DDx - Exam 1 Flashcards
Diagnosis: Lichenoid Mucositis
• Clinical category: White and red macules and patches
• DDx:
1) Erosive lichen planus
2) Lichenoid mucositis
3) Systemic allergy
4) Contact allergy
5) Candidiasis
• Diagnostic procedure: incisional biopsy
• Tissues: Stratified squamous epithelium, Fibrous connective tissue with chronic inflammation
• Treatment: Replace [drug], topical steroids if necessary
• Prognosis: Excellent if [drug] is the cause and can be replaced
Diagnosis: Mucous Membrane Pemphigoid
• Classical category: Multiple ulcers
• DDx:
1) Mucous membrane pemphigoid
2) Pemphigus vulgaris
3) Systemic allergy
4) Erosive lichen planus
5) Chronic ulcerative stomatitis
• Diagnostic procedure: Perilesional biopsy
• Tissues: Stratified squamous epithelium, connective tissue (lamina propria)
• Treatment: Change medication. If condition persists, treat initially with topical steroids, or if necessary, with prednisone
• Prognosis: Good if ocular lesions are avoided
Diagnosis: HSV ulcer
• Clinical category: Multiple ulcers
• DDx:
1) Eosinophilic ulcers
2) Traumatic ulcers
3) HSV ulcers
4) Aphthous ulcers
5) Bacterial ulcer
6) Deep fungal ulcers
7) Granulomatous diseases (Sarcoid, Crohn’s)
• Diagnostic procedure: incisional biopsy (or exfoliative cytology)
• Tissues: Stratified squamous epithelium with intraepithelial cleft containing multinucleated epithelial cells with jagged nuclear inclusions
• Treatment: Acyclovir, gancylovir – intravenous, if necessary
• Prognosis: controlling the infection in severely immunocompromised patients is difficult
Diagnosis: Neuroma consistent with mucosal neuroma syndrome
• Clinical category: Multiple papules or nodules
• DDx:
1) Neurofibromatosis
2) Mucosal neuroma syndrome
3) Focal epithelial hyperplasia
4) Crohn’s disease
5) Sarcoidosis
6) Amyloidosis
• Diagnostic procedure: incisional biopsy
• Tissues: Peripheral nerve fiber bundles, collagenous fibrous connective tissue
• Treatment: Monitor for thyroid medullary carcinoma and pheochromocytoma
• Prognosis: Good if neoplasms are treated early
Diagnosis: Lichen planus
• Clinical category: White plaques/desquamative gingivitis
• DDx:
1) Erosive lichen planus
2) MMP
3) Pemphigus vulgaris
4) Hypersensitivity reaction
5) Lichenoid mucositis
OR 1) Lichen planus 2) Lichenoid mucositis 3) Hypersensitivity reaction 4) Frictional keratosis 5) Candidiasis
• Diagnostic procedure: Perilesional biopsy
• Tissues: Stratified squamous epithelium, fibrous connective tissue (lamina propria)
• Treatment: Topical corticosteroids
• Prognosis: Malignant change occurs in a small %age of cases
Diagnosis: Eosinophilic ulcer
• Clinical category: solitary ulcer or ulcerated enlargement
• DDx:
1) Squamous cell carcinoma
2) Eosinophilic ulcer
3) Traumatic ulcer
4) Bacterial ulcer
5) Deep fungal ulcer
6) Granulomatous diseases (Sarcoid., Crohn’s)
• Diagnostic procedure: Incisional biopsy
• Tissues: Stratified squamous epithelium, inflamed granulation tissue with eosinophils
• Treatment: topical corticosteroids if the condition does not resolve
• Prognosis: Good although recurrence is possible
Diagnosis: Pemphigus vulgaris
• Clinical category: Multiple ulcers
• DDx:
1) MMP
2) Pemphigus vulgaris
3) Systemic hypersensitivity reaction
4) Erosive lichen planus
5) Chronic ulcerative stomatitis
• Diagnostic procedure: perilesional biopsy
• Tissues: Stratified squamous epithelium with suprabasilar clefting, connective tissue (lamina propria)
• Treatment: Systemic corticosteroids (by physician), Antifungals to control candidiasis
• Prognosis IIF to monitor treatment. Mortality is 5-10% due to steroid side-effects
