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Oral Pathology > Introduction to Pathology of Oral Soft Tissues > Flashcards

Introduction to Pathology of Oral Soft Tissues Flashcards

1
Q

The two parallel/pedagogic methodologies for categorizing abnormalities of the oral mucosa…

A
  • Etiologic Approach

- Clinical Features

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2
Q

Etiologic approach…

A

Abnormalities of the oral mucosa are presented in a sequence based on their cause, irrespective of their clinical presentation.

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3
Q

Etiologic categories

A
  • Developmental
  • Autoimmune
  • Metabolic
  • Neoplastic
  • Infectious
  • Traumatic
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4
Q

Clinical features approach

A

Categorizes disease based on clinical features rather than their etiology

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5
Q

Differential diagnosis method

A

Groups diseases sharing a similar clinical presentation

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6
Q

Most lesions of the oral mucosa fall into one (or more) of the following categories:

A
  • Flat lesions

- Raised lesions (enlargements)

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7
Q

Flat lesions may present as…

A
  • Solitary ulcers
  • Multiple ulcers
  • White plaques and patches
  • Red macules and patches
  • Red and white patches or plaques
  • Pigmented merciless and patches
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8
Q

Raised lesions (enlargements) may present as…

A
  • Normal-colored well-defined nodules
  • Discolored well-defined nodules
  • Verrucous (warty) enlargements
  • Cratered or ulcerated enlargements
  • Multiple enlargements
  • Generalized gingival enlargements
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9
Q

Criteria used to classify lesions of the oral mucosa…

A

include the number of lesions (single or multiple), color, and shape –> these correlate with histologic changes

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10
Q

In general, what does oral mucosa consist of?

A
  • Surface layer of stratified squamous epithelium
  • Underlying layer of connective tissue
    • This basic architecture is modified to correspond with function in different areas of the mouth.
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11
Q

Regions of the oral mucosa that are keratinized

A
  • Masticatory gingivae
  • Palatal raphe
  • Anterior hard palate
  • Posterior hard palate
  • Anterior dorsal tongue
  • Vermilion
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12
Q

Regions of the oral mucosa that are non-keratinized

A
  • Sulcular gingivae
  • Posterior dorsal tongue
  • Ventral tongue
  • Soft palate
  • Buccal mucosa
  • Labial mucosa
  • Floor of mouth
  • Alveolar mucosa
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13
Q

Regions of the oral mucosa with attached submucosa

A
  • Anterior hard palate
  • Posterior hard palate
  • Posterior dorsal tongue
  • Ventral tongue (+/-)
  • Soft palate
  • Buccal mucosa
  • Labial mucosa
  • Vermilion
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14
Q

Regions of the oral mucosa with loose submucosa

A
  • Floor of mouth

- Alveolar mucosa

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15
Q

Regions of the oral mucosa with no-submucosa – firmly attached

A
  • Masticatory gingivae
  • Sulcular gingivae
  • Palatal raphe
  • Anterior dorsal tongue
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16
Q

(Keratinized) Stratified squamous epithelium can be…

A
  • ortho-keratinized

- parakeratinized

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17
Q

What is orthokeratinized?

A

When the stratum corner is an amorphous layer of keratin without nuclei

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18
Q

What is parakeratinized?

A

Pyknotic nuclei are retained in the epithelium

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19
Q

Where is the epithelium keratinized or parakeratinized?

A

In the masticatory mucosa of the hard palate and gingivae, and in the specialized mucosa of the dorsal surface of the tongue.

Note: these areas are particularly subject to friction.

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20
Q

This is usually prominent in keratinized areas…

A

Rete ridges

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21
Q

Lining mucosa

A
  • Subject to less friction

* The stratified squamous epithelium usually lacks both keratin and prominent rete ridges.

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22
Q

Predominant cell type in stratified squamous epithelium.

A

keratinocytes (in stratum spinosum)

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23
Q

Shape of keratinocytes

A

polygonal

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24
Q

What joins keratinocytes?

