Exam 2 Flashcards
Salivary Gland Neoplasia usually arise during:
Adulthood
The SECOND most common site of involvement of Salivary Gland Neoplasms (after parotid) are ______ on the _____
MINOR glands
Palate
What has a greater chance of MALIGNANCY for Salivary Gland Neoplams….upper or lower lip?
LOWER
Most MALIGNANT spot for Salivary Gland Neoplasm
Retromolar
Most common salivary gland neoplasm:
Pleomorphic Adenoma (aka Benign Mixed Tumor)
Most common site of Pleomorphic Adenoma
Parotid (80%)
Pleomorphic Adeoma is..
- (slow/fast) growing:
- pain?
- Movable or stationary
- On palpation, feels:
- Only time it is NOT movable:
- slow
- painless
- freely movable
- rubbery firm
- on hard palate
Pleomorphic Adenoma intraoraly is most frequently located:
Palate (followed by upper lip)
___________ has myoepithelial cells that have the ability to produce hyaline, cartilage, and even bone.
Pleomorphic Adenoma
Pleomorphic Adenoma tx:
Remove lesion and involved gland
Papillary Cystadenoma Lymphomatosum is aka:
Warthin Tumor
Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor) is found exclusively in:
Parotid gland
Presents as a non-tender, slowly growing freely movable mass in parotid region and may be caused by CIGARETTE smoking!
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
What is encapsulated with cystic spaces containing milky or chocolate-syrup-like fluid AND GERMINAL CENTER formation
Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
Monomorphic Adenoma is ___ common than pleomorphic. It’s a proliferation of ONE cell type
less
2 major subtypes of Monomorphic Adenoma
Canalicular Adenoma + Basal Cell Adenoma
Canalicular Adenoma (a type of Monomorphic Adenoma) is common where?
Upper labial mucosa
Which Monomorphic Adenoma has a FEMALE predominance in OLDER adults.
Canalicular Adenoma
Most common intraoral salivary gland MALIGNANCY (very common in children too)
Mucoepidermoid Carcinoma
Most common intraoral site of Mucoepidermoid Carcinoma
Palate (followed by retromolar area)
What lesion may be bluish due to entrapped mucin?
Mucoepidermoid Carcinoma
Mucocele-appearing lesion of retromolar area should be considered a ________ until proven otherwise
Mucoepidermoid Carcinoma
Does Mucoepidermoid Carcinoma hurt?
Yes, ulceration and pain may develop as lesion progresses
Does Mucoepidermoid Carcinoma need mucous cells AND epidermoid cells to make a diagnosis?
YES
In Mucoepidermoid Carcinoma, cells don’t usually show _____ or increased ____ activity, but a spectrum of ______ is recognized
- Pleomorphism
- Mitotic
- Differentition
Mucoepidermoid Carcinoma lesions less than 2.5cm
Excellent
What is the SECOND most common intraoral salivary gland MALIGNANCY
Polymorphous Low-Grade Adenocarcinoma (PLGA)
Polymorphous Low-Grade Adenocarcinoma (PLGA) has a _____predilection
Female
PLGA is most commonly found where?
Posterior hard palate /soft palate
PLGA is usually _____ growing
very SLOW
PLGA has a ____ growth pattern that infiltrates surrounding normal tissue, although a ______ can be present in some areas
lobular
-psuedocapsule
Why is PLGA “polymorphous”
You usually see a variety of growth patterns from lesion to lesion or within same lesion
PLGA prognosis:
Excellent
Adenoid Cystic Carcinoma most commonly affects:
Palate
Does Adenoid Cystic Carcinoma cause pain?
Yes! and tenderness
Which salivary gland malignancy can invade nerves (perineural and intraneural)
Adenoid Cystic Carcinoma
Is Adenoid Cystic Carcinoma encapsulated?
-What is the intermediate growth pattern?
NO!
-Cribiform “swiss cheese”
Adenoid Cystic Carcinoma tx:
surgical excision AND THEN radiation
Adenoid Cystic Carcinoma prognosis
Poor. 10yr survival = 50%
Slow growing and relentless. You can die from disease up to 25 yrs after
Adenoid Cystic Carcimoma usually metastasize to:
-Does it usually affect lymph nodes?
Lung
-Rarely
Is Acinic Cell Adenocarcinoma a popular salivary gland tumor?
NO only 2%
Describe Acinic Cell Adenocarcinoma clinically:
Is pain common?
