Lecture 44: Oral Manifestations of GI disease

Question 1

What are the different categories of oral manifestatiosn of GI disease?

Answer 1

1. Ulcerations
2. Tooth Defects
3. Masses
4. Pigmentation
5. Paraneoplastic phenomena

Question 2

What GI diseases cause ulcerations?

Answer 2

1. CD
2. UC
3. Celiac Disease
4. Malignancy

Question 3

What GI diseases cause tooth defects?

Answer 3

1. Celiac disease
2. GE reflux disease
3. FAP

Question 4

What GI diseases cause masses?

Answer 4

1. FAP

2. hereditary non-polyposis colorectal cancer (HNPCC)

Question 5

What GI diseases cause pigmentation?

Answer 5

1. Peutz-Jegher’s Syndrome

Question 6

What is recurrent apthous stomatitis?

Answer 6

canker sores
basically mouth ulcers
occurs almost exclusively on non-keratinized mucosa

Question 7

Where are apthous stomatitis found?

Answer 7

On non-keratinized mucosa, if healthy

If patient is not healthy, then it can be on keratinized surfaces

Question 8

What is the primary DDx of keratinized apthous stomatitis?

Answer 8

Herpes

Question 9

Histologically, what do apthous stomatitis look like?

Answer 9

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)

Question 10

What are the characteristics of oral lesions of CD?

Answer 10

1. ulcerations (linear ulcerations are pathognomonic!)
2. localized/generalized erythema
3. Hyperplastic Polypoid or popular lesions
4. Non-caseating granulomas seen in 50% of cases

Question 11

What GI manifestation is pathognomonic of Crohn’s?

Answer 11

Linear ulcerations

Question 12

Are there any pathognomonic oral findings in UC?

Answer 12

No there are not

Yet some UC patients can still have oral manifestations

Question 13

What are the oral manifestations of celiac disease?

Answer 13

1. Ulcerations

2. Enamel Pitting

Question 14

What is enamel pitting?

Answer 14

Little holes or divets in the tooth

Question 15

What is Peutz-Jeghers syndrome?

Answer 15

Known as hereditary intestinal polyposis syndrome
Auto dominant
Development of hamartomatous polyps and hyperpigmented macules on lips/oral mucosa

Question 16

What is a hamartoma?

Answer 16

A BENIGN focal malformation that resembles a neoplasm but is not

Question 17

What are the oral manifestations of FAP (Gardner Syndrome)?

Answer 17

1. Osteomas
2. Odontomas
3. Supernumerary teeth

Question 18

What are odontomas?

Answer 18

A hamartoma of odontogenic origin

Question 19

What are osteomas?

Answer 19

True benign bone tumors

Older adults

Question 20

What GI disease leads to formation of Fordyce graunles?

Answer 20

HNPCC

Question 21

What does Fordyce granules suggest?

Answer 21

HNPCC

Question 22

What are the oral manifestations of HNPCC?

Answer 22

Fordyce granules

Question 23

What are Fordyce granules?

Answer 23

Ectopic Sebaceous glands

>80% of population, usually Asymptomatic yellow-white papules

Question 24

What are the characteristics of Peutz-Jeghers syndrome?

Answer 24

Mutation in STK11/LKB1 gene, chromosome 19
Freckle like lesions of oral mucosa, perioral skin and fingertips!!
Lots of BLACK FRECKLING!!

Question 25

What are examples of oral manifestations of | paraneoplastic phenomena?

Answer 25

Paraneoplastic phenomena = signs of GI tract malignancy 1. Pysostomatitis vegetans 2. Malignant acanthosis nigricans Unknown pathogenesis for both

Question 26

What are characteristics of pyostomatitis vegetans?

Answer 26

1. oral manifestation of IBD or GI malignancy 2. snail track pustules/ulcerations 3. minimal oral discomfort, strangely 4. Oral lesions may precede intestinal findings Looks like someone took a scalpel and sliced patient’s oral cavity

Question 27

What is the histological diagnosis of pystomatitis vegetans?

Answer 27

``` Thickened epithelial layer Suprabasal clefting Some splitting At high power, eosinophils are present Eosinophilic absceses Acantholysis ```

Question 28

What is acantholysis?

Answer 28

Loss of intercellular connections

Question 29

What is the treatment for pyostomatitis vegetans?

Answer 29

Systemic corticosteroid therapy will resolve oral lesions quickly Complete resolution with treatment

Question 30

What are the key characteristics of malignant acanthosis nigricans?

Answer 30

1. Unusual manifestation of GI cancer and other malignancies 2. Benign variant often associated with endocrinopathies 3. Tends to affect flexural areas of skin 4. papillary, hyperkeratotic brownish patches 5. velvety/leathery texture 6. intraoral lesions rare