Chapter 10 Epithelial Pathology Flashcards
What is this?
Heck’s disease
Multifocal epithelial hyperplasia
HPV 13, 32
Mucosal colored
No risk of malignant transformation
What is this?
Actinic cheilosis
(Actinic keratosis of the lip)
Further progression leads to ulceration and suggest transformation into SCCA
Changes are irreversible, but patients should be instructed to use lip balms with sunscreens to prevent further damage
submitted for biopsy if: Induration (firm to the touch), Thickening (leukoplakia), Ulceration
Treatment of leukoplakia
First arrive at definitive diagnosis, therefore biopsy
Long term follow up is important because recurrences are frequent
5% of leukoplakias become SCCA in 2-4 years
What is this?
Basal cell carcinoma
Most common of all cancers
80% are found in the H&N
Results from UV radiation
Most common form = nodular (noduloulcerative)
One or more telangiectatic blood vessels are typically seen
Metastasis is extremely rare
Mohs micrographic surgery - Essentially uses frozen-sections to evaluate margins during surgery
98% cure rate
Death is usually result of local invasion into vital structures
What is this?
Squamous cell papilloma
Benign proliferation of stratified squamous epithelium
Caused by human papillomavirus (HPV) (DNA viruse of the papovavirus)
Types 6, 11
Extremely low virulence and infectivity rate
Sites of predilection:Tongue, Lips, Soft palate
pedunculated
What are the BANS of melanoma?
Interscapular area of the Back
Posterior upper Arm
Posterior & lateral Neck
Scalp
Prognosis for oral melanoma is extremely poor
5-year survival is 15-20%
What is this?
Condyloma acuminatum
Venereal wart
Caused by HPV 6, 11, 16*, 18*, 31
*increased risk for malignant transformation to SCCN
Considered a sexually transmitted disease
Short, blunted surface projection
Differential diagnosis is the same as squamous papilloma
List of white lesions that can be scraped off
Materia Alba
White coated tongue
Burn (thermal, chemical, cotton roll, etc.)
Pseudomembranous candidiasis
Sloughing from toothpaste
What is this?
Oral submucous fibrosis
Linked to chronic placement of betel quid or paan
Seen primarily in the Indian subcontinent
Characterized by mucosal rigidity
First chief complaint = trismus and mucosal pain from eating spicy foods
Most commonly affected sites: Buccal mucosa, Retromolar areas, Soft palate
Lesion does NOT regress with habit cessation
10% undergo malignant transformation
What is this?
Nicotine stomatitis
Due to heat
Reverse smoking (lit end in the mouth)
More erythematous, bleeding, ulcerated
What are the 6 etiologies for leukoplakia?
Tobacco
Alcohol
Sanguinaria
UV radiation
Microorganisms
Trauma
SCCA staging
Clinical staging is a better prognostic indicator than histologic grading
TNM sysytem
Staging classifications
I - T1 N0 M0
II - T2 N0 M0
III - T3 N0 M0 or any T, N1, M0
IV - any M, T4, any N3
Clinical stage guides tx for intraoral carcinoma
Tendency toward development of multiple mucosal cancers = *field cancerization
What are all the N’s and their meanings?
N1= single ipsilateral node, 3cm or less
N2= ipsilateral or contralateral node or nodes, 6cm or less
N3= any metastasis in a node greater than 6cm
What is this?
Blue nevus
Oral lesions are almost always on the palate
Blue color is due to Tyndall effect
What is this?
Erythroplakia
True erythroplakias are never completely benign
90% show moderate dysplasia or worse on biopsy
Most common locations: Floor of mouth, Ventral tongue, Soft palate
Biopsy is mandatory for erythroplakia
What is a leukoplakia?
An intraoral white plaque that does not rub off and cannot be identified as any well known entity
Considered a premalignant lesion
Comprises 85% of oral precancer
70% are found on: Lower lip vermilion, Buccal mucosa, Gingiva
90% with dysplasia or carcinoma are found: Lower lip vermilion, Lateral/ventral tongue, Floor of mouth
What is this?
Actinic lentigo
Benign brown macule resulting from chronic UV light damage to the skin
Well-demarcated but irregular borders
No change in color intensity with UV light exposure (unlike ephelis)
SCCA metastasis
Usually through lymphatics
Ipsilateral lymph cervical nodes
Fixed-spread outside capsule
If below clavicles- liver, lungs, and bone
What are all of the T’s and their meaining?
Tis= carcinoma in situ
T1= 2cm or less
T2= >2 but <4
T3= >4
T4a= resectable no involvment of major anatomy
T4b= non resectable involement of major anatomy
What are the M’s and their meanings?
M0= not present
M1= present
What is this?