Fairly circumscribed, Slow-growing, In parotid region
-Pain in half of the cases
Is Acinic Cell Adenocarcinoma encapsulated?
Psuedo-encapsulated
Where does Acinic Cell Adenocarcinoma metastasize to
Lymph nodes
Long staniding asymptomatic mass that suddenly becomes tender or causes parasthesia describes:
Carcinoma ex-Mixed Tumor (PA pleomorphic adenoma)
Which salivary gland malignancy caused everyone to die if invasion was >8mm (and everyone lived if less than 6)
Carcinoma ex-Mixed Tumor (PA)
What is collagen deposition secondary to chronic trauma
Fibroma
Inflammatory FIBROUS Hyperplasia is caused by:
-What gives it away?
Ill-fitting denture
-Central fissure
Numerous asymptomatic red papules on central region of hard palate from denture:
Inflammatory PAPILLARY Hyperplasia
Pyogenic Granuloma…
- Grows ___
- Pain?
- Color?
- Location?
- Does it bleed?
- Frequently occurs when?
Fast
- NO pain
- Red
- Any body surface
- Bleeds easily
- During pregnancy
What painless mass has a dusky-purple hue?
Peripheral Giant Cell Granuloma
Peripheral Giant Cell Granuloma is only found in which two places:
Gingiva + Alveoler process
Painless firm coral-pink mass:
Peripheral Ossifying Fibroma
Peripheral Ossifying Fibroma is only found where?
Gingiva
Benign tumor of adipose tissue:
-Does it become malignant?
Lipoma
-NO
Traumatic Neuroma clinically appears as:
Smooth-surfaced, dome-shaped papule,
Slow-growing, solitary (single), encapsulated, rubbery mass that may be seen in mandible
NeuriLEMOMA (Schwannoma)
Does Nuerilemoma have a capsule?
- What are the 2 patterns seen
- Malignancy?
YES
- Antoni A and B
- NEVER
Antoni A and B are associated with:
NeuriLEMOMA
Which lesion usually “shells out” due to dense connective tissue capsule
NeuriLEMOMA
Difference between Neurilemoma and Neurofibroma?
NeuriLEMOMA has CAPSULE
What lesion could potentially (not likely) transfrom to Malignant Peripheral Nerve Sheath Tumor
NeuroFIBROMA
NeuroFIBROMATOSIS is one of the most common:
Autosomal genetic problems
What can cause Cafe-au-lait spots on skin?
-How many spots do they usually have
NeuroFIBROMATOSIS
-Usually >6 greater than 1.5cm
NeuroFIBROMATOSIS prognosis
fair to guarded. If malignant transformation occurs, prognosis is poor
Melanotic Neuroectodermal Tumor of Infancy…
- Most develop where?
- Growth speed?
- What is characteristic?
- Prognosis?
Anterior maxilla
- Rapid
- Radiographic appearance (radiolucency of anterior maxilla)…“TOOTH FLOATING IN SPACE”
- Good
Granular Cell tumor most common location:
- Size:
- Prognosis
tongue (followed by floor of mouth and buccal mucosa)
- less than 1cm
- excellent
PEH (psuedoepitheliomatous hyperplasia) is present in 30% of:
Granular Cell Tumors
Rare lesion found at birth on maxillary ridge of GIRL babies
Congenital Epulis
Does Congenital Epulis have PEH (pseudoepitheliomatous hyperplasia?
-Does it have S-100 positivity?
Which lesion DOES have PEH?
NO
-NO
-Granular Cell Tumor
Most common tumor of childhood:
-Most common intraoral site
hemangioma
-Tongue
How to diagnose Hemangioma clinically:
Press on lesion with glass slide (diascopy). Lesion will blanch (blood within vessels will be pushed into adjacent vessels)
Hemangioma treatment:
If lesion impairs vision, treat ASAP. Otherwise, WAIT until child is at least 6 yrs old
Is Encephalotrigeminal Angiomatosis (aka Sturge-Weber Syndrome) congenital?
-Is it inherited/genetic
Yes
-NO (just present since birth)
In Encepthalotrigeminal Angiomatosis, which CN is most frequently affected (exhibits nevus flammeus)
-Symptoms
1st
-Seizures, retardation, and hemiplegia (paralysis of one side of body)
What is classic radiographic finding of Encephalotrigeminal Angiomatosis
“tram line” calcifications seen on skull film
Lymphangioma most common site:
- Surface has vesicular appearance, similar to:
- Recurrence?
