Chapter 16: Head and Neck Flashcards

1
Q

How do Mucoceles present clinically (i.e., how do they look on examination)?

Patients often report what in regards to the size of the lesion?

A

- Fluctuant swellings of lower lip that have a blue translucent hue

  • Often report hx of changes in size in assoc. w/ meals
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2
Q

What is the morpholgy of peripheral ossifying fibroma?

Peak incidence in whom?

Treatment of choice?

A
  • Red, ulcerated and nodular lesions of gingiva
  • Increased incidence in young/teenage females
  • Complete surgical exicison down to periosteum
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3
Q

Which systemic diseases are associated w/ Periodontitis?

A
  • AIDS
  • Leukemia
  • Chron disease
  • DM
  • Down syndrome (high risk for leukemia)
  • Sarcoidosis
  • Dz asso. w/ defect in neutrophils (Chediak-Higashi, agranulocytosis, and cyclic neutropenia)
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4
Q

Exposure to what increases risk for Pleomorphic Adenomas?

Associated with what genetic mutation?

A
  • Radiation
  • PLAG1overexpression –> Increased cell growth
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5
Q

Which disorder is associated w/ multiple congenital aneurysmal telangiectasias beneath mucosal surfaces of the oral cavity and lips?

A

Rendu-Osler-Weber syndrome

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6
Q

Hairy leukoplakia is caused by what virus?

Found where in oral cavity?

A
  • EBV
  • Lateral border of the tongue
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7
Q

Apthous ulcers (canker sores) tend to be more prevalent in and associated with what disorders?

A
  • IBD
  • Celiac disease
  • Behcet disease
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8
Q

Which stain helps to visualize a mucoepidermoid carcinoma?

A

Mucin stains

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9
Q

How does the clinical presentation in terms of lesions differ between the classic type and HPV-type of oral SCC?

A
  • Classic-type - lesions can be on ventral tongue, floor of mouth, lower lip, soft palate, gingiva
  • HPV-type - has NO preceding/precancerous lesion. Originate in tonsillar crypts, base of tongue, or pharynx
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10
Q

In the oropharynx, as many as 70% of SCCs, particularly those involving the tonsils, base of the tongue, and the pharynx, harbor what?

A
  • Oncogenic variants of HPV
  • Particularly HPV-16
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11
Q

Which glands may be affected w/ a mumps infection?

A
  • Parotids b/l
  • Testes - orchitis
  • Pancreas
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12
Q

What is the basis of “Field Cancerization?”

A

Multiple individual primary tumors develop independently in the upper aerodigestive tract as a result of years of chronic exposure of the mucosa to carcinogens

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13
Q

What are the 2 most common organisms responsible for sialolithiasis leading to sialadentitis?

Unilateral or bilateral process?

A

1) S. aureus
2) S. viridans
- UNILATERAL

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14
Q

Which test is diagnostic for Acute Herpetic Gingivostomatitis?

What are you looking for?

A

- Tzanck test, microscopic examination of the vesicle fluid

  • Presence of multinucleate polykaryons (giant cells) or eosinophilic intranuclear viral inclusions
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15
Q

What is the morphological hallmark of Acinic cell carcinoma of the salivary glands?

A

Clear cytoplasm

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16
Q

What is typically overexpressed in HPV-associated SCC’s?

Other common genetic alterations?

A
  • p16 (cyclin dependent kinase inhibitor) = overexpressed
  • p53 inactivation –> E6
  • RB inactivation –> E7
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17
Q

Which diseases can periodontal infections be the origin for?

A
  • Infective endocarditis
  • Pulmonary and Brain abscesses
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18
Q

Adenoid cystic carcinoma of the salivary gland often shows which type of pattern?

A

Cribiform

*Gaps between the cancer cells within the duct, with an appearance similar to the ‘holes in swiss cheese‘ or perhaps ‘ripples‘.

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19
Q

Periapical, Residual, and Paradental cysts of the oral cavity are classified how (inflammatory or developmental cysts)?

A

Inflammatory cysts

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20
Q

A carcinoma arising in a pleomorphic adenoma is referred to as a?

