Fellowship MC Flashcards
Metastases to the jaws bypassing filtration through the lungs occurs via the ?
Batson plexus
Following chemotherapy for leukemia a patient has a recurrence. What region of the body may still harbor neoplastic cells for recurrence and why?
Recurrence may spread from the brain because the blood brain barrier is not crossed by traditional chemotherapy agents
Metastatic disease to the jaw is typically via ______ spread
hematogenous
Location (s) of cleft in paraneoplastic pemphigus
subepithelial or intraepithelial
Location (s) of cleft in mucous membrane pemphigoid
subepithelial
Antibodies against ? are implicated in paraneoplastic pemphigus
plakin family of desmosomal components including periplakin and envoplakin (also sometimes desmoglein 1 &3)
What internal malignancy(ies) are most commonly associated with paraneoplastic pemphigus?
CLL, lymphoma
What is bronchiolitis obliterans
sloughing occuring in the bronchioles that can obstruct the airway, listed as a clinical feature of paraneoplastic pemphigus
Location (s) of cleft in angina bullosa hemorrhagica
subepithelial
Location (s) of cleft in epidermolysis bullosa acquisita
subepithelial
INheritance pattern of epidermolysis bullosa acquisita and autoantibodies implicated
Not inherited! (occurs in older adults)
autoantibodies to collagen type VII
Differentiate the DIF of MMP and epidermolysis bullosa acquisita
MMP: IgG C3 on the “roof” of the bullous lesion aka on the epithelial side
EBA: IgG deposits on the CT side of the bulla where the type VII collagen is
Location (s) of cleft in fogo selvage
fogo selvage aka endemic pemphigus foliaceus
intraepithelial clefting (IgG/C3)
Common feature of malignant acanthosis nigricans and Leser-Trelat sign
Gastrointestinal malignancy
Inheritance pattern of hereditary mucoepithelial dyspasia
autosomal dominant or sporadic
Inheritance pattern for incontinentia pigmenti
X-linked dominant so female predominant disease
Location (s) of cleft in warty dyskeratoma
suprabasilar cleft
what is Papyraceous healing and what population does it occur in?
“crumpled cigarette paper” look to the skin after it heals in Ehlers Danlos, occurs with minor injury
Conditions with premature loss of teeth
Sarcoidosis hypophosphatasia papillon-lefevre syndrome Ehlers Danlos Haim-Munk Dentin dysplasia type 1 Swift-feer disease (Acrodynia)
Amianthoid fibers are characteristic of
Intranodal palisaded myofibroblastoma aka intranodal hemorrhagic spindle cell tumor with amianthoid fibers
“tissue culture-like” and “feathery” growth describe
nodular fasciitis
pattern-less round to spindle proliferation describes
solitary fibrous tumor
Short intersecting fascicles aka storiform pattern describes
fibrous histiocytoma
Nodular or multinodular (lobular) fibroblastic proliferation decribes
myofibroma
What molecular test can be used to distinguish lipoblastoma from liposarcoma
lipoblastoma (occurs in infants) = recurrent rearrangement that includes PLAG1
liposarc also CDK4+ MDM2+
Cells of origin for CEOT
stratum intermedium aka rests of the dental lamina
Entities that can originate from the rests of the dental lamina
gingival cyst of the newborn gingival cyst of the adult LPC Ameloblastoma (other things it can originate from too) AOT CEOT SOT OKC
entities that can originate from the rests of Malassez
SOT
Periapical cyst/radicular
The rests of malassez are derived from
hertwigs epithelial root sheath
Infectious process resulting in a subcutaneous vascular proliferation recognized in patients with AIDS is termed? causative organism?
Bacillary angiomatosis
Bartonella henselae
Most common cause of chronic regional LAD in children
Cat scratch disease
Features of unicystic ameloblastoma
younger age group
90% in mandible, usually posterior
Classified with vickers gorlin criteria
treated with enucleation with only 10-20% recurrence
EBV related malignancies
extranodal NK/T cell lymphoma, sinonasal type
Some nasopharyngeal carcinomas
Hodgkin lymphoma (significant # of cases)
Burkitt lymphoma
lymphomatoid granulomatosis
salivary lymphoepithelial carcinoma
Plasmablastic lymphoma
Increased levels of serum alpha-fetoprotein are seen in?
hepatocellular carcinoma, ovarian cancer, germ cell tumor of the testes
Hypertension, gross hematuria, fever, and Abdominal pain in a child may be indicative of?
Wilm’s tumor: most common kidney cancer in children
What syndromes have Wilm’s tumor as a component
Beckwith weidemann
Hemifacial hyperplasia
Hyperparathyroidism jaw tumor syndrome
Angiomyolipoma and cardiac rhabdomyoma are less common features of what condition?
-What are the major features of this condition?
Tuberous sclerosis
-Major: ash leaf spots, shagreen patches, facial angiofibromas, gingival fibromas, ungual and periungal fibromas, hamartomas of the CNS –> intellectual disability, seizures
Primitive mesenchymal cells, cartilage, muscle, necrosis and foci of neuroepithelial differentiation describes
immature teratoma
Most common malignant ovarian germ cell tumor
Female counterpart to testicular seminoma
Most common in children and young women
describes?
Dysgerminoma
Biphasic, malignant tumor with high grade epithelial and sarcomatous components arising in the uterus describes what entity?
Malignant mixed mullerian tumor aka carcinosarcoma
Most commonly used diagnostic test for systemic sclerosis
Laboratory studies may be helpful to the diagnostic
process if anticentromere antibodies or anti-Scl 70 (topoisomerase
I) is detected. Anti-topoisomerase I antibodies are
seen more often with diffuse cutaneous systemic sclerosis
and development of pulmonary fibrosis; anticentromere
antibodies are usually associated with limited cutaneous
systemic sclerosis (including CREST syndrome
Antibodies against periplakin and envoplakin
outside of neville: also desmoglein 3, epiplakin, BP230
Paraneoplastic pemphigus
DIF continuous band of IgG and C3 localized to the basement membrane zone
Mucous membrane pemphigoid
DIF linear deposition of only IgA along the
basement membrane zone
IgA bullous dermatosis
Most common CNS tumor
Glioma (includes astrocytoma, ependymoma, glioblastoma, oligodendroglioma and various subtypes / combinations)
Most specific marker for wegner’s granulomatosis
c-ANCA (antineutrophil cytoplasm antibodies) aka PR3-ANCA
-less specific p-ANCA
serum antinuclear antibodies are a non-specific marker that can be seen in what conditions
Lupus, chronic ulcerative stomatitis, sjogren syndrome, lupus like drug reactions
Drugs for Crohns
mesalamine (5-aminosalicylic acid) or sulfasalazine
What autoantibodies are implicated in chronic ulcerative stomatitis
What tests are used for this diagnosis?
autoantibodies against 70-kD nuclear protein (ΔNp63α,) an isoform of p63
Direct immunofluorescence: IgG to the nuclei of the basal and parabasal region of the epithelium
Indirect immunofluorescence: stratified epithelium-specific antinuclear antibodies (SES-ANA)
Commissural lip pits are associated with?
high incidence of preauricular pits
A layer of balloon cells just beneath the keratin layer in a biopsy is characteristic of?
Oral hairy leukoplakia
Hypochromic microcytic anemia is a finding of
Iron deficiency anemia
also plummer vinson which is just syndrome with iron def anemia
inability of the stomach to form intrinsic factor describes what disease
Pernicious anemia
Megaloblastic/Macrocytic anemia occurs in what conditions
Pernicious anemia
VitB12 def
Folate deficiency
Malignant epithelial cells have an increased number and wider distribution of what receptor?
Laminin
biphasic cell population represented by peripheral large, polygonal, clear cells and central cuboidal darkly staining cells with eosinophilic cytoplasm describes?
epithelial myoepithelial carcinoma
Oral bisphosphonates
Fosamax (alendronate)
Actonel (risedronate)
Boniva (ibandronate)
IV bisphosphonates
Zometa (zolendronate)
Aredia (pamidronate)
A patient presents with HHT, they have apparent telangiectasias of the oral cavity and facial skin. What other manifestations of this disease may affect your management?
- recurrent spontaneous epistaxis
- AV malformations of lungs, liver, CNS
- Rupture of vascular lesions in the GI frequently causes iron deficiency anemia
DDX large verrucous lesion of the buccal mucosa present for 6 months
Verrucous carcinoma
SCC
PVL
Verruca vulgaris
Serologic tests for mono
- Paul-Bunnell test OR rapid slide agglutination (Monospot) assay. Both look for heterophile antibodies
- indirect immunofluorescence for viral capsid antigens and EBV nuclear antigens
enlarged, tender, inflamed, hemorrhagic gingiva with little response to oral hygiene for 2 month duration DDX (4)
Leukemic infiltrate
Wegners granulomatosis
scurvy
plasma cell gingivitis
Storiform pattern describes
Fibrous histiocytoma
Patients with what condition(s) have an increased propensity to develop aggressive form of fibromatosis
familial adenomatous polyposis, Gardner syndrome (a form of FAP)
Russell bodies can be found in what lesions?
What is another name for a russell body?
Russell body (aka a dutcher body): plasma cells with homogeneous immunoglobulin (Ig)-containing intranuclear inclusions usually found in cells undergoing excessive synthesis. Found in chronic infection and myeloma.
Bone marrow aspirates in myeloma
Periapical granulomas
Rosai Dorfman disease
Rhinoscleroma
Russell body is also called a Mott cell
Enameloid conglomerates occur in what entity?
What other histologic feature is common for this diagnosis?
Regional odontodysplasia
-Interglobular dentin
Hydroxychloroquine has been used in the treatment of what conditions?
Orofacial granulomatosis
Chronic ulcerative stomatitis
Lupus erythematosus
Coloboma affecting the eye is reported in what conditions?
