Epithelial Pathology Flashcards

Question

clinical appearance of BCC

Answer 1

firm painless papule enlarges with a central depression and rolled borders umbilication with resultant ulceration - rodent ulcer fine blood vessels over lesion

Answer 2

moh's micrographic surgery for best esthetic results for BCC excellent aesthetics with this procedure

Answer 3

-malignancy of melanocytic differentiiation -most are cutaneous; 3rd most common skin cnacer -5% of skin cancers; 65% of deaths due to skin cancer -fair skin patient, 40-70 years

Answer 4

malignancy of melanocytic differentation

Answer 5

-acute sun damage with blistering sunburn early in life -tendency to burn easily -indoor occupation; outdoor recreation -family history -personal history

Answer 6

93.3% 5-year survival (because people are aware)

Answer 7

asymmetry border irregularity color variation diameter greater than 6mm evolving rapidly in shape / size / color / surface

Answer 8

-lack pigment -challenging to diagnose -will require immunological stains for accurate diagnosis -melanoma with ZERO pigment

Answer 9

8% of melanomas -affect palms, soles, oral mucosa (no relation to soalr exposure) -MOST COMMON CLINICOPATHOLOGIC TYPE OF MELANOMA IN PERSONS OF COLOR -begins as darkly pigmented macule with irregular borders

Answer 10

-surgical excision with / without lymph nodes -chemotherapy, radiation therapy with little impact on the disease -biologica agents ot boose immune system

Answer 11

determines prognosis of melanoma

Answer 12

common skin condition (does not occur on mucosa)

Answer 13

some cases are hereditary (autosomal dominant)

Answer 14

onset during the 4th decade of life become more pregalent thereafter

Answer 15

-most common on skin of face / trunk / extremities -begins as small pigmented macules and evolve to enlarge and raise with fine fissured, pitted surface -stuck on dirty candle wax

Answer 16

-form of seborrheic keratosis in about 30% of blacks -autosomal dominant trait -multiple small pigmented papules over skin of zygoma

Answer 17

no treatment required, except for esthetic purposes

Answer 18

melanomas may look like seborrheic keratosis sudden eruptions of multiple seborrheic keratosis with pruritus (leser-trelat sign) associated with internal malignancy

Answer 19

most common benign intraoral epithelial neoplasm

Answer 20

may / may not show human papilloma virus direct cause / effect is uncertain

Answer 21

solitary lesion, typically found on soft palate / uvula or tongue -finger like fronds, usually pedunculated, may be sessile -range of color (reddish to white)

Answer 22

-orthokeratinized or parakeratinized surface -papillary proliferation of surface epithelium -finger like projections of fibrous CT that support the epithelial proliferation

Answer 23

conservative excision, including base of lesion prognosis is excellent

Answer 24

DNA virus nearly 100 subtypes

Answer 25

24 types, specifically infect genital and oral mucosa tropism for epithelial cells

Answer 26

16, 18, 31 stornlgy associated with cervical, anogenital and some oropharyngeal cancers

Answer 27

sexually transmitted

Answer 28

gardasil immunization of girls and boys at ages 11 / 12

Answer 29

common wart

Answer 30

common lesion caused by several strains of HPV HPV 2 / 4 / 6 / 40

Answer 31

-frequently affects children - hands and facial skin -usually sessile, exophytic, papillary lesion; often multiple

Answer 32

contagious autoinoculation

Answer 33

-hyperkeratotic epithelium raised into finger-like proections -elongated rete pegs converge towards center of lesion producing a "cupping" effect -prominent granular cell layer with coarse, clumped keratohyalin granules -koilocytes

Answer 34

virally infected cells with pyknotic nuclei and clear perinuclear cytoplasm

Answer 35

spontaneous regression common in kids excision, cryotherapy, keratolytic agents may recur

Answer 36

isolates of native indians of north and central america and brazil

Answer 37

1. multiple sessile, pink and white, papules of the gigniva, buccal and labial mucosa 2. asymptomatic 3. mostly found in children, may be foudn in older patients

