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DMD3 > Epithelial pathoses > Flashcards

Epithelial pathoses Flashcards

1
Q

What are the types of benign epithelial white lesions?

A

Leukoedema (swelling of mucosa)

White sponge nevus

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2
Q

What are the types of HPV associated benign epithelial lesions?

A

Squamous papilloma

Verruca vulgaris

Condyloma acuminatum

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3
Q

What are the types of pigmented lesions that are benign epithelial pathoses?

A

Physiological and racial pigmentation

Oral melanotic macules

Oral nevi

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4
Q

What is the aetiology and pathogenesis of leukoedema?

A

Caused by keratinocyte oedema in response to mild irritation (cigarette and marijuana smoking, some toothpaste, mouth rinses, and physical trauma)

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5
Q

What are the clinical features of leukoedema?

A

Very common and especially common in dark skinned individuals. It has a milky white translucent surface that disappears with stretching.

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6
Q

What are the histopathologic features of leukoedema?

A

Acanthosis (always present)

Superficial keratinocyte oedema (enlarged, pale, and ballooned cells)

Anucleation

Jigsaw puzzle cell membrane

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7
Q

What is done for Leukoedema diagnosis?

A

Can be done clinically (blanching)

Generally does not require a biopsy for diagnosis

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8
Q

Leukoedema treatment:

A

No treatment required

Educate the patient about the condition

Avoid causative irritant if possible

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9
Q

What causes white sponge nevus?

A

Relatively rare:

Autosomal dominant with high degree of penetrance and variable expressivity.

Caused by a defect in normal keratinization (Mutation in keratin 4 and 13; KRT4 and KRT13)

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10
Q

What age does white sponge nevus typically show up?

A

Appears at early childhood or birth

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11
Q

What are the clinical features of white sponge nevus?

A

Usually bilateral and symmetric

• Asymptomatic white spongy plaques

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12
Q

Where are white sponge nevi typically seen?

A

Bilateral buccal mucosa

Ventral tongue

Lip mucosa

Soft palate

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13
Q

What are the histopathological features of white sponge nevus?

A

This must be seen for diagnosis: Perinuclear eosinophilic condensations of keratin

Parakeratosis and acanthosis

Spongy appearance
– Due to cytoplasmic vacuolation

Minimal to no inflammation

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14
Q

Does white sponge naevus have any malignant potential? Why or why not?

A

No, it is simply a defect in keratinization not a disorder of keratinocyte hyperplasia or dysplasia

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15
Q

How is white sponge nevus diagnosed?

A

Family history

Biopsy

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16
Q

How is white sponge nevus treated?

A

No effective treatment

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17
Q

Which types of HPV cause squamous papillomas?

A

HPV6 and HPV11 (Extremely low virulence and infectivity rate)

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18
Q

How common is squamous papilloma?

A

Occurs in 1/250 adults

Makes up 3% of all oral lesions

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19
Q

What does squamous papilloma look like?

A

Exophytic nodule

Soft, painless and usually pedunculated

Has numerous fingerlike surface projections which makes it resemble a cabbage or wart (pointed or blunted)

White, slightly red, or normal in colour

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20
Q

How does squamous papilloma grow?

A

Usually grows fast until 5mm then stops growing

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21
Q

What are the histopathological features of squamous papilloma?

A

Fingerlike proliferation of oral epithelium.

Fibrovascular connective tissue core which can have inflammation.

May have a thickened keratin layer

Koilocytes

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22
Q

What are koilocytes?

A

Virus-altered epithelial cells with crenated pyknotic nuclei surrounded by clear halos

Enlarged hyperchromatic nuclei with a folded appearance and prominent cytoplasmic halo

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23
Q

What are the cellular changes seen in squamous papilloma?

A

Binucleate cells

Dyskeratotic cells (Individual cell keratinisation)

Koilocytes

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24
Q

How is a squamous papilloma diagnosed?