A

These polygonal cells are joined to one another by desmosomes which look like intercellular bridges under light microscope.

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25
Q

Purpose of desmosomes?

A

joins keratinocytes

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26
Q

Desmosomes contain specific proteins, what are they?

A

desmoglein 1 and 3, two of several proteins in the desmosomal cadherin family

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27
Q

What produces keratin?

A

keratinocytes

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28
Q

Cell types found in oral stratified squamous epithelium

A
  • keratinocytes
  • melanocytes
  • Langerhans cells
  • Merkel cells
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29
Q

Location of melanocytes

A

Stratum basale (basal layer)

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30
Q

What do melanocytes do?

A

Inject melanosomes (melanin) into adjacent keratinocytes

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31
Q

Characteristics of melanocytes

A
  • found in basal layer
  • no intercellular bridges
  • dendritic
  • inject melanin into keratinocytes
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32
Q

What are merkel cells?

A

sensory mechanoreceptors

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33
Q

What do merkel cells contain?

A

small dense neurosecretory granules

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34
Q

Characteristic of base of Merkel cell?

A

Base of cell associated with free nerve endings with an expanded terminal disc

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35
Q

What are Langerhans cells?

A

Dendritic, antigen-presenting cells

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36
Q

What do Langerhans cells do?

A

They trap antigens entering epithelium and present them to T lymphocytes.

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37
Q

Characteristic shape of Langerhans cells

A

Tennis racket or rod-shaped Birbeck granules

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38
Q

What are Birbeck granules?

A
  • Small vesicles with bulbous extensions on their end.

* Associated with Langerhans cells.

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39
Q

Where do you find hemidesmosomes?

A

At regular intervals on the cytoplasmic side of the keratinocyte basal cell membrane.

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40
Q

What do hemidesmosomes do?

A

Anchor keratinocytes to the basement membrane.

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41
Q

What do hemidesmosomal plaque contain?

A

plectin, desmoplakin and BPAG-1 (all of which bind to keratin filaments) and transmembrane proteins (BPAG-2 and integrin α6β4) that link plaque to basal lamina

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42
Q

What is the basement membrane?

A

An acellular layer between the epithelium and the underlying connective tissue.

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43
Q

Is the basement membrane visible with light microscope?

A

Yes, but its components are not.

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44
Q

What makes up the basement membrane?

A
  • a basal lamina (produced by the epithelium)

* a reticular lamina (a product of the connective tissue)

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45
Q

Anchoring filaments

A

Threadlike structures that connect hemidesmosomes to the basal lamina

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46
Q

Layers of the basal lamina

A
  • Lamina Lucida (adjacent to the epithilium)

* Lamina densa (deep to epithelium)

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47
Q

Basal lamina contains antigens important in….

A

vesiculobullous diseases

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48
Q

What does lamina lucida contain?

A

laminin, BPAG-2, integrins

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49
Q

What does lamina densa contain?

A

type IV collagen, heparan sulfate

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50
Q

Type of collagen in anchoring fibrils

A

type VII

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51
Q

Where does the anchoring fibrils connect?

A

lamina densa into the reticular lamina

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52
Q

What is epidermolysis bullosa?

A

a group of inherited diseases characterized by mucocutaneous vesicles and bullae

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53
Q

Defective cellular cohesion causes what?

A

Clefting at various levels, within or below the surface epithelium

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54
Q

Broad categories of epidermolysis bullosa

A

simplex, junctional, dystrophic, hemidesmosomal

55
Q

Clefting occurs where in the simplex, junctional, dystrophic, and in the hemidesmosomal types of epidermolysis bullosa?

A
  • simplex - within the epithelium
  • junctional - at the level of the lamina lucida (affecting the α3, β3 and γ2 subunits of laminin)
  • dystrophic types - below the lamina densa (involving type VII collagen)
  • hemidesmosomal type - abnormalities associated with hemidesmosomal attachment proteins, such as plectin, BP180 (BPAG-2), and α6β4
56
Q

What property of connective tissue has clinical significance?

