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Oral Pathology > Chapter 13 > Flashcards

Chapter 13 Flashcards

1
Q

Anemia

A

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

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2
Q

Anemia Oral Symptoms

A

Pallor of mucosa

Bald tongue (tongue atropy)

Burning (glossopyrosis)

Pain localized to the tongue (glossodynia)

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3
Q
A

Tongue (PAPILLA) atropy

“bald tongue”

Oral symptom: Anemia

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4
Q

Glossopyrosis

A

Burning of the tongue

Sign of anemia

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5
Q

Glossodynia

A

Pain localized to the tongue

sign of anemia

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6
Q

Thrombocytopenia

A

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

__________________________________________________________________

Condition is often initially detected due ORAL LESION__S

**Petechiae, Purpura, Ecchymosis**

Spontaneous gingival hemorrhage

Bleeding from minor sites of trauma

_______________________________________________________________

Two types: Thrombotic thrombocytopenia purpura (TTP)

Idiopathic thrombocytopenia purpura (ITP)

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7
Q

Thrombocytopenia Oral lesion

A

Petechia, Purpura, Ecchymosis

Spontaneous gingival hemorrhage

Bleeding from minor sites of trauma

** Difficulty blood clotting**

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8
Q

Two types of thrombocytopenia

A

Thrombotic thrombocytopenia purpura

Idiopathic thrombocytopenia purpura

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9
Q

Thrombotic thromboctopenia purpura (TTP)

A

Serious disorder

May be due to endothelial damage

Worse thrombocytopenia of the two types

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10
Q

Idiopathic Thrombocytopenic Purpura (ITP)

A

Childhood

Due to viral infection

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11
Q
A

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

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12
Q
A
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13
Q

Agranulocytosis

A

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

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14
Q

Oral symptoms of Agranulocytosis

A

Necrotizing, Deep, punched out ulcerations of buccal mucosa, tongue and palate

May look similar to NUG

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15
Q

Neutropenia

A

Decrease in # of circulating neutrophils

Associated with bacterial infection – neutrophils are first host defense

“Agranulocytosis”

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16
Q

Lymphopenia

A

Decrease in lymphocytes (immunosuppression)

Results in VIRAL and FUNGAL infections

“agranulocytosis”

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17
Q

Leukemia

A

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

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18
Q

Myeloid –>

Lymphoid –>

A

Myeloid –> Thrombocytes, RBC, Mast cells, Granulocytes (neutrophils, basophils, monocytes, eiosinophils)

Lymphoid –> T cells and B cells

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19
Q

Acute Leukemia –>

Chronic Leukemia –>

A

Acute –> Aggressive course, death in few months if untreated

Chronic –> indolent course, death eventually comes

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20
Q

Chronic Myeloid Leukemia

A

Translocation of chromosomal material (9 and 22) –> Philadelphia Chromosome

commonly occurs in ADULTHOOD

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21
Q

Acute Lymphoblastic Leukemia

A

common in CHILDHOOD malignancies

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22
Q

Oral manifestation of Leukemia

A

Leukemic cells infiltrate the oral soft tissues

Boggy

Non-tender swelling

“Granulocytic sarcoma“

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23
Q

Differential for punched out papilla

A

NUG

Agranulocytosis

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24
Q
A

Oral manifestation of LEUKEMIA

Diffuse swelling and dicoloration.

Upon palpation will feel BOGGY

May look similar to Kaposi’s sarcoma but is generalized

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25
Q
A

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

26
Q

Langerhans Cell Histiocytoma X-ray

A

Sharply demarcated “punched out” radiolucencies

(may be ill-defined)

Mandibular lesions–> scooped out, loss of superfical alveolar bone

Resembles severe periodontitis – teeth “floating”

27
Q

Raised lesion on the gingiva

Malignancy vs 3Ps and IFH

A

Malignancy –> radiographic bone loss

3Ps and IFH –> NO radiographic bone loss

28
Q

Langerhans Cell Histiocytoma Histology

A

Necessary for diagnosis.

