Chapter 13 Flashcards
What term describes a decrease in volume of RBCs (hematocrit) or in the concentration of hemoglobin?
Anemia
What is anemia often a sign of?
Underlying disease, such as renal failure, liver disease, chronic inflammatory conditions, malignancies, vitamin or mineral deficiencies
What are the general symptoms of anemia related to and what are they?
The reduced oxygen carrying capacity of blood, and they are tiredness, headache, fainting/lightheaded, pallor
What are some oral symptoms of anemia?
Mucosa may show pallor, petechiae, spontaneous gingival hemorrhage, etc but the major ones are an erythematous bald tongue, glossopyrosis, glossodynia
What term describes a hematologic disorder characterized by a decrease in the number of circulating blood platelets?
Thrombocytopenia
What are the 3 general causes of thrombocytopenia?
Reduced production, Increased destruction, Sequestration in spleen
What can cause a reduced production of platelets?
Various causes, like infiltration of the bone marrow by malignant cells, or effects of chemo
What can cause increased destruction of platelets?
Immunologic reaction (autoimmune), drugs (heparin), systemic disease (lupus erythematous or IHV), abnormal clot formation (thrombotic thrombocytopenia purpura)
What can sequestration of platelets in the spleen?
Splenomegaly or a blockage in the spleen caused by cancer (?)
What is normal platelet count?
200,000-400,000, although clinical evidence of thrombocytopenia is not seen until the platelet count is below 100,000
What are the 2 types of thrombocytopenia?
Idiopathic/immune thrombocytopenic purpura, and thrombotic thrombocytopenia purprua
What is thrombotic thrombocytopenia purpura?
A serious disorder of coagulation and is probably due to endothelial damage
What term describes an enlargement of lymphoid tissue?
Lymphoid hyperplasia
What is the typically the cause of lymphoid hyperplasia?
Infection
Where are aggregates of lymphoid most common seen in the mouth?
Oropharynx, soft palate, lateral tongue, floor of mouth
What is the clinical presentation of lymphoid hyperplasia due to acute infections?
Enlarged, tender, soft and freely movable nodules
What is the clinical presentation of lymphoid hyperplasia due to chronic infection and what are they similar to?
Enlarged, non tender, firm, freely movable nodules – hard to distinguish clinically from lymphoma
In what age population is lymphoid tissue more prominent?
In younger patients, before 20
What characteristic is a potentially serious sign in lymphoid hyperplasia?
Tonsillar asymmetry – need further evaluation!
How is lymphoid hyperplasia diagnosed?
Biospy, but usually no other treatment is required once confirmed
What term describes a lack of granulocytes?
Agranulocytosis
What is neutropenia?
A decrease in the number of circulating neutrophils (below 1500)
What is lymphopenia?
Decrease in lymphocytes (usually due to viral and fungal infections)
What can cause agranulocytosis?
Drugs, Bacterial?viral/fungal infections
What are some oral symptoms of agranulocytosis?
Necrotizing, deep, punched out ulcerations on the buccal mucosa, tongue and palate
What term represents several types of malignancies of hematopoietic stem cell derivation?
Leukemia
Where does leukemia start?
In the bone marrow, with the malignant transformation of the a stem cell
How are leukemias classified?
According to their histogenesis and clinical behavior: myeloid vs lymphoid, or acute vs chronic
How are acute leukemias and chronic leukemias different?
Acute leukemias run an aggressive course and usually the patient will die in a few months, where as chronic leukemias frun a more indolent course though patients usually succumb to the disease
What 2 things contribute to the development of leukemias?
Environmental and genetic factors
What leukemia shows specific chromosomal abnormalities?
Chronic myeloid leukemia!!
What is chronic myeloid leukemia characterized by?
The Philadelphia chromosome! = A translocation of the chromosomal material between chromosomes 9 and 22
What are some of the environmental factors that may lead to leukemia?
Exposure to pesticides and/or benzene, ionizing radiation, viruses (human T cell leukemia type 1)
Which leukemia is one of the more common childhood malignancies?
Acute lymphoblastic leukemia
What is the most common type of leukemia?
Chronic lymphocytic leukemia
In what population does chronic lymphocytic leukemia occur in?
Adults
What are some signs of leukemia?
Reduction in the number of RBCs and WBCs, decreased oxygen carrying capacity of the blood (fatigue), and easy bruising due to lack of platelets
What are some oral manifestations of leukemia?
Leukemic cell infiltration into oral soft tissues to produce a boggy (doughy), non tender swelling, that can be ulcerated. (historically used to be known as granulocytic sarcoma)
True or False: Chronic lymphoid leukemia is incurable
True, patients typically survive 10 years
What term describes an accumulation of too many immature langerhans cells?
Langerhans cell histiocytosis
What is a langerhan cell?
Dendritic (antigen presenting cell) mononuclear cells that are normally found in the epidermis, mucosa, lymph nodes and bone marrow
What term describes one or multiple lesions or langerhans cell histiocytosis with no visceral involvement?
Eosinophilic granuloma of bone
What term describes a disease that involves bone, skin and viscera, is associated with Langerhans cell histiocytosis and occurs mostly in infants?
Acute disseminated histiocytosis, in infants it is Letterer-Siwe disease
What term describes a disease that involves bone, skin and viscera, and is associated with langerhans cell histiocytosis?
