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Pathology > Epithelial Neoplasms > Flashcards

Epithelial Neoplasms Flashcards

1
Q

Head and Neck Cancer
(5)

A
  • Squamous Cell Carcinoma
  • Adenocarcinoma
  • Lymphoma
  • Metastatic Carcinoma
  • Sarcoma
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2
Q

Etiology of Oral and Oropharyngeal Carcinoma
Primary etiologic agents
(4)

A
  • Tobacco
  • Alcohol
  • Actinic radiation
  • Human papilloma virus – HPV
    – High risk subtypes: HPV-16 and 18
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3
Q

HPV-(2) are low-risk subtypes associated with genital warts

A

6 and 11

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4
Q

skipped
Betel Quid - Paan
(5)

A
  • Areca nut
  • Betel leaf
  • Lime
  • Reactive Oxygen Species
  • Nitrosamines
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5
Q

Early Diagnosis of Oral Cancer Improves Survival
* The larger the tumor the —
the incidence of metastasis
* The occurrence of metastasis
— survival

A

higher
decreases

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6
Q

What Does Oral Squamous Cell Carcinoma Look Like Clinically?
(5)

A
  • Exophytic
  • Endophytic
  • Leukoplakia – a white patch
  • Erythroplakia – a red patch
  • Erythroleukoplakia – a red-and-white patch
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7
Q
  • Exophytic
    (4)
A

– Mass-forming
– Fungating
– Papillary
– Verruciform

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8
Q
  • Endophytic
    (3)
A

– Invasive
– Burrowing
– Ulcerated

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9
Q

Early Diagnosis of Oral Cancer
Identify precursor lesions
(2)

A

– Leukoplakia
– Erythroplakia
* Be suspicious - biopsy clinically
suspicious lesions

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10
Q

Leukoplakia

A

A white patch or plaque that can’t be characterized clinically or
pathologically as any other disease.

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11
Q

Why are White Lesions White?
(3)

A
  • Hyperkeratosis
  • Acanthosis
  • Surface coating
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12
Q
  • Hyperkeratosis -
A

increased opacity

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13
Q
  • Acanthosis -
A

increased thickness

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14
Q
  • Surface coating -
A

fibrin membrane
or fungal hyphae

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15
Q

What is the likelihood of Leukoplakia being Premalignant?
Rule of thumb: —% of Leukoplakia will be premalignant

A

20

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16
Q

Erythroplakia

A

A red patch that can’t be characterized clinically or pathologically as
any other disease.

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17
Q

Why are Red Lesions Red?
(2)

A

Thin epithelium
* Red blood cells

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18
Q

What is the likelihood of Dysplasia in Erythroplakia?
Rule of thumb: —% of Erythroplakia will be dysplastic

A

90

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19
Q

High Risk Areas for Premalignancy and Malignancy
(5)

A
  • Lower Lip **
  • Floor of Mouth
  • Ventral Tongue
  • Lateral Border of Tongue
  • Soft Palate
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20
Q

Diagnosis of Oral Squamous Cell Carcinoma
* — is
required for definitive diagnosis

A

Incisional or excisional biopsy

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21
Q

skipped
Epithelial Dysplasia - Premalignant Change
(2)

A
  • Cellular alterations
  • Architectural alterations
22
Q

Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Size
(1)

A

– N/C Ratio

23
Q

Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Shape
(1)

A

– Pleomorphism

24
Q

Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Proliferation
(3)

A

– Hyperchromatism
– Mitotic figures
– Abnormal mitoses

25
Q

Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Keratinization
(1)

A

– Dyskeratosis

26
Q

Cytologic and Architectural Features of Squamous Epithelial Dysplasia
* Maturation
(3)

A

– Loss of cohesion
– Loss of polarity
– Rete-ridge architecture

27
Q

Oral Squamous Cell Carcinoma Staging: TNM Classification

A

Tumor size
Metastasis
Stage determines:

28
Q

Metastasis
(2)

A
  • Regional lymph
    nodes
  • Distant sites
29
Q

Stage determines:
(2)

A
  • Treatment
  • Prognosis
30
Q

Treatment of Head and Neck Squamous Cell Carcinoma
(4)

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Combined therapy
31
Q

skipped
Multidisciplinary Head and Neck Tumor Board for Treatment Planning

A
  • Surgical oncologist
  • Medical oncologist
  • Radiation oncologist
  • Radiologist
  • Pathologist
  • Dentists
    – Oral surgeon
    – Maxillofacial prosthodontist
  • Speech pathologist
  • Social worker
  • Physical therapist
  • Occupational therapist
32
Q

