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Oral Pathology - My deck > Chapter 13 > Flashcards

Chapter 13 Flashcards

1
Q

What term describes a decrease in volume of RBCs (hematocrit) or in the concentration of hemoglobin?

A

Anemia

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2
Q

What is anemia often a sign of?

A

Underlying disease, such as renal failure, liver disease, chronic inflammatory conditions, malignancies, vitamin or mineral deficiencies

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3
Q

What are the general symptoms of anemia related to and what are they?

A

The reduced oxygen carrying capacity of blood, and they are tiredness, headache, fainting/lightheaded, pallor

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4
Q

What are some oral symptoms of anemia?

A

Mucosa may show pallor, petechiae, spontaneous gingival hemorrhage, etc but the major ones are an erythematous bald tongue, glossopyrosis, glossodynia

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5
Q

What term describes a hematologic disorder characterized by a decrease in the number of circulating blood platelets?

A

Thrombocytopenia

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6
Q

What are the 3 general causes of thrombocytopenia?

A

Reduced production, Increased destruction, Sequestration in spleen

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7
Q

What can cause a reduced production of platelets?

A

Various causes, like infiltration of the bone marrow by malignant cells, or effects of chemo

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8
Q

What can cause increased destruction of platelets?

A

Immunologic reaction (autoimmune), drugs (heparin), systemic disease (lupus erythematous or IHV), abnormal clot formation (thrombotic thrombocytopenia purpura)

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9
Q

What can sequestration of platelets in the spleen?

A

Splenomegaly or a blockage in the spleen caused by cancer (?)

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10
Q

What is normal platelet count?

A

200,000-400,000, although clinical evidence of thrombocytopenia is not seen until the platelet count is below 100,000

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11
Q

What are the 2 types of thrombocytopenia?

A

Idiopathic/immune thrombocytopenic purpura, and thrombotic thrombocytopenia purprua

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12
Q

What is thrombotic thrombocytopenia purpura?

A

A serious disorder of coagulation and is probably due to endothelial damage

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13
Q

What term describes an enlargement of lymphoid tissue?

A

Lymphoid hyperplasia

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14
Q

What is the typically the cause of lymphoid hyperplasia?

A

Infection

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15
Q

Where are aggregates of lymphoid most common seen in the mouth?

A

Oropharynx, soft palate, lateral tongue, floor of mouth

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16
Q

What is the clinical presentation of lymphoid hyperplasia due to acute infections?

A

Enlarged, tender, soft and freely movable nodules

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17
Q

What is the clinical presentation of lymphoid hyperplasia due to chronic infection and what are they similar to?

A

Enlarged, non tender, firm, freely movable nodules – hard to distinguish clinically from lymphoma

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18
Q

In what age population is lymphoid tissue more prominent?

A

In younger patients, before 20

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19
Q

What characteristic is a potentially serious sign in lymphoid hyperplasia?

A

Tonsillar asymmetry – need further evaluation!

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20
Q

How is lymphoid hyperplasia diagnosed?

A

Biospy, but usually no other treatment is required once confirmed

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21
Q

What term describes a lack of granulocytes?

A

Agranulocytosis

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22
Q

What is neutropenia?

A

A decrease in the number of circulating neutrophils (below 1500)

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23
Q

What is lymphopenia?

A

Decrease in lymphocytes (usually due to viral and fungal infections)

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24
Q

What can cause agranulocytosis?

A

Drugs, Bacterial?viral/fungal infections

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25
Q

What are some oral symptoms of agranulocytosis?

A

Necrotizing, deep, punched out ulcerations on the buccal mucosa, tongue and palate

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26
Q

What term represents several types of malignancies of hematopoietic stem cell derivation?

A

Leukemia

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27
Q

Where does leukemia start?

A

In the bone marrow, with the malignant transformation of the a stem cell

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28
Q

How are leukemias classified?

