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ORAL PATHOLOGY > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

leiomyomas are most common in ? (3)

A

uterus, GI, skin

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2
Q

• Attempts to regenerate and reestablish
innervation of the distal segment;
encounters scar tissue

A

traumatic neuroma

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3
Q

Endothelial cell
– Kaposi sarcoma
• Treatment:

A

–Excision for small cosmetically
problematic lesions

–Radiation

–Injections of chemotherapeutic agents

(3)

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4
Q

boggy consistency

A

non hodgkin lymphoma

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5
Q

• Lymphoreticular
– Langerhans cell histiocytosis
• Radiographic features:

affects where?

how many?

may ?

A

–Any bone affected but skull, mandible,
ribs, vertebrae most frequent –Solitary or multiple –May break out of bone

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6
Q

oral invovlement seen in leukemia? (2)

A

Diffuse gingival enlargement
• “Granulocytic sarcoma” - focal
proliferation of leukemic cells at one soft tissue site

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7
Q

• Sjögren syndrome
– Primary (sicca syndrome)

is what? (2)

A

• Xerostomia and keratoconjunctivitis sicca

(dry eyes)

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8
Q

–Most common hematologic
malignancy in black persons in the U.S.

A

multiple myeloma

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9
Q

laangerhaan cell histiocytosis prefers F

A

False

no gender predilection

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10
Q

gender preference of congenital epulis?

A

female

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11
Q

canalicular adenoma occurs when?

A

7th decade, 65 avg

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12
Q

Mucoepidermoid carcinoma makes up what % of major gland

A

10%

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13
Q

adenoid cystic carcinoma represents ____ of all salivary gland neoplasms?

A

5%

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14
Q
A

adenoid cystic carcinoma

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15
Q

Sjogren syndrome secondary is what?

A 
Sicca syndrome plus any other
autoimmune disease (e.g. rheumatoid arthritis, SLE, Hashimoto’s thyroiditis, mixed connective tissue disease, etc.)
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16
Q

–Pathologic fractures (due to tumor
destruction of bone)

A

multiple myeloma

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17
Q

Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Treatment: (3)

A
  • Targeted therapies for several types • Localized disease
  • Radiation ± chemotherapy • Generalized disease
  • Chemotherapy
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18
Q

during what period of life do salivary gland neoplasms arise?

A

adulthood

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19
Q

collection of lymphoid tissue, often shows germinal centers

A

Papillary cystadenoma lymphomatosum “Warthin tumor”

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20
Q

–Immunohistochemical studies show
monoclonal light chain restriction (kappa or lambda) of the lesional cell population (Similar finding of monoclonal gammopathy on serum protein immunoelectrophoresis

A

multiple myeloma

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21
Q

Salivary Gland Neoplasms • Carcinoma ex-pleomorphic adenoma – Treatment:

A

• Usually wide excision • ± lymph node dissection • ± radiation

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22
Q
A

aids related karposi sarcoma

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23
Q

what types of cells are found in canalicular adenoma?

A

cuboidal to columnar cells

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24
Q

–Importance is potential to cause
airway obstruction, especially if secondarily infected

A

cystic hygroma

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25
Q

population affected in hodgkin lymphoma?

A

• Bimodal age distribution:
• Teenagers and young adults, 2nd-
3rd decades • > 50 yrs old

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26
Q

–HHV-8 positivity in endothelial cells and
some spindle cells

A

Kaposi Sarcoma

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27
Q

Papillary cystadenoma lymphomatosum “Warthin tumor” Prognosis (2)

A

• Good; low recurrence rate (5%) • Recurrence may represent metachronous lesion

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28
Q

histogenesis “Warthin tumor” Papillary cystadenoma lymphomatosum

A

salivary duct epithelium entrapped in parotid lymph nodes during development

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29
Q

• Fibrous
– Fibrosarcoma
• Treatment:

A

–Wide to radical surgical excision
–Little to no response to radiation or
chemotherapy

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30
Q

Salivary Gland Neoplasms • Prevalence of malignancy major glands: (4) + %

A

– Parotid 15-32% – Submandibular 37-45% – Sublingual 70-90% – Minor 45-50%

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31
Q

neurofibroma locations (4)

A

–Skin (most common location) –Mucosa (oral lesions not uncommon)
• Tongue
• Buccal mucosa

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32
Q

– Common cause of oral mucosal swelling

A

mucocele ranula

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33
Q

• Acute/Chronic Sialadenitis
– Clinical features:

A

• Diffuse, painful and tender, unilateral
swelling • Pain, especially around meal times

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34
Q
A

pyogenic granuloma

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35
Q

name 3 reactive lesions

A

pyogenic granuloma

peripheral giant cell granuloma

peripheral ossifying fibroma

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36
Q

– Neurilemoma (schwannoma)
• Clinical features:

(5)

A

–Most in adults –Slow-growing –Solitary –Encapsulated –Rubbery-firm

–Non-tender

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37
Q

pleomorphic adenoma • Predilection of minor gland sites: (3) + %

A

–Palate – 54% –Upper lip – 18% –Buccal mucosa – 11%

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38
Q
A

fiboma

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39
Q

• Not a true neoplasm; reactive
proliferation of nerve tissue after damage of the nerve bundle

A

– Traumatic neuroma

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40
Q

melanotic neuroectodermal tumor of infancy prognosis? (3)

A

–Good
–Sporadic reports of aggressive behavior
–Clinical f/u is prudent

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41
Q

• Lymphoreticular
– Multiple myeloma
• Prognosis:

A

–Varies among patients, unlikely to be
cured –Younger age better –Worse for pts with widespread disease or
comorbidities –Survival rate 6 – 7 yrs after Dx

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42
Q

malignancy of fibroblastic
differentiation

A

fibrosarcoma

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43
Q
A

melanotic neuroectodermal tumor of infancy

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44
Q

• May be a vascular hamartoma
(overgrowth of tissue normally present in the site) rather than a neoplasm

A

hemangioma

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45
Q
A

langerhans cell histiocytosis

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46
Q

Benign Mesenchymal Tumors • Nerve
– Neurofibroma - central
• Radiographic features:

A

–Radiolucent
• Unilocular
• Multilocular

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47
Q
A

hodgkin lymphoma

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48
Q

• Fluctuant to hard on palpation

A

mucoepidermoid carcinoma

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49
Q
A

pleomorphic adenoma

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50
Q

acinic cell adenocarcinoma?

A

2th-7th decade ( mid 40s to early 50s)

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51
Q

canalicular adenoma occurs more often where?

A

minor glands, esp. labial mucosa

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52
Q

• Lymphoreticular
– Multiple myeloma
• Treatment (5)

A

to control disease and keep pt.
comfortable): • Chemotherapy • Bone marrow transplant • Radiation only as palliative treatment • Bisphosphonates help prevent fracture

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53
Q

lipoma clinical features (6)

A

–Adult patients

–Slow-growing

–Non-tender

–Soft, doughy

–Common in head and neck;
occasionally found intraorally

–Yellow if close to the surface

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54
Q

Canalicular adenoma occurs where?

A

minor and major salivary gland

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55
Q
A

Warthrin tumor

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56
Q

massive, pendulous known as

A

plexiform neurofibroma

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57
Q
A

leukemia

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58
Q
A
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59
Q

necrotizing sialometaplasia shows what on surface epithelium?

A

pseudoepitheliomatous hyperplasia

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60
Q
A

retrocuspid papilla

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61
Q

sites of involvement of salivary gland neoplasms for benign and malignant (4)

A

Parotid Submandibular Sublingual Minor

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62
Q

also known as benign mixed tumor

A

pleomorphic adenoma

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63
Q

granular cell tumor (clinical features) 4

A

–Slow-growing –Demarcated submucosal –Non-tender –Most < 1 cm

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64
Q

most common intraoral site of rhabdomyosarcoma

A

palate

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65
Q

most common location of necrotizing sialometaplasia

A

posterior hard
palate/anterior soft palate

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66
Q

• Endothelial cell
– Kaposi sarcoma
• Prognosis: for all 4

A 
1. Classic – fair; pts usually die of
something else (MI, CVA, etc.) 2. Endemic lymphadenopathic – poor 3. Iatrogenic – fair to poor 4. AIDS-related - fair
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67
Q

clinical features of neurofibroma (5)

A

soft

non-tender

dome shaped papule or nodule

demarcated

unencapsulated

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68
Q

AKA neurogenic sarcoma, or neurofibrosarcoma

A

Malignant peripheral nerve sheath tumor

(MPNST)

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69
Q
A

lymphangioma

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70
Q
A

traumatic neuroma

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71
Q

laangerhaan cell histiocytosis radiographic features are radioopaque.

A

False

Radiolucent

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72
Q

–Diffuse infiltration and destruction of
the normal host tissue by sheets of poorly differentiated cells with either myelomonocytic characteristics or lymphoid features

A

leukemia

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73
Q

inflammatory papillary hyperplasis may have what condition with it?

A

superficial candidiasis

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74
Q

• Squamous metaplasia of the ductal
epithelium – confined to the normal
boundaries of the gland

A

• Necrotizing sialometaplasia

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75
Q

• Muscle
– Rhabdomyosarcoma
• Treatment: (3)

A

–Wide excision
–Multiagent chemotherapy
–Post-op radiation

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76
Q

what % of cardiac rhabdomyomas are associated with tubular sclerosis?