Oral Cavity Cancer Five Year Survival by Stage - ACS
* All stages combined —%
– Local disease —%
– Regional metastasis —%
– Distant metastasis —%

A

59
81
51
30

33
Q

skipped
Components of an Oral Cancer
(8)

A
  • Extraoral examination– Inspect head and neck.– Bimanually palpate lymph nodes and salivary glands.
  • Lips– Inspect and palpate outer surfaces of lip and vermilion border.– Inspect and palpate inner labial mucosa.
  • Buccal mucosa– Inspect and palpate inner cheek lining.
  • Gingiva/alveolar ridge– Inspect maxillary/mandibular gingiva and alveolar ridges on both the buccal and lingual aspects.
  • Tongue– Have patient protrude tongue and inspect the dorsal surface.– Have patient lift tongue and inspect the ventral surface.– Grasping tongue with a piece of gauze and pulling it out to each side, inspect the lateral borders of the tongue from its tip back to the lingual tonsil region.– Palpate tongue.
  • Floor of mouth– Inspect and palpate floor of mouth.
  • Hard palate– Inspect hard palate.
  • Soft palate and oropharynx– Gently depressing the patient’s tongue with a mouth mirror or tongue blade, inspect the soft palate and oropharynx.
34
Q

Verrucous Carcinoma
(5)

A
  • Low-grade variant
    of squamous cell carcinoma
  • Locally invasive, no metastasis
  • Cytologically bland
  • Clinicopathologic correlation
  • Associated with smokeless
    tobacco
35
Q

Proliferative Verrucous Leukoplakia
(10)

A
  • High-risk, aggressive type
    of oral leukoplakia
  • High potential for
    malignant transformation
  • Not associated with
    tobacco use
  • Women outnumber men
  • Slow-growing
  • Begins as hyperkeratosis
  • Spreads to become multifocal
    and verruciform
  • Resistant to therapy - recurs
  • Malignant transformation
  • Diagnosis often retrospective
36
Q

skin cancers
(3)

A
  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  • Malignant Melanoma
37
Q
  • Basal Cell Carcinoma
    (2)
A
  • Most common
    – No metastasis
38
Q
  • Malignant Melanoma
    (2)
A
  • Least common
    – Most deaths
39
Q

Basal Cell Carcinoma
(5)

A
  • Most common skin cancer
  • Sun-exposed skin of adults
    with fair complexions
  • Locally invasive
  • Metastasis extremely rare
  • Arises from basal cell layer
    and skin appendages
40
Q

Oral Melanotic Macule
(3)

A
  • Focal increase in melanin
  • Normal number of melanocytes
  • Lower lip vermillion most common
41
Q

ABCD Clinical Features of Melanoma

A
  • A Asymmetry
  • B Border irregularity
  • C Color variegation
  • D Diameter
    E Changing
42
Q
  • A Asymmetry
A
  • Uncontrolled growth pattern
43
Q
  • B Border irregularity
A
  • Often with notching
44
Q
  • C Color variegation
A
  • Amount and depth of melanin
  • Brown, black, red, white and blue
45
Q
  • D Diameter
A
  • Diameter greater than 6mm
46
Q

Nevus
(7)

A
  • Generic term for a
    developmental
    malformation of skin or
    musosa
  • Melanocytic nevus
  • Epithelial nevus
  • Vascular nevus
  • Basal cell nevus
  • White sponge nevus
  • Sebaceous nevus
47
Q

Acquired Melanocytic Nevi
(2)

A
  • A benign proliferation
    of nevus cells that
    develops during
    childhood and evolves
    through clinical stages
    (nevus life cycle)
  • Less than 6 mm
48
Q

Nevus Life Cycle
* Nevi evolve through

A

clinical stages

49
Q

Malignant Melanoma
(3)

A
  • Malignant lesion of
    melanocytic origin
  • Acute rather than
    chronic sun damage
  • Prognosis related to
    depth of invasion
50
Q

Melanomas Exhibit Two Directional Patterns of Growth
(2)

A
  • Radial Growth Phase - within the epithelium (in situ)
  • Vertical Growth Phase – invasion
51
Q

Prognosis of Malignant Melanoma correlates with Depth of invasion
(2)

A
  • Clark’s levels
  • Breslow depth
52
Q

Oral Mucosal Melanoma
(3)

A
  • White adults over 50 years
  • Hard palate, maxillary alveolus
  • Amelanotic forms

Pathology (23 decks)

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