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DT3- EXAM 2 > Lecture + Case: Head/Neck Tumors (3)-Leah* > Flashcards

Lecture + Case: Head/Neck Tumors (3)-Leah* Flashcards

1
Q

Two “fibrous” lesions of the oral cavity:

Which is fast growing and might scare people?

A
  1. Fibroma

2. Pyogenic granuloma: rapidly growing scary looking vascular proliferation

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2
Q

Three infections commonly involving the oral cavity?

Which two are similar? How can they be distinguished?

A
  1. HSV (primary gingivostomatosis; “cold sores”)
  • These two are both white “coatings” of the tongue:
    2. Candidia (thrush)– whole mouth; scrapes off
    3. Hairy leukoplakia (EBV)– lateral; doesn’t scrape off
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3
Q

Name the two precancerous lesions of the oral cavity.

Which is MORE LIKELY to become malignant.

A
  1. Leukoplakia
  2. Erythroplakia
    * Erythroplakia has a higher rate of malignant transformation.
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4
Q

Cancerous lesion of the mouth is most often:

A

Squamous cell

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5
Q

Three types of rhinitis

A
  1. Infectious
  2. Allergic
  3. Chronic
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6
Q

Benign mass found in the nose following recurrent rhinitis:

A

Nasal polyps

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7
Q

Rare but commonly tested caused of recurrent sinusitis:

A

Ciliary dysfunction –> Kartagener Syndrome
Note: chronic sinusitis = POLYPS.

  • *First Aid Fact this is also one cause of SITUS INVERSUS**
  • *First Aid Fact: mutant L–>R Dynein**
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8
Q

Two infections that are considered nasopharyngeal infections:

A

Pharyngitis

Tonsillitis

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9
Q

Two nasopharyngeal masses:

A
  • Sinonasal (Scheiderian) papilloma

- Nasopharyngeal carcinoma

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10
Q

Two infections of the larynx:

A
  • Laryngitis

- Croup (Fenger note= paramyxo –> parainfluenza virus!!)

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11
Q

Three types of laryngeal masses:

A
  • Polyps
  • Papilloma
  • Carcinoma
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12
Q

How common are ear tumors?

What types exist?

A
  • Rare

- Squamous cell and Basal cell carincomas

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13
Q

What is otosclerosis?

With what disease should you associate it?

A

Thickening of bones in middle ear = hearing loss.
Fibrous Deposition–> Bone

  • **You can see this in OSTEOPETROSIS!!!
  • **AD disease causing OSTEOCLAST DYSFUNCTION!!!
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14
Q

Three lesions you may see in the neck? (3)
What are two important midline structures in the neck?
How can these be associated with pathology?

A

There are SO SO many but she lists….

  1. Branchial cleft cysts
  2. Thyroglossal duct remnants
  3. Paraganglioma
  • Side note: thymus and thyroid are important midline neck structures!
  • Hyperthyroid = goiter (can be hypothyroid too: ^ TSH w/out response)
  • Thymus in babies = fat looking heart on CXR. This is also important. No thymus in babies = DiGeorge or SCID.*
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15
Q

Two benign masses affecting glands:

A
  • Pleomorphic adenoma

- Warthin tumor

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16
Q

Two malignant masses affecting glands

A
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma

a note about Adenoid cystic carcinoma: yes, it happens in salivary glands. But it can be ANYWHERE that has epithelium including SECRETORY cells. Even the uterus. I saw it up a lady’s nose. It’s definitely not just a glandular tumor.

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17
Q

Glandular condition assc with Sjorgens? Trauma?

A

Xerostoma: dry mouth/ eyes. Sjorgens.
Saildenitis: can be caused by trauma, among other things.

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18
Q

Autoimmune related lesion of the oral cavity:

A

Aphthous ulcers (Canker sore)

**Fun fact: according to other sources, including Dr. Fry, this is part of BEHCETS disease…
= Aphthous ulcers, iritis, genital lesions; (it’s a vasculidity in Japan/China)

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19
Q

Overall: what is the most common tumor of both the head and the neck?

A

Squamous cell carcinoma represents NINETY FIVE% of head and neck masses!!!!!

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20
Q

Hyperplasia and Dysplasia are _______.

Cancer is not.

A

Reversible.

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21
Q

How does tissue progress from normal to cancerous?