A

Carcinoma ex pleomorphic adenoma or malignant mixed tumor

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21
Q

Pleomorphic adenomas contain a mixture of _________ and _________ cells

A

Pleomorphic adenomas contain a mixture of ductal (epithelial) and myoepithelial cells

*MIXED tumor

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22
Q

Which benign tumor is virtually restricted to the parotid gland?

A

Warthin Tumor (aka papillary cystadenoma lymphomatosum)

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23
Q

What are the histological characteristics of a mucoepidermoid carcinoma?

How large do they grow?

A
  • Grow to 8 cm in diameter and are circumscribed, but lack well-defined capsules and are infiltrative at margins
  • Cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells
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24
Q

What are the normal class of bacteria that colonize healthy gingival sites?

A

Facultative gram positives

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25
Where do Odontomas arise from? Show extensive deposition of?
- Arise from **epithelium** - Extensive deposition of **enamel** and **dentin**
26
Complications of Xerstomia include increased rates of?
- Dental caries - **Candidiasis** - Difficulty swallowing **and** speaking
27
What is the most common Odontogenic tumor?
Odontoma
28
What is the most common type of salivary gland lesion?
Mucoceles
29
Change in oral flora ---\> ________ + ________ = periodontitis
Change in oral flora ---\> **anaerobic** + **microaerophilic G (-)** = periodontitis
30
The likelihood of a salivary gland tumor being malignant is more or less ___________ proportional to the size of the gland
Inversely \*Smaller the gland = higher risk of malignancy
31
Around 95% of the cancers of the head and neck are of which type? Remainder largely consists of which type?
- Squamous Cell Carcinoma (SCC) = **majority (95%)** - Adenocarcinomas of salivary gland origin = **remainder**
32
What is the most common and second most common site for Acinic cell carcinoma of the salivary glands?
- **Most common** = parotids - **2nd** = submandibular glands
33
How does the progression of oral SCC differ from that of cervical cancer?
- **Oral SCC** may invade underlying CT stroma **before** progression to full-thickness dysplaisa (carcinoma in situ) - In **cervical cancer**, carcinoma in situ, develops **before** invasion
34
What are the 5 favored locations in the oral cavity for the development of SCC?
- Ventral surface tongue - **Floor of mouth** - Lower lip (associated w/ sun exposure and pipe smoking) - Soft palate - Gingiva
35
What is the Tx for Mucoceles?
Complete excision of the cyst **and** its accompanying minor salivary gland
36
Which infection produces **spotty enanthema** in the oral cavity often preceding a skin rash; ulcerations on the buccal mucosa about Stensen duct producing **Koplik spots** (small red lesions w/ blue-white centers)?
Measles
37
Until proven otherwise, all leukoplakias must be considered \_\_\_\_\_\_\_\_\_\_.
Precancerous
38
Multiple Keratocystic Odontogenic Tumors (OKC's) occuring in a patient should prompt evaluation for what?
Nevoid basal cell carcinoma (**Gorlin syndrome**)
39
What is the reason for the granular appearance of the cytoplasm in the upper layer of cells seen in Warthin Tumors?
NUMEROUS **mitochondria**, feature referred to as "**oncocytic**"
40
Bacterial sialadenitis, most often involves the __________ glands and is a common condition secondary to \_\_\_\_\_\_\_\_\_\_\_
Bacterial sialadenitis, most often involves the **submandibular** glands and is a common condition secondary to **sialolithiasis**
41
Mucoceles are caused by what? Most commonly found where in oral cavity and due to what?
- **Blockage/rupture** of the **salivary gland duct** w/ leakage of saliva into CT stroma - Most often **LOWER LIP** due to **TRAUMA**
42
What is the prognosis of a malignant pleomorphic adenoma (i.e., *carcinoma ex pleomorphic adenoma*)?
- Most **aggressive** of **all** salivary gland tumors - Mortality rates of **30-50% at 5 years**
43