A

50%

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77
Q

rhabdomyoma age preference

A

middle-age and older males

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78
Q

– Kaposi sarcoma
• 4 clinical presentations (con’t)<
–Classic

usually appear where?

A

• Usually appears on the lower
extremities of elderly pts, most
often male

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79
Q

list lymphocytic leukemia conditions and numbers seen yearly

A

–Acute lymphocytic leukemia (4,000)
–Chronic lymphocytic leukemia (10,000)

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80
Q
A

sialothiasis

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81
Q

• Also known as denture papillomatosis –
maxillary complete denture

A

– Inflammatory papillary hyperplasia

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82
Q

Benign Mesenchymal Tumors • Muscle
– Rhabdomyoma
• Histopathologic features: (3)

A

–Round to polygonal cells

–Granular eosinophilic cytoplasm

–Multiple vacuolated cells, many with
“spider web” appearance

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83
Q

tx of pleomorphic adenoma depends on

A

location

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84
Q

oral cavity is the inital site of presentation in what and what %

A

AIDS related Karposi sarcoma 22%

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85
Q

–Vesicular surface similar to “frogs
eggs” or tapioca pudding

A

lymphangioma

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86
Q

Lymphoreticular
– Lymphoma
• Hodgkin lymphoma
–Prognosis (3)

A

• Fairly good today (1,300 deaths in
2011) • Low stage with chemo/rads ~ 100%
5-yr survival rate • Before modern cancer therapy 5-
year survival rate only 5%.

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87
Q

three features of “Warthin tumor” Papillary cystadenoma lymphomatosum

A

• Non-tender • Slow-growing • Freely moveable

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88
Q

– Kaposi sarcoma
• 4 clinical presentations (con’t)<
–Iatrogenic (transplant-associated)
• Affects

A

skin amd mucosa

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89
Q
A

acute disseminated histiocytosis

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90
Q

• Hodgkin lymphoma
–Clinical features (con’t)

Category a

A

no systemic signs

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91
Q

• Nerve
– Melanotic neuroectodermal tumor of infancy
• Treatment:

A

–Conservative excision usually curative

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92
Q

cystic hygroma can affect where?

A

Neck, mediastinum, axilla, oral cavity (4)

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93
Q

–Renal failure (due to circulating light
chain proteins)

A

multiple myeloma

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94
Q

• Concentric laminations that may surround a
nidus of amorphous debris

A

sialothiasis

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95
Q

(acellular zones made of reduplicated basement membrane and cytoplasmic processes)

A

verocay bodies

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96
Q
A

rhabdomyosarcoma

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97
Q

BLEL could be isolatd or from?

A

Sjogren syndrome

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98
Q

– Most common salivary gland malignancy in children

A

Mucoepidermoid carcinoma

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99
Q 
–Soft tissue mass or centrally as an
intrabony lesion (2)

–Slow-growing
–Pain is a late feature

A

fibrosarcoma

MPNST

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100
Q

Fibrous
– Inflammatory fibrous hyperplasia
• Also known as

(3)

A

–denture epulis –epulis fissuratum –denture-induced fibrous hyperplasia

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101
Q

tubules and narrow trabecular cords with appearance of channels or “canals”

A

canalicular adenoma

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102
Q

Parotid gland involvment benign and malignant makes up what percent of salivary gland neoplasms?

A

64-80%

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103
Q

• Painless cervical, supraclavicular
lymphadenopathy

% ? and seen in what condition

A

70-75% of hodgkin lymphoma

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104
Q

port wine stains occur where?

A

anywhere on the body

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105
Q

gender preference of Papillary cystadenoma lymphomatosum “Warthin tumor”

A

males

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106
Q

neurilemomma can occur centrally ______

A

within bone

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107
Q

most common locations of salivary gland neoplasms in minor glands + %.

A

Palate -50% Lips 20% Buccal Mucosa 15%

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108
Q

• Acute/Chronic Sialadenitis
– Prognosis:

A

• Can range from excellent to poor if gland
must be removed

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109
Q

–Lesional tissue mingles with adjacent
normal tissue

A

neurofibroma

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110
Q

adenoid cystic carcinoma accounts for __% of submandibualr gland tumors?

A

11-17%

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111
Q

PLGA – Clinical features (con’t): (4)

A

• Slow-growing • Firm, painless swelling • ± ulceration • Well-demarcated initially, later becomes infiltrative

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112
Q

Blood
– Vascular malformations
• Treatment: (3)

A

–Depends on severity –Port wine stain
• Pulsed dye laser

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113
Q

prevalence of “Warthin tumor or papillary cystadenoma lymphomatosum

A

Comprises 5% of all salivary gland neoplasms and 5-14% of parotid gland neoplasms

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114
Q

tx of pleomorphic adenoma in the parotid

A

remove lesion w/involved lobe

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115
Q

what are laangerhaan cells?

A

are related to monocytes
and serve as antigen-presenting cells

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116
Q

when should you wait to tx hemangioma?

A

if the lesion impairs vision, ASAP

otherwise, wait until child is at least 6 yrs

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117
Q

Benign Mesenchymal Tumors • Nerve
– Traumatic neuroma
• Prognosis:

(3)

A

–Good –Pain may persist or return at a later
date –Recurrence is not common

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118
Q
A

peripheral giant cell granuloma

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119
Q

how many cases of hodgkin lymphoma in 2015?

A

9000

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120
Q
A

periorbital amyloid deposits in pts with multiple myeloma

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121
Q
A

necrotizing sialometaplasia

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122
Q

– Granular cell tumor
• Treatment:

A

–Conservative excision usually curative

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123
Q

–Sheets of large, pale histiocytic-appearing
cells are what and seen where?

A

neoplastic langerhans cells

langerhans cell histiocytosis

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124
Q

• Sjögren syndrome
– Prognosis:

A

• Fair
–Patients with Sjögren Syndrome have a
44x increase in lymphoma compared to age- and sex-matched population

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125
Q

what % of AIDS-related KS will develop
oral lesions

A

70%

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126
Q

• Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Radiographic features:

A

• Early changes subtle or nonexistent • “moth-eaten” or ill-defined
radiolucency • Expansion; can perforate and “break
out” of bone into the soft tissue

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127
Q

histopathologic features of peripheral giant cell granuloma

A

–granulation tissue with numerous
benign multinucleated giant cells

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128
Q

–Spindle-shaped, with cigar-shaped nuclei,
eosinophilic cytoplasm

A

leiomyoma

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129
Q

neurofibromas are seen where? (4)

A

• Tongue, gingiva, bone • Enlargement fungiform papillae
reported, but specificity for NF1
unknown

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130
Q

prognosis of peripheral ossifying fibroma

A

15% recur

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131
Q

–Many poorly defined vascular slits

A

Kaposi Sarcoma

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132
Q

• Lymphoreticular
– Multiple myeloma
• Radiographic features:(5)

A

–Widespread lytic lesions of bone
–Any bone can be affected
–“punched-out” non-corticated
radiolucencies, especially skull –May appear as osteomyelitis –Mandible involved ~ 30% of cases

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133
Q

Papillary cystadenoma lymphomatosum “Warthin tumor” has a strong association with what?

A

smoking, 8x greater risk

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134
Q

Malignant Mesenchymal Tumors and Lymphoreticular Malignancies
• Lymphoreticular

(6)

A

– Langerhans cell histiocytosis
– Leukemia
– Lymphoma
• Hodgkin lymphoma • Non-Hodgkin lymphoma
– Plasmacytoma/Multiple myeloma

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135
Q

parallel calcifications probably represent the calcified walls of abnormal blood vessels)

A

tram-
line” calcifications seen on skull film

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136
Q

• Oral considerations port wine stain:

(4)

A

– Hemorrhage may be encountered
• Flossing and dental prophylaxis may be
difficult • Caution with surgical procedures
– Lasers may be helpful in removing
hyperplastic lesions

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137
Q

pleomorphic adenoma are proliferation of

A

ductal and myoepithelial cells

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138
Q

small, innocuous growth easily diagnosed clinically, usually no treatment is necessary.

A

frenal tag

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139
Q

• Lymphadenopathic – esp. young
children, visceral tumors

A

Endemic (African Kaposi Sarcoma)

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140
Q

• Mucocele/Ranula
– Histopathologic features: (3)

A

• Extravasated mucin, granulation tissue
and variable numbers of inflammatory
cells

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141
Q

Inflammatory fibrous hyperplasia prognosis

A

excellent if appropriately tx

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142
Q

– Langerhans cell histiocytosis
• Eosinophilic granuloma

seen in what population

A

teenagers, young adults

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143
Q

mucocele/ranula occurs where?

