCH

119
Q

What is the virus found in 80% of merkel cell carcinomas?

A

MCPYV (merkel cell PolYoma virus)

120
Q

What is the most common melanoma genetic abnormality? What about MUCOSAL melanomas?

A

BRAF (50%)….mucosal = KIT

121
Q

What is the most common histo form of melanoma?

A

superficial spreading (70%)

122
Q

What are two alternate terms for a lentigo maligna?

A

Hutchinson freckel or melanoma in situ

123
Q

What is the most common oral form of melanoma?

A

acral lentigenous melanoma

124
Q

What % of oral melanomas are Amelanotic?

A

10%

125
Q

What is the alternate name for a pilomatrixoma?

A

Calcifyed Epithelioma of Malherbe

126
Q

What are the three types of sinonasal papillomas?

A
  1. Fungiform (almost always on nasal septum, 65% HPV related, minimal malignant potential)
  2. Inverted (most common, greatest potential for malignant transformation (3-24% SCC), 38% HPV related, lateral nasal wall)
  3. Cylindrical cell (least common, lateral nasal wall, 23% HPV related)
127
Q

Inverted sinonasal papilloma: gender?

A

3:1 to 5:1 MALE

128
Q

What are 3 proto-oncogenes associated with Oral SCC?

What are 3 tumor suppressor genes associated with oral SCC?

A

Oncogenes:

  1. Ras
  2. Myc
  3. EGFR

Tumor suppressors:

  1. p53
  2. pRB
  3. p16
  4. E-cadherin
129
Q

Head and neck squamous cell carcinomas associated with tobacco and alcohol use often exhibit ______TP53, pRb _______, and ________ p16 expression

A

mutated TP53, pRb overexpression, and decreased p16 expression

130
Q

HPV-associated HNSCC cases typically express _______ TP53, _________ of pRb, and _________ levels of p16.

A

HPV-associated HNSCC cases typically express wild-type TP53, low levels of pRb, and increased levels of p16.

131
Q

What is the gold standard for determining active HPV causing oropharyngeal carcinoma?

A

high-risk HPV E6 and E7 oncogene expression analysis by qRT-PCR (needs fresh frozen tissue)

p16 IHC is more widely available and is a highly sensative (not specific) surrogate for transcriptionally active, high-risk HPV infection in oropharyngeal SCCs

132
Q

What is the molecular basis for using p16 as a surrogate marker in HPV+ SCC?

A

overexpression of p16 results from inactivation of pRB which is a result of the HPV E7 oncogene

E7 –> blocks pRB —> overexpresses p16

133
Q

How does HPV 16 ISH compare to using p16 IHC for detection of HPV+ SCC?

A

ISH exhibits strong agreement with p16 immunohistochemistry, although it may fail to detect
the minority of oropharyngeal tumors caused by other HPV types

134
Q

What is the best prognostic indicator for lip and oral SCC?

What are the 3 best prognostic indicators for oralpharyngeal SCC?

A

lip/oral: tumor stage

oropharyngeal: HPV status, then tobacco, then stage

135
Q

conventional squamous cell carcinoma develops concurrently within up to ____% of verrucous carcinomas.

A

20%

136
Q

Approximately ___% of verrucous carcinoma patients are disease free 5 years after surgery

A

90%

Neville and Damm (72 decks)

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