Langherhans cell contain rod shaped cytoplasmic structure –> BIRBECK GRANULES

Coffee bean, pac man, eosinophil filtration

29
Q

Birbeck Granules

A

Rod cytoplasmic structures of langerhans

Help determine histologically of langerhans cell histiocytoma

30
Q

How to diagnos Langerhans Cell Histiocytoma

A

Birbeck granules in electromicroscopy

31
Q

Langerhans Cell Xray

A

Sharply demarcated radiolucency –> PUNCHED OUT

May be ill defined (not symmetrically shaped)

Mandibular: scooped out, loss of superficial alveolar bone

Resembles severe periodontitis

32
Q

Hodgkin’s Lymphoma

A

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)

33
Q

Diagnostic of Hodgkin’s Lymphoma

A

Reed-Sternberg Cells

34
Q

What diseases are associated with EBV?

A

Hodgkin’s lymphoma

Burkitt’s lymphoma

Nasopharyngeal carcinoma

Mono

Hairy oral leukoplakia (AIDS patients)

35
Q

Two types of Hodgkin’s Lymphoma

A

Nodular lymphocyte (predominant)

Classical

36
Q

Non-Hodgkin’s Lymphoma

A

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)

37
Q

What is the predominant cell type in Non-Hodgkin’s Lymphoma

A

B cell lymphocyte

38
Q

Fixed nodues because….

A

Tumor violates the capsule and infiltrates the adjacent tissue

39
Q

Intraoral SOFT TISSUE lesions in Non-Hodgkin’s Lymphoma

A

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

40
Q

Boggy on palpation

A

Non-Hodgkin’s Lymphoma

Intraoral: most likely –> Diffuse large B cell lymphoma

41
Q

Presence of Reed-Sternberg Cells

A

Hodgkin’s Lymphoma

42
Q

Non-Hodgkin’s Lymphoma in BONE (jaw)

A

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)

43
Q

X ray manifestation of Non-Hodgkin’s Lymphoma

A

Ill defined

Ragged radiolucency

44
Q

Mycosis Fungoides

A

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

45
Q
A

Sezary Syndrome

Aggressive expresion of mycosis fungoides

DERMATOPATHIC T cell leukemia

46
Q

Histology of Sezary syndrome and Mycosis fungoides

A

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

47
Q

Epidermotropism

A

Atypcial lymphocytic cells (malignant T cells) infiltrate surface epithelium

Histology of Mycosis Fungoides or Sezary syndrome

48
Q

Pautrier’s Microabscesses

A

Atypical lymphocytes (malignant T cells) form intraepiehtlial aggregates

Histology of Mycosis Fungoides and Sezary syndrome

49
Q

Burkitt’s Lymphoma

A

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)

50
Q

Burkitt’s Lymphoma malignant cells?

A

B cell origin

51
Q

X ray features of Burkitt’s Lymphoma

A

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

52
Q
A

Burkitt’s Lymphoma

Enlarged mass of jaw

Proptosis (bulging eyes)

53
Q

Histology of Burkitt’s Lymphoma

A

Starry Sky Pattern

Macrophages within tumor tissue

** Large number of B cells with a few white macrophages **

54
Q

NK/T Cell lymphoma

A

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

55
Q
A
56
Q
A

Differential:

Cocain addiction

Syphillis (gumma)

TB - scrofula

NK/T cell lymphoma

57
Q

Multiple Myeloma

A

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

58
Q

What is the most common hematologic malignancy of African Americans?

A

Multiple Myeloma

59
Q

Malignant cells of mutliple myeloma

A

PLASMA CELLS

60
Q

X ray features of MUTLIPLE MYELOMA

A

Multiple – well defined punced out radiolucencies

(may be ragged lesions)

Especially evident in the SKULL

61
Q

Diagnosis of multiple myeloma

A

Bence Jones Proteins

May cuase renal failure

62
Q

Plasmacytoma

A

Multiple myeloma –> progresses to plasmacytoma

Unifocal monoclonal neoplastic proliferation of plasma cells

Typciall arises in bone

Oral Pathology (17 decks)

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