A

82% lower lip, also seen buccal mucosa,
ventral tongue floor of mouth (FOM)

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144
Q

–Fever (result of neutropenia and
increased susceptibility of infection)

A

– Multiple myeloma

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145
Q
  • Sialolithiasis – Prognosis:
  • Minor glands:

Major glands:

A

Good

Good, but morbidity if gland requires
removal

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146
Q
A
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147
Q

demographics of necrotizing sialometaplasia

A

adults, male

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148
Q

Salivary Gland Neoplasms • Prevalence of malignancy intraoral minor glands: (6) + %

A

– Palate 45% – Upper lip 20% – Lower lip 60% – Buccal mucosa 50% – Retromolar region 90% – Tongue 90%

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149
Q

• Lymphoreticular
– Leukemia
• Treatment: (3)

A

–Chemotherapy
–Bone marrow or stem cell
transplantation –Targeted gene therapy – promising e.g.,
imatinib (Gleevec) and several other
tyrosine kinase inhibitors for CML

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150
Q

4 clinical features of mucocele/ranula

A

• Non-tender, soft swelling • May be fluctuant or firm • Color translucent to bluish • May have history of repeated swelling
and resolution

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151
Q

adenoid cystic carcinoma accounts for what % of all parotid tumors?

A

2%

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152
Q

Pyogenic granuloma most common sites intraorally

A
  • Gingiva (~80%)
  • lips
  • tongue
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153
Q

– Prognosis: of acinic cell carcinoma • According to Armed Forces Institute of Pathology series: (3)

A

–35% recurred –16% metastasized via lymphatics –16% dies of disease

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154
Q

rhabdomyoma clinical features? (3)

A

–Non-tender

–Well-circumscribed nodule (may be
multinodular)

–May grow several centimeters

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155
Q

• Group of hematologic malignancies
characterized by tumor cells circulating in
the blood

A

– Leukemia

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156
Q

• Lymphoreticular
– Langerhans cell histiocytosis
• Prognosis:

generally better for ?

acute?

chronic?

eosinophilic granuloma?

A

older patients

poor

guarded

good

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157
Q

–Surrounded by plump epithelioid cells
with vesicular nuclei, which produce
melanin

A

Melanotic neuroectodermal tumor of infancy

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158
Q

what percent of neurofibroma are solitary

A

90%

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159
Q

Blood
– Hemangioma
• Clinical features (con’t): (2)

A

–Most elevated, but macular lesions
seen –Variable size

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160
Q

• Acute or chronic sialadenitis of the feeding
gland

A

sialothiasis

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161
Q

most common salivary gland neoplasm

A

pleomorphic adenoma

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162
Q

could be assoc. with

A

sjogren syndrome

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163
Q

Pleomorphic adenoma – Prognosis: (3)

A

• Will recur if inadequately treated • Parotid lesions have more recurrences than minor glands • 5% undergo malignant transformation if not removed

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164
Q

pyogenic granuloma treatment

A

–Excise, remove irritants

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165
Q

• Spectrum of disorders characterized by
proliferation of histiocyte-like cells
accompanied by varying numbers of
eosinophils, lymphocytes, plasma cells and
multinucleated giant cells

A

– Langerhans cell histiocytosis (LCH)

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166
Q

• Axillary or inguinal freckling

A

type 1 NF1

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167
Q

• Lymphoreticular
– Leukemia
• Diagnosis: (2)

A

–Usually based on finding of increased
numbers of atypical white blood cells in the circulation
–Type of leukemia is determined by
immunohistochemical/cytogenetic studies

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168
Q

multiple myeloma accounts for what % of malignancies involving bone

A

50%

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169
Q

– Kaposi sarcoma
• 4 clinical presentations (con’t)<
–AIDS- related (con’t)<
• Skin lesions have predilection for

A

face and lower extremities

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170
Q

necrotizing sialometaplasia can be mistaken for what?

A

SCC or mucoepidermoid carcinoma

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171
Q

Fibrous
– Inflammatory papillary hyperplasia
• Clinical features: (4)

A

–Numerous asymptomatic
red/erythematous papules

–Central region of hard palatal mucosa

  • High palatal vault
  • Habitual mouth breathers
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172
Q

• BLEL
– Histopathologic features:
• Must identify

A

epimyoepithelial islands,
which probably represent residual ductal
structures

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173
Q
A
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174
Q

(a very
large lymphangioma)

A

cystic hygroma

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175
Q

how many cases of mulltiple myeloma are diagnosed yearly?

A

26,000

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176
Q

2nd most common benign tumor of salivary glands

A

“Warthin tumor” Papillary cystadenoma lymphomatosum

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177
Q
A

neurofibroma

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178
Q

Sjogren syndrome usually affects who? and what gender?

A

• Usually middle-age to older adults, but
has been seen in children

female predilection 9:1

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179
Q

• Hodgkin lymphoma develops in the

non-Hodgkin lymphoma mostly arises

A

lymph nodes

lymph nodes, but can also arise in soft
tissue or bone

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180
Q

• May have bluish tinge due to entrapped mucin

A

• Mucoepidermoid carcinoma

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181
Q

• Chronic disseminated histiocytosis (Hand-
Schüller-Christian disease)

seen in ?

A

older children

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182
Q

– Neurofibromatosis • Type I (NF1)
–Treatment

A

• Remove traumatized neurofibromas
or disfiguring lesions • Genetic counseling • f/u due to potential of malignant
transformation

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183
Q

• Pain can be lancing and constant

A

adenoid cystic carcinoma

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184
Q

adenoid cystic carcinoma occurs where?

A

Can occur in any salivary gland but 40% - 45% are in minor glands

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185
Q

found at birth on maxillary ridge, lateral to midline?

A

congenital epulis

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186
Q

– calcified structures that develop within the
salivary ductal system

A

sialothiasis

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187
Q

what type of cell is associated with pleomorphic adenoma?

A

myoepithelial cells

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188
Q

myoepithelial cells in pleomorphic adenoma appear

A

plasmacytoid spindled

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189
Q

Nonspecific reactive hyperplasia of
stratified mucocutaneous epithelia,
which simulates squamous cell
carcinoma

A

necrotizing sialometaplasia

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190
Q

which is more common

non-hodgkin lymphoma or hodgkin lymphoma?

how many cases of the greater one

A

non-hodgkin lymphoma (70,000)

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191
Q

multiple neurofibromas (2)

A

• Small, discrete • Massive, pendulous known as
plexiform neurofibroma

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192
Q

• If something is growing out of a socket (3)

A
  1. Epulis granulomatosa 2. Lymphoma 3. Metastatic disease
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193
Q

• Non-Hodgkin lymphoma
–Histopathologic features:

A

• Varies by type of lymphoma • Need IHC to identify

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194
Q

• Acute disseminated histiocytosis (Letterer-
Siwe disease):

is an aggressive malignant course. T/F

A

true

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195
Q

laangerhaan cell histiocytosis clinical features (2)

A

rare

dull pain or tenderness

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196
Q

Muscle
– Rhabdomyosarcoma
• Clinical features: occurs in what population

A

–Children or adolescents

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197
Q

• Effacement of normal nodal
architecture by infiltrate of
inflammatory cells

A

hodgkin lymphoma

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198
Q

• Nerve
– MPNST
• Histopathologic features (2)

A

–Spindle-shaped cells with wavy nuclei
–Mitoses

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199
Q

Site predilection of pleomorphic adenoma (3) + %

A

–80% - parotid (63% of all parotid tumors) –10% - submandibular (60% of all submandibular tumors) –10% - intraoral minor salivary glands (43% of all minor salivary gland tumors)

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200
Q

–Port wine stain in distribution of 1st and
sometimes 2nd or 3rd division of CN V

A

• Encephalotrigeminal angiomatosis

(Sturge-Weber syndrome)

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201
Q

tumor of smooth muscle
differentiation

A

Leiomyoma

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202
Q

–Collection of mesenchymal cells with
granular-appearing cytoplasm

A

granular cell tumor

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203
Q

what percent of hodgkin lymphoma are relapse free after after 10 years in stage 1 and 2

stage 3/4 show what percentage of survival rate after 10 year

A

80-90

55-85

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204
Q

• Adenoid cystic carcinoma – Clinical features (con’t): (3)

A

• Variably firm • Usually poorly demarcated on palpation • ± ulceration, more often seen later in the course of the lesion

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205
Q

• Low-power - lobular growth pattern infiltrating surrounding tissue

A

PLGA

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206
Q

vascular malformation clinical features (3)

A

–Port wine stain (capillaries)
–Venous malformation (blue)
–arteriovenous malformation (bruit, thrill)

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207
Q

leiomyomas clnical features? (6)

A

–Well-demarcated –Rubbery firm – ˂ 1 cm diameter

–Reddish-purple color due to vascular
nature –Slow growing

–Usually painless

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208
Q

laangerhaan cell histiocytosis is not a neoplastic process T/F

A

False

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209
Q

Benign Mesenchymal Tumors • Fibrous

List 6

A

– Fibroma

– Inflammatory fibrous hyperplasia

– Inflammatory papillary hyperplasia

– Pyogenic granuloma

– Peripheral giant cell granuloma

– Peripheral ossifying fibroma

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210
Q

Lymphoreticular
– Langerhans cell histiocytosis
• Chronic disseminated histiocytosis (con’t)<
–Classic triad

A

bone, skin, viscera)
• Exophthalmos • Diabetes insipidus • Bone lesions

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211
Q

Mucoepidermoid carcinoma epidemiology

A

– Wide age range, 2nd to 7th decade

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212
Q

– Neurilimoma (schwannoma)
• Histopathologic features: (2)

A

–Well-developed connective tissue
capsule –Benign proliferation of spindle-shaped
Schwann cells

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213
Q

Benign Mesenchymal Tumors • Adipose
– Lipoma
• Treatment:

A

–Enucleation or conservative surgical
excision

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214
Q

• Sialolithiasis
– Radiographic features:

A

• Soft tissue film shows opaque, lamellated
structure

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215
Q

–More than 50% of cases seen in patients
younger than 15 y.o.