A

Excisional biopsy including the base of the lesion

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25
Q

Which HPV types cause squamous papilloma?

A

HPV6 and HPV11

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26
Q

Which HPV types cause verruca vulgaris?

A

HPV2 most often

Can also be caused by HPV1, 4, and 57

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27
Q

How does HPV transmit from one person to another?

A

Autoinoculation

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28
Q

Is verruca vulgaris seen commonly in the mouth?

A

No, it is more common in the skin

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29
Q

Where is verruca vulgaris commonly seen?

A

Mostly seen in children but can develop in older adults as well.

Most commonly seen on hands

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30
Q

Where intraorally are you most likely to find verruca vulgaris?

A

Vermilion zone

Labial mucosa

Anterior tongue

Palate

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31
Q

What does verruca vulgaris look like?

A

Painless papule or nodule with papillary projections or a rough pebbly surface

32
Q

What are the histopathological features of verruca vulgaris?

A

Acanthosis

Finger-like projections with connective tissue cores

Convergence of the projections towards the lesion

Hypergranulosis

Koilocytes

33
Q

How can verruca vulgaris be diagnosed?

A

Biopsy

34
Q

How is verruca vulgaris treated?

A

Skin lesions treated topically.

Oral lesions are treated with surgery, laser excision, cryotherapy, and electrosurgery.

35
Q

What is condyloma acuminatum?

A

A venereal wart (STD)

36
Q

What causes condyloma acuminatum?

A

Caused by HPV6 and HPV11 in 90% of cases

Coinfection with HPV 16 and 18 are high risk if seen in child consider child abuse.

37
Q

How common is condyloma acuminatum?

A

1% of sexually active population due to HPV vaccine

38
Q

Who most commonly gets condyloma acuminatum?

A

Teenagers and young adults

39
Q

What does condyloma acuminatum look like in the mouth?

A

Typically a sessile, pink, well-demarcated, non-tender, exophytic mass with short, blunted surface projections

40
Q

What are the histopathological features of condyloma acuminatum?

A

Acanthosis

Mild keratosis

Papillary projections (blunted and broader than squamous papilloma)

Thin connective tissue core

Koilocytes

41
Q

How is condyloma acuminatum diagnosed?

A

Excisional biopsy if appropriate

42
Q

How is condyloma acuminatum treated?

A

Conservative surgical excision

Cryotherapy

Laser ablation

Topical treatment (Imiquimod, podophyllotoxin and sincecatchins)

43
Q

What are the sites of physiologic and racial pigmentation?

A

Gingiva

Buccal mucosa

Lips

Palate

Tongue

44
Q

What are the histopathologic features of physiologic and racial pigmentation?

A

Presence of increased amounts of melanin deposition within the basal cell layer

45
Q

How is racial pigmentation diagnosed?

A

Clinical diagnosis

Biopsy is indicated if pigmentation is of recent onset as an adult or patient reports physical symptoms that may be related to a systemic disorder

46
Q

How is racial pigmentation treated?

A

No treatment needed

47
Q

What causes oral melanotic macules?

A

Idiopathic or post-inflammatory

48
Q

Who most commonly gets oral melanotic macules?

A

Most common oral mucosal lesion of melanocytic origin.

affects 3% of the population

Mostly people of the 5th or 6th decade of life.

Females more often than males 2 - 3:1

49
Q

What do melanotic macules look like?

A

Solitary, asymptomatic, well-circumscribed lesions.

Uniformly tan to dark brown

Typically are less than a cm in diameter

50
Q

What are the histopathologic features of oral melanotic macules?

A

Normal stratified epithelium

Increased melanin production in the basal and parabasal layers

Without increase in number of melanocyes

Extra melanin is seen in melanophages

51
Q

How is oral melanotic macule diagnosed?

A

Excisional biopsy of suspected lesions

52
Q

How do oral nevi arise?

