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AU'18 Oral Path II > Malignant Mesenchymal Tumors and Lymphoreticular Malignancies - part II > Flashcards

Malignant Mesenchymal Tumors and Lymphoreticular Malignancies - part II Flashcards

1
Q

who is affected by non-Hodgkin lymphoma?

A

older age group than Hodgkin lymphoma

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2
Q

T/F: non-Hodgkin lymphoma is more common than Hodgkin lymphoma

A

true

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3
Q

T/F: incidence of non-Hodgkin lymphoma is decreasing in the US

A

false, rising

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4
Q

prevalence of non-Hodgkin lymphoma in increased in what type of patients?

A

patients who have immunologic problems (HIV, organ transplant, congenital and autoimmune disease)

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5
Q

T/F: all of non-Hodgkin lymphoma arise in lymph nodes

A

flase, most arise in lymph nodes but globally ~30-40% extranodal

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6
Q

T/F: primary site for non-Hodgkin lymphoma is often oral

A

true, it’s extranodal

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7
Q

where does non-Hodgkin lymphoma affect intraorally?

A

mass soft palate or buccal mucosa

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8
Q

lesions of PDL in non-Hodgkin lymphoma may be mistaken for what?

A

periapical or perio disease

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9
Q

oral clinical features of non-Hodgkin lymphoma

A
  1. soft tissue
  2. centrally in bone
  3. “boggy” consistency
  4. color range erythematous, purple
  5. ± ulceration
  6. vague pain, discomfort
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10
Q

mandibular involvement of oral non-Hodgkin lymphoma may have what?

A

“numb chin” sign due to paresthesia

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11
Q

what might a denture patient complain about with oral non-Hodgkin lymphoma?

A

“denture too tight”

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12
Q

the pain or discomfort from oral non-Hodgkin lymphoma may be mistaken for what?

A

toothache

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13
Q

T/F: early changes of non-Hodgkin lymphoma may be subtle or nonexistent

A

true

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14
Q

radiographic features of non-Hodgkin lymphoma

A
  1. “moth-eaten” or ill-defined radiolucency

2. expansion; can perforate and “break out” of bone into soft tissue

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15
Q

histopathologic features of non-Hodgkin lymphoma varies depending on what?

A

varies by type of lymphoma

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16
Q

what is needed to identify non-Hodgkin lymphoma under the microscope?

A

need IHC

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17
Q

Burkitt lymphoma histopathologically

A

“starry sky” (macrophages)

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18
Q

treatment of localized non-Hodgkin lymphoma

A

radiation ± chemotherapy

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19
Q

treatment for generalized non-Hodgkin lymphoma

A

chemotherapy

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20
Q

prognosis of non-Hodgkin lymphoma depends on what?

A

grade and stage

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21
Q

how many people die from non-Hodgkin lymphoma every year?

A

~1/3 die of disease

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22
Q

T/F: multiple myeloma/plasmacytoma has a plasma cell origin

A

true

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23
Q

what does plasma cells produce?

A

protein immunoglobulins (Ig) also known as antibodies (IgG, IgM, IgA, IgE, IgD)

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24
Q

multiple myeloma/plasmacytoma

A

clonal proliferation of one specific immunoglobulin type that is not normal or function –> disease

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25
Q

immunoglobulins are made of what?

A
  1. 2 heavy chain

2. 2 light chain

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26
Q

what are the 2 light chains?

A
  1. Kappa

2. Lambda

27
Q

T/F: more heavy chains are produced

A

false, nearly equal amounts of heavy and light chains produced

28
Q

T/F: in multiple myeloma, light chain (usually kappa) is not attached to heavy chain

A

true

29
Q

what happens to the circulating unattached light chains?

A

filtered in kidney then secreted in urine (Bence Jones proteins)

30
Q

spectrum of multiple myeloma/plasmacytoma

A
  1. smoldering
  2. solitary plasmacytoma
  3. multiple myelmoma
31
Q

T/F: smoldering multiple myeloma/plasmacytoma is symptomatic

A

false, asymptomatic

32
Q

T/F smoldering multiple myeloma is often diagnosed by chance finding on a blood test

A

true

33
Q

what is a precursor to multiple myeloma?