A

Langerhans cell histiocytosis

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216
Q

prognosis of lipoma

A

–Little or no tendency to recur
–No evidence of malignant
transformation

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217
Q

–Calcifications in soft tissue (metastatic
calcifications) caused by hypercalcemia secondary to tumor- related osteolysis

A

multiple myeloma

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218
Q

• Carcinoma ex-pleomorphic adenoma occurs which age?

A

6th -7th decade

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219
Q

Acute Sialdenitis usually affects the?

what is expressed from the parotid papilla

A

parotid, purulent exudate

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220
Q

“Bumps on the gums”
• Fibrous
– “3 P’s”

A

• Pyogenic granuloma • Peripheral giant cell granuloma • Peripheral ossifying fibroma

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221
Q

• Fibrous
– Fibrosarcoma
• Prognosis:

A

–50% 5-year survival
–Metastasizes via blood
• Lung • Liver • Bone

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222
Q
A

lipoma

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223
Q

– Neurilimoma (schwannoma)
• Histopathologic features:
–Patterns seen microscopically:
• Antoni B – (2)

A

• less organized • sometimes myxoid

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224
Q

Benign Mesenchymal Tumors • Muscle (2)

A

– Leiomyoma – Rhabdomyoma

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225
Q

• 10-year survival rates: of mucoepidermoid carcinoma

A

–Low-grade – 95% –High-grade – 40%

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226
Q

• Mucocele/Ranula
– Treatment: (4)

A
  • Microscopic exam to rule-out neoplasm
  • Some resolve with no treatment

• Excision of mucous deposit including
involved gland

• Marsupialization – unroofing

227
Q

• BLEL
– Prognosis:

A

• Good, but malignant transformation of
lymphoid or epithelial components has
been reported

228
Q

• Muscle
– Rhabdomyoma • Treatment:

A

–Conservative surgical excision

229
Q
A

peripheral ossifying fibroma

230
Q

Fibrous
– Peripheral giant cell granuloma
• Radiographic features:

A

–Cupping of underlying bone
sometimes seen

231
Q

–Most common soft tissue sarcoma in
children under 15 y.o.

A

– Rhabdomyosarcoma

232
Q
A

laangerhaan cell histiocytosis

233
Q

pleomorphic adenoma develops what age and gender?

A

4th-6th decade, avg 45 slight female

234
Q

• Circulating unattached light chains filtered
in kidney–> secreted in urine

A

bence jone proteins

235
Q

neurilemoma can cause what (2)

A

expansion and push on other nerves

236
Q

fibrosarcoma affect what population

A

adult

237
Q

most rhabdomyomas are?

A

cardiac rhabdomyomas

238
Q

which salivary gland neoplasm is Fairly circumscribed? check for others?

A

acinic cell adenocarcinoma

239
Q

• Aggregates (foci) of >50 lymphocytes ±
plasma cells scattered throughout
glandular parenchyma

A

• Sjögren syndrome

240
Q

tx of fibroma

A

conservative excision

241
Q

savliary gland disease thought to be related to ischemic necrosis

A

• Necrotizing sialometaplasia

242
Q

prognosis if peripheral giant cell granuloma

A

15% recur

243
Q

• Acinar necrosis, but overall architecture
of the involved glands is preserved

A

• Necrotizing sialometaplasia

244
Q

where is frequently affect in angioma

A

head and neck

245
Q

ranula occurs where?

A

– FOM to right or left of midline

246
Q

Salivary Gland Neoplasms • Carcinoma ex-pleomorphic adenoma – Prognosis – related to =(3)

A

histologic subtype • Guarded –Survival rates • 5-year 25% - 60% • 15-year 10%

247
Q

• Adenoid cystic carcinoma – Prognosis:

A

• Generally poor; tumor is slow-growing and relentless • Depends on lesion location, grade, anatomic structures involved, presence of tumor at surgical margins

248
Q

granular cell tumor prognosis

A

excellent

249
Q

what is often the primary site in non-hodgkin lymphoma extra-nodally?

A

oral

250
Q

• Muscle
– Rhabdomyosarcoma
• 3 types:

A
  1. Embryonal
  2. Alveolar
  3. Pleomorphic
251
Q
A

mucocele

252
Q

• Fibrous
– Inflammatory papillary hyperplasia
• Prognosis

A

good after Tx if patient keeps
denture out and keeps it clean

253
Q

most leiomyomas arise from what?

A

vascular smooth muscle

254
Q

• Prevalence increased in patients who
have for non-hodgkin lymphoma?

A

immunologic problems

255
Q

adenoid cystic carcinoma displays what 3 growth patterns

A

–Tubular – well-differentiated –Cribriform – classic “Swiss cheese” pattern – intermediate –Solid – poorly-differentiated

256
Q

what stage of life does the Papillary cystadenoma lymphomatosum “Warthin tumor occur?

A

6th – 7th decade (mean age 55 – 60 y.o.)

257
Q

which salivary gland neoplasm is unencapsulated?

A

adenoid cystic carcinoma

258
Q

• Patients often present with myelophthisic
anemia

A

leukemia

259
Q

• Lymphoreticular
– Langerhans cell histiocytosis
• Acute disseminated histiocytosis (Letterer-
Siwe disease):

seen in what population

A

infants

260
Q

what are b signs in hodgkin lymphoma (4)

A
  1. Fever 2. Weight loss 3. Drenching night sweats 4. Generalized pruritus (itching)
261
Q

–Extensive alveolar involvement causes
teeth to appear as if they are “floating in
air”

A

Langerhans cell histiocytosis

262
Q

what percent of MPNFT are associated with NF1

A

50%

263
Q

Benign Mesenchymal Tumors • Nerve
– Neurilemoma (schwannoma)
• Prognosis: (2)

A

–No tendency to recur –Extremely rare malignant
transformation

264
Q

• Plasma cell origin

A

– Multiple myeloma/Plasmacytoma

265
Q

– Lymphangioma
• Histopathologic features: (3)

A

–Lymphatic vessels showing mild
dilatation to large cystic spaces
containing fluid, ± red blood cells –Vessels infiltrate soft tissue –Thin endothelial lining

266
Q

Lymphoreticular
– Leukemia
• Prognosis (con’t)<
–CML: (3)

A

• Indolent period
• 5-year survival ~80% • Blast transformation (less
differentiated, proliferate wildly) leads to death in 3 – 6 months

267
Q

Papillary cystadenoma lymphomatosum “Warthin tumor” occurs exclusively where?

A

parotid gland

268
Q

submandibular gland involvement benign and malignant makes up what percent of salivary gland neoplasms

A

6-11%

269
Q

• Nerve
– Neurilemoma (schwannoma)
• Treatment: (2)

A

–Conservative excision –Usually “shells out” due to dense
connective tissue capsule

270
Q

• PLGA – Clinical features (con’t): • Almost exclusively + % (3)

A

in minor salivary glands –Posterior hard/soft palate 62% –Buccal mucosa 15% –Upper lip 10%

271
Q

– Prognosis: PLGA (3)

A

Excellent –Recurrence 20% –Lymph node metastasis 7% –Dead of disease 2%

272
Q

• May also be found centrally within maxilla or mandible

A

• Mucoepidermoid carcinoma

273
Q

• Pt may c/o “denture too tight” • Vague pain, discomfort can be
mistaken for toothache

A

non hodgkin lymphoma

274
Q

• Radiographic features: – Chronic sialadenitis

A

• Sialography “sausage-link” appearance
of ductal system due to ductal dilatation

275
Q

–Bone pain, especially lumbar spine

(most characteristic symptom)

A

multiple myeloma

276
Q

multiple myeloma affects what gender, what age?

race?

A

–Mean age of 65 years; rare < 40 years
–2:1 male predilection; black males
affected 2X more than white males

277
Q

• Lymphoreticular
– Langerhans cell histiocytosis
• Acute disseminated histiocytosis (Letterer-
Siwe disease): involves where?

