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Exam 3 - ST Masses (Infectious/Neoplasms) Flashcards

1
Q

Name the lesion

Caries, periodontal disease, or trauma. Accumulation of acute inflammatory cells. Associated with a nonvital tooth
Often painful.

A

Palatal Abscess

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2
Q

How to tx palatal abscess?

A

“Vitality testing - this rules out nasopalatine duct cyst

Imaging (periapical RL) “

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3
Q

How to tx palatal abscess?

A

Treat source of infection (RCT or EXT)
If EXT, submit any soft tissue removed for histo exam
Monitor for improvement

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4
Q

Name the lesion

Caries, periodontal disease, or trauma. Inflammatory cells perforate through epithelium and drain through intraoral sinus.

A

Parulis

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5
Q

Name the lesion

Yellow-red nodule on gingiva or in vestibule
Associated with non vital tooth
Usually asymptomatic

A

Parulis

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6
Q

How to diagnose parulis?

A

Vitality testing
Imaging (PA RL)

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7
Q

How to tx parulis?

A

Treat source of infection (RCT or EXT)
If EXT submit soft tissue for histo exam
Monitor for improvement

Can poke gutta purcha in and take a PA the gutta purcha will point to the tooth of origin

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8
Q

T/F Tx for parulis and palatal abscess follow same guidelines.

A

True

Treat source of infection (RCT or EXT)
If EXT submit soft tissue for histo exam
Monitor for improvement

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9
Q

Name the lesion

Reaction to infection (bacterial, viral, fungi). Enlarged, tender LN
Mobile upon palpation
Accompanying symptoms of infection (fever, sore throat, fatigue).

A

Infectious LAD

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10
Q

With Infectious LAD, LN are usually ______. Where as in LAD secondary to malignancy LN are usually _____ and _________.

A

Tender
Firm; Non-tender

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11
Q

How to diagnose infectious LAD?

A

Clinical Diagnosis
Lab Tests
Biopsy if persistent

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12
Q

How to diagnose LAD 2ndary to malignancy?

A

Imaging
Lab tests - to rule out infection
Biopsy - deep core with needle not done by dentist usually

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13
Q

How to tx infectious LAD?

A

Often self limiting (should be gone in 2 weeks), resolved with tx of underlying conditions.

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14
Q

How to tx LAD 2ndary to malignancy?

A

Treat underlying malignancy, need to fully describe what you see to primary care so they can be pushed up on the waitlist

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15
Q

Name the lesion

A

Direct spread from a primary cancer (metastasis) or
Lymphoproliferative disorders (lymphoma, leukemia). Firm-non tender LN
May feel fixed or matted to underlying tissue
Typically unilat
May have B symptoms (Night sweat, fever, weight loss)

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16
Q

What are the clinical presentations of LAD 2ndary to Malignancy?

A

Firm-non tender LN

May feel fixed or matted to underlying tissue

Typically unilat

May have B symptoms (Night sweats, fever, weight loss)

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17
Q

What are the B symptoms?

A

Fever
Night sweats
Weight loss

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18
Q

What is the demographic for LAD 2ndary to malignancy?

A

Middle age and elderly

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19
Q

Name the lesion:

Benign neoplasm derived from schwann cells (mesenchymal)

A

Granular Cell Tumor

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20
Q

Name the lesion

Benign tumor of fat

A

Lipoma

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21
Q

Name the lesion

Benign vascular tumor

A

Hemangioma

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22
Q

Name the lesion

Structural anomaly of blood vessels

A

Vascular malformation

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23
Q

Name the lesion

Benign Nerve origin - a lot of different cells.

Can occur in many parts of the body. _____ and ______ mucosa common oral sites

A

Neurofibromma

Tongue; Buccal mucosa

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24
Q

Name the lesion

Benign Nerve origin - schwann cells

______ most common oral site

A

Schwannoma

Tongue

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25
Q

Demographics for granular cell tumor

A

Female predilection
Rare in Children.

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26
Q

Demographics for lipoma

A

Rare in children

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27
Q

Demographics for hemangioma

A

Infancy
Female predilection

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28
Q

Demographics for Vascular Malformation

A

Present at birth but persist and may become more apparent throughout life

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29
Q

What two benign Neoplastic ST lesion did we talk about that are rare in children?