A
  1. Normal –> 2. Hyperplasia –> 3. Mild/moderate dysplasia –> 4. Severe dysplasia (carcinoma in situ) –> 5. Cancer

Note: hyperplasia = ^^^number of cell layers.
Dysplasia = change in the cells themselves.
Severe dysplasia takes up entire epithelium but does not invade the basement membrane of tissue.
(Mild = 1/3, Moderate = 2/3 dysplastic)

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22
Q

Describe an aphthous ulcer (gross appearance)

A
  • round, erythematous
  • central white exudate

These guys hurt like heck but go away by themselves.

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23
Q

Fibroma histologic appearance:
_______proliferation of ________tissue
Causative factor:
Treatment:

A

Submucosal proliferation of fibrous tissue
Response to trauma
Won’t go away; have to cut it out.
(NOT malignant. Just annoying.)

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24
Q

Pyogenic granuloma:
- one alternative name
- histo appearance
(2 cells on _______stroma)

A

Pregnancy tumor (common in pregnant patients probably due to ^^VEGF?)

Vascular granulomas composed of:
lymphs + fibroblasts on an erythematous stroma

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25
Q

Two possible oral manifestations of herpes in the mouth:

A 
Acute gingivostomatosis (primary) 
Herpetic stomatosis (reactivation of latent virus)
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26
Q

Most common fungal infection in the mouth?

A

Candida albicans

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27
Q

What predisposes patients to Candida albicans/thrush?

A

Use of abs (+ immunocompromised)

28
Q

Cause of hairy leukopenia

A

EBV infection in an Immunocompromised patient

- lesions on lateral tongue, can not scrape off

29
Q

Who is susceptible to deep fungal infections?
Common ending for names of infections fungal species?
Which one is a bid deal in WV?

A

Immunocompromised patients; –osis

Histoplasmosis = local problem

30
Q

Who gets leukoplakia and erythroplakia in their oral cavity?
What’s the significance?

A

Middle aged male smokers.
These lesions can transform and become malignant.
Higher risk assc with erythoplakia than leukoplakia.
E comes before L in the alphabet.

31
Q

Leukoplakia gross appearance:

________ _________ plaque that ___________.

Histo shows full ________.

A

Small white plaque that doesn’t scrape off in the presence of no better diagnosis.

Histo shows full thickness dysplasia! This thing is waiting to invade at any time.

32
Q

Gross appearance of ERYTHroplakia:

A

Red velvety lesion in the mouth +/- erosion .

Full thickness dysplasia like leukoplakia.

33
Q

What are some risks for oral squamous cell ca? (4)

What does it look like grossly?

A
  • tobacco, pipes, alcohol
  • chewing “betel quid and pann” (Asian stimulant)
  • HPV (as with any squamous cell)
  • sunlight
  • I’m really confused about how you expose your mouth to sunlight….but she said it…..*

SCC is an ulcerated irregular lesion

34
Q

Describe the histologic appearance of oral squamous cell carcinoma or ANY squamous cell carcinoma:

A

Full INVASIVE dysplasia +/- keratin pearls

35
Q

Common causes of acute rhinitis?
Allergic rhinitis is called?
What might chronic rhinitis cause?

A

Acute rhinitis: viral, especially adenovirus and rhinovirus (PicORNaviridae)
Allergic = hay fever
Chronic –> nasal polyps

36
Q

Polyp (mucosal proliferation):

Histo appearance

A

Loose CT surrounded by respiratory epi in the case of nasal polyps.
GI polyps surrounded by GI epi.

Will also see “vascular congestion”.

37
Q

Sinonasal papilloma is a proliferation of _______.
Benign Or malignant?
Population and assc?

A

BENIGN proliferation of mucosal tissue (like a polyp)
Assc with HPV 6, HPV 11
Middle aged males
Will recur and can transform (unlike a polyp)

38
Q

Three growth patterns of sinonasal papillomas

A
  • Exophytic
  • Endophytic
  • Cylindrical
39
Q

Ddx for a suspicious lesion in the nose:

A

Sinonasalpapilloma (benign) vs nasopharyngeal carcinoma (bad)

40
Q

Three important things to remember about nasopharyngeal carcinoma

A
  1. Likes lymphoid tissue
  2. Has a geographic distribution
  3. EBV +
41
Q

Nasopharyngeal carcinoma:

  1. Presentation (symptomatic)
  2. Treatment
A

Nose bleeds and obstruction

Poor prognosis; but accepted treatment is radiotherapy

42
Q

Three possible patterns assc with nasopharyngeal carcinoma:

A
  • Keratinizing
  • Non keratinizing
  • Undifferentiated (has basaloid- small blue cells)
43
Q

Histo appearance of nasopharyngeal carcinoma is:
_______ surrounded by _________.
___________ stain is positive.