A

its layers which vary in thickness

57
Q

Layers of connective tissue: At sites where the connective tissue is wide, it is usual to refer to the layers as…

A

Superficial region is referred to as lamina propria, and the deeper region as submucosa.

58
Q

Only site in the human oral mucosa where an anatomical border has been reported between the two layers of connective tissue

A

soft palate, where an elastic lamina has been described

59
Q

Where is lamina propria found in the oral mucosa?

A

all sites

60
Q

Where is submucosa found?

A
  • beneath lining (non-keratinized) mucosa Except on the ventral surface of tongue (where there may be a small amount)
  • beneath masticatory (keratinized) mucosa in lateral hard palate
61
Q

Submucosa is loose in…

A
  • Floor of mouth

* Alveolar mucosa including vestibular folds

62
Q

Submucosa tightly binds mucosa to skeletal muscle in the…

A
  • lips
  • soft palate
  • buccal mucosa
  • posterior dorsal surface of the tongue
63
Q

Masticatory (keratinized) mucosa is tightly bound to what?

A

Underlying tissue

64
Q

How is masticatory mucosa bound to bone?

A

The mucosa is tightly bound to underlying bone without an intervening mucosa in the midline palatal raphe and gingivae; this is known as mucoperiosteum.

65
Q

How is masticatory mucosa bound to skeletal muscle?

A

Tightly bound without a submucosa on the anterior dorsal surface of the tongue

66
Q

Masticatory mucosa in the _______ regions of the _______ palate is tightly bound to bone by what?

A

Masticatory mucosa in the lateral regions of the hard palate is tightly bound to bone by COLLAGEN.

67
Q

What is mucoperiosteum?

A

mucosa attached to bone without submucosa

68
Q

Mucoperiosteum is found in what structures?

A
  • Gingivae

* Midline palatal raphe

69
Q

Vertical bands of collagen create what?

A

Compartments that are occupied by:
• anterior tissue in the anterior half of the hard palate
• minor salivary glands posteriorly

70
Q

Where are minor salivary glands found?

A

In the lamina propria or submucosa of all regions of the oral cavity with the following exceptions: gingivae, anterior hard palate and palatal raphe, and dorsal surface of the anterior two thirds of the tongue.

71
Q

Where are salivary gland neoplasms exceedingly uncommon?

A

Gingivae, anterior hard palate and palatal raphe, and dorsal surface of the anterior two thirds of the tongue.

72
Q

Intraoral minor salivary glands are what?

A

Except for the serous glands of von Ebner, intraoral minor salivary glands are purely or mainly mucous.

73
Q

Aggregations of lymphoid nodules covered by surface epithelium with an incomplete fibrous connective tissue capsule on their deep surface.

A

Tonsils

74
Q

Crypts

A

Tonsils are penetrated by invaginations lined by extensions of the surface epithelium. When these infoldings are deep, they are known as crypts.

75
Q

Location of palatine tonsils

A

Between the palatoglossal and palatopharyngeal folds

76
Q

Location of lingual tonsils

A

dorsal surface of the posterior one third of the tongue

77
Q

Where are foliate papillae found?

A

Vertical folds on the lateral surface of the tongue at the junction between the anterior two-thirds and posterior one third.

78
Q

Foliate papillae usually contain what?

A

Lymphoid nodules

79
Q

Where are ectopic lymphoid tissue (tonsils) found?

A

Sometimes seen as yellowish papules in the anterior floor of the mouth, soft palate or buccal mucosa.

80
Q

What are fordyce granules?

A

Sebaceous glands within the oral mucosa

81
Q

Present as multiple small (1 to 2 mm) yellowish macules or papules on the buccal mucosa, labial mucosa and other sites.

A

Fordyce granules

82
Q

Mucosal disturbances in color, shape, and consistency are correlated with…

A

histologic change

83
Q

Macule

A

Circumscribed discolored spot not raised above level of surrounding mucosa

84
Q

Patch

A

Flat, discolored area exceeding 5 mm in diameter

85
Q

Plaque

A

Slightly elevated mucosal enlargement with a flat surface

86
Q

White lesions of the oral mucosa have a white appearance why?