A

Granular cell tumor and Lipoma

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30
Q

What is the most common tumor of infancy?

A

Hemangioma

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31
Q

Where is granular cell tumor most likely to be found in the oral cavity (site)?

A

Dorsal tongue most common oral site but can be anywhere

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32
Q

Where is Lipoma most likely to be found in the oral cavity (site)?

A

Buccal mucosa and buccal vestibule most common.

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33
Q

Where is hemangioma most likely to be found?

A

60% in the head and neck

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34
Q

Where is neurofibroma most likely to be found in the oral cavity (site)?

A

Tongue and buccal mucosa

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35
Q

Where is schwannoma most likely to be found in the oral cavity (site)?

A

Tongue

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36
Q

Clinical presentation of granular cell tumor?

A

Sessile submucosal nodule
Pink sometimes with yellow hue, usually on dorsal tongue

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37
Q

Clinical presentation of Lipoma

A

Soft smooth surfaced nodule
Usually yellow, sometimes pink depends on how much tissue overlay’s
buccal vestibule and buccal mucosa most common oral sites

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38
Q

Clinical presentation of hemangioma

A

Bright red to dull/purple nodule
Undergo rapid growth for 6-12 months then involute
90% resolve by age 9

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39
Q

Hemangioma: Undergo rapid growth for _____ months then involute
______ resolve by age ____

A

6-12
90%
9

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40
Q

Clinical presentation of hemangioma

A

Can vary from pink/red macule to blue/purple mass

Presentation varies based on kind of vasculature involve (capillary, venous, av)

Port wine staines (capillary malformations) common on the face

Bruit- “large vessels”

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41
Q

How to tx granular cell tumor?

A

Excisional biopsy

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42
Q

How to tx lipoma?

A

Excisional biopsy

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43
Q

How to tx hemangioma?

A

Varies depending on subtype, location, and size. It does respond to medication

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44
Q

How to tx vascular malformation?

A

Varies depending on subtype, location and size
Does NOT respond to medications

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45
Q

What test can be used to determine if a lesion is vascular?

46
Q

Diascopy: Vascular lesion tend to _____ with pressure. Blood displaced.

47
Q

How can you diagnose
granular cell tumor, lipoma, hemangioma, and vascular malformations?

A

granular cell tumor, lipoma, hemangioma diagnose with biopsy

vascular malformation can be diagnosed by aspiration (dx vascular origin), imaging (angiogram), and biopsy

48
Q

What is the function of lymphoid tissue?

A

Recognize and process foreign antigens (Bacterial, fungal, and viral)
Respond to antigenic challenges

Lymphoid cells proliferate, causing lymphoid hyperplasia

49
Q

Name the three Lymphoid tissue head and neck locations

A

A. Cervical lymph nodes (anterior and posterior)

B. Lymphoid tissue of waldeyer’s ring (tonsils)

C. Scattering lymphoid aggregates (oropharynx, soft palate, lateral tongue, floor of mouth) —- Bilateral +multiple patches good sign it is an scattering lymphoid

50
Q

What is the one benign salivary gland tumor we talked about?

A

Pleomorphic adenoma

51
Q

What is the most common salivary neoplasm?

A

Pleomorphic adenoma

52
Q

What are the three malignant salivary gland tumors we talked about? (MPA)

A
  1. Mucoepidermoid Carcinoma
  2. Polymorphous adenocarcinoma
  3. Adenoid cystic carcinoma
53
Q

What is the most common salivary gland malignancy?

A

Mucoepidermoid carcinoma

54
Q

What is the most common salivary gland malignancy?

A

Mucoepidermoid Carcinoma

55
Q

What is the most aggressive salivary gland tumor?

A

Adenoid cystic carcinoma (perineural invasion)

56
Q

What salivary tumor can recur?

A

Pleomorphic adenoma

57
Q

T/F Mucoepidermoid Carcinoma and Polymorphous adenocarcinoma are usually low grade salivary tumors.

58
Q

Major glands: The larger the salivary gland the more likely it is to be ________. The smaller the gland the more likely it is to _________.