A

According to their histogenesis and clinical behavior: myeloid vs lymphoid, or acute vs chronic

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29
Q

How are acute leukemias and chronic leukemias different?

A

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

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30
Q

What 2 things contribute to the development of leukemias?

A

Environmental and genetic factors

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31
Q

What leukemia shows specific chromosomal abnormalities?

A

Chronic myeloid leukemia!!

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32
Q

What is chronic myeloid leukemia characterized by?

A

The Philadelphia chromosome! = A translocation of the chromosomal material between chromosomes 9 and 22

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33
Q

What are some of the environmental factors that may lead to leukemia?

A

Exposure to pesticides and/or benzene, ionizing radiation, viruses (human T cell leukemia type 1)

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34
Q

Which leukemia is one of the more common childhood malignancies?

A

Acute lymphoblastic leukemia

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35
Q

What is the most common type of leukemia?

A

Chronic lymphocytic leukemia

36
Q

In what population does chronic lymphocytic leukemia occur in?

A

Adults

37
Q

What are some signs of leukemia?

A

Reduction in the number of RBCs and WBCs, decreased oxygen carrying capacity of the blood (fatigue), and easy bruising due to lack of platelets

38
Q

What are some oral manifestations of leukemia?

A

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)

39
Q

True or False: Chronic lymphoid leukemia is incurable

A

True, patients typically survive 10 years

40
Q

What term describes an accumulation of too many immature langerhans cells?

A

Langerhans cell histiocytosis

41
Q

What is a langerhan cell?

A

Dendritic (antigen presenting cell) mononuclear cells that are normally found in the epidermis, mucosa, lymph nodes and bone marrow

42
Q

What term describes one or multiple lesions or langerhans cell histiocytosis with no visceral involvement?

A

Eosinophilic granuloma of bone

43
Q

What term describes a disease that involves bone, skin and viscera, is associated with Langerhans cell histiocytosis and occurs mostly in infants?

A

Acute disseminated histiocytosis, in infants it is Letterer-Siwe disease

44
Q

What term describes a disease that involves bone, skin and viscera, and is associated with langerhans cell histiocytosis?

A

Chronic disseminated histiocytosis, also known as Hand-Shculler Christian disease

45
Q

At what age does langerhans cell histiocytosis usually occur?

A

Patients are younger than 15

46
Q

Where is the most common location/presentation of langerhans cell histiocytosis?

A

Bone, lesions are commonly found in the skill, ribs, vertebrae and mandible (15% of cases)

47
Q

What is the radiographic presentation of langerhans cell histiocytosis?

A

Sharply demarcated (punched out) radiolucencies, that may occasionally be ill defined – teeth appear floating in air

48
Q

What other symptoms accompany Langerhans cell histiocytosis?

A

Pain and tenderness

49
Q

What histopathologic features used to confirm langerhans cell histiocytosis?

A

Identification of a lesional langerhans cell, identification of Birbeck granules (rod shaped cytoplasmic structures)

50
Q

What is the most common lymphoma?

A

Hodgkin’s lymphoma

51
Q

What is Hodgkin’s lymphoma?

A

It is a malignant lymphoproliferative disorder

52
Q

What are the neoplastic cells called in Hodgkin’s lymphoma?

A

Reed-Sternberg cells (typically binucleated owl eye nuclei)

53
Q

What is a significant percentage of hodgkin’s lymphoma linked to?

A

Epstein Barr Virus

54
Q

Where does Hodgkin’s lymphoma start?

A

In any lymph node, 75% occur in the cervical and supraclavicular nodes

55
Q

At what age does hodgkins lymphoma usually occur? In what population?

A

Between 15-35, and after 50, In males more commonly than females

56
Q

What is the clinical presentation of hodgkins lymphoma?

A

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

57
Q

Why is non-hodgkin’s lymphoma hard to diagnose?

A

Lymphoma, it is a diverse and complex group of malignancies, but 85% are B-lymphocyte origin

58
Q

What is the most common lymphoma in the oral cavity?