A

–Skin rash, splenic, hepatic and marrow
involvement

278
Q

oral findings are seen in what percent of NF1

A

72-92%

279
Q

Benign Mesenchymal Tumors • Fibrous
– Inflammatory papillary hyperplasia
• Histopathologic features:

A

–Papillary surface –Edema

280
Q

Muscle
– Leiomyoma
• Clinical features (con’t):
–Most common sites of mouth:

A
  • Upper lip
  • Tongue
  • Palate
  • Buccal mucosa
281
Q

can include neurological deficits

A

• Encephalotrigeminal angiomatosis

(Sturge-Weber syndrome)

282
Q

tx of pleomorphic adenoma in the hard palate

A

remove lesion, including overlying mucosa down to periosteum

283
Q

• Sjögren syndrome
– Treatment: (5)

A

• Artificial tears and artificial saliva • Sialogogues - pilocarpine (Salagen
Tablets) or cevimeline (Evoxac) • Daily topical fluorides for natural teeth

• Anti-fungal agents for candidiasis, prn • For secondary Sjögren syndrome,
appropriate therapy should be given the
other autoimmune process as well

284
Q

• One or more non-tender, palpable
rubbery-firm, enlarging lymph nodes

A

hodgkin lymphoma

285
Q

• Autoimmune process attacks lacrimal and
salivary glands

A

Sjogren syndrome

286
Q

–Rare lesion of undetermined
histogenesis

A

congenital epulis

287
Q

• Lymphatics
– Prognosis: (3)

A

• Good for most patients
• Relatively high recurrence rate – up to
40% in some series • Large tumors of the head and neck may
result in airway obstruction and death

288
Q

peripheral giant cell granuloma (3) clinical features

A

–Painless –Dusky purple-red –Only on gingiva of alveolar ridge,
including edentulous ridge

289
Q

lymph node involvment accounts for what percent of adenoid cystic carcinoma?

A

5%

290
Q

Canalicular adenoma is tender.

A

F

291
Q

• BLEL
– Treatment: (3)

A

• Varies:
–Do nothing
–Low-dose radiation
–Corticosteroid therapy

292
Q

Salivary Gland Neoplasms • Adenoid cystic carcinoma – Prognosis - Routes of metastasis –Most metastasize via and other sites? (4)

A

blood 1. Lung 2. Brain 3. Bone 4. Liver

293
Q

• Parotid swelling (BLEL) may or may not
be dramatic

A

Sjogren syndrome

294
Q

–Usually develops in the 1st year of life

(only 9% of cases seen after 12 mos. old)

A

Melanotic neuroectodermal tumor of infancy

295
Q

what percent of non hodgkin lymphoma are extranodal

A

30% - 40%

296
Q

chronic sialadenitis usually affects?

A

submandibular gland

297
Q

gender prefernence of PLGA

A

• 2:1 female predilection

298
Q

pts with sjogren syndrome tend to have elevated (3)

A

sedimentation rate, elevated levels of
ANA and
polyhypergammaglobulinemia

299
Q

Prognosis of mucocele/ranula

A

– Excellent
– Occasionally recur if involved gland not
excised

300
Q

mucoepidermoid carcinoma represents what percent of minor salivary glands?

A

13-23%

301
Q
A

ranula

302
Q

Lymphatics
– Lymphangioma • Treatment:

(3)

A

–Depends on size of lesion –Surgical excision is the treatment of
choice –More difficult to treat than hemangioma
because it is often difficult to discern the
borders of the tumor

303
Q

Birbeck bodies are seen where?

A

cytoplasm of langerhan cells in langerhans cell histiocytosis

304
Q

• After 15 yrs. post-tx mortality due
more in hodgkin lymphoma due to what?

A

secondary malignancy or
cardiovascular disease

305
Q
A

neurofibroma

306
Q

what can help regression of kaposi sarcoma in iatrogenic (transplant associated)

A

• Reducing degree of immune-
suppression may cause regression
of KS

307
Q

fibromas are located where?

A

buccal mucosa, tongue ( any mucosal surface)

308
Q

– Benign tumor of Schwann cell origin

(surround axons of peripheral nerves)

A

– Neurilemoma (schwannoma)

309
Q

• Highlighted by S100 protein –Mast cells

A

neurofibroma

310
Q

what percent of malignant neuroectodermal tumor of infacny are malignant?

A

7%

311
Q

– Ductal obstruction, retrograde infection -
associated with xerostomia, may follow general anesthesia

A

• Acute/Chronic Sialadenitis

312
Q

• Carcinomatous elements which arise in areas of benign pleomorphic adenoma

A

• Carcinoma ex-pleomorphic adenoma

313
Q

encapsulated salivary gland neoplasms? (3)

A

pleomorphic adenoma papillary cystadenoma lymphomatosum canicular adenoma

314
Q

polystotic laangerhaan cell histiocytosis is seen in _____

monostotic laangerhaan cell histiocytosis is seen in_______

A

teenagers

adults

315
Q

Lymphoreticular
– Langerhans cell histiocytosis
• Eosinophilic granuloma

occupies what locations?

A

–Intrabony only; no visceral involvement

316
Q

• Solid organ transplants (0.5% of
renal transplants)

A

iatrogenic (transplant associated) karposi sarcoma

317
Q
A

acinic cell carcinoma

318
Q

Benign Mesenchymal Tumors • Fibrous
– Peripheral giant cell granuloma
• Treatment:

A

–Excise, remove irritants

319
Q

Benign Mesenchymal Lesions • Fibrous
– Inflammatory fibrous hyperplasia:
• Clinical features:

(2)

A

Flange of ill-fitting denture –May have central fissure/ulcer

320
Q

tumor of striated muscle
differentiation

A

Rhabdomyoma

321
Q

pain and tenderness develops in half of the cases

A

acinic cell adenocarcinoma

322
Q

arises from sublingual gland

A

ranula

323
Q

hogdkin lymphoma has no gender preference. T/F

A

F. male

324
Q

Mucoepidermoid carcinoma – Histopathologic features: • 2 distinct cellular elements:

A

–Mucous cells –Epidermoid cells

325
Q

frequently occurs during pregnancy

A

pyogenic granuloma

326
Q

• Prior to advent of HIV/AIDS was
already recognized in sub-Saharan
Africa

A

Endemic (African)

327
Q

list lymphreticular malignancies

A

Lymphoreticular

  • Langerhans Cell Histiocytosis
  • Leukemia

• Lymphoma
– Hodgkin
– Non-Hodgkin • Multiple Myeloma/
Plasmacytoma

328
Q

– Congenital epulis
• Histopathologic features: (3)

A

–Benign proliferation of cells with
granular cytoplasm –No PEH –Does not stain for neural
differentiation with IHC

329
Q

• Frequently associated with pain or tenderness, which may be an early finding

A

adenoid cystic carcinoma

330
Q

pt may die ___ years after diagnosis of adenoid cystic carcinoma

A

20 years

331
Q

what medications cause xerostomia (4)

A

–Antihistamines
–Antidepressants
–Sedatives and anxiolytic agents
–Antihypertensive agents

332
Q

myoepithelial cells in pleomorphic adenoma produce (4)

A

myxoid stroma hyaline material cartilaginous material osteoid

333
Q

benign mesenchymal tumors of blood (4)

A

Blood
– Hemangioma – Vascular malformations
• Port wine stain
• Encephalotrigeminal angiomatosis
(Sturge-Weber anomaly, Sturge-Weber syndrome)

334
Q

AIDS related KS can invade bone. T/F

A

T

335
Q

what is the most common intraoral site in lymphangioma? which can result in ?

A

tongue

macroglossia

336
Q

Benign Mesenchymal Tumors • Nerve
– Traumatic neuroma
• Treatment:

A

–Surgical excision, including a small
portion of the proximal nerve
bundle

337
Q

granules) • Dark, eccentrically place nucleus

A

acinic cell carcinoma

338
Q

– Neurofibromatosis • Type I (NF1)
–Prognosis:

A

• Fair to guarded
• If malignant transformation occurs,
prognosis is poor (usually a malignant peripheral nerve sheath tumor)

339
Q

List benign salivary gland neoplasms (4)

A

– Pleomorphic adenoma – Papillary cystadenoma lymphomatosum “Warthin tumor” – Monomorphic adenoma • Canalicular adenoma

340
Q

• Caused by infection with HHV-8

A

Kaposi Sarcoma

341
Q
A

inflammatory papillary hyperplasia

342
Q

what can occur centrally within bone?

A

neurilemma

neurofibroma

343
Q

Inflammation of the salivary gland

A

Acute/Chronic Sialadenitis

344
Q

BLEL
– Histopathologic features:

remants of what?

A

ductal epithelium

“epimyoepithelial islands”

345
Q

extraoral symptoms associated with leukemia (4)

A

–Fatigue, shortness of breath (SOB),
pallor (decreased R’s) –Easy bruising (decreased platelets) –Infection (decreased W’s)

346
Q
A

congenital epulis

347
Q

slight female predilection (4)

A

salivary gland tumors pleomorphic adenoma PLGA adenoid cystic carcinoma

348
Q
A

neurilemomma (schwannoma)

349
Q

neurilemoma occur in what age group?

A

adults

350
Q

rhabdomyoma prognosis

A

–Good
–Recurrence has been reported but is
not common (may be due to incomplete removal)

351
Q

involves deeper soft tissue and meninges and brain

A

• Encephalotrigeminal angiomatosis

(Sturge-Weber syndrome)

352
Q

what percent of lymphangioma are present at birth?

A

50%

353
Q

sialothiasis typically affects what?