NBCCS
Mandibulofacial dysostosis (treacher collins)
Otodental syndrome
(brief mention in regional odontodysplasia)
Michaelis Gutmann bodies are seen in
Malakoplakia
Syndromes associated with a lateral facial cleft
- Treacher collins (mandibulofacial dysostosis)
- Nager acrofacial dysostosis
- Amniotic rupture sequence
- Oculo-auriculo-vertebral spectrum (hemifacial microsomia)
Syndromes associated with a median cleft of the upper lip
oral-facial-digital syndromes
Ellis-van creveld syndrome
Libman-sacks endocarditis may be seen in patients with?
Systemic lupus erythematosus
What are the components of PHACES syndrome
posterior fossa brain abnormality hemangioma arterial abnormalities cardiac defects Eye anomalies sternal cleft
What is the dandy walker malformation?
the most common posterior fossa brain abnormality seen in PHACES syndrome
What syndrome characteristically has many types of dermal adnexal tumors including trichoepitheliomas
Brooke-spiegler syndrome
Development of a hoarse cry in infancy is characteristic of?
Lipoid proteinosis (Urbach-wiethe)
4 other clinical findings of sturge weber (aside from the port wine stain)
Intellectual disability Seizures Leptomeningeal angiomas Contralateral hemiplegia Migraine headaches stroke-like episodes gyriform tramline calcifications hyper or hypodontia Ocular manifestations --> glaucoma
3 syndromes associated with taurodontism
Down ectodermal dysplasia Klinefelters Hypophosphastasia tricho-dento-osseous syndrome
DDX for the clinical manifestations of paraneoplastic pemphigus
Erythema multiforme
Paraneoplastic pemphigus
Pemphigus vulgaris
Steven-Johnson syndrome
Signaling molecule of chemotaxis
C5a
Molecule involved in apoptosis
caspase
Biopsy of a posterior cervical lymph node shows
1) Reactive Follicular hyperplasia
2) clusters of proliferating epithelioid histiocytes, with a mixed lymphocytic and immunoblastic cell population
3) distension of marginal and cortical sinuses with epithelioid cells
DX?
Toxoplasmosis
What is the term for the toxoplasmosis organism you can rarely see on histology
tachyzoite
Widening of the periodontal ligament space DDX
- Osteosarcoma
- Metastatic carcinoma
- Systemic sclerosis (present throughout the dentition)
- HIV-associated NHL
A triangular elevation of the periosteum may be seen in _____, this finding is termed _____?
Osteosarcoma
Codman triangle
Hemorrhagic crusted lips and peri-oral tissues DDX
EM
Pemphigus
Paraneoplastic pemphigus
primary herpes
List the 3 criteria for diagnosis of Cowden syndrome
- Multiple facial trichilemommas
- Acral keratoses
- Multiple oral papules
(2 of 3 for DX)
Aside from the major criteria for the diagnosis of Cowden name common other manifestations of the disease
- Skin lesions: Cutaneous hemangiomas, neuromas, lipomas, xanthomas
- thyroid disease
- fibrocystic disease of the breast in women
- breast cancer in up to 50% of women by 40
- Benign hamartomatous polyps of the GI tract
Central ridges in the nails are termed ____ ____, and are characteristic of what disease process?
Beau lines
Mentioned in neville: Hand foot mouth disease
ALL conditions via outside sources: Conditions associated with Beau’s lines include uncontrolled diabetes and peripheral vascular disease, as well as illnesses associated with a high fever, such as scarlet fever, measles, mumps and pneumonia. Beau’s lines can also be a sign of zinc deficiency.
yellow/white pseudo membrane covering right tonsil DDX
- Herpangina (acute lymphnodular pharyngitis)
- Diphtheria
- Strep tonsillitis
Entities that can cause saddle nose deformity
- Congenital syphilis
- Snorting cocaine
- Wegner granulomatosis
Most common site of origin for nasopharyngeal carcinoma
lateral nasal wall
Which sinus is the most common site of origin for carcinoma of the paranasal sinuses
maxillary sinus
Typical population affected by Kimura disease
Young Asian males vs epithelioid hemangioma (females slightly older)
Two common tumors from the middle ear
- Cholesteatoma
- Paraganglioma
Syndromes associated with paragangliomas
PGL1-4 (types 1&2 paternal inheritance) Associations: NF1, MEN 2, von Hippel-Lindau syndrome
Fontaine’s sign
- carotid body tumors can be displaced laterally but not vertically
- feel the carotid pulse move with the tumor
A dense lymphoplasmacytic infiltrate, Storiform fibrosis, and Obliterative phlebitis are the characteristic histologic features of what entity
IgG4 disease
Corps ronds and grains describe
dyskeratotic cells present in warty dyskeratomas and identical lesions of darier’s disease
Ochronosis occurs in what condition
Alkaptonuria
ochronosis: blue-black pigment that deposits in the skin/eyes as a result of not being able to process phenylalanine/tyrosine
Green pigmented teeth in a young child may be a result of what conditions at birth
Hyperbilirubinemia from: Erythroblastosis fetalis or
Biliary atresia
Testing to confirm behcets disease
- Biopsy with leukocytoclastic vasculitis
2. Positive pathergy test
All natural reservoirs for leprosy
Human
Chimp
Mangabey monkey
Armadillo
Fugal infection with 25:1 male to female predilection
paracoccidiomycosis
the rose bengal dye test is most helpful in the diagnosis of
sjogrens syndrome
dye is added to the eye and it is examined with a slit lamp
Elevated serum IgE, LAD, peripheral eosinophilia, vascular lesions are characteristic of
Kimura disease
the deposition of amorphous eosinophilic hyaline material around pathogenic organism seen in some fungal and parasitic diseases is a result of antigen-antibody rxn known as
Splendore–hoeppli phenomenon
Azzopardi effect
histomorphologic phenomenon of incrustation of blood vessel wall with basophilic nuclear material. It had been primarily described in small cell (neuroendocrine) carcinoma of lung
Jarisch-herxheimer reaction
a short-lived immunologic response to antimicrobial treatment of syphilis characterized by fever, onset of constitutional symptoms, and worsening of rash. It typically begins 2-8 hours after the initial dose of antibiotic is given and resolves spontaneously within 24 hours
What tumor originates from the dental lamina associated with the gubernacular cord
adenomatoid odontogenic tumor
Gorlin cyst is another name for
Calcifying odontogenic cyst
What is the other name for CEOT
Pindborg tumor
Frequently scalloped margins of a radiolucent cyst is associated with what entities
Simple bone cyst
Pindborg tumor
Myxoma
A triangular radiolucent defect is characteristic of
Squamous odontogenic tumor
35% of ameloblastic sarcomas occur in what scenario
recurrent ameloblastic fibroma (not fibro-odontoma)
S100 status for: Granular cell odontogenic tumor, granular cell tumor, and congenital granular cell lesion (congenital epulis)
- -
- +
- -
Soap bubble radiographic entities
Myxoma
Ameloblastoma
Hypodactylia: absence of digits
Hypoamelia: absence of limbs
Microglossia
Are all features of what syndrome
Oro-mandibular-limb hypogenesis syndrome
5 features of Beckwith-Wiedemann Syndrome
- Macroglossia
- Wilms tumor
- Omaphocele
- Neonatal hypoglycemia
- Gigantism
- Other childhood tumors: hepatoblastoma, adrenal carcinoma, rhabdomyosarcoma, neuroblastoma
overgrowth of bone under a pontic is termed
subpontic osseous proliferation
Name 5 key clinical features of treacher collins
- Lateral cleft palate
- ear deformities
- micrognathia
- colomboma
- salivary gland hypoplasia
Goldenhar syndrome is another name for
Oculo-auriculo-vertebral syndrome (one of the lateral cleft syndromes)
Palatal cyst of the newborn occurring in the midline
Epstein pearl
Dysontogenic Cysts is a category name that encompasses what 3 entities
Teratoma
Epidermoid cyst
Dermoid cyst
A soft tissue lesion removed from the oral cavity in an infant shows simple columnar epithelial cells organized in foveolar structures extending to the full depth of the lamina propria. What is the appropriate diagnosis?
Heterotopic oral gastrointestinal cyst or foregut duplication cyst
Name at least 5 conditions that may cause hemihyperplasia
- Beckwith-Wiedemann syndrome
- Neurofibromatosis
- Klippel-Trénaunay-Weber syndrome
- Proteus syndrome
- McCune-Albright syndrome
- Epidermal nevus syndrome
- Triploid/diploid mixoploidy
- Langer-Giedion syndrome
- Multiple exostoses syndrome
- Maffucci syndrome
- Ollier syndrome
- Segmental odontomaxillary dysplasia
Hemifacial atrophy is also called
Romberg or Parry-Romberg syndrome
What cranial nerves are impacted in eagle syndrome
CN 5, 7, 9, 10
Features of segmental odontomaxillary dysplasia
- gingival hyperplasia
- missing premolar
- retained primary
- vertical trabec of bone
- sinus is smaller on the affected side
What branchial arches are affected in treacher collins
1st and 2nd
Neutrophil nitroblue tetrazolium reduction test is useful in? A negative test would indicate?
chronic granulomatous disease
A patient with CGD would have a NEGATIVE NBT test
Indicates a patients inability to produce ROS and therefore they have diminished ability to fight off infection
a predisposing factor for angioedema attacks precipitated by a dental procedure is
use of ACE inhibitors
Beta 2 microglobulin and albumin levels are a prognostic marker for
Multiple myeloma
*though they are also elevated in hemodialysis associated amyloidosis
Eosinophilic cuff like deposits around blood vessels is a common(though not entirely specific) histologic finding in what neoplasm?
CGCGs of cherubism
Erythema nodosum is most often idiopathic, however it can be a sign of systemic diseases such as?
- Sarcoidosis (Lofgren syndrome)
- strep throat infections
- fungal and parasitic infections
- IBD
- behcets
- malignancy
- MANY conditions
What is the codman triangle and what does it occur in?
-triangular elevation of the periosteum
occurs in osteosarcoma
String sign is a term for?
the radiolucent line that corresponds to the periosteum attching a parosteal osteosarcoma to the cortex
Patients with what conditions are at higher risk for chondrosarcoma
Ollier
Maffucci
Most common oral manifestation of NF1
enlargement of the fungiform papillae
Common hemangioma treatment
propanolol (beta blockers)
A malignant peripheral nerve sheath tumor with rhabdomyosarcomatous differentiation is also called what?