A

benign ; malignant

59
Q

Minor glands have almost ____ chance of being malignant.

60
Q

Parotid Gland ____ of neoplasms
Minor gland _____ of neoplasms
Submandibular gland ____ of neoplasms
Sublingual gland _____ of neoplasms

61
Q

What are the common site for minor salivary gland neoplasms?

A

Hard palate
Soft palate
Upper Lip

62
Q

How do you tx a salivary tumor?

A

Varies depending on benign vs malignant, location, histopathologic grade and clinical stage

Local surgical excision or wide surgical excision
Superficial parotidectomy, or total gland removal with or without neck dissection

63
Q

What is the most common site for a minor salivary neoplasm?

A

Hard palate

64
Q

Name the lesion

Group of malignancies characterized by overproduction of neoplastic white blood cells
Originates in bone marrow, then spills over into circulation blood and tissues

65
Q

Leukemia is the overproduction of what cells?

A

Neoplastic WBCs

66
Q

What is the demographic you find leukemia?
Acute -
Chronic -

A

Acute - children and young adults

Chronic - middle-aged adults

67
Q

What is the clinical presentation of leukemia?

A

Fatigue, Fever, Dyspnea
Splenomegaly and Hepatomegaly
LAD
Easy bruising and bleeding

Diffuse, boggy, nontender swelling on gingiva with or without ulceration that is asymptomatic

68
Q

What is the difference between acute and chronic leukemia?

A

Acute - children and young adults
proliferation of immature WBC
more aggressive clinical course

Chronic - middle aged adults
proliferation of mature WBC
Slowly progressive clinical course

69
Q

Name the pathology

middle aged adults
proliferation of mature WBC
Slowly progressive clinical course

A

Chronic Leukemia

70
Q

Name the pathology

children and young adults
proliferation of immature WBC
more aggressive clinical course

A

Acute Leukemia

71
Q

How to diagnose leukemia?

A

Biopsy -you can do this first before sending to ER because at ER may not immediately do bone marrow biopsy, however ER can get results from blood test

Bone Marrow Biopsy will be done in hospital

72
Q

How to tx leukemia? and its oral presentation?

A

Chemotherapy
Bone marrow transplant

With tx of cancer the oral lesions will heal

73
Q

T/F The diffuse boggy swelling gingiva with or without ulceration that is sometime associated with leukemia is usually asymptomatic.

A

True - but there are some symptomatic cases

74
Q

A patient with CLL is more likely to be an adult or child?

A

Adult think chronic = adult

75
Q

What is the most common leukemia?

76
Q

T/F Leukemia starts in the LN and Lymphoma starts in the bone marrow.

A

False Leukemia starts in the bone marrow and Lymphoma starts in the LN.

77
Q

Name the Pathology

Group of malignant tumors of LN
Originates in LN then can become more widely disseminated

78
Q

What is the clinical presentation of lymphoma?

A

Enlarging, non-tender, discrete mass in LN region

May have weight loss, fever, night sweats (B symptoms)

Pruritus

Oral non tender, diffuse soft tissue swelling, boggy can have ulceration

79
Q

What type of lymphoma most commonly presents with oral manifestations?

A

Most commonly diffuse large B cell lymphoma

80
Q

How to diagnose lymphoma?

A

Biopsy - can do a narrow slice but need to go deep
Imaging

81
Q

How to tx lymphoma?

82
Q

Which has a more diffuse oral manifestation?
Leukemia or lymphoma

A

Leukemia usually

83
Q

Name the pathology

Vascular malignancy
Caused by infection with HHV-8

A

Kaposi sarcoma

84
Q

What is the demographic for kaposi sarcoma?

Most commonly seen in pt with _______.

Classic Form -

Endemic -

Iatrogenic -

Which one male or female more likely?

A

Most commonly seen in pt with AIDS in US

Classic form seen in the mediterranean, eastern europe, and central africa

Endemic form seen in africa

Iatrogenic form seen in recipient of solid organ transplants

90% in men

85
Q

Kaposi sarcoma is found ____% in ____.

A

90% in men

86
Q

What type of infection causes kaposi sarcoma?