A 
submandibular gland (80%),
but can affect parotid or minor glands
354
Q

• Nerve
– Traumatic neuroma
• Clinical features: (2)

A

–Smooth-surfaced –Dome-shaped papule or nodule,
usually < 1 cm

355
Q

Papillary infoldings lined by a double row of cuboidal and columnar oncocytes (altered ductal epithelial cells) project into the cystic spaces

A

“Warthin tumor” Papillary cystadenoma lymphomatosum

356
Q

• Unilateral or bilateral, firm, non-tender
swelling of the parotid area

A

BLEL

357
Q

• Atypical neoplastic lymphoid cell –

A

reed sternberg cell

358
Q

– Congenital epulis
• Clinical features:

(3)

A

–Smooth surface –Often pedunculated –Vary in size

359
Q

Fibrous
– Peripheral ossifying fibroma
• Treatment:

A

Excise, remove irritants

360
Q

mucocele/ranula appears in what demographic

A

children, young adults but all ages

361
Q

• Previously thought to be myoblastoma
(immature muscle cells) but immunohistochemistry (IHC) shows neural differentiation

A

granular cell tumor

362
Q

• Primarily HIV-infected adult male
homosexuals (other types of KS seen
in both genders; children in endemic)

A

– Kaposi sarcoma
• 4 clinical presentations (con’t)<
–AIDS- related:

363
Q

minor gland involvement benign and malignant makes up what percent of salivary gland neoplasms

A

9-23%

364
Q

prognosis of fibroma

A

recurrence is rare

365
Q

______ of mucoepidermoid carcinoma have excellent prognosis

A

< 2.5 cm

366
Q

• Fibrous
– Inflammatory papillary hyperplasia
• Has been attributed to (3)

A

–Ill-fitting denture –Poor denture hygiene –Wearing the denture 24/7

367
Q

Benign Mesenchymal Tumors • Nerve
– Neurofibroma
• Treatment:

A

–Conservative excision

368
Q

Kaposi Sarcoma clinical presentations (5)

A
  • Painless • Purple – red • Macules plaques tumors • Do not blanch on pressure
  • Slow-growing
369
Q

what are oncocytes

A

altered ductal epithelial cells

370
Q

histopatholgic features of peripheral ossifying fibroma

A

–Cellular fibrous connective tissue,
variable amounts of calcification

371
Q

• Periductal inflammation

A

sialothiasis

372
Q

what patterns are seen histopathologically in neuriiloma (schwannoma)

A

Antoni A

Antoni B

373
Q

PLGA can be confused with? (2)

A

adenoid cystic carcinoma or carcinoma ex-pleomorphic adenoma

374
Q

Benign Mesenchymal Tumors • Fibroma
– Histopathologic features:

A

• Nodular mass of dense fibrous
connective tissue

375
Q
A

frenal tag

376
Q

• Xerostomia
– Treatment:

(4)

A

Artificial saliva/lubricants • Sialogogues, sugar-free lemon drops
–Salagen (pilocarpine) or Evoxac
(cevimeline) • 1% neutral sodium fluoride gel or
toothpaste nightly • Antifungal therapy as needed

377
Q

– Deposition of calcium salts around nidus of
debris in lumen

A

sialothiasis

378
Q

• Begins in the bone marrow with
malignant transformation of one of the
stem cells, which proliferates and
eventually overflows into the peripheral
blood

A

leukemia

379
Q

– Encephalotrigeminal angiomatosis
(Sturge-Weber syndrome)
• Radiographic feature:

A

“tram-
line” calcifications seen on skull film

380
Q

–Petechial hemorrhages of skin and oral
mucosa (if platelet production affected)

A

multiple myeloma

381
Q

• Lymphoreticular
– Leukemia
• Prognosis depends on:

A

–Type of leukemia
–Age of patient
–Cytogenetic alterations

382
Q

list 4 clinical features of pleomorphic adenoma?

A

• Slow-growing • Painless • Moveable • Rubbery-firm on palpation

383
Q

what is myelophthisic anemia?

A

normal bone marrow cells
replaced by leukemic cells)

384
Q

Much less common than pleomorphic adenoma, it is characterized by a proliferation of one cell type

A

monomorphic adenoma

385
Q

a portion of Benign lymphoepithelial lesion (BLEL)

of the infiltrate is ____, perhaps representing ______

A

monocolonal

low grade lymphoma in situ

386
Q

Lymphoreticular
– Leukemia
• Prognosis (con’t)<
–CLL:

A

• Incurable, but highly variable course
of disease, 2 – 10 years

387
Q

how much of oral traumatic neuromas are painful

A

1/4-1/3

388
Q

with the
salivary component of Sjögren syndrome

A

• >1 focus/4 mm2

389
Q

could be from?

A

xerostomia

390
Q

– Neurilemoma (schwannoma) - central
• Radiographic features: (3)

A

–Radiolucent
• Unilocular
• Multilocula

391
Q

tx of pleomorphic adenoma in the submandibular gland

A

remove lesion and the involved gland

392
Q

• Benign tumor of adipose tissue (fat)

A

lipoma

393
Q

–Sarcoma botryoides is associated with

A

rhabdomyosarcoma

394
Q

–Collection of spindle-shaped cells with
wavy nuclei

A

neurofibroma

395
Q

Salivary Gland Neoplasms • Acinic cell adenocarcinoma – Treatment:

A

surgical excision

396
Q

most common intraoral site of hemangioma?

A

tongue

397
Q

• Nerve
– Traumatic neuroma
• Histopathologic features:

A

–Tangled mass of peripheral nerve
fibers in a collagenous background

398
Q

• Mild tenderness to burning severe

radiating pain

A

traumatic neuroma

399
Q

• Basophilic granular cells (zymogen granules)

A

acinic cell adenocarcinoma

400
Q

Extracardiac rhabdomyomas have striking
predilection

A

for H/N

401
Q

what percent of neurofibroma are multiple and associ with?

A

10% neurofibromatosis

402
Q

bilateral papular lesions on the gingiva lingual to the mandibular canines

A

retrocuspid papilla

403
Q

–Cellular spindle cell tumor within the
connective tissue, extravasated blood

A

Kaposi sarcoma

404
Q

• Muscle
– Rhabdomyosarcoma
• Prognosis: (2)

A

–Depends on type
–Much improved compared to 40 yrs ago.
Prior to 1960 more than 90% patients died

405
Q

• Often appear pseudoencapsulated

A

acinic cell adenocarcinoma

406
Q

most common location of rhabdomyosarcoma

A

head and neck

407
Q

clinical features peripheral ossifying fibroma (5)

A

–Painless –Firm –Coral-pink

–May be ulcerated
–Found only on the gingiva

408
Q

–Mucocele-appearing lesion of retromolar area should be considered

A

mucoepidermoid carcinoma until proven otherwise!!

409
Q
A

PLGA

410
Q

• Atypical neoplastic lymphoid cell –
Reed-Sternberg cell

A

hodgkin lymphoma

411
Q

clinical features of necrotizing sialometaplasia

A

• Swelling ± pain, paresthesia

• After ~ 2 weeks patient usually reports,
“a piece of my palate fell out”

• Sharply demarcated ulcer, non-elevated
margins

• Minimal peripheral erythema

412
Q

Canalicular adenoma – Treatment:

A

enucleation

413
Q

• Von Recklinghausen disease of the
skin • Majority of neurofibromatosis cases

A

Type 1 (NF1)

414
Q

– Congenital epulis • Treatment: (2)

A

–Conservative excision –Some reports of spontaneous
resolution without surgery

415
Q

______ of all minor salivary gland adenoid cystic carcinomas are in palate

A

50%

416
Q

• Sialography: “blossoms on a tree”
pattern of punctate sialectasis is often
observed

A

BLEL

417
Q

• Sjögren syndrome
– Diagnosis

A

–Nuclear autoantibodies: Anti-SS-A
(anti-Rho) and anti-SS-B (anti-La) may
be found in ~ 50% of these patients

418
Q

prognosis of pyogenic granuloma

A

15% recur

419
Q

Tend to grow as solid masses

A

lymphoma

420
Q

Type 1 (NF1) occurs how often? AD or AR, what % new mutations

A

– ~ 1 in 3000 live births – Autosomal dominant – ~ 50% new mutations

421
Q

demographics of BLEL

A

female predilection, middle aged or older

422
Q

–Bence Jones proteins
• Found in urine of

A

30-50% of cases multiple myeloma

423
Q

– Most common salivary gland malignancy

A

Mucoepidermoid carcinoma

424
Q

Papillary cystadenoma lymphomatosum “Warthin tumor” – Treatment:

A

surgical excision

425
Q

myelomonocytic leukemia seen yearly?

and two types

A

• Myelomonocytic: (AML and CML)
–Acute myeloid leukemia (12,000)
–Chronic myeloid leukemia (4,700)

426
Q

• Plexiform neurofibroma - feels
like “a bag of worms” • Pathognomonic for NF1

A

Type 1 NF1

427
Q

focal
proliferation of leukemic cells at one soft tissue site

A

“Granulocytic sarcoma”

428
Q

–Oral involvement most often in

what forms of leukemia

A

myelomonocytic forms

429
Q

etiology of salivary gland neoplasms

A

unknown

430
Q

• Patients often complain of dry, gritty
feeling in eyes and a dry mouth

A

Sjogren syndrome

431
Q

• Adipose
– Lipoma
• Histopathologic features:

A

–Demarcated or encapsulated collection of mature fat cells

432
Q

–Clonal proliferation of one specific
immunoglobulin type that is not normal or functional disease

A

multiple myeloma/plasmacytoma

433
Q

oncocytes are associated with

A

“Warthin tumor” Papillary cystadenoma lymphomatosum

434
Q

adenoid cystic carcinoma occurs what age?