Tongue
- “frog eggs”
- Yes, up to 40%!
Cystic Hygroma is just a very large _____.
-Why is it significant?
Lymphanigioma
-Can cause airway obstruction
Which is harder to treat, lymphangioma or hemangioma?
Lymphangioma (cuz the borders aren’t as defined)
Leiomyoma is a benign tumor of ______
- Most in the oral region arise from ____ smooth muscle
- Most common in what locations:
- Recurrence?
smooth muscle
- vascular (might be reddish/purplish)
- upper lip, buccal mucosa, and palate
- NONE
Rhabdomyoma is a very rare benign tumor of ____
- Most arise in the _____ and are associated with the syndrome ______
- Where are they located intraoraly?
skeletal muscle
- Heart
- Tuberous Sclerosis
- Submandibular or base of tongue
Mesenchymal Neoplasms are aka:
Sarcomas
Fibrosarcoma may present as _____ mass or _____lesion
- Hows the response to radiation?
- Prognosis:
- Metastasizes to:
soft tissue or intrabony
- little response to radiation
- BAD ~50% 5-year survival
- lung, bone, and liver
Malignant Peripheral Nerve Sheath Tumor may arise spontaneously or in association with:
- Which patients are affected earlier, spontaneous or NF1?
- What positivity does it show?
- 5 yr survival? 10?
Neurofibromatosis Type 1 (NF1)
- NF1 earlier
- S100
- 50% … 35%
Kaposi Sarcoma is malignancy of:
- Result of infections by:
- Classically presents where (on older males)?
- Which is the only form of Kaposi Sarcoma that has oral lesions?
Endothelium cells (in blood vessels)
- HHV-8
- Lower extremeties
- AIDS-related
What is treated with vinblastine (anticancer agent)
Kaposi Sarcoma
Most common soft tissue sarcoma of children
Rhabdomyosarcoma
Rhabdomyosarcoma usually affects what region of children?
-When it grows into body cavity, the lesion may look like:
head & neck
-Bunch of grapes “sarcoma botryoides”
Langerhans Cell Histiocytosis…
- Langerhans cells are related to ____ and serve as ______ cells
- Most common type:
Monocytes
Antigen-presenting
-Eosinophilic Granuloma
Which form of Langerhans Cell Histiocytosis is seen in infants?
- Clinical appearance:
- Aggressive?
ACUTE Disseminated Histiocytosis (Letterer-Siwe Disease)
- Rash, splenic + hepatic involvement
- YES! malignant!
Which form of Langerhans Cell Histiocyotsis is seen in older children
-Clinical appearance:
CHRONIC Disseminated Histiocytosis
-Classic triad of exophthalmos (eye bulging), diabetes insipidus, and bone lesions
Difference of Langerhans Cell Histiocytosis in teenagers and adults:
Teenagers: polystotic
Adults: monostotic
Three forms of Langerhans Cell Histiocytosis and their prognoses:
Acute: poor
Chronic: guarded
Eosinophilic granuloma: good
What are the group of hematologic malignancies characterized by tumor cells in blood called?
Leukemia
Leukemia..
Pts often present with signs related to ______ anemia (normal bone marrow replaced by leukemic cells)
-Symptoms:
-Diagnosis is usually based on finding increased:
Myelophthisic
- Fatigue (decreased RBC’s), easy bruising (decreased platelets), infection (decreased WBC’s)
- Atypical WBC’s in circulation
Leukemia in the mouth is most frequently seen which form?
-What affect does Leukemia have intraoraly?
Myelomonocytic form
-Diffuse gingival enlargement
Targeted Gene Therapy is the future for treating:
Leukemia
Difference of Hodgkins and NH lymphoma
Hodgkin: develops in lymph nodes
NH: may develop in nodes, soft tissue, or bone. Older pts
Common site of initial involvement of Hodgkin Lymphoma:
-Prognosis is based on ____
Head and neck
-Stage
Oral involvement for Non-Hodgkin Lymphoma is usually seen as:
- How do you know if it has mandibular involvement?
- What do you see radiographically?
Diffuse mass of soft palate or buccal vestibule
- numb chin
- moth eaten
Lymphoma tx…
Localized:
Generalized:
Radiation (and possible chemo)
-multi-agent chemo
What is Plasmacytoma/Multiple Myeloma?