Chronic disseminated histiocytosis, also known as Hand-Shculler Christian disease
At what age does langerhans cell histiocytosis usually occur?
Patients are younger than 15
Where is the most common location/presentation of langerhans cell histiocytosis?
Bone, lesions are commonly found in the skill, ribs, vertebrae and mandible (15% of cases)
What is the radiographic presentation of langerhans cell histiocytosis?
Sharply demarcated (punched out) radiolucencies, that may occasionally be ill defined – teeth appear floating in air
What other symptoms accompany Langerhans cell histiocytosis?
Pain and tenderness
What histopathologic features used to confirm langerhans cell histiocytosis?
Identification of a lesional langerhans cell, identification of Birbeck granules (rod shaped cytoplasmic structures)
What is the most common lymphoma?
Hodgkin’s lymphoma
What is Hodgkin’s lymphoma?
It is a malignant lymphoproliferative disorder
What are the neoplastic cells called in Hodgkin’s lymphoma?
Reed-Sternberg cells (typically binucleated owl eye nuclei)
What is a significant percentage of hodgkin’s lymphoma linked to?
Epstein Barr Virus
Where does Hodgkin’s lymphoma start?
In any lymph node, 75% occur in the cervical and supraclavicular nodes
At what age does hodgkins lymphoma usually occur? In what population?
Between 15-35, and after 50, In males more commonly than females
What is the clinical presentation of hodgkins lymphoma?
Persistently enlarging, nontender, discrete mass or masses in a lymph node region. Early lesions are movable, but late lesions are more fixed – usually unexpected WEIGHT LOSS
Why is non-hodgkin’s lymphoma hard to diagnose?
Lymphoma, it is a diverse and complex group of malignancies, but 85% are B-lymphocyte origin
What is the most common lymphoma in the oral cavity?
Diffuse large B cell lymphoma
At what age does lymphoma usually occur?
In adults
What is the clinical presentation of lymphoma?
BOGGY, erythematous/purple, Slowly enlarging, nontender, discrete mass in a lymph node region. Early lesions are movable, but late lesions are more fixed (b/c they violate the capsule)
Where do lymphomas occur in the oral cavity?
The soft tissue or the jaws (if bone it can cause vague pain which can be mistaken for a toothache)
What term describes a T cell lymphoma that clinically resembles a fungal infection?
Mycosis fungoides
Mycosis fungoides is the most common _______ lymphoma
most common CUTANEOUS lymphoma
In what population does mycosis fungoides usually occur?
Average age is 60, and usually men
What are the 3 stages of mycosis fungoides?
Eczematous, plaque, then tumor
What term describes an aggressive expression of mycosis fungoies that represent dermatopathic T cell luekemia?
Sezary syndrome, will result in patients death within 3 years
What are the histopathologic features of mycosis fungoides?
Infiltration of atypical lymphocytic cells in the surface epithelium (epidermotropism), called pautrier’s microabscesses
What are the atypical lymphocytes of mycosis fungoides called?
Mycosis cells are sezary cells
What term describes am aggressive malignancy of B cell origin that was first documented in African children?
Burkitt’s lymphoma
Where does Burkitt’s lymphoma usually occur?
In the jaws (70%)
What virus is Burkitt’t Lymphoma associated with?
Epstein Barr Virus
In what population does Burkitt’s lymphoma usually occur?
Average age is 7, usually in men
What may happen to the face and eyes as Burkitt’s lymphoma grows?
Facial swelling and proptosis
What are the histopathologic features of Burkitt’s lymphoma?
Starry sky pattern (solid sheet of B cells with occasional macrophages)
What term describes an agressive, nonrelenting, necrotizing, ulcerating destruction of the midline structures of the palate and nasal process?
NK/T cell lymohoma (angiocentric T cell lymphoma)
Why do paitents with NK/T cell lymphoma need to be treated ASAP?
They will succumb to a secondary infection, massive hemorrhage or infiltration of vital structures.
What 4 things can cause “holes” in the roof of the mouth?
Syphilis, recreational drug use, deep fungal infections (mucormycosis), and NK/T cell lymphoma
What term describes a malignancy of plasma cell origin that has a multicentric origin within bone?
Multiple myeloma
What is unique about the abnormal cells in multiple myeloma?
Abnormal cells are monoclonal, so they arise from a single precursor
At what age and in what population does multiple myeloma occur?
Average age is 65, men, and african americans!! (most common hematoligic malignancy of african americans!)
What is the most common presenting symptom of multiple myeloma?
Bone pain, common in the lumbar spine
What are some clinical and radiographic characteristics of multiple myeloma?
Bone fractures, fatigue, petechiae and multiple,well defined radiolucencies (“punched out”)
Why do some patients with multiple myeloma experience renal failure?
Kidneys are overburdened with the Bence Jones proteins, which are from the tumors
How is multiple myeloma treated?
The goal of tx is to make the pt comfortable, control malignancy but virtually all patients relapse
What term describes a unifocal, monoclonal neoplastic proliferation of plasma cells?
Plasmacytoma
Why is the progression of plasmacytoma important?
Because 50% of patients with plasmacytoma will have mutliple myeloma in 2-3 years, so plasmacytoma is though to give rise to multiple myeloma