A

• Most 5th decade, but wide age range (mean 55 y.o.)

435
Q

light brown
macules, smooth borders “coast of California”

seen where?

A

cafe au lait

Type 1 NF1

436
Q

– Rhabdomyosarcoma
• linical features (3)

A

–Usually painless
–Rapidly growing

rare

437
Q

–“scooped-out” appearance of superficial
bone, esp. posterior mandible

A

– Langerhans cell histiocytosis

438
Q

congenital epulis prognosis

A

–Excellent, no tendency to recur

439
Q

describe fibroma? 6 characteristics

A

smooth or slightly papillary surface

dome shaped

sessile or pedunculated

<1.5 cm or 1.5

–May ulcerate if traumatized –Asymptomatic unless traumatized

440
Q

BLEL histopathologic features

shows destruction of what and replacement with

A

• Destruction of the normal parotid
parenchyma with replacement by a
diffuse lymphocytic infiltrate

441
Q

canalicular adenoma prognosis

A

• Excellent – no tendency to recur

442
Q
A

carcinoma ex-pleomorphic adenoma

443
Q

– Leukemia
• Broadly divided types (4)

A

–Lymphocytic
–Myelomonocytic
–Acute
–Chronic

444
Q

gradual involution percentages of hemangioma

A
  • 50% resolve by age 5
  • 90% are resolved by age 9
445
Q
A

benign lymphoepithelial lesion

446
Q

list malignant mesenchymal tumors? (4)

A

Mesenchymal • Fibrous • Nerve • Endothelial cell (Kaposi
sarcoma) • Muscle

447
Q

neurofibroma prognosis (2)

A

–Generally good, especially small,
superficial lesions –Uncommonly transform to malignant
peripheral nerve sheath tumor

448
Q

sublingual gland benign and malignant involvement makes up what percent of salivary gland neoplasms?

A

<1%

449
Q

• Fibrous
– Inflammatory papillary hyperplasia
• Treatment: (3)

A

–Topical or systemic antifungal therapy

–Removal of the denture may allow the
erythema and edema to subside

–Excise hyperplastic tissue before
fabricating a new denture (various
surgical methods have been used)

450
Q

Lymphoreticular
– Leukemia
• Prognosis (con’t)<
–AML: (2)

A

• <60y.o. 40% 5-yr survival • >60 y.o. less than 10% survival

451
Q

• Sjögren syndrome
– Clinical features (con’t):

(5) seen in mouth

A

• Cervical caries, often rampant • Increased prevalence of oral candidiasis • Burning feeling on tongue • Angular cheilitis • Atrophy of dorsal tongue papillae

452
Q

• Adenoid cystic carcinoma – Treatment:

A

• Wide surgical excision followed by radiation

453
Q

list two examples of fibroma

A

• Frenal tag • Retrocuspid papilla

454
Q

If the associated duct also is removed, then
it often demonstrates squamous metaplasia

A

sialothiasis

455
Q

• Uncommon reaction to the sectioning of
a nerve

A

– Traumatic neuroma

456
Q

what age does PLGA occur

A

• 6th – 8th decade (mean 56 y.o.), but wide age range 23 – 94 y.o.

457
Q

what is the most common malignancy in the submandiublar gland tumors

A

adenoid cystic carcinoma

458
Q

salivary gland neoplasms represent ___ of all H/N neoplasms

A

3%

459
Q

Mucoepidermoid carcinoma – Clinical features: (4)

A

• Well-demarcated or infiltrative • Non-tender • Usually non-ulcerated, but can be • Ulceration and pain may develop as lesion progresses

460
Q
A

canalicular adenoma

461
Q

• Fibrous
– Pyogenic granuloma • Clinical features: (6)

A

–Rapid growth –Painless –Red –Often ulcerated

–Any body surface –Bleeds easily

462
Q

sites of initial involvment in hodgkin lymphoma?

A

Head

Neck

463
Q

–If port wine stain involves entire
distribution of V1, the risk for neurologic and ocular involvement is

A

78%

464
Q

–Pseudoepitheliomatous hyperplasia

seen in what two conditions

A

granular cell tumor

necrotizing sialometaplasia

465
Q

manifestations of Type 1 (NF1) (4)

A

– Highly variable gene expression (mild
to severe) –Cutaneous manifestations –Oral manifestations –Ocular manifestations

466
Q

how many new cases of salivary gland neoplasms are diagnosed yearly?

A

4000

467
Q

• Blood
– Hemangioma
• Treatment:

A

–“watchful neglect” unless problematic
or life-threatening –β- blocker, steroids, cryotherapy,
embolization, lasers or use of
sclerosing agents if cosmetically
unacceptable, surgical excision rarely

468
Q

–Iatrogenic (transplant-associated) Kaposi Sarcoma
• Affects

A

skin and oral mucosa

469
Q

what major glands are affected in adenoid cystic carcinoma

A

parotid and submandibular, equally

470
Q
A
471
Q

developmental
hamartoma of lymphatic vessel
differentiation, rather than true
neoplasm

A

Lymphangioma

472
Q

cause of mucocele/ranula

A

Cause: rupture of salivary gland duct,
spillage of mucin into surrounding tissues

473
Q

May be helpful in determining whether a
red lesion is due to extravasated blood or to
blood that is contained within vessels

A

diascopy

474
Q

____ % “Warthin tumor” Papillary cystadenoma lymphomatosumcases are synchronous or metachronous lesions

A

10%

475
Q

–Iatrogenic (transplant-associate (2)

A

• Solid organ transplants (0.5% of
renal transplants) • Several months – years after
transplant

476
Q

age range of endemic (African) kaposi sarcoma

A

wide age range esp. young adults

477
Q

Lymphoreticular
– Leukemia
• Prognosis (con’t)<
–ALL (2)

A

• Children ~90% considered cured
after tx • Adults ~80% initial remission, lower
5-year survival rate

478
Q

–Rapid growth (endothelial cells) –Gradual involution

A

hemangioma

479
Q

Muscle
– Rhabdomyosarcoma
• Histopathologic features: (2)

A

–Small round cells, hyperchromatic nuclei
–May see strap-shaped rhabdomyoblasts
with cross striations

480
Q

cause of sialothiasis

A

– Cause unclear, may be promoted by chronic
sialadenitis and partial duct obstruction

481
Q

early stages of necrotizing sialometaplasia are what?

A

lobular ischemic
necrosis

482
Q

Previously known as histiocytosis X

A

Langerhans cell histiocytosis

483
Q

amyloid deposits seen in what % of patients who have mutliple myeloma?

A

10-15

484
Q

means frogs belly

A

ranula

485
Q

–Monotonous sheets of atypical plasma
cells –Varying stages of differentiation

A

multiple myeloma

486
Q

palisaded nuclei arranged
around Verocay bodies

A

Antoni A in schwannoma

487
Q

MPNST mean age with NF1

A

29 years

488
Q
A

classic kaposi sarcoma

489
Q

• Acinic cell adenocarcinoma – Clinical features: • _____ of all salivary gland tumors • ____ in parotid • ____ minor salivary glands –Especially _____(3).

A

2% 90% 10% buccal mucosa, lips, and palate

490
Q

Lymphadenopathic – esp. young
children, visceral tumors

A

karposi sarcoma endemic (African)

491
Q

– Melanotic neuroectodermal tumor of infancy
• Radiographic features: (2)

A

–Radiolucency anterior maxilla –Deciduous maxillary incisor pushed
labially appearing as “tooth floating in
space”

492
Q

• Lymphoreticular
– Lymphoma
• Hodgkin lymphoma
–Treatment depends on

A

stage:
• Multiagent chemotherapy • Radiation for later stages

493
Q

–Most not associated with other
abnormalities, but some seen in rare syndromes, i.e., encephalotrigeminal angiomatosis (Sturge-Weber)

A

vascular malformation

494
Q

–Collagen deposition secondary to trauma

A

fibroma

495
Q

List 8 Salivary Gland Diseases

A

• Mucocele/Ranula • Sialolithiasis • Acute and Chronic Sialadenitis • Xerostomia • Benign lymphoepithelial lesion (BLEL) • Sjögren syndrome • Necrotizing sialometaplasia • Salivary gland neoplasia

496
Q

• Benign tumor of infancy

A

hemangioma

497
Q

necrotizing sialometaplasia heals in how many weeks

A

4-6 weeks

498
Q

– Kaposi sarcoma
• 4 clinical presentations:

A
  1. Classic
  2. Endemic (African)
  3. Iatrogenic
    (transplant-associated) 4. Epidemic (AIDS-related)
499
Q

• Lymphoreticular
– Langerhans cell histiocytosis
• Treatment:
–Depends on form of LCH

acute?

chronic?

eosinophilic granuloma?