A

Due to disturbances in the surface stratified squamous epithelium. These include:
• epithelial hyperkeratosis (ortho or para)
• epithelial hyperplasia
• vacuolization of epithelial cells
• epithelial necrosis (overlying an ulcer)

87
Q

This may create a white appearance within the lamina propria…

A

dense collagenous fibrous connective tissue within the lamina propria

88
Q

Fibrinous exudate over an ulcer appears how?

A

white or whitish-yellow

89
Q

Causes of mucosal erythema (red lesions) include…

A
  • erosion (loss of superficial epithelium) allowing vasculature to show
  • epithelial atrophy or frank ulceration
  • an actual increase in number of vessels (often seen in inflammation, granulation tissue and vascular tumors)
  • extravasation of blood into tissues
90
Q

Pigmented (black, blue, or brown) lesions/discolorations are due to…

A
  • melanin (with or without an increased number of melanocytes)
  • hemosiderin
  • foreign material (such as amalgam)
  • medications (due to stimulation of melanin deposition or deposition of drug metabolites)
91
Q

Physiologic melanosis and melanotic macules

A

Increased melanin with little or no melanocyte proliferation

92
Q

Increased number of melanocytes are observed in…

A
  • lentigines
  • nevomelanocytic nevi
  • melanoacanthosis
  • melanomas
93
Q

What’s responsible for producing the yellow appearance observed in yellow lesions

A

Increased amounts of adipose tissue, sebaceous glands, amyloid, keratin (as in oral lymphoepithelial cysts) or a fibrinopurulent membrane over an ulcer

94
Q

Represent the loss of continuity of the full-thickness of surface epithelium…

A

Ulcers

95
Q

Exposure of underlying vascular connective tissue creates…

A

a red ulceration

96
Q

Structure of ulcer bed

A

Often white or yellow due to a thin removable fibrinopurulent film or necrotic epithelium over the connective tissue

97
Q

Cause of mucosal enlargements

A

Uneven proliferation of cells or an increased amount of semisolid material

98
Q

Solid enlargements are usually due to…

A
  • Proliferation of cells which are normally found at the site of the swelling.
  • Occasionally, the proliferating cells are cell types not normally found in the oral mucosa.
99
Q

Proliferating cells normally found at the site of the lesion include:

A
  • neoplasms
  • hamartomas
  • reactive lesions
100
Q

What are hamartomas?

A

Developmental anomalies involving abnormal arrangement of tissues normally occuring at a particular site

101
Q

What is a reactive lesion?

A

A limited response to a challenge such as irritation.

102
Q

Proliferating cells not normally found at the site of lesion include:

A
  • metastases
  • choristomas
  • teratomas
103
Q

What are choristomas?

A

Normal cells in an abnormal location

104
Q

What are teratomas?

A

Cells representative of more than one germ-cell layer

105
Q

Enlargements usually exhibit a smooth surface except…

A
  • unless proliferation occurs within the surface stratified squamous epithelium
  • the surface is ulcerated or cratered as a consequence of trauma to the swelling or due to tumor necrosis
  • benign proliferation of the surface stratified squamous epithelium produces a papillary, verrucous or warty surface contour
106
Q

Terms applied to soft tissue enlargements of various shapes and dimensions

A
  • plaque
  • papule
  • nodule
  • tumor
  • mass
107
Q

What is a papule?

A

Circumscribed solid lesion elevated above level of adjacent mucosa not more than 5 mm in diameter

108
Q

What is a nodule?

A

Circumscribed solid lesion elevated above level of adjacent mucosa more than 5 mm in diameter (some texts say more than 1 cm in diameter)

Note: the surface may be smooth, cratered (a raised lesion having a central cavity), or verrucous (warty or cauliflower in appearance)

109
Q

What is a tumor?