Diagnosis: Benign hyperkeratosis c/w morsicatio buccarum
• Clinical category: White plaque
• DDx:
1) Frictional keratosis
2) Lichen planus
3) Candidiasis
4) Hypersensitivity reaction
5) Leukoedema
• Diagnostic procedure: Incisional biopsy
• Tissues: Parakeratinized stratified squamous epithelium, Connective tissue (lamina propria)
• Treatment: No treatment is necessary, but an acrylic shield may be used
• Prognosis: Good
Diagnosis: c/w Sjogren syndrome
• Clinical category: Parotid gland enlargement (bilateral)
• DDx:
1) Sjogren syndrome
2) Mikulicz disease
3) Sarcoidosis
4) Sialosis
5) Salivary lymphoepithelial lesion
• Diagnostic procedure: None is definitive. Excise 4-5 lobules of lower labial mucosa minor salivary glands. Serology, sialography, Schirmeer test, scintigraphy
• Tissues: Minor salivary glands with foci of lymphocytes
• Treatment: Sialogogues, oral hygiene, topical fluoride, low cariogenic diet. (Antifungals may be needed)
• Prognosis: Chronic course, increased risk of lymphoma
Diagnosis: Non-specific (traumatic) ulcer
• Clinical category: Solitary ulcer • DDx: 1) Traumatic ulcer 2) Eosinophilic ulcer 3) Bacterial ulcer 4) Deep fungal ulcer 5) Squamous cell carcinoma • Diagnostic procedure: Incisional OR excisional biopsy OR remove bridge • Tissues: ulcerated stratified squamous epithelium, fibrin, connective tissue (lamina propria) • Diagnosis: Non-specific (traumatic) ulcer • Treatment: Remove bridge • Prognosis: Excellent
Diagnosis: Pemphigous
Alternate DDx than the previous card
1) Pemphigus vulgaris
2) Bullous pemphigoid
3) Lichen planus
4) Hypersensitivity reaction
Diagnosis: Non-necrotizing granulomas consistent with sarcoidosis
• Clinical category: bilateral parotid enlargement
• DDx:
1) Sarcoidosis
2) Sjogren’s syndrome
3) Sialosis
• Diagnostic procedure: Biopsy
• Alternate diagnostic procedures: Salivary flow, lacrimal flow, sialography, Scintigraphy, Serology, Chest film, ACE, Kveim skin test, Gallium scintiscan
• Tissues: Fibrous connective tissue (with chronic inflammatory cells & giant cells)
• Treatment: Corticosteroids, steroid-sparing agents, antimalarial agent
• Prognosis: Most recover
Diagnosis: Frictional keratosis (morsicatio buccarum)
• Clinical category: white plaques • DDx: 1) Frictional keratosis 2) Lichen planus 3) White sponge nevus • Diagnostic procedure: incisional biopsy • Tissues: Stratified squamous epithelium, connective tissue • Prognosis: excellent
Diagnosis: Orofacial granulomatosis
• Clinical category: multiple enlargements
• DDx:
1) Orofacial granulomatosis
2) MRS syndrome
3) Cheilitis granulomatosa
4) Sarcoidosis
5) Crohn’s disease
6) Foreign body reaction
7) Hypersensitivity reaction
• Diagnostic procedure: incisional biopsy
• Tissues: Non-necrotizing granulomas
• Treatment: R/O sarcoidosis, infection, foreign body reaction, etc.
• Prognosis: Variable depending on underlying etiology
Diagnosis: Erosive lichen planus
• Clinical category: Red and white plaques
• DDx:
1) Pemphigus vulgaris [POOR CHOICE]
2) Erosive lichen planus
3) Lichenoid mucositis
4) Hypersensitivity reaction
5) Erythroleukoplakia
6) Candidiasis
7) Chronic ulcerative stomatitis
• Diagnostic procedure: Perilesional biopsy for routing processing & possible IF studies
• Tissues: Stratified squamous epithelium, lamina propria with lichenoid reaction
• Treatment: Topical steroids or topical tacrolinus. Custom-made flexible tray, (systemic corticosteroids if necessary.) Antifungals to prevent overgrowth of C albicans.
• Prognosis: Recurrence is likely (oral lesions more persistent than skin lesions). Malignant change in a small %age of cases of ELP