Which observation associated with tumors of the upper aerodigestive tract has led to the concept of "field cancerization?"
Development of **multiple primary tumors** is **more common** here than any other malignancy
44
Adenoid cystic carcinoma is most often seen where?
- **Minor salivary glands** (particularly the **palatine** glands) - May also be seen in **major** salivary glands (**parotid** and **submandibular**)
45
Keratocystic Odontogenic Tumors (OKC's) are most often diagnosed between what ages and which sex is more commonly affected? Where do they most often arise within the oral cavity?
- Ages **10-40 yo**; most often in **males** - **Posterior mandible**
46
A patient presenting with unilateral, sialadentitis with overt suppurative necrosis and abscess formation should raise suspicion of?
**Sialolithiasis** causing **sialadentitis**, likely due to ***S. aureus*** or *S**. viridans***
47
What is the prognosis (5-year survival rate) of the "classic" (smoking and alcohol related) early-stage SCC? Late stage?
- **Good (80%)** - Drops to 20% for late-stage disease
48
What is the morphology of oral SCC in the early stage?
**Raised**, **firm**, **pearly plaques** or **irregular**, **roughened** or **verrucous** areas of mucosal thickening --\> may look like **leukoplacia**
49
What is the inheritance pattern of Rendu-Osler-Weber syndrome?
Autosomal **Dominant**
50
What is the prognosis of Acinic cell carcinoma after resection?
- Overall recurrence = **uncommon** - 90% at 5 years and 60% at 20 years = **good prognosis**
51
What is the significance of Keratocystic Odontogenic Tumors (OKC's)?
Must be differentiated from other cysts due to its **aggressive behavior**
52
Inflammatory process affecting the supporting structures of the teeth (peridontal lig.), alveolar bone, and cementum?
Periodontitis
53
Nevoid basal cell carcinoma (Gorlin syndrome) is associated with mutations in what gene and on what chromosome?
- ***PTCH*** (tumor suppressor gene) - Cr. **9**
54
A pt presenting with acute pharyngitis and tonsilitis w/ a gray-white exudative membrane; enlargement of LN's in the neck and **palatal petechiae** should raise suspicion of which type of infection and by what?
- Infectious mononucleosis - **EBV** of the ***Herpeviridae* family** = dsDNA virus
55
What are the common causes of Periapical cysts (Periapical Granulomas)?
- **Long-standing inflammation** of a **tooth** (**pulpitis**) - May be due to **advanced carious lesions** or **trauma** to the **tooth**
56
Which oral lesion is characterized by a distinct microscopic appearance consisting of **hyperkeratosis** and **acanthsosis** with **"balloon cells"** in the upper spinous layer?
Hairy leukoplakia
57
Which genetic mutations are commonly associated with the "classic - tobacco/alcohol" SCC subset?
- **Frequently** involve **p53** - p63 and *NOTCH1*
58
Periapical cysts are common lesions found where in the oral cavity?
Apex of teeth
59
Which form of Oral Candidiasis (Thrush) is the most common? How does it appear in the oral cavity?
- **Pseudomembranous** form - Superficial, gray to white inflammatory membrane, that can be **readily scarped off**
60
What is the morphology of Adenoid cystic carcinomas?
- Small, **poorly encapsulated**, infiltrative, gray-pink lesions - Small cells w/ **dark, compact nuclei** and scant cytoplasm - Often create a **cribiform pattern**
61
Adenoid cystic carcinomas have a tendency to invade which spaces? Often metastasize to which distant locations?
- Invade **perineural spaces** - **Bone, liver,** and **brain**
62
When do Warthin tumors usually arise? Which sex is most affected? What is a major risk factor?
- **5th to 7th decade** of life - More common in **males** - Smokers have **8x** the risk
63
Majority of salivary gland tumors arise where?
Parotid gland
64
Xerostomia is a major feature of?
Sjorgren Syndrome
65
The prognosis and clinical course of Mucoepidermoid Carcinomas are dependent on what?
Grade of the neoplasm
66
Which inflammatory lesion is typically found on the gingiva of children, young adults, and pregnant woman (pregnancy tumor)?
Pyogenic granuloma
67
How do pleomorphic adenomas present clinically (i.e., mass where, any pain, and rate of growth)?
