Nelson: Oral and Esophageal Pahtology Flashcards
What is an oral cavity canker sore?
Common, painful, often recurrent, spontaneously regress w/in wks
Shallow, superficial mucosal ulceration
What are oral cavity canker sores associated with?
celiac disease
IBD
What is a mucosal fibroma?
Reactive proliferation of sq. mucosa and underlying subepithelial fibrous tissue
Mucosal fibromas are often secondary to…
chronic irritaiton
What is a squamous papilloma?
Exophytic papillary proliferation of squamous mucosa of fibrovascular core
What are squamous papillomas commonly associated with?
HPV
Rxn to trauma/infection
What is the danger of a squamous papilloma?
Can undergo malignant transformation in situ and become an invasive squamous cell carcinoma
What is a pyogenic granuloma?
Polypod red lesion; composed of lobular reactive proliferation of capillaries (eruptive hemangioma)
Pyogenic granulomas are commonly seen in what population?
Gingiva of children, YA and pregnant women
What is glossitis?
Atrophy of the papillae of the tongue and thinning of mucosa→ inflammation of the tongue (beefy red appearance)
What causes glossitis?
Deficiency states!
B12
What is plummer vinson syndrome?
IDA + glossitis + esophageal dysphagia that is assoc. w/ esophageal webs
What is geographic tongue?
Focal loss of papillae→ “Map like” appearance of the tongue
A pt presents and says that they feel fine except that their tongue burns a little.
Geographic tongue
What are fordyce’s Granules?
Heterotropic collections of SEBACEOUS GLANDS in the oral cavity
A pt presents with white, confluent patches of “fluffy hyperkeratosis on the lateral sides of the tongue that CANNOT be scraped off (Thrush can).
Hairy Leukoplakia
Hairy Leukoplakia is commonly observed in what populations?
Immunocompromised (HIV, treated cancer pts, organ transplant pts) secondary to an EBV infection
What can be the first presenting sign of HIV?
Hairy Leukoplakia
A pt presents w/ a white patch/plaque in the oral cavity that can’t be scraped off and can’t be characterized clinically as any other disease.
Leukoplakia
A pt presents w/ a red, velvety patch in the oral cavity that may be flat or slightly eroded.
Erythroplakia
What is the difference between erythroplakia and leukoplakia related to dysplasia?
In leukoplakia the risk of precancerous dysplasia is MUCH HIGHER than in erythroplakia
What lesions are typically seen in ADULTS and are associated w/ tobacco use?
Erythroplakia
What is Acitinic Cheilitis?
Leukoplakic lesion of the lower lip with loss of the distinct demarcation between the red of the lip and the lower skin
What are RFs for SCC?
- Tobacco and alcohol use.
- Risk is increased even more in those who both smoke and drink.
- Oncogenic HPV is also a risk factor, and 50% of oropharyngeal SCC (tonsils, base of tongue, tonsillar pillars) are HPV positive.
- Exposure to sunlight and pipe smoking are risk factors for SCC of the lower lip.
What are the RF for nasopharyngeal SCC (specifically nonkeratinizing and undifferentiated)?
Strong association w/ EBV
Why are inverted sinonasal papillomas more likely to recur than other sinonasal papillomas?
Arises from lateral nasal wall and is prone to recurrence d/t inverted growth pattern
What is the most common site of metastases for oral cavity squamous cell carcinomas?
Cervical lymph nodes
then spreads more distally to the mediastinal LN, lungs, liver and bone
What is the MC site of metastases for pharyngeal SCC?
Cervical neck LNs
Xerostomia
Dry mouth d/t decreased salivary production
Caused :
Sjogren’s syndrome
previous radiation therapy
SE of medication
Sialadenitis
inflammation of salivary glands
Cause: trauma bacteria virus autoimmune
What is a sialolithiasis and what can it lead to?
stone in the salivary duct
Secondary bacterial infection (s. Aureus or s. viridans)
What is LESA?