A

Syncitiums surrounded by dark lymphs

Positive for EBER1 stain. (For EBV)

44
Q

Small bilateral lesions on the vocal cord of a singer are what?
What do you do about this?

A

Laryngeal polyps!
The equivalent of a nasal polyp in the larynx.
Caused by overuse or smoking.
Cut them out.

45
Q

Cauliflower lesion on one of the true vocal cords?

What do you do about this?

A

Squamous papilloma

Resect it.

46
Q

How do you tell a branchial cyst apart from a thyroglossal duct remnant?

A

Location!!
Thyroglossal will be MIDLINE.
Branchial cyst is LATERAL (and may leak fluid).

47
Q

Both branchial cleft cysts and thyroglossal duct remnants have what two tissue types?

A

Squamoid and lymph tissue

48
Q

When do these congenital neck masses presnt?

A

Not until MIDDLE AGE!!!

49
Q

Paraganglioma:
ONE characteristic Histo appearance; positive stain
Most COMMON Location

A

NEUROENDOCRINE TUMOR
-salt and pepper cells; catecholamines +
-rare tumor; most common at the CAROTID BODIES
(Can be paravertebral or assc with vasculature)

50
Q

Sialdentis is caused by?

See a ______ grossly and a _______ on Histo.

A

Trauma to a salivary gland.

See a mucocele grossly; pseudocyst on Histo

51
Q

Pleomorphic adenoma:
Why is it called pleomorphic?
How does the patient describe the lesion?
What is the assc chromosomal rearrangement?

A

Pleomorphic because it’s Histo has many possible patterns. May get bone, cartilage, epi. (epi + mesenchyme)

Painless, MOBILE mass
P in pleomorphic = P in PLAG1 rearrangement.

52
Q

Location of a warthog tumor/ papillary cyst adenoma lymphomatosum?
Who gets these?

A

Parotid gland of old male smokers!

Poor old grandpa Warthin has a big fat lump in his neck but he keeps smoking those cigarettes!!!

53
Q

t(11,19) (q21, p13) // MECT1; MAML2 is assc with what malignancy?
Where is it?
What does its name mean?

A

Mucoepidermioid carcinoma in the salivary glands.

Called MUCO-EPI-Dermoid because it has mucous, epi (squamous cells/ mucus neck cells) and intermediate cells on Histo

54
Q

Adenoid Cyctic Ca:
Location
How does the patient describe the lesion?
Histo pattern + strange ability of this tumor?

A

It’s PAINFUL (only one that hurts!)
Minor salivary glands = most common.
When in major salivary glands: parotid, submandibular
It can INVADE NERVES!!!! …. Which means you can get cranial nerve deficits!

It has a cribiform pattern.
It is malignant.

55
Q

HPV is related to what two head and neck masses?

EBV?

A

HPV- sinonasal papilloma; squamous cell carcinoma

EBV- hairy leukoplakia; nasopharyngeal carcinoma

56
Q

Tell me again: what are the translocations/ mutations associated with mucoepidermoid ca of the salivary glands?

A

t(11,19) (q21, p13) // MECT1; MAML2

57
Q

You find a white oral plaque. What do you want to know about it first?

A

Can you scrape it off? Yes- then candidiasis, no- something else (hairy Leukoplakia, leukoplakia, squamous cell)

58
Q

Hyperkeratosis means?

Parakeratosis means?

A

Hyper- extra cell layers

Para- cells retain their nuclei in the upper layers of skin (where there should only be dead cells)

59
Q

Mild vs moderate vs severe dysplasia?

A

Mild = irregular cells in 1/3 of the epidermis, moderate 2/3, severe- all layers but NO INVASION of the basement membrane.

60
Q

When can you use a fine needle aspirate?

A

on superficial nodes not in close proximity to vital structures.

61
Q

What should you do for patients who smoke, drink, work outside?

A

Thorough oral cavity exam

62
Q

Neural involvement is a red flag for?

A

Adenoid cystic carcinoma

63
Q

“Motor oil fluid” is a buzz word for?

A

Warthins

64
Q

Blue always means…..

A

Bad

65
Q

Lesion that may masquerade as a primary tongue cancer?

A

Mucoepidermoid (because it is most commonly in the minor salivary glands)

DT3- EXAM 2 (19 decks)

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