87
Q

What sites in the oral cavity does kaposi sarcoma have a predilection for?

A

Hard palate, gingiva, and tongue but can be at other sites as well

88
Q

Describe the clinical presentation of kaposi sarcoma

A

Multiple blue-purple macules, plaques and nodules on the face and oral mucosa

Predilection for Hard palate, gingiva, and tongue but can be at other sites as well

89
Q

How to diagnose Kaposi Sarcoma?

90
Q

T/F For all the ST Neoplasms we talked about take a biopsy.

91
Q

How do you tx kaposi sarcoma?

A

Varies, but usually involves management of the underlying AIDS (if applicable) and possibly chemotherapy

92
Q

What type of kaposi sarcoma is the most common?

Endemic
Iatrogenic
AIDs related
Classic

A

AIDs related

93
Q

Describe metastatic tumor.

A

Spread of malignancy
Middle aged and older adults with cancer

94
Q

For MEN what are the most common metastatic tumors that metastasize to the oral cavity?

A

Lung, kidney, melanoma

95
Q

For WOMEN what are the most common metastatic tumors that metastasize to the oral cavity?

A

Lung, kidney, breast, genitalia

96
Q

What is the clinical presentation for metastatic tumors the metastasis to the oral cavity?

A

Nodular soft tissue mass resembling hyperplastic or reactive growth, 50% on the gingiva

97
Q

Where are you most likely to find (site) the metastasizes of a metastatic tumor to the to the oral cavity?

A

50% on the gingiva

98
Q

How to dx and tx metastatic carcinoma?

A

Incisional biopsy and manage primary malignancy (poor prognosis)

99
Q

In _____ of pt with oral metastasis they do not know about the primary malignancy yet.

100
Q

Thyroid gland enlargement etiology (5 things)

A

Goiter (most common)
Thyroid adenoma (benign)
Thyroid carcinoma (malignant)
Graves disease - more likely symptomatic
Hashimoto’s thyroiditis - more likely symptomatic

101
Q

What is the most common thyroid gland enlargement

102
Q

What are the two neoplasms that can cause thyroid gland enlargement?

A

Thyroid adenoma (benign)
Thyroid carcinoma (malignant)

103
Q

An enlarged thyroid + symptoms is most likely _________ ________ or ________ ____________. (autoimmune conditions)

A

Graves disease

Hashimoto’s thyroiditis

104
Q

Hyperthyroidism

A

Diffuse thyroid enlargement
Weight loss despite increased appetite
Tachycardia
Excessive perspiration - sweating
Warm, smooth skin
Tremors
Exophthalmos

105
Q

T/F Generalized enlargement is more likely to be goiter, graves or hashimoto’s vs a discrete nodule which is more likely to be a neoplasm.

106
Q

Hyperthyroidism - Graves disease Clinical Presentation (7 things)

A
  1. Diffuse thyroid enlargement
  2. Weight loss despite increased appetite
  3. Tachycardia
  4. Excessive perspiration - sweating
  5. Warm, smooth skin
  6. Tremors
  7. Exophthalmos
107
Q

Match the pathology to the correct category.

Graves disease

Hyperparathyroidism or Hypoparathyroidism

A

Hyperparathyroidism

108
Q

Match the pathology to the correct category.

Hashimoto’s thyroiditis

Hyperparathyroidism or Hypoparathyroidism

A

Hypoparathyroidism

109
Q

Hypothyroidism - Hashimoto’s thyroiditis Clinical presentation (7 things)

A
  1. Lethargy
  2. Dry coarse skin
  3. Swelling of face and extremities
  4. Huskiness of voice
  5. Constipation
  6. Bradycardia
  7. Hypothermia
110
Q

How to diagnose thyroid enlargment?

A

Fine needle aspiration (FNA)

Imaging

Blood work

111
Q

Name the pathology

Soft tissue mass of the gingiva

Odontogenic neoplasm: Peripheral ameloblastoma
Peripheral calcifying epithelial odontogenic tumor, ETC”

A

Peripheral odontogenic cyst/tumors

112
Q

How to diagnose and tx Peripheral odontogenic cyst/tumors?

A

Biopsy, Excisional Biopsy

OPath (17 decks)

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