Exam 2- Head and Neck Pathology Flashcards
realm of ENT?
-otolaryngology includes: dzs of nose, nasal cavity, nasopharynx, oral cavity, oropharynx, larynx & laryngopharynx
B/c ENT area is a tougher stratified squamous mucous, how does it behave? what does it behave similarly to?
-degenerative, inflammatory & neoplastic influences
what can cause tooth decay/cavities/caries?
processed carbohydrates
bacterial= acidic erosion of enamel
tartar–> plaque–> calculus= bac, proteins, cells can get trapped
what is periodontal dz? caused by and outcome?
infection with actinobacilli, porphyromonas and prevotella species which cause travel from the gingiva–> periodontal ligaments–> bone–> cementum and erode all of them
What is an irritation fibroma?
inflammatory endpoint or a true neoplasm
what is a pyogenic granuloma?
pops out like a tumor & is 100% indistinguishable from normal granulation tissue, looks like normal and healthy tissue
would you expect a pyogenic granuloma to blanch? a fibroma?
would expect a pyogenic granuloma to blanch
would NOT expect a fibroma to blanch
what is an aphthous ulcer? causes?
canker sore
40% of pop has had/has them
caused by: stress, fatigue, illness, trauma, hormonal changes, menstruation, sudden weight loss, food allergies, vit B12, iron & folic acid deficiencies
what causes glossitis? what else is it known as?
- bacterial or viral infection
- mechanical irritation or injury, trauma
- tobacco, alcohol, hot foods or spices
- allergic rxns to mouth products
- iron deficiency anemia, pernicious, B vit deficiencies, oral lichen planus, erythema multiforme, aphthous ulcer, pemphigus vulgaris, syphilis, etc
- occasionally can be inherited
- geographic tongue
where does type 1 herpes infxn occur? type 2?
classically type 1 was oral and type 2 was genital but nowadays crossover is very common
how do you differentiate between something chronic and acute (such as in an oral herpes infxn)?
generally more inflammation= more acute
what is a Tzanck smear? when do you see a positive Tzanck?
- gently scrape a vesicle, smear it, stain, look for much larger than usu squamous nuclei with inclusions
- (+) Tzanck usu seen in herpes infection
what is candida also known as? what is it? who gets it? where do you see it?
- monilia, thrush
- whitish oral film, easily wiped off but bleeds afterwards
- kids, immunocompromised, diabetics
- see it in moist, non-keratinized stratified squamous mucous (mouth, vagina, moist genital skin areas)
what is PAS?
- periodic acid-schiff
- staining method used to detect polysaccharides (glycogen) & mucosubstances (glycoproteins, glycolipids & mucins)
what does PAS illuminate in a slide?
- non-septate hyphae along with yeasts & budding yeast
- DIAGNOSTIC if you find these things
what color does PAS turn yeasts & pseudohyphae relative to other squamous & inflammation, etc?
turns it BRIGHT RED
describe what leukoplakia looks like and where one finds it along with specific characteristics
- dry flat plaque
- oral mucosa
- non-malignant, non-dysplastic, 100% reversible, some are PREMALIGNANT
is leukoplakia a clinical description or a specific clinical or pathological entity?
it is a CLINICAL DESCRIPTION
-can range anywhere b/w hyperkeratosis/inflammation to carcinoma
what is hairy leukoplakia usu a sign of ?
HIV
what is the progression from normal tissue to malignancy?
normal–> dysplasia–> carcinoma in situ–> infiltrating malignancy
where can SCC occur? no matter what?
can occur on ANY LOCATION no matter the genetics, molecular bio or etiology
what is a classic appearance of scc?
infiltrating or infiltrative scc of the mouth will have ulceration and induration under the ulcer bed
what are the 3 types of differentiation in scc?
well, poor, moderate
what can you see in well scc?
pearls
what can you see in moderate scc?
usu see intercellular bridges but NOT pearls
what can you see in poor scc?
usu have no idea you’re even looking at squamous cells, have to rely on squamous or immunochemical markers
what are the 3 major salivary glands?
parotid, submandibular, sublingual
what can be associated with salivary gland enlargement?