Triton tumor
4 Conditions that may be more likely to have papillomatosis
Acanthosis nigricans
Down syndrome
Nevus unius lateris (large nevi only on 1 side of body)
Goltz-gorlin (aka focal dermal hyperplasia)
Verruca vulgaris HPV type
HPV 2
Characteristic features of Hecks disease papilloma
Club shaped rete ridges
Mitosoid cells
Overall most common site of sinonasal papilloma
Lateral nasal wall
Which sinonasal papilloma type almost always occurs on the nasal septum
fungiform sinonasal papilloma
A patient presents with multiple pruritic lesions that look similar to sebks, the lesions have been rapidly developing and increasing in size, what may this be a sign of?
-What condition does this frequently occur in conjunction with?
Leser-Trelat sign
Concerning for “internal malignancy”
-Malignant acanthosis nigricans
Kamino bodies are a histologic feature of?
Spitz nevus
2 inherited conditions that increase the risk of oral SCC
1 acquired condition that increases the risk of oral SCC
Inherited: -Dyskeratosis Congenita
-Fanconi Anemia
Acquired: HIV/AIDS (2x)
Cell of origin in sinonasal undifferentiated carcinoma
-Schneiderian membrane or olfactory epithelium
Demographic of patient affected by nasopharyngeal carcinoma
Young, southern chinese men– typically the undifferentiated form of the disease
-thought to be environmental: salt fish diet high in N-nitrosamines, EBV infection, Vit C def
Most common cancer of all
basal cell carcinoma
What systemic immunotherapy may be considered for Gorlin syndrome pts with many BCCs
Vismodegib
Water brash defintion
sialorrhea that occurs in patients with GERD
What salivary gland tumor has a specific subtype that appears inherited?
Membranous types of basal cell adenoma
membranous type basal cell adenoma frequently occurs in conjunction with what other lesions? What syndrome may it also be associated with?
Trichoepitheliomas
Dermal cylindromas
-WHO lightly suggests some BCAs may be associated with Brooke-spiegler syndrome
Recurrence rate for membranous basal cell adenoma
25%- much higher than typical BCA
What lesion is the salivary analogue of cutaneous syringocystadenoma papilliferum
Sialadenoma papilliferum
Most common inherited bleeding disorder
von willebrand disease
Injection of what medication is recommended 1 day before oral surgery and 7-10 days after in patients with significant Factor 8 deficiency
epsilon-aminocaproic acid
In patients with >5% factor 8 what medication can be given right before surgery to aid in clotting
Desmopressin (DDAVP)- releases bound F8 to create a transient increase in its plasma availability
What causes hemoglobin H disease
3 deleted alpha chain of hemoglobin encoding genes
-results in hemolytic anemia and splenomegaly
What is given as an iron chelating agent. What is a typical clinical scenario for this drug? What type of infection might this patient also be more prone to?
- deferoxamine
- iron overload from blood transfusions
- mucormycosis
What two conditions have an increased risk for aplastic anemia as a component of disease?
Fanconi anemia
Dyskeratosis congenita
Cell count threshold to be considered neutropenic?
below 1500 cells/mm3
Agranulocytosis is?
- cells of the granulocyte lineage are absent, particularly affects neutrophils
- typically drug induced but can be congenital
What type of leukemia predominantly affects children
ALL- acute lymphoblastic leukemia
tumor like growths of leukemic cells are called
myeloid sarcoma
Epidermotropism definition
propensity to invade the epidermis of the skin; such as in mycosis fungoides
What test for wegners granulomatosis
-indirect immunofluorescence for c-ANCA also called PR3-ANCA
Pattern of INDIRECT immunofluorescence in lichenoid drug reaction
IgG in a string of pearls pattern at the basement membrane
Kleeblattschadel deformity occurs in?
-means cloverleaf skull
Apert
Crouzan
What is the plexus of myelinated nerve in the odontoblast layer that transmits pain sensation called?
raschkow plexus
What might a striae of retzuis indicate
these are the normal lines of enamel deposition which could be altered during systemic disturbances
Ochronosis is another term for?
What is the cause?
Alkaptonuria
-blue-black pigmentation in CT, sclera, teeth, cartilage caused by build up of homogentisic acid
Hurler, Scheie, Hunter, Sanfilippo A/B, Morquio A/B, Maroteaux-Lamy are all forms of?
Mucopolysaccharidosis
Loss of the distal tooth of each type is associated with what mutation
MSX1
List all of the genes associated with hypodontia of various patterns
- AXIN2 (associattion with colorectal carcinoma)
- MSX1 (distal tooth of each type missing)
- He-Zao deficiency
- LTBP3 (Pakistani)
- EDA
- PAX9
- WNTI0A
3 syndromes associated with taurodontism
Down syndrome
ectodermal dysplasia
ellis-van crevald
Klinefelter
systemic factors associated with hypercementosis
- Acromegaly and pituitary gigantism
- Arthritis
- Calcinosis
- Paget disease of bone
- Rheumatic fever
- Thyroid goiter
- Gardner syndrome
- Vitamin A deficiency (possibly)
Common local factors that may cause hypercementosis
- occlusal forces
- unopposed teeth
- adjacent inflammation
TX for chronic sclerosing osteomyelitis
debridement and antibiotic tx
Medications associated with gingival hyperplasia
Anticonvulsants: • Carbamazepine • Ethosuximide • Ethotoin • Felbamate • Mephenytoin • Methsuximide • Phenobarbital • Phensuximide • Phenytoin • Primidone • Sodium valproate • Vigabatrin Calcium channel blockers: • Amlodipine • Bepridil • Diltiazem • Felodipine • Nifedipine • Nitrendipine • Verapamil Cyclosporine Erythromycin Oral contraceptives
Premature loss of teeth occurs in?
acatalasia acrodynia oxalosis AIDS All blood issues: leukemia, cyclic neutropenia etc DM hemochromatosis langerhan cell disease sarcoid trisomy 21 Cohen Crohns Dyskeratosis congenita More but I tried to pick the weird surprising ones
Treponema pallidum may escape lethal antibiotic effect by being confined within?
lymph nodes
Massons trichrome stains?
keratin: red
collagen: blue
muscle: red
Spontaneous gingival hemorrhage, petechiae, and ecchymosis are signs of?
- Thrombocytopenia:
- most commonly caused by medications
- immune/idiopathic thrombocytopenia purpura (ITP)
- Thrombotic thrombocytpenia purpura
- malignant infiltration of the BM or chemotoxicity
What is the term for anemia caused by malignant infiltration of the bone marrow
myelophthisic anemia
Genetic disorders that predispose you to leukemia
Down syndrome Bloom syndrome Neurofibromatosis type 1 Schwachman (Schwachman-Diamond) syndrome Ataxia-telangiectasia syndrome Klinefelter syndrome Fanconi anemia Wiskott-aldrich syndrome
About how many cases of hodgkin lymphoma per year?
9000 vs 54000 non-hodgkin
Ann Arbor System for Classification of
Hodgkin Lymphoma
- ONE site
- 2+ lymph nodes on one side OR a lymph node + some non-lymph node site
- Lymph nodes on both sides of diaphragm +/- other sites
- Diffuse disease, LNs, organs etc +/- patient symptoms
Disorders that predispose you to non-hodgkin lymphoma
Wiskott-Aldrich Common variable immune deficiency AIDs organ transplant SLE RA Sjogrens
Cell implicated in mycosis fungoides
CD4 T cell
Preliminary screening procedure for Crohns?
hematologic eval for evidence of malasorption: low albumin, calcium, iron etc
- Leukocyte scintigraphy 99mTc-HMPAO
- endoscopy
Two screening tests for sarcoidosis
- serum angiotensin converting enzyme
2. chest x-ray for hilar LAD
Preliminary screening tests for TB
Skin test
chest x-ray
American college of rheumatology criteria for diagnosis of Wegner Granulomatosis
- Oral ulcers or nasal discharge
- nodules, cavities on chest xray
- abnormal urinary sediment (RBC casts)
- Granulomatous inflammation on bx
Serum markers used to monitor multiple myeloma
Beta 2 microglobulin
Albumin
What percent of patients with mucocutaneous candidiasis as a part of APECED will go on to develop oral or esophageal cancer?
~10%
Pitting of the palms and soles can occur in?
- NBCCS
- Dariers disease
What component of amalgam is usually responsible for contact stomatitis
mercury
Why does C1-INH deficiency result in angioedema
C1 cleaves C2 and C4 which results in angioedema from only minor trauma
High levels of antigen-antibody complexes may be seen in?
Lupus
Bacterial infections
C1-INH deficiency
List 3 causes of angioedema
- Allergic reaction to something contacted
- ACE-I use
- C1-INH deficiency (hereditary or acquired)
Hereditary forms of angioedema are caused by? What is the preferred treatment
- C1-INH deficiency or dysfunctional
- TX: attenuated androgens (induce hepatic production of C1-INH), infusions of C1-INH
Witkopp-von sallman is another name for?
hereditary benign intraepithelial dyskeratosis
Non-melanoma skin cancer in patients with xeroderma pigmentosum occurs at a rate ____x higher
10,000x
Explain the secretion method: Merocrine Holocrine Apocrine Endocrine
Merocrine aka Eccrine: excrete via a duct
Holocrine: cell ruptures and releases its contents
Apocrine: apical portion of the cell pinches off to release contents
Endocrine: secrete molecules directly into the blood
Most common site for palisaded encapsulated neuroma
face (nose and cheek)
Perivascular deposits of basement membrane material are a feature of
lipoid proteinosis
Thickened periodontal ligament may be seen in?