**Painless**, slow-growing, **mobile**, discrete masses within the **parotid** or **submandibular** areas or in the **buccal cavity**
68
Which 3 hematologic disorders may present w/ oral changes?
1) Pancytopenia (agranulocytosis, aplastic anemia) 2) Leukemia 3) Monocytic leukemia
69
What is the typical **age of onset** and **sex** most affected by leukoplakia and erythroplakia?
- Age **40-70** - M:F (**2****:1**)
70
Pt presenting w/ a fiery red tongue w/ prominent papillae (raspberry tongue); white-coated tongue through which hyperemic papillae project should raise suspicion of which infection and organism?
- Scarlet Fever - *Strep pyogenes* --\> **Gram (+)**
71
What is the most common form of **viral sialadenitis**? Which major salivary is most commonly affected?
- Mumps - Parotids b/l = **most common**
72
Ameloblastoma arises from ___________ and shows **no** \_\_\_\_\_\_\_\_\_\_\_\_\_
Ameloblastoma arises from **odontogenic epithelium** and shows **no ectomesenchymal differentiation**
73
What is the histological characteristics of Mucoceles? Most common inflammatory cell present?
- **Pseudocysts** w/ cyst-like spaces **lined by granulation tissue** or **fibrous CT** - Cystic spaces filled w/ **mucin** and most often **MACROPHAGES**
74
Irritation fibroma (aka traumatic fibroma) typically arise where in the oral cavity?
**Buccal mucosa along the bite line** or **the gingiva**
75
What is the prognosis of both low-grade and high-grade Mucoepidermoid Carcinomas?
- **Low grade** ---\> 5-year survival of **90%** - **High grade** ---\> 5-year survival of **50%**
76
What are the favored sites for **local metastasis** of SCC? Favored sites for **distal metastasis**?
- **Local** ---\> cervical LN's - **Distal** ---\> mediastinal LN's, lungs, liver, and bones
77
Radiographically, **dentigerous cysts** are seen as what type of lesions and most often associated with which teeth? Treatment?
- **Unilocular** lesion - Impacted **third molar (wisdom) teeth** - Complete removal = **curative**
78
What type of tumor is shown here and how can you tell?
- **Pleomorphic adenoma** - **Well-demarcated tumor** w/ **epithelial** cells and **myoepithelial** cells within a **chondroid matrix = DOMINANT histological features**
79
Which infection produces a characteristic **dirty white, fibrinosuppurative**, tough, inflammatory membrane over the tonsils and retropharynx?
Diptheria
80
Actinic radiation (sunlight) and pipe smoking are known predisposing factors for what type of oral cancer?
**SCC** of the **lower lip**
81
Which type of cyst is defined as originating around the crown of an unerupted tooth and is thought to be the result of fluid accumulation between the developing tooth and dental follicle?
Detingerous cyst
82
Odontomas are more likely __________ rather than true neoplasms
Hamartomas
83
What are some of the distinct morphological characteristics of a Warthin tumor?
- **Round** to **oval** **encapsulated** mass, **2-5 cm in diameter**, in superfical parotid gland - **Double layer** of lining cells resting on **dense lymphoid stroma** sometimes w/ **GERMINAL** **centers** - Upper layer = **palisading columnar cells** w/ abundant, finely **granular**, eosinophilic cytoplasm - Lower layer = **cuboidal to polygonal cells**
84
What are the histological changes of the epithelium seen with **erythroplakia**?
**Severe dysplasia**, carcinoma in situ, or minimally invasive carcinoma
85
What is the most common tumor of the salivary gland and is it benign or malignant?
Pleomorphic adenoma (60%) -- **benign**
86
What is the most common primary malignant tumor of the salivary glands?
Mucoepidermoid carcinoma
87
How does an HPV (+) vs. HPV (-) SCC affect the prognosis?
- HPV (+) = **BETTER** **prognosis** if **p16+** - HPV (-) = **worse prognosis**
88
Which genetic mutation (i.e., translocation and gene products) is thought to play a key role in Mucoepidermoid carcinoma?
- Balanced (**11;19**) translocation - Creates fusion gene = ***MECT1*** *and **MAML2 genes***
89
What is a Ranula?
**Epithelial-lined cysts** that arise when **duct of sublingual gland** has been **damaged**