A

Melanocytic growth and proliferation

Increase in melanin pigment synthesis. (dermal melanocytic nevi: BRAF mutation but in oral unknown)

53
Q

Who are oral nevi most common in?

A

F>M

2nd - 4th decade of life

54
Q

What are the clinical features of oral nevi?

A

<1cm

Solitary

Most common on the palate

55
Q

What are the types of oral nevi?

A

Intramucosal nevus (64-80%)

Blue nevus (8 - 17%)

Compound nevus (6 - 17%)

Junctional (uncommon)

56
Q

What are the histopathologic features of intramucosal nevi?

A

Nests and theques of epithelioid cells with pigment content lie just beneath the epithelium

More pigment close to the epithelium

No nuclear polymorphism

57
Q

What are the histopathologic features of junctional nevi?

A

Many nests of benign nevus cells in the BASAL LAYER ONLY

58
Q

What are the histopathologic features of compound nevi?

A

Combination of intramucosal

and junctional nevus

59
Q

What are the histopathologic features of a blue nevus?

A

Discrete proliferation of spindled nevus cells:

– Variable melanin
– Benign nuclei

60
Q

How is an oral nevus diagnosed?

A

Through history and a biopsy if appropriate

61
Q

How is an oral nevus treated?

A

No treatment is required unless cosmetically indicated

62
Q

What is nicotine stomatitis?

A

A reactive keratosis to heat (not nicotine)

63
Q

What cause nicotine somtitis?

A

Usually caused from pipe smoking

Often seen in heavy cigarette smokers or those who drink very hot beverages

64
Q

What are the clinical features of nicotine stomatitis?

A

Symmetric

Painless or sensitive

Often affects the hard palate (sometimes the soft palate as well)

White cast (variable intensity)

Red punctate papules (represent the opening of excretory salivary ducts)

65
Q

What are the histopathological features of nicotine stomatitis?

A

Hyperkeratosis or parakeratosis

With or without reactive epithelial atypia

Variable chronic inflammation

Squamous metaplasia of excretory salivary ducts

Chronic sialodochitis (periductal inflammation)

66
Q

How is nicotine stomatitis diagnosed?

A

Clinical presentation and history

Early mucosal changes are generally reversible on stopping the habit.

67
Q

What are the adverse outcomes that can can develop with nicotine stomatitis?

A

Leukoplakias that develop require close follow-up and surveillance biopsies

68
Q

What causes hairy tongue?

A

Dry mouth and soft diet.

Lack of vegetables and little water drinking

69
Q

What are the features of hairy tongue?

A

Elongated filiform papillae (may be stained)

70
Q

What are the histopathologic features of hairy tongue?

A

Hyperplastic filiform papillae

Spires of parakeratin with many bacterial colonies

71
Q

How is hairy tongue diagnosed?

A

Diagnosis is through clinical examination

72
Q

How is hairy tongue treated?

A

Improving diet (fresh pineapple helps)

73
Q

What causes verruciform xanthoma?

A

It is a reactive lesion (Histiocytic response to products of epithelial breakdown)

Accumulation of lipid-laden macrophages

Benign papillary proliferation of stratified squamous epithelium

74
Q

Who most commonly gets verruciform xanthoma?

A

Both males and females of the 5th and 6th decade of life.

75
Q

What are the clinical features of verruciform xanthoma? which tissue are they typically seen on?

A

Discrete, nontender, yellowish, or mucosa-coloured plaque

Pebbly, warty appearance

Some are also flat

75% are located on the keratinized tissues (gingiva and hard palate)

Also popular near excision sites because of epithelium breakdown.

76
Q

What are the histopathologic features of verruciform xanthoma?

A

Acanthosis

Elongated rete ridges:
Generally of the same length and confluent at the tips

Parakeratosis

Bright eosinophilic hue

77
Q

How can verruciform xanthoma be diagnosed and treated?

A

Incisional or excisional biopsy

Excision is the treatment of choice

DMD3 (53 decks)

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