Systemic sclerosis osteosarcoma periapical abscess orthodontic tooth movement increased occlusal function
Generalized loss of lamina dura can be seen in what conditions?
hyperparathyroidism
osteomalacia
pagets disease of bone
fibrous dysplasia
Causes of premature exfoliation of teeth not related to a syndrome
trauma aggressive periodontitis AIDs DM cyclic neutropenia langerhan cell histiocytosis DD type 1 scurvy
Syndromes associated with melanin pigmentation of oral mucosa
peutz-jeghers mccune albright LEOPARD Laugier-hunziker cronkite-canada syndrome bloom syndrome dyskeratosis congenita carney complex XP Addisons rothmund thompson
Chronic exposure to high levels of polychlorinated bephenyls produces oral pigmentation and is termed?
Yusho
Systemic medications that cause pigmentation in the oral mucosa
chloroquine
phenolphthalein- additive in laxatives
estrogen
AIDs-related medications
Types of developmental nevi
epidermal nevus nevus sebaceous nevus flammeus basal cell nevus white sponge nevus
Enlarged LNs featuring necrosis with nuclear debris surrounded by histiocytes, aggregates of lymphocytes and large numbers of plasmacytoid monocytes in a young male with a fever and leukopenia are characteristic of what disease?
Kikuchi-fujimoto disease
Lymphangiomyomatosis is seen exclusively in what population
women of child bearing age
Lesions of uremic stomatitis may mimic what other clinically entity
oral hairy leukoplakia
The most frequent cardiac complication of lupus is?
pericarditis
Sterile warty vegetations affecting the heart valves in SLE patients is termed?
Libman-sacks endocarditis
p63 fun facts
- where is it located
- what does it do
- On chromosome 3
- In the same family as p53 but not a tumor suppressor
- It is essential for epidermal-mesenchymal interaction in development
Calretinin facts
- what is it?
- what does it stain (nuclear, cytoplasmic, membranous)
- Positivity in an oral tumor?
- Vitamin D dependent calcium-binding protein
- Positive in both cytoplasm and nuclei
- positive in ameloblastoma
- Positive in multiple malignancies: synovial sarcoma, liposarcoma etc
About how many new cases of oral cancer are diagnosed annually?
how many oral and oropharyngeal cases are diagnosed annually?
27,000
54,000
Multiple hamaratoma syndromes with a PTEN mutation
- Cowden syndrome (aka PTEN syndrome)
- Lhermitte-Duclos
- Bannayan-Riley-Ruvalcaba
- proteus-like syndrome
What procedure is most commonly used for the removal of an antral pseudocyst?
Caldwell-Luc operation
Oral lesions as the “first to show last to go” is a characteristic features of what disease
Pemphigus vulgaris
List the types of pemphigus. Which type is most common?
- Pemphigus vulgaris
- Pemphigus foliaceous
- Pemphigus vegatans
- Pemphigus erythematosus
- Most common is vulgaris
Most common autoimmune blistering disease
Bullous pemphigoid
eosionphils within a blister is characteristic off
bullae of bullous pemphigoid
Bullous pemphigoid antigens
BP180 and BP230
Teeth are described as conical in what two conditions
Incontinentia pigmenti
ectodermal dysplasia
Snow-capped pattern (white opaque enamel) of alteration to the enamel of teeth is characteristic of what
Hypomaturation amelogenesis imperfecta
What defines acute GVHD
-being within the first 100 days of the transplant
What lesion is evidence of GVHD affecting the minor salivary glands?
Superficial mucoceles
Psoralen and ultraviolet A (PUVA) therapy has shown to improve cutaneous and oral lesions of what conditions?
GVHD, psoriasis
“Well-demarcated, erythematous plaque with silvery scale” describes lesions of what condition?
psoriasis
Most common collagen-vascular/connective tissue disease in the US
Lupus erythematosus
Entropion refers to
inward turning of the eyelids from scarring that occurs in MMP
What term describes vaginal lesions associated with MMP
Dyspareunia
Histologic mimics of MMP include?
linear IgA bullous dermatosis
angina bullosa hemorrhagica
epidermolysis bullosa acquisita
Palmoplantar pustulosis is a feature of what diseases
- Celiac
- Psoriasis
- SAPHO
- strep tonsilitis
- TNF-alpha inhibitors etanercept
- Type 1 DM
Describe Blashkow’s lines and what do they occur in
Blaschko’s lines are lines of normal cell development in the skin. These lines are invisible under normal conditions. They become apparent when some diseases of the skin or mucosa manifest themselves according to these patterns
Become visible in: Goltz syndrome aka focal dermal hypoplasia
as welll as other diseases: incontinentia pigmenti, vitiligo and others
Indirect immunofluorescence finding for cases of MMP with diffuse disease
autoantibodies to epiligrin aka laminin-5
MMP that only affects the oral cavity is associated with what indirect immunofluorescence finding
autoantibodies to alpha-6-integrin
triggers for erythema multiforme
- recurrent herpes simplex
- mycoplasma pneumoniae
- drugs
Munro abscesses occur in
psoriasis or geographic tongue
Mucosal diseases that increase the risk of Oral SCC
- GVHD (small increase risk)
- Erosive LP
- Dyskeratosis congenita
- Fanconi anemia
- HIV (2x increase)
- oral submucous fibrosis (19x)
- Alcohol
- Vitamin A def
- Tertiary syphilis (4x, particularly the tongue)
Shaggy, granular band of C3 at the basement membrane on DIF is characteristic of
Lupus erythematosus
The strongest contributing factor to mortality in systemic sclerosis is involvement of what organ
Lungs
What systemic medications are associated with benign acanthosis nigricans
- corticosteroids
- birth control pills
Most common internal malignancy associated with malignant acanthosis nigricans
GI adenocarcinoma
**note the cutaneous lesions themselves are still benign
Syndrome associated with benign acanthosis nigricans
Crouzan
development of the face begins at what week of gestation
4 weeks
Cleft lip occurs from the failure of fusion of what two processes
median nasal process
maxillary process
Cleft palate only is associated with a syndrome in what % of cases
50%
Maternal behaviors and risk factors that increase the probably of an infant with cleft lip/palate
- tobacco and alcohol
- folic acid deficiency
- anticonvulsant therapy (phenytoin = 10x increased risk)
Acquired macroglossia causes
- Amyloidosis
- Edentulism
- Myxedema (adult hypothyroid)
- angioedema
- acromegaly (excessive growth hormone usually from a tumor)
- tumors
Congenital/hereditary causes of macroglossia
- Beckwith-weidemann
- Hemihyperplasia
- NF 1
- lymphangioma
- hemangioma
- down syndrome
- muccopolysaccharidosis
- Cretinism (childhood hypothyroid)
Most cases of microglossia are related to what syndrome?
oromandibular- limb hypogenesis syndrome
Ectopic thyroid tissue represents a patients only thyroid tissue in what percentage of cases
70%
Lingual thyroid tissue is more common in which sex?
Which sex are they more prone to malignant transformation?
4-7x more females
more common malignant transformation in males`
Lines of Zahn describe?
Concentrically layered platelets and RBCs in a thrombus
Most common site of caliber persistent artery
lip
Coronoid hyperplasia is more common in ___ (M vs F) and results in deviation towards _______ upon opening..
Males
Jaw deviates towards the affected side
Painless limited opening occurring in a young male may be the result of what?
coronoid hyperplasia
Condylar hyperplasia is more common in ___ (M vs F) and results in deviation towards _____ upon opening
Females
deviates towards the unaffected side
Condylar hypoplasia is associated with what syndromes?
Goldenhar syndrome (oculoauriculovertebral syndrome)
Mandibulofacial dysostosis
hemifacial microsomia
what is the term for a bony growth that occurs under a pontic
subpontic osseous proliferation
reactive subpontic exostosis
People will palatal tori may be more prone to what medication related bony disturbance?
medication related osteonecrosis
Distinguish between Classic eagle syndrome vs carotid artery syndrome
- classic is caused by tonsillectomy
- carotid artery syndrome: unrelated to tonsillectomy. Impingement on the internal and external carotid arteries and sympathetic fibers. neck pain- often radiates on movement
Stafne defect occurs in what sex 90% of the time
Males
Is staphne defect present at birth?
No, not congenital
usually develops in middle aged and older adults
elevation of the ala of the nose and eliminating mucolabial fold is characteristic of?
nasolabial cyst
Most common non-odontogenic cyst of the oral cavity
nasopalatine duct cyst
Vomeronasal organ function
aka organ of Jacobson
- accessory olfactory function though is typically a vestigial organ
- in the area of the nasal septum
Inverted pear or heart shaped radiolucency of the anterior maxilla is characteristic of? What is the size cut off to be considered pathologic?
Nasopalatine duct cyst
6 mm or less is within normal range
>6 mm pathologic
What malignant entity might you consider on the differential for a neck mass that appears like a branchial cleft cyst but is in an older adults (50s male)
cystic metastasis from an HPV+ SCC of the oropharynx
En coupe de sabre is characteristic of what condition? What other condition may it occur in?
Morphea- localized systemic sclerosis
Can also occur in parry-romberg/progressive hemifacial atrophy
Define Craniosynostosis. What condition (s) does this occur in
Premature fusing of the cranial sutures
Crouzan, Apert
A prominent antegonial notch seen on PAN is common finding in what condition
Treacher collins syndrome
Rate of enamel deposition
0.023mm/day
What specific genetic finding is associated with increased risk (5.6 x) of root resorption during orthodontic treatment
homozygosity for IL-1 beta allele
Name causes of intrinsic tooth staining and the resultant color alteration seen.
