Chapter 13 Flashcards
Anemia
Decrease in volume of RBC or in the concentration of hemoglobin
Often a sign of an underlying disease: (renal failure, liver disease, chronic inflmmatory conditions, malignancies, vitamin or mineral deficiencies)
Symptoms relate to reduced oxygen:
Tiredness
Headache
Fainting/feeling lightheaded
Pallor
Anemia Oral Symptoms
Pallor of mucosa
Bald tongue (tongue atropy)
Burning (glossopyrosis)
Pain localized to the tongue (glossodynia)
Tongue (PAPILLA) atropy
“bald tongue”
Oral symptom: Anemia
Glossopyrosis
Burning of the tongue
Sign of anemia
Glossodynia
Pain localized to the tongue
sign of anemia
Thrombocytopenia
Markedly decreased number of circulating blood PLATELETS
Results in abnormal bleeding – blood cannot clot. (be careful during when considering surgery)
Normal Platelet: 200,000 - 400,000 mm^3
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Condition is often initially detected due ORAL LESION__S
**Petechiae, Purpura, Ecchymosis**
Spontaneous gingival hemorrhage
Bleeding from minor sites of trauma
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Two types: Thrombotic thrombocytopenia purpura (TTP)
Idiopathic thrombocytopenia purpura (ITP)
Thrombocytopenia Oral lesion
Petechia, Purpura, Ecchymosis
Spontaneous gingival hemorrhage
Bleeding from minor sites of trauma
** Difficulty blood clotting**
Two types of thrombocytopenia
Thrombotic thrombocytopenia purpura
Idiopathic thrombocytopenia purpura
Thrombotic thromboctopenia purpura (TTP)
Serious disorder
May be due to endothelial damage
Worse thrombocytopenia of the two types
Idiopathic Thrombocytopenic Purpura (ITP)
Childhood
Due to viral infection
Lymphoid Hyperplasia
Enlargement of lymphoid tissue
May affect:
Lymph nodes,
waldeyer’s ring,
or aggregates of lymphoid tissues scattered throughout the oral cavity (tongue).
Aggregates of lymphoid tissue commonly seen:
Oropharynx
Soft palate
Lateral tongue - posterior (usually bilateral)
FOM
Appears: enlarged, tender (acute infection), nontender (chronic infection, oral) soft, freely movable nodules, usually yellow, submucous swelling
If Large tonsils are symmetric and asymptomatic –> normal for that patient
Biopsy usually necessary to establish diagnosis – no treatment needed
Agranulocytosis
Without granulocytes – usually neutrophils
Most induced by drugs (anticancer drug)
Associated with bacterial infections - because neutrophils are FIRST line of host defense
Oral symptoms: Necrotizing, deep, punched out ulcerations of the buccal mucosa, tongue, and palate
Oral symptoms of Agranulocytosis
Necrotizing, Deep, punched out ulcerations of buccal mucosa, tongue and palate
May look similar to NUG
Neutropenia
Decrease in # of circulating neutrophils
Associated with bacterial infection – neutrophils are first host defense
“Agranulocytosis”
Lymphopenia
Decrease in lymphocytes (immunosuppression)
Results in VIRAL and FUNGAL infections
“agranulocytosis”
Leukemia
Types of malignances of HEMATOPOIETIC stem cell derivation
** malignant transformation of a stem cell that proliferates in bone marrow and overflows into peripheral blood **
Classifications (4):
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphoblastic leukemia
Chronic lymphoblastic leukemia
Clinical Signs: reduction in RBCs and WBCs
Decrease oxygen carrying capacity – fatigue
Bruise easily due to platelet count
Myeloid –>
Lymphoid –>
Myeloid –> Thrombocytes, RBC, Mast cells, Granulocytes (neutrophils, basophils, monocytes, eiosinophils)
Lymphoid –> T cells and B cells
Acute Leukemia –>
Chronic Leukemia –>
Acute –> Aggressive course, death in few months if untreated
Chronic –> indolent course, death eventually comes
Chronic Myeloid Leukemia
Translocation of chromosomal material (9 and 22) –> Philadelphia Chromosome
commonly occurs in ADULTHOOD
Acute Lymphoblastic Leukemia
common in CHILDHOOD malignancies
Oral manifestation of Leukemia
Leukemic cells infiltrate the oral soft tissues
Boggy
Non-tender swelling
“Granulocytic sarcoma“
Differential for punched out papilla
NUG
Agranulocytosis
Oral manifestation of LEUKEMIA
Diffuse swelling and dicoloration.