A

A solid growth more than 1 cm in diameter or any solid growth or a neoplastic growth.

110
Q

What is a mass?

A

Non-specific term for enlargement or surface swelling.

111
Q

Where do benign encapsulated neoplasms lie?

A

within connective tissue

112
Q

Mobility of solid lesions is due to what?

A

Lining (non-keratinized) mucosa has an underlying submucosa; therefore the mucosa can be moved over the surface of a submucosal encapsulated tumor in these areas.

113
Q

Describe the mobility of solid lesions of the lining mucosa on the ventral surface of the tongue

A

Lining mucosa on the ventral surface of the tongue cannot be moved over the surface of a tumor because the submucosa is scanty or absent.

114
Q

Mobility of tumors in masticatory (keratinized) mucosa

A
  • Masticatory mucosa cannot be moved over the surface of tumor on the anterior dorsum of the tongue where there is no submucosa.
  • Masticatory mucosa cannot be moved over the surface of a tumor in the gingivae and palatal raphe because there is no submucosa; there is mucoperiosteum at these sites.
  • Even though most of the hard palate possesses a submucosa, the mucosa cannot be moved over surface of a tumor because the mucosa is tied down along its borders on both sides by mucoperiosteum.
115
Q

Where do reactive enlargements arise?

A
  • Recall reactive enlargements are proliferations in response to local irritation.
  • They arise from the connective tissue of the lamina propria and remain attached to it.
116
Q

Describe mobility of reactive enlargements?

A

Not movable between adjacent tissue layers

117
Q

What neoplasms are fixed or attached to adjacent connective tissue or adjacent structures?

A
  • Unencapsulated benign neoplasms
  • Malignant neoplasms
    • typically infiltrate or invade surrounding connective tissue, skeletal muscle, and bone
118
Q

How are blisters created?

A

Created by the accumulation of fluid within surface stratified squamous epithelium or at the junction of the epithelium with underlying lamina propria.

119
Q

Blister-like lesions include

A

vesicles, bullae, and pustules

120
Q

What is a vesicle?

A

a fluid-filled cavity (or blister) smaller than 5 mm in diameter in the mucosa (forming within or below the stratified squamous epithelium)

121
Q

What is a bullae?

A

A fluid-filled cavity larger than 5 mm in diameter, within or below epithelium

122
Q

What is a pustule?

A

A vesicle or bullae containing pus, within or below epithelium.

123
Q

What is fluctuance?

A
  • When gentle digital pressure is applied to one side of a swelling, a wave passes through the lesion and is detectable by fingers placed on the far side.
  • Most often in cysts or pseudocysts containing fluid or semisolid material.
124
Q

Consistency of fluid-filled lesions

A

Soft in consistency, in contrast to solid enlargements which range in consistency from soft (easily compressible) to hard (indurated).

125
Q

When are soft enlargements containing fluid or semisolid material fluctuant?

A

They are often fluctuant when they are more than 1 cm in diameter in a superficial location.

126
Q

Fluctuance is often detectable in…

A
  • fluid-filled cysts
  • pseudocysts
  • abscesses
  • vascular swellings
127
Q

What are doughy in consistency and are frequently fluctuant?

A

Cysts containing semi-solid material (such as keratin)

128
Q

An abnormal cavity containing fluid (or keratin) lined by epithelium

A

true cyst

129
Q

An abnormal cavity containing fluid lined by compressed granulation tissue

A

pseudocyst

130
Q

Abnormal cavity containing puss

A

abscess

131
Q

Color of blood-filled vascular enlargements

A
  • red or blue

* often blanch when pressure is applied and return to their original color when the pressure is released

132
Q

What is blanching?

A

Red or blue, blood-filled vascular enlargements become pale when pressure is applied and return to their original color when pressure is released.

133
Q

What is diascopy?

A

Use of a glass slide to exhibit blanching.

134
Q

Consistency of lesions composed of adipose tissue…

A

soft

Oral Pathology (9 decks)

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