- IV cipro to infants: greenish
- Tetracycline: brown; bright yellow fluorescence
- Minocycline: grey
- congenital erythropoietic porphyria (Gunther dz): red
- alkaptonuria: blue-black
- hyperbilirubinemia: green
What is the most commonly ankylosed tooth
mandibular primary first molar
Syndromes associated with both hyperdontia and hypodontia
- Down
- Ehlers danlos
- Incontinentia pigmenti
- Sturge-Weber
- Orofacial digital syndrome type 1
- Crouzan
Hypodontia only syndromes
- Ectodermal dysplasia
- Gorlin syndrome
- Goldenhar
- lipoid proteinosis
- Hurler
- Progeria
- turner
- Ellis van crevald
most common site of dental transposition
maxillary premolar and canine switched
Natal teeth vs neonatal teeth
natal = present at birth neonatal = arising within the first 30 days
Name the three types of accessory cusps and where they are located
- cusp of carabelli (ML cusp max molar)
- talon cusp (1/2 distance CEJ to incisal edge to count)
- dens evaginatus (buccal cusp, central groove, lingual ridge of the molar or premolar)
There is an increased prevalence of dilaceration in what syndromes
- Smith-Magenis syndrome
- Ehlers Danlos
- Axenfeld-Rieger syndrome
- Congenital ichthyosis
“Denture dipped in white paint” is used to describe?
snow capped hypomaturation pattern of amelogenesis imperfecta
What two systemic conditions should you consider if a patient has generalized delayed eruption, impacted teeth, and generalized thin hypoplastic enamel
- Renal failure
- nephrocalcinosis
If neither is present then the tooth findings are just amelogenesis imperfecta
4 syndromes that produce dental findings similar to dentionogenesis imperfecta
osteogenesis imperfecta
ehlers danlos
Goldblatt syndrome
Schimke immuno-osseous dysplasia
Mutations in DSPP have been described in what conditions
Dentin dysplasia type 2
dentinogenesis imperfecta
What are the defining features of the brandywine isolate
“dentinogenesis imperfecta type 3”
Shell teeth with multiple pulp exposures, seen mostly in deciduous teeth
Whorls of tubular dentin with peripheral normal dentin that appears as a “stream flowing around boulders” describes the histology of what condition
dentin dysplasia type 1
What pathoses are seen more frequently/in association with patients with regional odontodysplasia
- Ectodermal dysplasia
- Epidermal nevi
- Hydrocephalus
- Hypophosphatasia
- Ipsilateral facial hypoplasia
- Neurofibromatosis
- Orbital coloboma
- Rh factor incompatibility
- Vascular nevi
Enameloid conglomerates are seen on histology of what two conditions
- regional odontodysplasia
- amelogenesis imperfecta
What tests are used to assess for mucopolysaccharidosis?
- elevated levels of glycosaminoglycans
in the urine - Deficiencies of the specific
enzymes in the patient’s leukocytes and fibroblasts
Name all of the mucopolysaccharidoses syndromes
- Hurler
- Scheie
- Hunter
- Sanfilippino A/B
- Morquio I/II
- Maroteaux-Lamy
List all types of lipid reticuloendothelioses
- Gaucher disease
- Neimann Pick disease
- Tay-sachs disease
Icterus is another term for
jaundice
Causes of excess bilirubin?
- higher breakdown of RBCs: sickle cell anemia, hemolytic anemia
- liver dysfunction : decreased conjugation of bilirubin, swelling of hepatocytes, obstructions
What type of biopsy is most commonly used to confirm systemic amyloidosis?
What oral biopsy shows positivity in 80% of cases?
- rectal biopsy
- minor salivary gland
Common medications for systemic amyloidosis (not multiple myeloma associated)
colchicine, prednisone, melphalan
Vitamin B6 deficiency is most commonly caused by
drug isoniazid for TB
In a patient with prolonged scurvy what is the mechanism of death?
Untreated leads to death by intracranial hemorrhage
Deficiency of vitamin E in children is most commonly caused by
chronic cholestatic liver disease- severe impairment of all fat soluble vitamins
Vit K is necessary for which clotting factors
clotting factors II, VII, IX, X
Patients with plummer vinson syndrome have a high frequently of what type(s) of malignancy
Both oral and esophageal
Hypochromic microcytic anemia is found in what condition (s)
- iron deficiency anemia
- plummer vinson
Macrocytic/ megaloblastic anemia is found in what condition(s)
- pernicious anemia (B12 def)
- folate deficiency
- tx of B12 def with folate will resolve oral symptoms but CNS damage continues
The Schilling test compares what? Was once used in the diagnosis of?
absorption and secretion of radiolabeled cobalamine
-used previously to diagnose pernicious anemia
Patients with pernicious anemia have a 7x higher risk of developing what type of malignancy?
gastric carcinoma
The posterior pituitary releases what hormones
oxytocin
ADH
The anterior pituitary releases?
ACTH TSH LH GH Prolactin MSH FSH
abnormally short stature with normal body proportions is characteristic of?
pituitary dwarfism
Most common cause of gigantism?
What radiographic feature might this produce?
What syndrome may cause up to 20% of cases of gigantism?
- functional pituitary adenoma
- enlarged sella turcica
- Mccune albright syndrome
Excess production of growth hormone after closure of the epiphyseal plates, describes what disease process?
acromegaly
What test do they employ in the diagnosis of acromegaly
- glucose challenge
- normally GH decreases in the face of a glucose challenge but in acromegaly it remains the same - MRI to assess for pituitary adenoma
Hypothyroidism in childhood is termed?
Hypothyroidism with onset in adulthood is termed?
children = cretinism adults = myxedema
Parathyroid hormone functions
- PTH causes resorption of calcium in the kidney
- PTH acts directly on osteoblasts causing them to produce cytokines that result in osteoclasts breaking down bone
Syndromes that may be associated with hypoparathyroidism
- Digeorge syndrome
- APECED/APS-1
Describe Chvostek sign and what condition it may indicate
Chvostek sign= twitching of the upper lip when the facial nerve is tapped just below the zygomatic process
- it is a sign of tetany
- occurs in hypocalcemia that can results from hypoparathyroidism
Syndromes associated with hyperparathyroidism
hyperparathyroidism jaw tumor syndrome
MEN2a
MEN1
A striking enlargement of the jaws that have a ground glass appearance on radiology may be a sequela of what systemic disease
end stage renal disease because of secondary hyperparathyroidism
stones bones abdominal groans refers to the symptoms associated with what?
hyperparathyroidism
generalized loss of lamina dura is seen in what condition (s)?
hyperparathyroidism, osteomalacia, pagets disease, fibrous dysplasia
Long standing browns tumors of hyperparathyroidism may undergo fibrosis and degeneration. This process is described as?
Osteitis fibrosa cystica
What is the typical abdominal finding in patients with abdominal groans of hyperparathyroidism?
duodenal ulcers
What is the difference between cushing syndrome and cushing disease
Cushing syndrome: hypercortisolism from an inside or outside source
Cushing disease: a specific type of cushing syndrome in which a pituitary adenoma produces excess cortisol
What test may be used in the diagnosis of hypercortisolism resulting from pituitary adenoma secreting ACTH or a functional adrenal corticol tumor
dexamethasone challenge- patients ACTH and cortisol levels should drop in response normally but patients with hypercortisolism do not
Addisonian crisis
Patients chronically receiving corticosteroids begin to produce less ACTH which then makes them unable to produce an adequate response in a time or stress producing an acute hypoadrenocortisolism = addisonian crisis
Clinical features of addison’s disease are not present until ___% destruction of the gland
90%
What causes the bronzing of the skin seen in addisons disease
increased levels of beta-lipotropin or ACTH which stimulate melanocytes
18
Common systemic complications of DM
- microangiopathy, peripheral vascular disease
- predisposition to infection
- neutrophil dysfunction
- kidney disease
- retinal involvement –> blindness
Common oral sequela of DM
- delayed eruption
- perio dz
- diabetic sialadenosis
- enlargement and erythema of the gums
- candidiasis
- poorly controlled type 1 :mucor
Acute angle branching and septations are characteristics of what organism
fungal hyphae of aspergillosis
Decreased blood levels of ________ and increased blood and urinary levels of ________ are characteristic of hypophosphatasia
decreased alk phos
increased phosphoethanolamine
Bony changes in hypophosphatasia resemble what other process
Rickets
The premature exfoliation of teeth in hypophosphatasia is a direct result of what?
Lack of cementum present on the teeth inhibiting the attachment of PDL fibers
Vitamin D resistant rickets is caused by a lack of?
1-alpha-hydroxylase; converts vitD to activated form
Large pulp chambers, pulp horns extending almost to the DEJ is a characteristic dental finding of what systemic condition?
-What does this process often present as clinically?
vitamin D resistant rickets
-Clinical presentation: childhood abscesses
Interglobular dentin and scattered enameloid conglomerates are characteristic of?
regional odontodysplasia
Globular dentin in a child with pulpal extensions to the surface and abscesses is characteritic of
vitamin d resistant rickets
Numerous areas of interglobular dentin and radicular dentin that is atubular, amorphous, and hypertrophic is characteristic of?
dentin dysplasia type 2
whorls of tubular dentin and atypical osteodentin forming the appearance of a stream flowing around boulders is characteristic of?
Dentin dysplasia type 1
Medications for the treatment of mild crohns
Mesalamine or sulfasalazine
intraepithelial eosinophilic abscesses are a characteristic histologic finding in what inflammatory condition
pyostomatitis vegetans in patients with IBD
A mucosal biopsy shows: Subepithelial abscesses, mixed inflammatory cellular infiltrate composed of epithelioid histiocytes, eos, neutrophils, multinucleated giant cells, often obscured by extensive extravasation of red blood cells. This histology is characteristic of?
Wegners granulomatosis
What hormone is implicated in pregnancy gingivitis
progesterone
An isolated patch of exteriorized junctional or sulcular epithelium is thought to be the cause of what condition? What immunohistochemical marker is commonly positive in this type of epithelium?
Localized juvenile spongiotic gingivitis
CK19
atypical gingivostomatitis is another term for?
plasma cell gingivitis
Histology: Psoriasiform hyperplasia and spongiosis, exocytosis and dense chronic inflammatory infiltrate composed predominantly of plasma cells. Dx?
Plasma cell gingivitis
Gingival fibromatosis occurs in many syndromes including?
- Byars-Jurkiewicz syndrome
- Costello syndrome
- Cross syndrome
- Infantile systemic hyalinosis
- Jones-Hartsfield syndrome
- Murray-Puretic-Drescher syndrome
- Ramon syndrome
- Rutherford syndrome
- Zimmerman-Laband syndrome
A 10 year old patient is diagnosed with gingival fibromatosis. What tx would you recommend?