- bac infxn
- viral infxn
- tuberculosis
- sjogren’s syndrome
- sarcoidosis
- alcoholism
- tumors
what is sialolithiasis? risk factors?
- salivary duct stones, most commonly calcium phosphate stones
- risk factors: obstruction of duct (food, edema, cellular debris), prior traumatic injury and dehydration
what is sialadenitis?
inflamm of gland causing mild to sever enlargement of gland which may produce serous or purulent d/c
term used to describe inflamm w/or w/o subsequent supra-infxn
what are the 3 forms of sialadenitis?
acute, chronic, recurrent
what is a very common finding in sialadenitis or any duct injury?
squamous metaplasia of interlobular duct
what can cause sialadenitis?
- viral infxn–> most common viral is secondary to mumps
- bac infxn
- trauma
- food sensitivities
- autoimmune–> sjogren’s
where is the classic place for any visible parotid swelling or tumor?
between the tip of the ear and the angle of the mandible
what is mikulicz syndrome? causes?
- combo of salivary & lacrimal gland enlargement plus xerostomia
- leukemia, lymphoma, sjogren’s, sarcoidosis & other granulomatous dzs
what is xerostomia?
- dry mouth
- see in sjogren’s (also dry eyes)
- lack of salivary secretions may be complication of radiation tx
- oral cavity may be dry or there may be atrophy of papillae with fissuring and ulcerations
what is a mucocele? where? what does it look like? does it fluctuate?
- blockage or rupture of salivary gland duct with saliva leaking into surrounding CT stroma caused by trauma
- lower lip commonly
- in toddlers & young adults as well as geriatric pop
- blue translucent hue, size may fluctuate esp in association w/meals
what is a mucocele in terms of cell type and what’s in it?
big cyst filled w/mucin & lined by mucinous columnar epithelium often inflamed and/or squamous metaplastic
prognosis of mucocele?
resolve spontaneously
if chronic, complete excision of cyst w/minor salivary gland lobule of origin may be necessary; if incomplete chronic mucocele can occur
when do salivary gland neoplasms develop? men or women more? what about warthin tumors?
- usu occurs in adults, slight female predominance
- warthin tumors occur much more often in males
when do benign vs malignant tumors tend to appear?
-benign tumors appear 5th-7th decades whereas malignant tumors appear >7th decade of life
what is the only clearly defined risk factor for development of salivary gland malignancy? what are NOT risk factors?
- head and neck exposure to radiation is only clearly defined risk factor
- heredity, alcohol, tobacco, salivary stones & trauma ARE NOT risk factors
what are the %ages for salivary gland tumors (location) and their rate of malignancy?
- 15-30% of all parotid gland tumors
- 40% of submandibular
- 50% of minor salivary gland tumors
- 70-90% of sublingual gland tumors
what are the two benign common salivary gland tumors?
- pleomorphic adenoma (mixed tumor)
- warthin tumor
what are malignant tumors? two types of salivary gland tumors that are malignant?
- ALL are adenocarcinomas
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
what %age of malignant tumors come from the salivary glands? if its from the salivary glands, which one will it be from? who gets them?
<2%
partoid gland is site of origin for majority of salivary gland tumors, 65-80% of salivary gland neoplasma
typically older adults
what is a pleomorphic adenoma?
painless, slow growing, mobile discrete mass w/in parotid or submandibular areas or in buccal cavity
what is the recurrence rate with adequate parotidectomy? with enucleation?
adequate parotidectomy= about 4%
enucleation= recurrence of about 25%
what can be in a pleomorphic adenoma?
epithelial elements dispersed through matrix along with myxoid, hyaline, chondroid and osseous tissue
what is the risk of a pleomorphic adenoma transforming into a malignant adenocarcinoma or undifferentiated carcinoma?
-2% risk for tumors present 15 yrs
what are the most aggressive salivary gland malignancies? mortality %age, in how many years?
- salivary gland adenocarcinomas or undifferentiated carcinomas
- 30-50% mortality in 5 yrs
what is a warthin tumor also known as?
papillar cystadenoma lymphomatosum
what is squamous metaplasia?
upper airway mucosa transforming into stratified squamous as a non specific response to wide variety of injurious stimuli