- Comprises nearly __% of malignancies involving bone
- Almost never seen in pts younger than:
- Who’s affected more…men or women..black or white
Neoplastic proliferation of plasma cells, frequently arising in bone marrow
- 50%
- 40 yrs old
- Black male is most affected
Plasmacytoma/Multiple Myeloma can cause ____ failure due to circulating monoclonal immunoglobulin light chains which can spill over into ____.
-It can also be deposited in tissues as acellular eosinophilic material - “_____”
renal
- urine
- “amyloid”
Plasmacytoma/Multiple Myeloma tx:
-Prognosis
Chemo (prednisone and alkylating agent), thalidomide, bone marrow transplant
-Poor (5 yr survival = 46%)
Osteogenesis Imperfecta aka:
- defective type _ collagen
- Mostly autosomal _____
- Tx:
Brittle Bone Disease
- 1
- Dominant
- Anti-resorptive meds
Osteopetrosis aka:
- Characterized by dysfunction of _____
- Adult type is autosomal ___
- Child type is autosomal ____
- _____is replaced by ____ leading to _____
- Tx:
Marble Bone disease
- osteoclasts
- dominant
- recessive
- marrow / bone / pancytopenia(deficiency of all 3 components of blood)
- Transfusions and bone marrow transplant
Cleidocranial Dysplasia is a mutation of___ which is associated with bone, cartilage, and TOOTH formation.
-Why is primary dentition retained?
RUNX2 gene
-Permanent teeth do not erupt
If patient has little to no clavicles (and numerous impacted and supernumerary teeth), they have:
Cleidocranial Dysplasia
What is Focal Osteoporotic Marrow Defect?
-Higher predilection in:
Asymptomatic, ill-defined radioLUCENCY in body of mandible
-Females
Diff of Focal Osteoporotic Marrow Defect and Idiopathic Osteosclerosis?
Focal = radioLUCENCY Idopathic = radiOPAQUE
Where is Idiopathic Osteosclerosis most common?
Mandible (premolar area)
Cherubism is:
- Symptoms
- Radiographically:
- What tx should you NOT do
Osteoclast hyperactivity
- Painless bilateral expansion of jaws
- Bilateral multilocular radiolucencies of posterior mandible
- Surgical. Can accelerate growth of lesion
Traumatic (Simple) Bone Cysts are seen in what age group?
- Where are they usually located?
- Radiographically
- At surgical exploration, what do they find?
- Tx
Young
- Symphyseal area and posterior mandible
- Well-circumscribed radiolucency with scalloping between roots (teeth are VITAL!)
- Empty cavity within bone
- Curettage to induce bleeding and bone growth
Osteitis Deformans aka
- Abnormal ____ and ____ resulting in:
- Age:
- Do most cases affect only one bone?
- Radiographically:
- More common in maxilla or mandible?
Pagets Disease
- Resorption + deposition / thickened but weak bone
- > 40
- NO! polyostotic
- “Cotton Wool”
- Maxilla (2:1)
Which disease causes Simian stance (bowing of legs) and hypercementosis of teeth?
Osteitis Deformans
Which disease causes markedly elevated serum alkaline phosphatase?
Osteitis Deformans
Which disease has irregular trabeculae with resting and reversal lines = “mosaic/jigsaw” pattern
Osteitis Deformans
Which disease has a 1% lifetime risk of developing into osteosarcoma?
Osteitis Deformans
What is Fibrous Dysplasia?
- Mutation of which gene?
- What percent are monostotic (one bone)
- Classic radiography:
- Can cause obliteration of:
Tumor-like lesion that replaces normal bone
- GNAS (tumor suppressor)
- 70-85%
- Ground glass
- Maxillary sinus
Which bone disorder can cause cafe au lait spots?
Fibrous Dysplasia (ONLY in the POLYostotic form)
Fibrous Dysplasia tx:
En Bloc resection
What is the most common fibro-osseous lesion of the jaws encountered in clinic?
- What are the 3 types?
- Which has most widespread expression?
Cemento-Osseous Dysplasia
- Focal, Periapical, Florid
- Florid
Focal Cemento-Osseous Dysplasia has a __% _____predilection.
- Radiographically?
- What is the appearance during surgery
- What is the shape of trabeculae?
90% female
- Radiolucency with radiopaque central component
- Gritty fragments come out
- Ginger root
What is the most common area and group of people that get Periapical Cemental Dysplasia?
-Tx?
- Mandibular Anterior region
- Black females (so is Florid)
- None needed
Florid Cemento-Osseous Dysplasia is most common in:
-It affects:
Black females (so is Periapical) -MULTIPLE quadrants of the jaws