Wait to remove excess tissue until all teeth have erupted and rigorous hygiene
What bacteria is predominantly implicated in vincent infection
aka NUG
Fusobacterium nucleatum
Most common cause of tooth loss in adults over 35
chronic periodontitis
What bacteria is implicated in localized aggressive periodontitis?
A. actinomycetemcomitans
What bacteria is implicated in generalized aggressive periodontitis
P. intermedia, P. gingivalis, tannerella forsythia, fusobacterium nucleatum, treponema denticola, campylobacter rectus
What bacteria is implicated in papillon lefevre
A. actinomycetemcomitans
Physiologic secondary dentin deposition is associated with an increased prevalence of what common systemic conditions
HTN arthritis gout kidney stones atherosclerosis gall stones
Early widespread formation of secondary dentin is associated with?
Progeria
Prominent pulpal calcifications are a finding in what conditions/syndromes?
Dentin dysplasia type 1 Dentin dysplasia type 2 Pulpal dysplasia Ehlers-danlos Tumoral calcinosis Calcinosis universalis ESRD
3 types of pulpal calcifications
Pulp stones
denticles
diffuse linear calcifications
Phoenix abscess
secondary acute inflammation in a periapical granuloma
What is a russell body
scattered eosinophilic globules of gamma globulin
Rushton bodies
linear or arch-shaped calcifications in periapical cyst epithelial lining
Hyaline bodies (pulse granuloma, giant-cell hyaline angiopathy) are frequently found where?
In the walls of inflammatory cysts
The ability of odontogenic epithelium to transform into multiple cell types is termed?
Prosoplasia
Woody tongue and bull neck and two clinical features of what process
Ludwig angina
Involucrum
fragments of necrotic bone that becomes surrounded by new vital bone
Most common cause of ostemyelitis in the US/Europe? Does this differ from third world countries?
US/Europe: dental infection or trauma
3rd world: NUG
What lesions has a propensity for posterior to the first molar on the mandible and anterior to the maxillary first molar
odontogenic fibroma
The palatal mucosa that overlies the tumor occasionally may exhibit a defect or groove, is a feature of?
central odontogenic fibroma
Most frequent location of alveolar soft part sarcoma
Most frequent head and neck sites?
Age group?
lower extremity
Orbit and tongue
Childhood tumor
A diagnosis of pancytopenia is characterized by at least two of the following findings: • Fewer than \_\_\_\_\_\_\_ granulocytes/μL • Fewer than \_\_\_\_\_\_\_ platelets/μL • Fewer than \_\_\_\_\_\_\_ reticulocytes/μL
- Fewer than 500 granulocytes/μL
- Fewer than 20,000 platelets/μL
- Fewer than 20,000 reticulocytes/μL
For many years a regimen known as __________ was widely used to treat Hodgkin lymphoma. Because significant long-term side effects can be associated with this chemotherapy, another regimen known
as _________
MOPP (mechlorethamine, Oncovin, procarbazine, prednisone)
ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine[DTIC])
Radiopaque objects superimposed on the midportion of the mandibular ramus is characteristic of?
Tonsilloliths
What is the natural reservoir for C. diphtheriae
only humans
Lues is another name for?
Syphilis
What is the natural reservoir for syphilis
only humans
Saddle nose is described in what conditions
- congenital syphilis
- drug abuse
Higoumenakis sign. Define and what condition does it occur in?
Congenital syphilis
-unilateral enlargement of the sternal end of the right clavicle in patients with congenital syphilis
What tests would you order for suspected syphilis
- RPR: rapid plasma reagin
- Biopsy
- The fluorescent treponemal antibody absorption (FTA-ABS) test
- dark field microscopy (not really done)
Treponema pallidum can escape antibiotic treatment when found where?
lymph nodes and the CNS
Most common reportable bacterial infection in the US
Gonorrhea
Gonorrhea infection passed to an infant on delivery will present as?
gonococcal ophthalmia neonatorum
Worldwide prevalence of tuberculosis
2 billion people; 1/3 population
What are Ghon complexes?
classic lesions of primary tuberculosis- calcified lesions seen on radiographic studies at sites of healed infection and in the local nodes
A different protocol termed _________ is used for patients who have a positive PPD skin test but no signs or symptoms of active disease.
chemoprophylaxis
What test can be used for diagnosis of certain types of leprosy? What are the findings in each type of leprosy?
Lepromin test: inject heat killed bacteria from armadillo
Tuberculoid leprosy: lepromin positive (high immune function)
Lepromatous leprosy: lepromin negative (low immune fn)
Incubation period for leprosy
Tuberculoid: 2-5 years
Lepromatous: 12-15 years
The WHO defines paucibacillary (which includes what categories of leprosy?) as ______ organisms on biopsy VS multibacillary(which includes what categories of leprosy?) which has ____ organsims on biopsy
Pacibacillary <2
Pauci = Tuberculoid and borderline-tuberculoid
Multi >2
Multi = borderline-borderline, borderline-lepromatous, lepromatous
Predisposing illness most commonly implicated in the initiation of NOMA
Measles
Others: HSV, TB, malaria, varicella
Causative organisms in NOMA
Key: Fusobacterium necrophorum, Prevotella intermedia
Others: Actinomyces pyogenes, Bacillus cereus, Bacteroides fragilis, Fusobacterium nucleatum, and Prevotella melaninogenica
What type of organism is Actinomyces israeli
filamentous, branching, gram positive anaerobic bacteria
Club-shaped with a radiating rosette pattern is descriptive of what organism on histology
Actinomycosis
How would you treat a suspected actinomycosis infection
Confirm with culture (bx is not entirely specific)
-debride and long term antibiotics
What are the natural reservoirs for bartonella henselae
Cats***via fleas
dogs, monkeys, thorns
no human to human transmission
Intranodal area of necrosis surrounded
by a band of epithelioid histiocytes and lymphocytes describes what disease
catch scratch disease
Brown-hopps method of gram staining is used for detection of what organisms?
- Bartonella henselae
- Leishmaniasis (protozoa)
What confirmatory test would you perform in a suspected case of catch scratch disease
indirect fluorescent assay (IFA) or enzyme linked
immunosorbent assay (ELISA) for detecting antibodies
to B. henselae
Chronic sinusitis is defined as?
symptomatic sinus disease for longer than 3 months
Maxillary sinusitis may be triggered by a dental infection in as many as ___% of cases
30%
chronic lip licking, thumb sucking, chronic use
of petrolatum-based salves in patients with angular cheilitis may result in what condition?
cheilocandidiasis- all the perioral skin infected
perleche is another term for?
angular cheilitis
Chairside assessment for candidal infection can be achieved using what test?
10-20% potassium hydroxide (KOH) preparation
Culture of candida should be performed using what medium? what is the appearance of the resulting colonies?
-Sabouraud agar slant
C. albicans will grow as creamy, smooth-surfaced colonies after 2 to 3 days of incubation at room temperature.
Most common SYSTEMIC fungal infection in the US
histoplasmosis
Histoplasmosis is endemic in what area
ohio-mississippi river valley
What size are the yeasts of histoplasmosis
1-3um
Which fungal infection is up to 15x more common in males and why?
paracoccidiomycosis because female hormone beta-estradiol appears protective
Calcified masses in the lungs is a typical finding of what infectious processes?
Histoplasmosis
Tuberculosis
A patient presents with symptoms suggestive of pulmonary infection. A chest xray shows diffuse lung infiltrates without evidence of calcification. What is the suspected diagnosis?
Blastomycosis
Buzz histologic features of blastomycosis
- doubly refractile cell wall
- overlying pseudoepitheliomatous hyperplasia
- large yeasts 8-20um
- broad attachment between daughter yeasts
Animal reservoir for histoplasmosis
bird and bat
In animal models interactions between _________ infection and ________ mutations can produce a pagetic phenotype.
measles virus infection and SQSTM1 mutations
thought that maybe interacting with farm animals could be linked to pagets disease
Animal reservoir for paracoccidiomycosis
nine-banded armadillo
Which fungus exists as a yeast form in both nature and when infecting a human host
cryptococcus neoformans
What animal reservoir is mentioned in association with cryptococcus
pigeons
A prominent mucopolysaccharide capsule is a key feature of what infectious organism? What does it stain positively with?
cryptococcus; mucicarmine
During surgical removal of tissue infected with mucormycosis evaluation of surgical margins is aided by what process ?
calcofluor white and fluorescence microscopy
Describe the organisms of mucormycosis
6-30um 90 degree branching, non-septate hyphae
Second most common opportunistic fungal infection
aspergillosis (1st is candida)
Allergic fungal sinusitis is most commonly caused by?
aspergillosis
Charcot-Leyden crystals are a feature of?
allergic fungal sinusitis; also in asthma or other allergic processes
- formed from the breakdown of eosinophils
- pink/red refractive, and form long needle-like structures
What is TORCH
- an acronym for a group of diseases that cause congenital conditions if a fetus is exposed to them in the uterus
- toxoplasmosis, other (such as syphilis, varicella, mumps, parvovirus, and HIV), rubella, CMV, HSV
What is the natural host for toxoplasmosis
Multiplies in the gut of a cat
Accumulation of eosinophilic macrophages within a lymph node macrophages encroaching on
the germinal centers and accumulating within the subcapsular and sinusoidal regions of the node is a microscopic description common for?
toxoplasmosis infection
Per neville what two infectious diseases are caused by protozoa?
Toxoplasmosis
Leishmaniasis
Transmission of leishmaniasis occurs via what animal vector(s)?
Dogs and other mammals are the primary reservoir
Transmission occurs via the sandfly
Kala-azar is caused by?
Visceral leishmaniasis infection
A volcano lesion is a sequelae of what disease?
Cutaneous leishmaniasis
The only natural reservoir for herpes viruses is?
Humans
What is the structure of human herpes viruses
double stranded DNA viruses
HHV6 and 7 frequently establish latency in what location and what cell
Latency in salivary glands and specifically in CD4 t lymphocytes
The major cell of latency for HHV8
Circulating B lymphocytes appear to be the major cell of latency
HHV8 obviously is linked to kaposi sarcoma but what other diseases is it linked to as well?