A

Diffuse large B cell lymphoma

59
Q

At what age does lymphoma usually occur?

A

In adults

60
Q

What is the clinical presentation of lymphoma?

A

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)

61
Q

Where do lymphomas occur in the oral cavity?

A

The soft tissue or the jaws (if bone it can cause vague pain which can be mistaken for a toothache)

62
Q

What term describes a T cell lymphoma that clinically resembles a fungal infection?

A

Mycosis fungoides

63
Q

Mycosis fungoides is the most common _______ lymphoma

A

most common CUTANEOUS lymphoma

64
Q

In what population does mycosis fungoides usually occur?

A

Average age is 60, and usually men

65
Q

What are the 3 stages of mycosis fungoides?

A

Eczematous, plaque, then tumor

66
Q

What term describes an aggressive expression of mycosis fungoies that represent dermatopathic T cell luekemia?

A

Sezary syndrome, will result in patients death within 3 years

67
Q

What are the histopathologic features of mycosis fungoides?

A

Infiltration of atypical lymphocytic cells in the surface epithelium (epidermotropism), called pautrier’s microabscesses

68
Q

What are the atypical lymphocytes of mycosis fungoides called?

A

Mycosis cells are sezary cells

69
Q

What term describes am aggressive malignancy of B cell origin that was first documented in African children?

A

Burkitt’s lymphoma

70
Q

Where does Burkitt’s lymphoma usually occur?

A

In the jaws (70%)

71
Q

What virus is Burkitt’t Lymphoma associated with?

A

Epstein Barr Virus

72
Q

In what population does Burkitt’s lymphoma usually occur?

A

Average age is 7, usually in men

73
Q

What may happen to the face and eyes as Burkitt’s lymphoma grows?

A

Facial swelling and proptosis

74
Q

What are the histopathologic features of Burkitt’s lymphoma?

A

Starry sky pattern (solid sheet of B cells with occasional macrophages)

75
Q

What term describes an agressive, nonrelenting, necrotizing, ulcerating destruction of the midline structures of the palate and nasal process?

A

NK/T cell lymohoma (angiocentric T cell lymphoma)

76
Q

Why do paitents with NK/T cell lymphoma need to be treated ASAP?

A

They will succumb to a secondary infection, massive hemorrhage or infiltration of vital structures.

77
Q

What 4 things can cause “holes” in the roof of the mouth?

A

Syphilis, recreational drug use, deep fungal infections (mucormycosis), and NK/T cell lymphoma

78
Q

What term describes a malignancy of plasma cell origin that has a multicentric origin within bone?

A

Multiple myeloma

79
Q

What is unique about the abnormal cells in multiple myeloma?

A

Abnormal cells are monoclonal, so they arise from a single precursor

80
Q

At what age and in what population does multiple myeloma occur?

A

Average age is 65, men, and african americans!! (most common hematoligic malignancy of african americans!)

81
Q

What is the most common presenting symptom of multiple myeloma?

A

Bone pain, common in the lumbar spine

82
Q

What are some clinical and radiographic characteristics of multiple myeloma?

A

Bone fractures, fatigue, petechiae and multiple,well defined radiolucencies (“punched out”)

83
Q

Why do some patients with multiple myeloma experience renal failure?

A

Kidneys are overburdened with the Bence Jones proteins, which are from the tumors

84
Q

How is multiple myeloma treated?

A

The goal of tx is to make the pt comfortable, control malignancy but virtually all patients relapse

85
Q

What term describes a unifocal, monoclonal neoplastic proliferation of plasma cells?

A

Plasmacytoma

86
Q

Why is the progression of plasmacytoma important?

A

Because 50% of patients with plasmacytoma will have mutliple myeloma in 2-3 years, so plasmacytoma is though to give rise to multiple myeloma

Oral Pathology - My deck (22 decks)

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