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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
Which HPV types cause squamous papilloma?
HPV6 and HPV11
26
Which HPV types cause verruca vulgaris?
HPV2 most often Can also be caused by HPV1, 4, and 57
27
How does HPV transmit from one person to another?
Autoinoculation
28
Is verruca vulgaris seen commonly in the mouth?
No, it is more common in the skin
29
Where is verruca vulgaris commonly seen?
Mostly seen in children but can develop in older adults as well. Most commonly seen on hands
30
Where intraorally are you most likely to find verruca vulgaris?
Vermilion zone Labial mucosa Anterior tongue Palate
31
What does verruca vulgaris look like?
Painless papule or nodule with papillary projections or a rough pebbly surface
32
What are the histopathological features of verruca vulgaris?
Acanthosis Finger-like projections with connective tissue cores Convergence of the projections towards the lesion Hypergranulosis Koilocytes
33
How can verruca vulgaris be diagnosed?
Biopsy
34
How is verruca vulgaris treated?
Skin lesions treated topically. Oral lesions are treated with surgery, laser excision, cryotherapy, and electrosurgery.
35
What is condyloma acuminatum?
A venereal wart (STD)
36
What causes condyloma acuminatum?
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
How common is condyloma acuminatum?
1% of sexually active population due to HPV vaccine
38
Who most commonly gets condyloma acuminatum?
Teenagers and young adults
39
What does condyloma acuminatum look like in the mouth?
Typically a sessile, pink, well-demarcated, non-tender, exophytic mass with short, blunted surface projections
40
What are the histopathological features of condyloma acuminatum?
Acanthosis Mild keratosis Papillary projections (blunted and broader than squamous papilloma) Thin connective tissue core Koilocytes
41
How is condyloma acuminatum diagnosed?
Excisional biopsy if appropriate
42
How is condyloma acuminatum treated?
Conservative surgical excision Cryotherapy Laser ablation Topical treatment (Imiquimod, podophyllotoxin and sincecatchins)
43
What are the sites of physiologic and racial pigmentation?
Gingiva Buccal mucosa Lips Palate Tongue
44
What are the histopathologic features of physiologic and racial pigmentation?
Presence of increased amounts of melanin deposition within the basal cell layer
45
How is racial pigmentation diagnosed?
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
How is racial pigmentation treated?
No treatment needed
47
What causes oral melanotic macules?
Idiopathic or post-inflammatory
48
Who most commonly gets oral melanotic macules?
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
What do melanotic macules look like?
Solitary, asymptomatic, well-circumscribed lesions. Uniformly tan to dark brown Typically are less than a cm in diameter
50
What are the histopathologic features of oral melanotic macules?
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
How is oral melanotic macule diagnosed?
Excisional biopsy of suspected lesions
52
How do oral nevi arise?
Melanocytic growth and proliferation Increase in melanin pigment synthesis. (dermal melanocytic nevi: BRAF mutation but in oral unknown)
53
Who are oral nevi most common in?
F>M 2nd - 4th decade of life
54
What are the clinical features of oral nevi?
<1cm Solitary Most common on the palate
55
What are the types of oral nevi?
Intramucosal nevus (64-80%) Blue nevus (8 - 17%) Compound nevus (6 - 17%) Junctional (uncommon)
56
What are the histopathologic features of intramucosal nevi?
Nests and theques of epithelioid cells with pigment content lie just beneath the epithelium More pigment close to the epithelium No nuclear polymorphism
57
What are the histopathologic features of junctional nevi?
Many nests of benign nevus cells in the BASAL LAYER ONLY
58
What are the histopathologic features of compound nevi?
Combination of intramucosal | and junctional nevus
59
What are the histopathologic features of a blue nevus?
Discrete proliferation of spindled nevus cells: – Variable melanin – Benign nuclei
60
How is an oral nevus diagnosed?
Through history and a biopsy if appropriate
61
How is an oral nevus treated?
No treatment is required unless cosmetically indicated
62
What is nicotine stomatitis?
A reactive keratosis to heat (not nicotine)
63
What cause nicotine somtitis?
Usually caused from pipe smoking Often seen in heavy cigarette smokers or those who drink very hot beverages
64
What are the clinical features of nicotine stomatitis?
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
What are the histopathological features of nicotine stomatitis?
Hyperkeratosis or parakeratosis With or without reactive epithelial atypia Variable chronic inflammation Squamous metaplasia of excretory salivary ducts Chronic sialodochitis (periductal inflammation)
66
How is nicotine stomatitis diagnosed?
Clinical presentation and history Early mucosal changes are generally reversible on stopping the habit.
67
What are the adverse outcomes that can can develop with nicotine stomatitis?
Leukoplakias that develop require close follow-up and surveillance biopsies
68
What causes hairy tongue?
Dry mouth and soft diet. Lack of vegetables and little water drinking
69
What are the features of hairy tongue?
Elongated filiform papillae (may be stained)
70
What are the histopathologic features of hairy tongue?
Hyperplastic filiform papillae Spires of parakeratin with many bacterial colonies
71
How is hairy tongue diagnosed?
Diagnosis is through clinical examination
72
How is hairy tongue treated?
Improving diet (fresh pineapple helps)
73
What causes verruciform xanthoma?
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
Who most commonly gets verruciform xanthoma?
Both males and females of the 5th and 6th decade of life.
75
What are the clinical features of verruciform xanthoma? which tissue are they typically seen on?
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
What are the histopathologic features of verruciform xanthoma?
Acanthosis Elongated rete ridges: Generally of the same length and confluent at the tips Parakeratosis Bright eosinophilic hue
77
How can verruciform xanthoma be diagnosed and treated?
Incisional or excisional biopsy Excision is the treatment of choice

DMD3 (53 decks)

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