A

chemotherapy

radioation/chemotherapy

curettage/radiation

500
Q

MPNST mean age without NFT

A

46 years

501
Q

gender preference of salivary gland neoplasms

A

slight F

502
Q

tx of pleomorphic adenoma soft palate, labial and buccal mucosa

A

enucleation

503
Q

what growth patterns do you see in PLGA

A
  • Solid, trabecular, cribriform-like, ductal and spindle-cell areas
504
Q

Non-hodgkin lymphoma affects younger patients compared to HL

A

False

Older age group than HL

505
Q
A

mucoepidermoid carcinoma

506
Q

3 clinical features of MPNST

A

may be spontaneous

may have pain

may have nerve deficit

507
Q

two forms of lymphoma

A

hodgkins and non hodgkins

508
Q

• Benign tumor of neural fibroblast origin

A

neurofibroma

509
Q

• Mucoepidermoid carcinoma – Treatment – depends on

A

grade: • Low-grade – wide surgical excision • High-grade – wide surgical excision plus radiation

510
Q

adenoid cystic carcinoma survival rates

A

–10-year survival 50% –20-year survival 25%

511
Q

Benign Mesenchymal Tumors

tissue of origin: soft tissue (list 6 areas)

A
  • Fibrous • Adipose • Nerve
  • Blood • Lymph • Muscle
512
Q

hemangioma usually arise by what age?

A

8 weeks

513
Q

neurilemoma (schwannoma) occurs where?

A

lips, tongue, buccal mucosa

514
Q

Benign Mesenchymal Tumors • Fibrous
– Pyogenic granuloma
• Histopathologic features

A

–Vascular granulation tissue

515
Q

• Common hereditary condition

A

neurofibromatosis

516
Q

–Proliferation of small, dark,
neuroectodermal-appearing cells nested
in aggregates

A

– Melanotic neuroectodermal tumor of infancy

517
Q

tx could include neurosurgery?

A

Sturge-Weber syndrome

518
Q

Benign Mesenchymal Lesions • Fibrous
– Inflammatory fibrous hyperplasia:
• Treatment:

A

–Conservative excision –Remake denture

519
Q

traumatic neuromas common intraoral sites (2)

A

• Tongue
• buccal vestibule, especially mental
foramen area
• Painful when impinged upon by
denture

520
Q

most common tumor of childhood

A

hemangioma

521
Q

–Fascicles of spindle-shaped cells often
forming a “herringbone” pattern –Variable number of mitoses

A

fibrosarcoma

522
Q

_____ occur in patients < 15 y.o. in mucoepidermoid carcinoma

A

15%

523
Q

– Kaposi sarcoma
• 4 clinical presentations (con’t)<
–Endemic (African) (2)

A

• Prior to advent of HIV/AIDS was
already recognized in sub-Saharan
Africa • Wide age range esp. young adults
and children

524
Q

which diseases are slow growing (5)

A

pleomorphic adenoma PLGA Warthrin Tumor adenoid cystic carcinoma acinic cell adenocarcinoma

525
Q

in AIDS related KS what areas of the mouth are affected?

A

• Hard palate, gingiva, tongue

526
Q

Originally was used to describe tumors demonstrating a more uniform histopathologic pattern

A

Monomorphic adenoma

527
Q

cystic spaces containing serous fluid

A

Papillary cystadenoma lymphomatosum “Warthin tumor”

528
Q

Melanotic neuroectodermal tumor of infancy

shows up where? and displays what type of growth

A

anterior maxilla

rapid growth

529
Q

Mucoepidermoid carcinoma – Prognosis: Depends on

A

tumor size and histologic grade (low, intermediate, high)

530
Q

• Bland cells, similar to normal acinar cells

A

acinic cell adenocarcinoma

531
Q

non hodgkin lymphoma mostly arise from where?

A

lymph nodes

532
Q

– Lymphoma
• Non-Hodgkin lymphoma
–linical features oral (con’t)<

(3)

A

• Soft tissue • Centrally in bone • Mandibular involvement may have
“numb chin” sign (paresthesia)

533
Q

Melanotic neuroectodermal tumor of infancy describe color?

A

brown and black

534
Q

• Pt. usually aware of long-standing, asymptomatic mass which suddenly becomes tender or is associated with paresthesia

A

• Carcinoma ex-pleomorphic adenoma

535
Q

–Congenital abnormality, not an inherited
or genetic problem –Dermal capillary vascular malformation
affecting superficial and deeper tissues in
region of cranial nerve V

A

• Encephalotrigeminal angiomatosis

(Sturge-Weber syndrome anomaly)

536
Q

Lymphoreticular
– Langerhans cell histiocytosis
• 3 clinical presentations: (overlapping
features)

A
  1. Acute disseminated histiocytosis 2. Chronic disseminated histiocytosis 3. Eosinophilic granuloma (monostotic or
    polyostotic, i.e., localized to one site
    or multiple skeletal sites)
537
Q

• Rare • Neural crest origin

A

Melanotic neuroectodermal tumor of
infancy

538
Q

• 2nd most common minor salivary gland malignancy

A

Salivary Gland Neoplasms • Polymorphous low-grade adenocarcinoma (PLGA)

539
Q

–Deposition of amyloid (accumulation of
light chains) in various soft tissues

A

– Multiple myeloma

540
Q

sites usually affected by amyloid? (2)

A

Periorbital skin

• oral mucosa, especially tongue

541
Q

lisch nodules of the iris?

A

type 1 (NF1)

542
Q

Periorbital skin
–Waxy, firm, plaque-like lesions

A

multiple myeloma

543
Q

• Non-Hodgkin lymphoma
–Clinical features oral:

where?

A

• Mass soft palate or buccal mucosa

544
Q

• Nerve
– MPNST
• Treatment:

A

–Surgical resection, radical excision,
amputation – ± radiation

545
Q

Mucoepidermoid carcinoma • Sites minor glands + % (5)

A

–Palate 28% –Retromolar region 23% –Lips, floor of mouth, tongue uncommon but mucoepidermoid carcinoma is the most common salivary gland carcinoma in those areas

546
Q

• Lymphoreticular
– Lymphoma
• Non-Hodgkin lymphoma
–Prognosis: (2)

A

• Variable, depends on grade and stage
(better due to targeted therapies) • ~ 1/3 die of disease each year (19,320
deaths due to disease in U.S. 2011)

547
Q
A

non hodgkin lymphoma

548
Q

Benign Mesenchymal Tumors • Nerve

(7)

A

– Traumatic neuroma – Neurilemoma (schwannoma) – Neurofibroma
• Neurofibromatosis – Melanotic neuroectodermal tumor of infancy – Granular cell tumor
• Discussion of congenital epulis

549
Q

xerostomia causes (5)

A

• Glandular aplasia or hypofunction • Radiation therapy • Graft vs. host disease • Sjögren syndrome

medications

550
Q

• Chronic Sialadenitis
– Histopathologic features:

A

• Chronic inflammatory cell infiltrate • Acinar atrophy, ductal dilatation and
fibrosis

551
Q
A

non hodgkin lymphoma

552
Q

• Sjögren syndrome
– Labial salivary gland biopsy technique: (3)

A

• Lower labial mucosa, lateral to midline,
uninflamed • 1cm incision, parallel to vermilion zone • Remove at least 5 minor glands through
the incision and place them in routine
10% buffered formalin

553
Q

Xerostomia
– Predisposes to:

(3)

A

• Mucosa susceptible to injury due to lack
of lubrication • Oral candidiasis • Increased caries, especially cervical

554
Q

Solitary plasmacytoma is precursor to ?

and confined to

A

multiple myeloma

bone

555
Q

list malignant salivary gland neoplasms (5)

A

– Mucoepidermoid carcinoma – Polymorphous low-grade adenocarcinoma – Adenoid cystic carcinoma – Acinic cell carcinoma – Carcinoma ex-pleomorphic adenoma

556
Q

Lesional cells usually bland

A

PLGA

557
Q

• PLGA – Treatment:

A

– Wide surgical excision

558
Q

• Fully developed at birth • Does not involute

A

non-involuting congenital
hemangioma

559
Q

cause of acute/chronic sialadenitits

A

infectious/non infectious causes

– Bacterial, often penicillinase-producing
staph. Viral, most often mumps

560
Q

• Sialolithiasis – Treatment: (try to name 3)

A

• Gentle massage to milk toward orifice • Sialogogues or sour sugarless candies • Moist heat

• Increase fluid intake to “flush” • Surgical removal, may include gland if
significant inflammatory damage • Lithotripsy, sialendoscopy with basket
retrieval (major glands)

561
Q

– Langerhans cell histiocytosis
• Incidence in general population ranges from

A

1-4 million cases

562
Q

• Nerve
– MPNST
• Prognosis:
–With NF1 –

-without NF1-

A

23% 5 year survival

50% 5 year survival

563
Q

three clinical features of sialothiasis

A

hard submucosal mass in soft tissue

+/- symptoms

swelling prior/during meals

564
Q

granular cell tumor found where (3)

A

–Any cutaneous surface –40% occur on the tongue –Also found on buccal mucosa, floor of
mouth

ORAL PATHOLOGY (3 decks)

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