Answer 38

HPV virus - contiguous contact of one mucous membrane and another Between people → between objects (ex. Food, fomites)

Answer 39

cells with unusual arrangement of nuclear chromatin resembling abnormal mitotic figures (mitosoid bodies) seen n spinous layer associated with multifocal epihtelial hyperplasia

Answer 40

Tend to regress spontaneously Topical interferon application

Answer 41

gnital warts venereal warts

Answer 42

Spread by direct contact

Answer 43

Caused by any one of several strains of HPV High risk strains (HPV 16 and 18) associated with cervical carcinoma

Answer 44

-may affect oral mucosa -usually diagnosed in teenagers and young adults -clinically presented as multiple sesile papules or plaques with cauliflower-like surface -affect the labial mucosa, soft palate, and lingual frenum most common

Answer 45

Histopathologically, characterized by parakeratotic papillary proliferation of surface epithelium with blunted fronds, acanthosis, broad rete ridges, and increased mitosis Perinuclear clearing (koilocytosis) is seen in the cells of the spinous layer associated with condyloma

Answer 46

common cutaneous infection caused by DNA poxvirus

Answer 47

Usually seen in children and young adults

Answer 48

Multiple pink papules affect the skin of the neck, eyelids, trunk, or genitalia Each papule as a central core or depression

Answer 49

-Histopathologically distinctive -Lobular proliferation of surface epithelium -Epithelial cells exhibit basophilic “molluscum (henderson-paterson) bodies” that are filled with viral particles -Move to top of skin and exfoliate → release lots of pox virus (creates divot!)

Answer 50

Consists of curettage or liquid nitrogen, although lesions often resolve spontaneously in the immune competent host in six to nine months Very difficult to treat

Answer 51

common, harmless lesion that may be seen either ont he lip or intraorally increased amount of melanin pigment in the basal cell layer of epithelium

Answer 52

-tan to dark brown, uniformly pigmented, demarcated margins -no change with sun exposure -could represent post-traumatic melanosis

Answer 53

-Lesions on vermilion zone of lip are often excised for cosmetic purposes -Tissues should be submitted for microscopic examination -Intraoral lesions may need to be excised to rule out early melanoma

Answer 54

young, adult african american females

Answer 55

Occurs on skin and oral mucosa Dark macule to patch that often arises rapidly Mimics melanoma

Answer 56

Long dendrites

Answer 57

Biopsy to establish diagnosis Spontaneous resolution may be seen following biopsy

Answer 58

Subsequent additional lesions may arise in same patient

Answer 59

moles -One of the most common lesions -Average 20/person in caucasians -My develop from first year of life through the fourths decade -Oftn involute with aging

Answer 60

functional compound intradermal

Answer 61

first stage, appear flat and usually appear dark -function of epithelium and CT -nevus cells present among basal epithelial cells

Answer 62

may evolve from jucntioanl nevus as the patient grows older -proliferaiton of nevus occurs with some of the nevus cells dropping off into the superficial CT -may begin to dhow elevation clincially

Answer 63

with time, nevus cells may proliferate to the extent that they are completley contained within the dermal CT -elevated, with variable degree of pigmentation (many are normal skin color) -no more nevus cells left in epithelium

Answer 64

infrequently, melanocytic nevi can develop in oral cavity usually located on the hard palate or attached gingiva, but potentially any site an be affected

Answer 65

no treatment absolutely neceesary

Answer 66

1 in a million changes in nevus or chronic irritation of a nevus would be reason for excision biopsy

Answer 67

type of melanocytic nevus present at birth 1% of newborns

Answer 68

designated as large or small, with small <15cm being uch more common large congenital nevus is also known as "garment nevus" or "bathing trunk" nevus due to extensive involvement on patient's skin

Answer 69

high 1% for small 15% for large

Answer 70

staged excision for large excision for small

Answer 71

-may affect any cutaneous mucosal site -appear blush / gray due to depth of the melanin pigment -simpel excision -excellent prognosis