Melasma
mask of pregnancy
melanocyte stimulating hormone
No risk of malignant transformation
What is this?
Ephelis
Freckle
Increased melanin production without increase in number of melanocytes
Become more pronounced with sun exposure
What is this?
Acquired melanocytic nevus
mole
localized proliferation of cells from the neural crest
most common of all adult tumors
What is this?
Lentigo simplex
increase in number of melanocytes
color intensity does not change with sunlight
What is this?
Halo nevus
What is this? Big arrow
Verriciform Xanthoma
Characterized by lipid-laden histiocytes
Differential diagnosis is same as squamous papilloma
No risk of malignant transformation
What is this?
Squamous cell carcinoma
Oral cancer accounts for 3% of cancers
Contributors: tobacco, alcohol, betel quid, phenolic, radiation, iron deficiency, Vit-A deficiency, oncogenic viruses, immunosuppression, oncogenes, tumor suppressor genes.
Most common site is the tongue, Posterior lateral, Ventral
Second most common site: floor of mouth
Third: soft palate
Fourth: Gingiva
Of all intraoral SCCA, it is least associated with tobacco use and is more common in females
What is this?
Dermatosis Papulsa Nigra
occurs in 30% of African Americans
AD inheritance
Found scattered around the zygomatic and periorbital region
What is this?
Melanoma
ABCDE’s
Acute sun exposure is significant
2-8x with family hx
3rd most common skin cancer but account for the most deaths
Radical and veritcal growth
Ulceration is an adverse prognostic indicator for cutaneous melanomas
Excision 3-5 cm margin
What is this?
Erythroleukoplakia
What is this?
Verruca vulgaris
Caused by HPV: 2, 4, 6, 40
Contagious
Oral lesions are almost always white
Maximum size is about 5 mm
Differential diagnosis is same as squamous papilloma
No chance of malignant transformation
What is the differential diagnosis for squamous cell papilloma?
Verruca vulgaris
Condyloma acuminatum
Verruciform xanthoma (Lipid laden macrophages)
What is the TNM system
T=size of primary local tumor in centimeters
N=Involvment of local lymph nodes
M=distant metastasis
What is this?
Tobacco pouch keratosis
Gingival recession may be accompanied by destruction of facial surface of alveolar bone
A brown-black extrinsic tobacco stain on the teeth is common
Halitosis
Appears fissured or rippled
A lesion remaining 6 weeks after habit is stopped requires biopsy
What is this?
SCCA oropharyngeal
pt is usually unaware of its presence
Therefore when it is discovered, there are more likely to be metastasis
80% of posterior oropharyngeal wall lesions have metastasized or extensively involved surrounding structures at the time of diagnosis
What is this?
Molluscum Contagiosum
DNA poxvirus
Contains molluscum bodies, aka Henderson-Paterson bodies
Spontaneous remission occurs in 9 months
What is this?
Verrucous carcinoma
Most common sites of involvement: Mandibular vestibule, Gingiva
Has a “deceptively benign” microscopic appearance
Adequate sampling is important because up to 20% have an SCCA developing within the verrucous carcinoma
What is this?
Actinic keratosis
Common cutaneous premalignant lesion
Caused by cumulative UV radiation
Keratotic scale peels off but will recur
10% of actinic keratoses will progress to SCCA in 2 years
What is the order of cancer risk with the plakias?
Least to most
Leukoplakis, erythroleukoplakia, erythroplakia, and proliferative verrucous leukoplakia
What are the three types of sinonasal papillomas?
Fungiform, Inverted and Cylindrical Cell
What is this?
Seborrheic Keratosis
looks like a raisin on the skin
Does not occur in the mouth
Sudden appearance of numerous seborrheic keratoses with pruritus has been associated with internal malignancy - Called Leser-Trélat sign
What are the different types of dysplasia and what do they mean?
Mild dysplasia-alterations are limited to the lower 1/3
Moderate dysplasia-alterations are limited to the lower ½
Severe dysplasia-alterations are present above the lower ½
Carcinoma in situ-alterations are present throughout epithelium
What is this?
Oral melanoacanthoma
Acquired pigmentation of the oral mucosa
Appears to be a reactive process due to trauma
Buccal mucosa is the most common site of occurrence
Lesions increase rapidly in size
Incisional biopsy is indicated to rule out melanoma
What is this?
Congenital melanocytic nevus
Birth mark
hypertrichosis (excess hair)
What is this?
Oral melanotic macule
Oral counterpart to the ephelis
Most common site = vermilion zone of the lower lip (labial melanotic macule)
No malignant transformation potential but cannot distinguish clinically from early melanoma; therefore, biopsy is mandatory