Lymphoma and Castleman disease
Ballooning degeneration refers to
HSV-infected epithelial cells exhibiting acantholysis, nuclear clearing, and nuclear enlargement
Potential presentations and sequelae of herpes zoster
- Zoster sine herpete (symptoms w/o rash)
- Ramsay-Hunt: reactivation in geniculate ganglion
- Post herpetic neuralgia
- Granulomatous angiitis: potentially fatal ischemic stroke syndrome that can develop weeks to months after rash resolution
Soft palate petechiae are a common finding in what infectious processes
- Infectious mononucleosis
- “Upper respiratory infections”
- Forchheimer’s sign is only listed under Rubella (aka german measles) but these are just small palatal petechiae
- scarlet fever seems reasonable too
a dewdrop on a rose petal describes a lesion of what disease?
Varicella
VZV establishes latency in the ________________?
Dorsal root ganglion
Hutchinson sign
Lesion of vzv at the tip of the nose which is a sign that the nasociliary nerve is affected which increases the risk for ocular involvement
Most common non-hereditary cause of sensorineural hearing loss in infants
CMV
Diagnostic tests for CMV
> 10% atypical lymphocytes
50% lymphocytosis
HETEROPHILE antibody NEGATIVE
-Bx of lesions: intracytoplasmic inclusions, owl eye nuclei
molluscum contagiosum virus is a member of what family of viruses
poxvirus family
p53 is located on what chromosome
17p
Cytogenetic studies have suggested that loss of heterozygosity (LOH) of chromosome arms \_\_\_\_\_\_\_\_\_\_\_ is associated with increased risk of malignant transformation in SCC
3p and 9p
Loss of p53 gene is involved in which stage of the adenoma-carcinoma sequence in colorectal cancer
late adenoma –> carcinoma
The activation of the p53/p21 pathway triggers?
momentary G1 cell cycle arrest or lead to a chronic state of senescence or apoptosis
P53 levels are negatively regulated by _____
MDM2
Verruca plana HPV types
3, 10
palmarplantar wart HPV type
1,4
butcher wart hpv type
2, 7
Of the currently discovered genes (pertaining to amelogenesis imperfecta), _________ is associated with the highest prevalence of disease and the most severe enamel alterations.
FAM83H
Hypodontia that particularly affects the molars is seen with what mutation?
PAX9
Hypodontia, colon polyps, and colorectal carcinoma are associated with what mutations
AXIN2
Diffuse macrodontia is seen in what condition(s)
otodental syndrome, gigantism, XYY males, pineal hyperplasia
Atubular dentin and pulp stones are common histologic findings for what condition(s)
dentin dysplasia type 2
dentinogenesis imperfecta
Enteroviruses are a genus that encompass what viral types
Echoviruses
coxsackie A & B
polioviruses
What three clinical patterns are characteristic of enterovirus infection
- Herpangina
- Hand foot mouth disease
- acute lymphonodular pharyngitis
Hand foot mouth disease is caused most commonly by?
coxsackie virus A16
Herpangina is most commonly caused by?
coxsackie viruses A1-A6
The nodules of acute lymphonodular pharyngitis if biopsied would show?
Hyperplastic lymphoid aggregates
Rubeola is another name for?
What is the causative virus?
Measles
-paramyxoviridae
Koplik spots if biopsied would show?
hyperparakeratotic epithelium with spongiosis, dyskeratosis, and epithelial syncytial giant cells
As late as 11 years after infection with measles patients can develop a rare complication called?
subacute sclerosing pan excephalitis (SSPE)- degenerative CNS disorder that can lead to death
What adjunct tests can confirm a diagnosis of measles?
IgM antibody assay on serum sample
Viral culture
Rubella is also called?
German measles or the 3 day measles
The causative agent for rubella is?
togavirus of the genus ribivirus
Discrete red papules of the soft palate in addition to palatal petechiae are features of what infectious disease? What is the term for this presentation
Rubella, german measles
Forchheimer sign
What is the causative agent in mumps?
paramyxovirdae genus: rubulavirus
What testing can be used to confirm suspected mumps diagnosis
-mumps-specific IgM
-mumps specific IgG titers
-Swab of secretions obtained from parotid or other affected salivary gland ducts can be used for
viral culture or real-time reverse transcription PCR testing.
In the “EC-Clearinghouse Classification of the Oral Manifestations of HIV Disease in Adults” what lesions are considered strongly associated aka GROUP 1 with HIV infection
- Oral hairy leukoplakia
- Periodontal diseases: NUG/NUP, linear gingival erythema,
- Non-hodgkin lymphoma
- Kaposi sarcoma
- Candidiasis
What lymphomas are most commonly occurring in HIV-positive patients?
primary effusion lymphoma and plasmablastic lymphoma
Atypical patterns of periodontal disease that are associated strongly with HIV infection include?
linear gingival erythema
NUG
NUP
AIDS-Defining Conditions
- Bacterial infections, multiple or recurrent*
- Candidiasis of bronchi, trachea, lungs, esophagus
- Cervical cancer, invasive†
- Coccidioidomycosis, disseminated or extrapulmonary
- Cryptococcosis, extrapulmonary
- Cryptosporidiosis, chronic intestinal (more than 1 month duration)
- CMV disease (other than liver, spleen, or nodes), onset at age of more than 1 month
- CMV-induced retinitis (with loss of vision)
- Encephalopathy, HIV-related
- Herpes simplex: Chronic ulcer or ulcers (more than 1 month duration) or bronchitis, pneumonitis, or esophagitis
- Histoplasmosis, disseminated or extrapulmonary
- Isosporiasis, chronic intestinal (more than 1 month duration)
- Kaposi sarcoma (KS)
- Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex*
- Lymphoma, Burkitt, Immunoblastic, primary of the brain
- Mycobacterium infections that are disseminated or extrapulmonary or avium type
- Pneumocystis jiroveci pneumonia
- Pneumonia, recurrent†
- Progressive multifocal leukoencephalopathy
- Salmonella septicemia, recurrent
- Toxoplasmosis of brain, onset at age of more than 1 month
- Wasting syndrome attributed to HIV
What conditions are part of the AIDS-related complex (ARC) (period of time before a person converts to overt AIDS)
period of chronic fever, weight loss, diarrhea, oral candidiasis, herpes zoster, and/or oral hairy leukoplakia (OHL)
HIV predominantly infects ______ cells, however it can also infect (3) other cell types
- CD4 helper t cells
- macrophages, dendritic cells, microglia
acute retroviral syndrome (aka the first few weeks of a patient becoming infected with HIV) symptoms resemble what other infectious disease?
infectious mononucleosis (e.g., generalized lymphadenopathy, sore throat, fever, maculopapular rash, headache, myalgia, arthralgia, diarrhea, photophobia, and peripheral neuropathies). Oral changes may include mucosal erythema and focal ulcerations.
Progressive encephalopathy in patients diagnosed with AIDS is known as?
AIDs dementia complex
What is the most common intraoral presentation of HIV infection?
Candidiasis
1/3 of HIV pts are infected at some point
90% of AIDs patients develop at some point
In HIV infected patients with CD4 count above 50 cells/mm3 what is the recommended antifungal regimen? What about in patients below 50
above 50: Clotrimazole
below 50: systemic therapy; fluconazole
Balloon cells with nuclear beading is a histologic hallmark for?
Oral hairy leukoplakia
candidal virulence factor known as ____________ is inhibited by cART therapy
secreted aspartic proteinase
Most common malignancy among the AIDS population in the United States
Non-hodgkin lymphoma
Most common intraoral site for TB infection
tongue
What diseases can secondarily produce Addison’s disease or an addisonian presentation?
- Disseminated infections associated with HIV/AIDs
- disseminated histoplasmosis
- paracoccidiomycosis
*not talked about in neville: sarcoidosis
What condition represents an uncommon manifestation of HIV infection characterized by CD8+ lymphocytosis with diffuse lymphocytic infiltration
DILS: diffuse infiltrative lymphocytosis syndrome
Increased prevalence of oral HPV lesions in HIV+ patients treated with cART is thought to be caused by
immune reconstitution syndrome
Some patients who receive antiretroviral therapy during advanced stages of disease develop a paradoxical worsening of their condition—termed?
immune reconstitution syndrome: hyper-inflammatory response to pathogens and pathogenic
antigen
Persistent reservoirs in the body that allows HIV to evade complete resolution include?
peripheral blood and lymphoid tissues
Persistence of HSV for ______ in a patient with HIV is indicative of AIDS
> 1 month
Criteria for the diagnosis of AIDS?
AIDS criteria:
- CD4 count <200
- CD4 % <14% of all lymphocytes
- Presence of an AIDs defining illness
Burton line is caused by?
bacterial hydrogen sulfide reaction on lead in the gingival sulcus creating a precipitate of lead sulfide
A rare subset of TUGSE contain atypical cells which react strongly with _____. As a result of this immuno finding it is thought that these may represent the oral counterpart of what disease? What are these lesions called?
-CD30 (a marker in lymphomatoid papulosis and anaplastic large cell lymphoma)
- primary cutaneous CD30+ lymphoproliferative
disorder
-atypical eosinophilic ulceration
*people are confused if this is a true low grade lymphoma or not. These lesions seem to heal spontaneously and patients do not show disseminated disease
A presentation similar to Riga-Fede disease can be the initial finding in a variety of neurologic conditions related to self-mutilation, such as?