Answer 72

white patch of posteiror hard palate and soft palate

Answer 73

Acute onset Secondary to heat of pipe / cigar, cigarette

Answer 74

Numerous pinpoint red areas signify inflamed openings of ducts of minor mucous glands of the palate

Answer 75

Resolves spontaneously

Answer 76

due to placement of quid containing smokeless tobacco Wrinkled, corrugated hyperkeratosis Does not show clear margin from surrounding mucosa Asymptomatic

Answer 77

loose leaf tobacco dry snuff

Answer 78

white patch of oral mucosa that cannot be scraped off and cannot be diagnosed clinically or microscopically as any other condition

Answer 79

Leukoderma (blend with surroundings, less severe when stretched) cheek chewing (rigid boundary) frictional / ridge keratosis, nicotine stomatitis, smokeless tobacco, keratosis

Answer 80

Lateral tongue Ventral tongue Floor of mouth Anterior pillar of tonsils Lateral soft palate

Answer 81

Typically some degree of hyperkeratosis (wet keratin appears white) Pre Cancerous changes may be evident microscopically - epithelial dysplasia Mild (low grade), moderate, severe dysplasia or carcinoma-in-situ (high grade)

Answer 82

1. sharply demarcated white plaques with smooth, verrucous or micronodular surface 2. crisp margins 3. cracked mud like appearance (because of movement)

Answer 83

if red component is present

Answer 84

not as many changes from normal

Answer 85

large change from normal (poorer prognosis) treated just like cancer

Answer 86

when high grade / cancer

Answer 87

from different areas of the lesion different portions of lesion will behave differently

Answer 88

1. discontinue carcinogenic habits and frequent follow up 2. biopsy if any progressive change (ex increase in size, thickening, ulceration, erosion, pain, mobility of tooth, exophytic growth, atlered sensation)

Answer 89

remove by the most convenient means available submit tissue for assessment of margins

Answer 90

1. prognosis is guarded 2. 33% of dysplastic lesions will transform to squamous cell carcinoma 3. 30% of leukoplakia will recur

Answer 91

altered development

Answer 92

signifies disorder at cellular and tissue level microscopically identifiable as changes associated with premalingancy / malignancy

Answer 93

1. abnormal variation in nuclear size and shape 2. abnormal variation in cell size and shape 3. increased nuclear / cytoplasmic ratio 4. hyperchromatic nuclei 5. increased mitotic figures 6. abnormal mitotic fitures

Answer 94

1. disordered maturaiton from basal to squamous cells 2. increased cellular density 3. basal cell hyperplasia 4. dyskeratosis 5. bulbous drop shaped rete pegs 6. acantholysis

Answer 95

compromise of basement membrane

Answer 96

1. uncommon, high risk presentation 2. extensive and often multiple keratotic plques in older adults 3. hyperkeratosis / hyperplasia with variable dysplasia

Answer 97

females (mean age 65 years) males (mean age 49 years)

Answer 98

female predilection (4:1) with only 1/3 having traditional risk factors

Answer 99

no history of alcohol or tobacco use common in post-menopausal women

Answer 100

1. optimal treatment remains to be determined 2. surgical or ablative therapy, but recurrence common 3. malignant transformation is frequent complication, even in lesion without previous biopsy evidence of dysplasia

Answer 101

100% will transform to carcinoma 70% of patients developed SCCa within 8 years (40% died as result of carcinoma)

Answer 102

red patch that cannot be diagnosed as any other condition clinically or microscopically more serious than leukoplakia

Answer 103

pipe smoking

Answer 104

treatment and prognosis are similar to leukoplakia having a siilar degree of epihtelial can be excised patient education is important!