Upon palpation will feel BOGGY
May look similar to Kaposi’s sarcoma but is generalized
Langerhans Cells Histiocytosis
Bone lesions are MOST COMMON PRESENTATION
Lesion found most commonly in –> Skull, rib, vertebrae, mandible
Symptoms: Pain and tenderness
X-ray:
Sharply demarcated “punched out” radiolucencies (occasionally ill defined)
Mandibular lesion –> “scooped out”, due to superficial alveolar bone loss
Resembles sever periodontitis - teeth “floating”
Treatment: Currettage or low dose radiation
Prognosis: bone– good, visceral involvment – poor
Langerhans Cell Histiocytoma X-ray
Sharply demarcated “punched out” radiolucencies
(may be ill-defined)
Mandibular lesions–> scooped out, loss of superfical alveolar bone
Resembles severe periodontitis – teeth “floating”
Raised lesion on the gingiva
Malignancy vs 3Ps and IFH
Malignancy –> radiographic bone loss
3Ps and IFH –> NO radiographic bone loss
Langerhans Cell Histiocytoma Histology
Necessary for diagnosis.
Langherhans cell contain rod shaped cytoplasmic structure –> BIRBECK GRANULES
Coffee bean, pac man, eosinophil filtration
Birbeck Granules
Rod cytoplasmic structures of langerhans
Help determine histologically of langerhans cell histiocytoma
How to diagnos Langerhans Cell Histiocytoma
Birbeck granules in electromicroscopy
Langerhans Cell Xray
Sharply demarcated radiolucency –> PUNCHED OUT
May be ill defined (not symmetrically shaped)
Mandibular: scooped out, loss of superficial alveolar bone
Resembles severe periodontitis
Hodgkin’s Lymphoma
Malignant lymphoproliferative disorder – lymphocytes
neoplastic cells–> _REED - STERNBERG cell_s
Linked to the EPSTEIN BARR VIRUS (EBV)
Begins in the lymph nodes - ANY node is susceptible
* majority occur in the cervical and supraclaviular nodes – anterior to SCM *
SIGN: nontender, discrete mass or masses in lymph node region. Enlarging.
early lesion are MOVEABLE - late lesion are FIXED
Two types: Classical and Nodular lymphocyte (predominant)
Diagnostic of Hodgkin’s Lymphoma
Reed-Sternberg Cells
What diseases are associated with EBV?
Hodgkin’s lymphoma
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Mono
Hairy oral leukoplakia (AIDS patients)
Two types of Hodgkin’s Lymphoma
Nodular lymphocyte (predominant)
Classical
Non-Hodgkin’s Lymphoma
AKA – lymphoma
Predominantly –> B-lymphocyte origin
Arises in lymph nodes and grows as large masses -> diseminates into other tissue (ORAL CAVITY)
Occrus primarily in ADULTS
Presentation: Nontender mass, SLOW growth
More numerous and FIXED - as malignancy progresses
Commonly found ORALLY –> soft tissues and jaw
* _Most common type –> LARGE B CELL LYMPHOMA (DLBCL) *_
Radiograph: Ill-defined and ragged radiolucent (typical for malignant lesions)
What is the predominant cell type in Non-Hodgkin’s Lymphoma
B cell lymphocyte
Fixed nodues because….
Tumor violates the capsule and infiltrates the adjacent tissue
Intraoral SOFT TISSUE lesions in Non-Hodgkin’s Lymphoma
Nontender
Diffuse swellings
Affects: Posterior HARD palate, Gingiva, Buccal vestibule
Swellings are characteristically BOGGY
Erythematous or purple
** Patients may complain of denture fitting too tightly**
** May look similar to salivary neoplasm until palpated **
most commonly –> DIFFUSE LARGE B CELL LYMPHOMA
Boggy on palpation
Non-Hodgkin’s Lymphoma
Intraoral: most likely –> Diffuse large B cell lymphoma
Presence of Reed-Sternberg Cells
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma in BONE (jaw)
Causes vague pain or discomfort –> may be mistaken as a toothache
May have parashtesia - mn lesion (Numb Chin Syndrome)
Xrays: Ill defined or ragged radiolucencey (typical of malignant lesion)
X ray manifestation of Non-Hodgkin’s Lymphoma
Ill defined
Ragged radiolucency
Mycosis Fungoides
Resembles a fungal infection – T CELL LYMPHOMA
**Most common CUTANEOUS lymphoma**
Three stages: Eczematous, Plaque, Tumor
Sezary Syndrome
Histology:
Epidermotropism –> atypcial lymphocytic cells infiltrate surface epithelium
Mycosis cells or Sezary cells (atypical lymphocytes)
Pautrier’s Microabscess – collection of atypical lymphocytes (malignant T cells)
No treatment! Disease is not curable.
