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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
**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
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"
27
Raised lesion on the gingiva Malignancy vs 3Ps and IFH
Malignancy --\> radiographic bone loss 3Ps and IFH --\> NO radiographic bone loss
28
Langerhans Cell Histiocytoma Histology
Necessary for diagnosis. Langherhans cell contain rod shaped cytoplasmic structure --\> **BIRBECK GRANULES** Coffee bean, pac man, eosinophil filtration
29
Birbeck Granules
Rod cytoplasmic structures of langerhans Help determine histologically of langerhans cell histiocytoma
30
How to diagnos Langerhans Cell Histiocytoma
Birbeck granules in electromicroscopy
31
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
32
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)
33
Diagnostic of Hodgkin's Lymphoma
**Reed-Sternberg Cells**
34
What diseases are associated with EBV?
Hodgkin's lymphoma Burkitt's lymphoma Nasopharyngeal carcinoma Mono Hairy oral leukoplakia (AIDS patients)
35
Two types of Hodgkin's Lymphoma
Nodular lymphocyte (predominant) Classical
36
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)
37
What is the predominant cell type in **Non-Hodgkin's Lymphoma**
B cell lymphocyte
38
Fixed nodues because....
Tumor violates the capsule and infiltrates the adjacent tissue
39
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_**
40
Boggy on palpation
Non-Hodgkin's Lymphoma Intraoral: most likely --\> Diffuse large B cell lymphoma
41
Presence of **Reed-Sternberg Cells**
Hodgkin's Lymphoma
42
_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)
43
X ray manifestation of Non-Hodgkin's Lymphoma
Ill defined Ragged radiolucency
44
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
45
**Sezary Syndrome** Aggressive expresion of ***_mycosis fungoides_*** DERMATOPATHIC T cell leukemia
46
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
47
Epidermotropism
Atypcial lymphocytic cells (malignant T cells) infiltrate surface epithelium Histology of Mycosis Fungoides or Sezary syndrome
48
Pautrier's Microabscesses
Atypical lymphocytes (malignant T cells) form intraepiehtlial aggregates Histology of Mycosis Fungoides and Sezary syndrome
49
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)
50
Burkitt's Lymphoma malignant cells?
B cell origin
51
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
52
Burkitt's Lymphoma Enlarged mass of jaw Proptosis (bulging eyes)
53
Histology of Burkitt's Lymphoma
Starry Sky Pattern Macrophages within tumor tissue \*\* Large number of B cells with a few white macrophages \*\*
54
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
55
56
Differential: Cocain addiction Syphillis (gumma) TB - scrofula **NK/T cell lymphoma**
57
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
58
What is the most common hematologic malignancy of African Americans?
Multiple Myeloma
59
Malignant cells of mutliple myeloma
PLASMA CELLS
60
X ray features of MUTLIPLE MYELOMA
Multiple -- well defined **_punced out_** radiolucencies (may be ragged lesions) Especially evident in the **SKULL**
61
Diagnosis of multiple myeloma
**Bence Jones Proteins** May cuase renal failure
62
Plasmacytoma
Multiple myeloma --\> progresses to plasmacytoma Unifocal monoclonal neoplastic proliferation of plasma cells Typciall arises in **bone**

Oral Pathology (17 decks)

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