A

solitary plasmacytoma

34
Q

T/F: unifocal solitary plasmacytoma usually affects bone but can also affect soft tissue

A

true

35
Q

excluding metastatic disease, multiple myeloma accounts for what percent of malignancies involving bone?

A

50%

36
Q

T/F: it is rare for multiple myeloma to occur in people <40 y.o

A

true

37
Q

T/F: multiple myeloma has a female predilection

A

false, 2:1 male

38
Q

T/F: white males are 2x more affected than black males

A

false, black males affected 2x more than white males

39
Q

what is the most common hematologic malignancy in black persons in the US?

A

multiple myeloma

40
Q

what is the most characteristic symptom of multiple myeloma?

A

pain in lumbar spine

41
Q

clinical features of multiple myeloma

A
  1. bone pain
  2. pathologic fractures
  3. renal failure
  4. calcifications in soft tissue (metastatic calcifications)
  5. fatigue
  6. petechial hemorrhages of skin and oral mucosa
  7. fever
  8. deposition of amyloid in various soft tissues
42
Q

pathologic fractures in multiple myeloma patients are due to what?

A

tumor destruction of bone

43
Q

why do multiple myeloma patients experience renal failure?

A

due to circulating light chain proteins

44
Q

metastatic calcifications in multiple myeloma patients are caused by what?

A

hypercalcemia secondary to tumor-related osteolysis

45
Q

why do multiple myeloma patients experience fatigue?

A

due to myelophthisic anemia

46
Q

what will happen clinically if the platelet production of multiple myeloma patients are affected?

A

petechial hemorrhages of skin and oral mucosa

47
Q

what causes fever in multiple myeloma patients?

A

results of neutropenia and increased susceptibility of infection

48
Q

what causes deposition of amyloid in multiple myeloma patients?

A

accumulation of light chains

49
Q

T/F: deposition of amyloid may be an initial manifestation of multiple myeloma

A

true, found in ~10-15% of cases

50
Q

which sites are classically affected by amyloid in multiple myeloma patients?

A
  1. periorbital skin

2. oral mucosa

51
Q

clinical features of amyloid deposition on the periorbital skin

A

waxy, firm, plaque-like lesions

52
Q

where in the oral cavity is deposition of amyloid most prevalent?

A

tongue

53
Q

clinical features of amyloid deposition on oral mucosa

A
  1. diffuse enlargement
  2. firmness
  3. nodular
  4. sometimes ulcerated
54
Q

which bone can be affected by multiple myeloma?

A

any bone can be affected

55
Q

radiographic features of multiple myeloma

A
  1. widespread lytic lesions of bone

2. “punched-out” non-corticated radiolucencies, especially skull

56
Q

what might multiple myeloma appear as radiographically?

A

osteomyelitis

57
Q

histopathologic features of multiple myeloma

A
  1. monotonous sheets of atypical plasma cells
  2. varying stages of differentiation
  3. IHC studies show monoclonal light chain restriction (kappa or lambda) of lesional cell population
58
Q

what is the purpose of treatment for multiple myeloma?

A
  1. to control disease

2. keep patient comfortable

59
Q

treatment for multiple myeloma

A
  1. chemotherapy
  2. bone marrow transplant
  3. radiation
  4. bisphosphonates
60
Q

T/F: radiation is used only as a palliative treatment of multiple myeloma

A

true

61
Q

what is bisphosphonates indicated for multiple myeloma treatment?

A

to help prevent fracture

62
Q

T/F: prognosis for multiple myeloma varies among patients, but it is unlikely to be cured

A

true

63
Q

T/F: prognosis for multiple myeloma patients is better for older patients

A

false, younger age better

64
Q

T/F: prognosis for multiple myeloma is worse for patients with widespread disease or comorbidities

A

true

AU'18 Oral Path II (31 decks)

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