Lecture 44: Oral Manifestations of GI disease Flashcards
What are the different categories of oral manifestatiosn of GI disease?
- Ulcerations
- Tooth Defects
- Masses
- Pigmentation
- Paraneoplastic phenomena
What GI diseases cause ulcerations?
- CD
- UC
- Celiac Disease
- Malignancy
What GI diseases cause tooth defects?
- Celiac disease
- GE reflux disease
- FAP
What GI diseases cause masses?
- FAP
2. hereditary non-polyposis colorectal cancer (HNPCC)
What GI diseases cause pigmentation?
- Peutz-Jegher’s Syndrome
What is recurrent apthous stomatitis?
canker sores
basically mouth ulcers
occurs almost exclusively on non-keratinized mucosa
Where are apthous stomatitis found?
On non-keratinized mucosa, if healthy
If patient is not healthy, then it can be on keratinized surfaces
What is the primary DDx of keratinized apthous stomatitis?
Herpes
Histologically, what do apthous stomatitis look like?
T-cell mediated phenomenon
So a lot of monos
Look for neutrophils deep in the tissue, that is a hallmark of apthous stomatitis (not pathognomonic)
What are the characteristics of oral lesions of CD?
- ulcerations (linear ulcerations are pathognomonic!)
- localized/generalized erythema
- Hyperplastic Polypoid or popular lesions
- Non-caseating granulomas seen in 50% of cases
What GI manifestation is pathognomonic of Crohn’s?
Linear ulcerations
Are there any pathognomonic oral findings in UC?
No there are not
Yet some UC patients can still have oral manifestations
What are the oral manifestations of celiac disease?
- Ulcerations
2. Enamel Pitting
What is enamel pitting?
Little holes or divets in the tooth
What is Peutz-Jeghers syndrome?
Known as hereditary intestinal polyposis syndrome
Auto dominant
Development of hamartomatous polyps and hyperpigmented macules on lips/oral mucosa
What is a hamartoma?
A BENIGN focal malformation that resembles a neoplasm but is not
What are the oral manifestations of FAP (Gardner Syndrome)?
- Osteomas
- Odontomas
- Supernumerary teeth
What are odontomas?
A hamartoma of odontogenic origin
What are osteomas?
True benign bone tumors
Older adults
What GI disease leads to formation of Fordyce graunles?
HNPCC
What does Fordyce granules suggest?
HNPCC
What are the oral manifestations of HNPCC?
Fordyce granules
What are Fordyce granules?
Ectopic Sebaceous glands
>80% of population, usually Asymptomatic yellow-white papules
What are the characteristics of Peutz-Jeghers syndrome?
Mutation in STK11/LKB1 gene, chromosome 19
Freckle like lesions of oral mucosa, perioral skin and fingertips!!
Lots of BLACK FRECKLING!!
What are examples of oral manifestations of
paraneoplastic phenomena?
Paraneoplastic phenomena = signs of GI tract malignancy
1. Pysostomatitis vegetans
2. Malignant acanthosis nigricans
Unknown pathogenesis for both
What are characteristics of pyostomatitis vegetans?
- oral manifestation of IBD or GI malignancy
- snail track pustules/ulcerations
- minimal oral discomfort, strangely
- Oral lesions may precede intestinal findings
Looks like someone took a scalpel and sliced patient’s oral cavity
What is the histological diagnosis of pystomatitis vegetans?
Thickened epithelial layer Suprabasal clefting Some splitting At high power, eosinophils are present Eosinophilic absceses Acantholysis
What is acantholysis?
Loss of intercellular connections
What is the treatment for pyostomatitis vegetans?
Systemic corticosteroid therapy will resolve oral lesions quickly
Complete resolution with treatment
What are the key characteristics of malignant acanthosis nigricans?
- Unusual manifestation of GI cancer and other malignancies
- Benign variant often associated with endocrinopathies
- Tends to affect flexural areas of skin
- papillary, hyperkeratotic brownish patches
- velvety/leathery texture
- intraoral lesions rare