Answer 105

associated with use of extract of native indian bloodroot

Answer 106

herbal oral health care products

Answer 107

1. homogenous white patch 2. slight "cracked mud" like appearance 3. distinct margin 4. cannot scratch away (not a pseudomembrane)

Answer 108

maxillary gingiva canine premolar region

Answer 109

1. sites differ 2. clinically identical to leukoplakia 3. to be managed like leukoplakia 4. complete excision with clear margins 5. close follow up for recurrence or new lesions

Answer 110

most common oral malignancy and second most common cutaneous malignancy

Answer 111

surface epithelial cells

Answer 112

arises from pre-existing actinic keratosis in many instances due to chronic sun (UV light) exposure

Answer 113

face helix of ear dorsum of hands and arms are common sites

Answer 114

1. treatment consists of surgical excision 2. actinically induced SCC generally are well differentiated and grow slowly 3. prognosis is generally very good if lesion is identified early in course

Answer 115

oral cancer

Answer 116

1. intraoral squamous cell CAs are usually (75-80%) associated with tobacco cigarettes, with or without alcohol 2. significant percentage (25-30%) are not associated with any identifiable risk factors - usually lateral tongue of younger people or gingiva of older women

Answer 117

tobacco reverse smoking pipe moking UV

Answer 118

plummer vinson syndrome graft vs host disease syphilitic glossitis submucous fibrosis preivous radiation chronic inflammation, poor oral hygiene

Answer 119

1. oral SCC accounts for 2-4% of all cancers in the US 2. most occur in older adults 3. men outnumber women by 2:1 ratio

Answer 120

1. irregular shape, mixture of red and white clinically 2. often ulcerated 3. exophytic (Growing out) or endophytic (growing in) growth pattern 4. often much firmer than surrounding tissues 5. early lesions are asymptomatic

Answer 121

1. nonspecific ulcer 2. specific indications (TB, histoplasmosis, syphilis) 3. immune mediated conditions (wegen'ers, crohn's) 4. carcinoma should be #1 in differential! (take biopsy!)

Answer 122

1. ragged radiolucency is characteristic of bone involvement 2. due to direct invasion of bone (usually late phenomenon)

Answer 123

1. microscopically, invades cords and nests of malignant squamous epithelial cells arise from dysplastic surface epithelium 2. tumor cells show an increase nuclear / cytoplasmic ratio, cellular and nuclear pleomorphism, and mitotic activity 3. varying degrees of keratin seen 4. intravascular, lymphatic, and perineural invasion may be seen

Answer 124

1. one of more common sites of involvement 2. secondary to ultraviolet light exposure 3. arises in the setting of actinic cheilitis 4. slow growing, well differentiated lesion

Answer 125

1. majroity of patients have history of cigarette smoking and alcohol abuse 2. when oral SCCa is seen in younger (<40) people, almost always develops at tongue

Answer 126

1. almost equal to lateral tongue as common site fo oral SCCa 2. most patients have history of cigarette smoking and alcohol abuse

Answer 127

1. unusual site epidemiologically for oral SCCa 2. more common in women at this site 3. more common in patients with no identifiable risk factors for oral SCCa

Answer 128

not very common site

Answer 129

1. most SCCa's affecting the palate arise on the lateral soft palate 2. rather rare to find this malignancy on the hard palate 3. may be different to determine whether lesion developed in maxillary sinus and invaded the floor

Answer 130

to dsicern extent of cancer

Answer 131

1. size of tumor (T) 2. involvement of regional lymph nodes (N) 3. whether the cancer has spread to different parts of body (M) 4. depth of invasion

Answer 132

if less than 5mm, fine! (stay at current staging) more than 5mm, T value goes up by 1

Answer 133

submandibular

Answer 134

upper jugular (anterior)

Answer 135

upper jugular (posterior)

Answer 136

mid jugular

Answer 137

lower jugular

Answer 138

medial supraclavicular

Answer 139

upper posterior triangle

Answer 140

lower posterior triangle

Answer 141

lateral supraclavicular

Answer 142

anterior cervical

Answer 143

retro-pharyngeal

Answer 144

retrostyloid

Answer 145

bucco-facial

Answer 146

retro-auricular

Answer 147

wide surgical excision / radiation therapy neck node dissection is based on staging chemotherapy not much impact

Answer 148

one of the worse cancer prognosis 67% 5-year survival rate