- familial dysautonomia(Riley-Day syndrome)
- Congenital indifference to pain
- Lesch-Nyhan syndrome
- Gaucher disease
- cerebral palsy
- Tourette syndrome
Local factors associated with dysgeusia
Oral candidiasis Oral trichomoniasis Desquamative gingivitis Oral galvanism Periodontitis or gingivitis Chlorhexidine rinse Oral lichen planus Xerostomia
Systemic factors associated with dysgeusia
Vitamin deficiencies Food allergy Sjogrens Nerve damage eating disorders Posionings Mental disorders Medications
Flattening of the articular surface, osteosclerosis and osteolysis of bone beneath the cartilage, radiolucent subchondral cysts, and ossification within the synovial membrane (ossicles) are all features of?
osteoarthritis
The most specific serologic marker for RA is
Anti-cyclic citrullinated protein antibodies (ACPAs or ACCPs)
Synovial membrane biopsy shows: small whitish villi fragments composed of cellular debris admixed with fibrin and collagen. What is the term for this finding and what condition is it seen in?
rice bodies
RA
Most common site affected by giant cell arteritis
Superficial temporal artery
Polymyalgia rheumatica is a symptom of?
Giant cell arteritis
Erethism
Neurologic symptoms of mercury poisoning including: excitability, tremors, memory loss, insomnia, shyness, weakness, and delirium.
Ideal amount of fixative to tissue?
10:1
Lewy bodies are a feature of what disease?
Parkinsons
Fixation of tissue should take place for a minimum of __hrs and a max of ___ hrs
6 hours
48hrs
Krukenberg tumor is what?
bilateral metastatic gastrointestinal neoplasia to the ovaries
Rokitansky-ASchoff sinuses are a frequent feature of?
chronic cholecystitis
What syndrome is a result of paternal deletion of 15q12
Prader-Willi syndrome
What viral glycoproteins are critical for HIV infection/entry into host cell
gp120 and gp41
Which light chain type is more common in amyloidosis
lambda (even though kappa is overall more prevalent normally)
Most common immunoglobulin subtype in multiple myeloma
IgG
Eczema herpeticum is a rare life-threatening manifestation of what disease? What populations are at increased risk?
HSV infection
-Dariers, eczema, newborns, pemphigus
Significant drug interactions with fluconazole may occur with what drugs?
phenytoin
warfarin
sulfonylureas
cyclosporine
Palmar and plantar pits are caused by?
localized impairment of the maturation of basal epithelial cells
Marquis sign on histology refers to?
organisms lining up around the edge of vacuoles of leishmaniasis
Erethism is the term for?
Neurologic symptoms of mercury poisoning
Black foot disease is a manifestation of?
Arsenic poisoning causing dry gangrene
What is Chrysiasis and what does it occur as a result of?
- slate-blue discoloration of skin exposed to sun
- exposure to gold/gold toxicity
- historically given as treatment for RA or TB
- also effects sclera of eyes. Rarely oral
A 12 year old presents with multiple nonvital teeth with associated parulides in the absence of caries or trauma. What is this characteristic of?
Vitamin D resistant rickets
Pulp horns extend to the DEJ
Micro: no cementum associated with the root surface of an exfoliated tooth is a finding of?
Hypophophatasia
A propensity for skin lesions to appear at a site of previous trauma is termed __________. What disease(s) do we frequently see this occur in?
- Kobner phenomenon
- lichen planus, vitiligo, psoriasis, halo nevus
Onionskin periosteal reaction is a feature of?
Ewing sarcoma
Onionskin-like reaction can be seen in what benign process
Osteomyelitis with proliferative periostitis
Rhomboid shaped PAS-D positive crystals are a feature of?
alveolar soft part sarcoma
What are the American college of RA criteria for Sjogren syndrome?
Patients have at least 2 of the 3 major features
- Positive autoantibodies (SSA and/or SSB, OR + RF AND + ANA titer >1:320)
- Labial minor gland biopsy with >1 focus score/4mm^2
- Keratoconjunctivities sicca with ocular staining score >/= 3
What are the two eye tests used in the diagnosis of Sjogrens syndrome
Rose bengal dye test: stain the eye and then examine under a slit lamp
Schirmer test: filter paper over the lower eye lid and measure <5mm in 5 minutes
Granules within oncocytes are mitochondria which can be seen with ________ stain
PTAH(phosphotungstic acid hematoxylin)
The differential for acinic cell carcinoma is frequently what other salivary entity?
secretory carcinoma
The amorphous material seen in a biopsy of plasminogen deficiency will stain positive with?
Fraser-lendrum stain
How do you treat lesions of plasminogen deficiency
- Topical heparin and prednisone combined
- Surgical excision + systemic doxy, topical chlorhexidine, systemic warfarin
Symmetric intracranial calcifications of the medial temporal lobes is a feature in 70% of people with what condition?
Lipoid proteinosis
PAS positive congo red negative amorphous material depositing in a lamellar configuration around blood vessels is the micro description of?
lipoid proteinosis
Ziehl-Neelson is a specific type of what stain?
acid-fast stain used to see mycobacterium like TB
What fluorescent stain is now frequently used to identify tuberculosis?
auramine-rhodamine stain
fluorescent stain for mycobacterium
A fite stain is used for the visualization of?
mycobacterium leprae of leprosy
The protozoa of leishmaniasis are stained with?
Giemsa
Brown-hopps (tissue gram stain)
What would be on your differential with neurothekeoma? What stains could you use to distinguish between these entities?
Nerve sheath myxoma
Maybe melanoma
Neurothekeoma= S100 NEGATIVE; MITF +, CD63+, Melan A negative
Nerve sheath myxoma: S100+,
Sydenham chorea is a manifestation of?
Acute rheumatic fever
= involuntary jerking movements that can occur for up to months after infection
What populations are most greatly affected by salivary lymphoepithelial carcinoma
Eskimos, Chinese, Taiwan
Follicular hyperplasia of lymph node= germinal centers are BCL2 _____
Follicular lymphoma = germinal centers are BCL2 _____
follicular hyperplasia GC: BCL2 negative
Lymphoma GC: BCL2 positive
Normal lymphoid follicles show positivity for what markers within GC ______; what maker is positive in the mantle cells and T cells?
Other positive general follicle markers include
CD10, BCL6 GC markers
BCL2 positive in mantle and T cells surrounding
Follicles are just B cells: CD19, CD20, CD22, and CD79a
Infiltrative spindle cell neoplasm in the myometrium that has prominent myxoid stroma and a dense lymphoplasmacytic infiltrate. It is positive for desmin, smooth muscle actin and ALK by immunohistochemistry and shows ALK rearrangement by FISH. What is the most likely diagnosis?
Inflammatory myofibroblastic tumor
H3F3A and H3F3B were found in 85% of _________ and 88% of ______.
giant cell tumors of bone
chondroblastomas
The following micro description is for what lesion: The neoplastic round and polygonal cells are chondroblasts positive for S-100. Multinucleated giant cells are of different cell line and stain positive for histiocytic markers (CD68). “Chicken-wire” calcifications.
Chondroblastoma
Medullary thyroid carcinoma is a malignancy of what cell type?
C cells aka parafollicular cells of the thyroid
Leukocytoclastic vasculitis is a histologic pattern seen in what conditions
Discussed in neville: Behcets, Wegners
ALSO: Includes drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, amyloidosis, antiphospholipid syndrome, atrial myxoma, Behcet disease, Churg-Strauss syndrome, granulomatosis with polyangiitis, Henoch-Schonlein Purpura, urticarial vasculitis, ITP and more
Argyrophilic granules of merkel cell carcinoma can be seen with______ stain
Grimelius
(or any silver stain for that matter Argyro = Ag aka silver)
soap bubble radiolucency has been used to describe what lesion(s)
Ameloblastoma
myxoma
intrabony vascular malformations
DILS represents a positive or negative prognostic marker in HIV infection?
Positive prognostic though increased risk of lymphoma
Laminated basophilic calcifications in sarcoidal granulomas are called _____ and composed of _____
Schaumann bodies
made of degenerated lysosomes
__________ are composed of reduplicated basement membrane and cytoplasmic processes
verocay bodies
loose bodies(joint mice) are a feature of
synovial chrondromatosis
round bodies are another name for? what are these a histologic feature of
corp ronds
-warty dyskeratoma
Auer rods are a feature of what disease(s)
(or Auer bodies)
large, crystalline cytoplasmic inclusion bodies sometimes observed in myeloid blast cells during acute myeloid leukemia, MDS, or CML
Marquee sign on histology refers to?
organisms lining up around the edge of vacuoles of leishmaniasis
Old person, sun-damaged skin, spindle cell tumor of the head and neck area. What is the most likely diagnosis
Angiosarcoma
Benign Lymphoepithelial Lesion are associated with what disease/condition?
Sjögren Syndrome.
Defined as: Lymphocytic infiltrate with an associated epimyoepithelial island.
Neonatal hypoglycemia is a feature of?
Beckwith wiedemann syndrome
Subperiosteal resorption of phalanges of index and middle finger are features of?
hyperparathyroidism
What lesion originates in Fossa of rosenmuller?
Nasopharyngeal carcinoma
Organ dysfunction caused by infiltration by LCH is considered low risk when involving what organs?
skin, bone, lymph node, pituitary gland
anti-Saccharomyces cerevisiae antibodies (ASCA) are used to distinguish between which two conditions? If present what do you favor?
Crohns and Ulcerative colitis
-ASCA+ favors Crohns
p-ANCA antibodies in the setting of IBD symptoms is most specific for?
Ulcerative colitis
____ is the 2nd most common primary malignant bone tumor in children after osteosarcoma
Ewing sarcoma
Benign, vascular tumor of spleen arising from red pulp is called?
Littoral cell angioma
Cerebriform nucleus of sezary cells seen on _______ _______ sections
semithin embedded
Tumors with Glycogen
Ewing Sarcoma
Oncocytoma
Clear cell odontogenic carcinoma
Leiomyosarcoma
Syndromes associated with neutropenia
Schwachman-Diamond Syndrome
Severe congenital neutropenia
Dyskeratosis congenita
Cartilage-hair syndrome
Hamman’s Crunch
Crepitus synchronous with heartbeat in cervicofacial emphysema with mediastinal involvement
Cell of origin for renal cell carcinoma
proximal convoluted tubule
Most significant risk factor for RCC
Smoking
Most common type of RCC and its genetic alteration
Clear cell
-deletion of short arm of chromo 3 harboring VHL gene
Denosumab mechanism of action and common drug names
RANK ligand inhibitor
Prolia, Xgeva