Once progressed beyond cutaneous – patient dies within a year
Sezary Syndrome
Aggressive expresion of mycosis fungoides
DERMATOPATHIC T cell leukemia
Histology of Sezary syndrome and Mycosis fungoides
Epidermotropism - malignant T cells infiltrate surface epithelium
Mycosis cells or Sezary cells - malignant T cells
Pautrier’s Microabscesses - malignant T cells collect in intraepithelial aggregates
Epidermotropism
Atypcial lymphocytic cells (malignant T cells) infiltrate surface epithelium
Histology of Mycosis Fungoides or Sezary syndrome
Pautrier’s Microabscesses
Atypical lymphocytes (malignant T cells) form intraepiehtlial aggregates
Histology of Mycosis Fungoides and Sezary syndrome
Burkitt’s Lymphoma
Malignancey of B CELLS
(African american children)
Predilection for JAW
_** Posterior jaw > Anterior jaw**_ (Maxilla > Mandible)
Associated with EBV
Growth of tumor –> facial swelling and proptosis (bulging eyes)
Xray: Radioluscent destruction of bone – RAGGED and ill defined margins
Begin as several smaller sites and enlarge and coalesce
Patchy loss of lamina dura (early sign)
Histology: Starry Sky Pattern - macrophages in tumor tissue
Treatment: intensive chemo (will succum to disease in 6 months if not treated)
Burkitt’s Lymphoma malignant cells?
B cell origin
X ray features of Burkitt’s Lymphoma
Radiolucent destruction of bone – ragged and ill defined margins
Begin as smaller sites – enlarge and coalesce
Patchy loss of lamina dura (early sign)
Consistent with malignant lesion
Burkitt’s Lymphoma
Enlarged mass of jaw
Proptosis (bulging eyes)
Histology of Burkitt’s Lymphoma
Starry Sky Pattern
Macrophages within tumor tissue
** Large number of B cells with a few white macrophages **
NK/T Cell lymphoma
Angiocentric T cell Lymphoma
( Malignant cells center around blood vessels)
**may crush blood vessels - killing blood supply to tissue. Leads to necrosis**
ADULTS
Aggressive
Nonrelenting destruction of midline structures – PALATE and NASAL PROCESS
* Swelling of palate
* Formation of deep necrotic ulceration
* Ulceration enlarges – destroys palatal tissues
Without treatement – die of secondary infections
Treate with RADIATION
Differential:
Cocain addiction
Syphillis (gumma)
TB - scrofula
NK/T cell lymphoma
Multiple Myeloma
Malignancy of PLASMA CELL ORIGIN
Multiple lesions in the bone – SWELLING OF PLASMA CELLS
(accounts for 50% of malignancies minus metastatic disease)
Most common hematologic malignancy of African Americans
Uncontrolled mitotic division
X rays: Well defined “punched out” radiolucencies
Ragged radiolucent lecions (sometimes)
Evident in skull film
Histology & Diagnosis –> Bence Jones Proteins (may cause renal failure)
Typically on bisphosphonates – reduce fractures
What is the most common hematologic malignancy of African Americans?
Multiple Myeloma
Malignant cells of mutliple myeloma
PLASMA CELLS
X ray features of MUTLIPLE MYELOMA
Multiple – well defined punced out radiolucencies
(may be ragged lesions)
Especially evident in the SKULL
Diagnosis of multiple myeloma
Bence Jones Proteins
May cuase renal failure
Plasmacytoma
Multiple myeloma –> progresses to plasmacytoma
Unifocal monoclonal neoplastic proliferation of plasma cells
Typciall arises in bone