Autoimmune disease involving the salivary glands (often a manifestation of Sjogren’s syndrome)
What causes LESA?
HIV (can cause beign lymphoepithelial cysts)
What pathological features are associated with LESA?
Polyclonal lymphoid inflammation of salivary glands> enlargement and lympoepithelial lesion
What causes a mucocele?
Blockage or trauma to a minor salivary gland>
leakage into surrounding CT
What does a mucocele look like?
Fluid filled mucosal nodule w/ varying degrees of inflammation
What are mucoceles called when they arise from a damaged sublingual duct? What’s the danger of a ranula?
ranula
Can become large and dissect into the neck (plunging ranula)
Pleomorphic adenoma
MC salivary tumor
Usually BENIGN in the parotid gland
Carcinoma RARELY arises form it
What makes up a pleomorphic adenoma?
Mix of proliferating epithelial cells w/ mesenchymal matrix of myxoid, hyaline and chondroid tissue
A pt presents w/ a painless discrete mass, that appears well circumscribed and has small protrusions.
Pleomorphic Adenoma
What is the second most common salivary tumor that is ALWAYS int he parotid?
Warthin tumor
Who is at greatest risk for a warthin tumor?
smokers
What does a Warthin tumor look like?
Encapsulated with microscopic appearance demonstration papillary, cystic lesion with dual layers of bland, neoplastic, eosinophilic epithelium, associated with reactive lymphoid stroma.
What is the MC malignant salivary gland tumor and the MC salivary gland tumor in children?
Mucoepidermoid carcinoma (60-70% are parotid)
Low grade recur in 15% of cases with >90% 5 year survival low frequency of metastases.
High grade recur in 25-30% with 5 year survival of 50%
What are mucoepidermoid carcinomas composed of?
Mix of sq. cells, mucus secreting cells, intm cells
What is the MC malignant tumor of minor salivary glands?
Adenoid cystic carcinoma
What salivary gland tumor is slow growing and may neurally invade?
Adenoid cystic carcinoma
What is the prognosis for an adenoid cystic carcinoma?
Despite resection, 50% disseminate to lungs, bone, liver, and brain often decades after removal. 5 year survival 60-70%, 10 year 30%, 15 year 15%
What is the MC benign salivary gland tumors?
MC- Pleomorphic adenoma, usually parotid
2nd MC- Warthin tumor (almost always parotid)
What is hte MC malignant salivary gland tumor?
Mucoepidermoid carcinoma
What is the MC malignant salivary gland tumor of minor salivary glands?
Adenoid cystic carcinoma
Which salivary gland is most often involved in salivary gland neoplasms?
?
What is esophageal atresia and TEE?
Congenital defect where the esophagus does not develop properly.
Most cases the upper esophagus ends (atresia) and does not connect with the lower esophagus and stomach.
The top end of the lower esophagus connects to the windpipe (this type is called a tracheoesophageal fistula TEF).
Occurs in 1/3000 live births.
What is esophageal stenosis?
NARROWING of esophagus d/t injury and inflammation from chronic gastroesophageal reflux, irradiation, or caustic injury.
It may also be congenital. Seen in 1/50,000 births.
What is the difference between esophageal mucosal webs and Schatzki rings?
Esophageal mucosal webs:
- Protrusions of MUCOSA that cause obstruction
- UPPER esophagus
- Plummer- vinson syndrome
Schatzki Rings:
- Like webs but THICKER and CIRCUMFERENTIAL
- may contain muscularis propria
- LOWER esophagus
What is plummer vinson syndrome?
upper esophageal webs assoc. w/ chronic iron-deficiency anemia, glossitis, oral leukoplakia, and spoon nails
Zenker’s diverticulum
Above the upper esophageal sphincter as an outpouching of mucosa and submucosa through a weakened posterior cricopharyngeus muscle
Can become large enough to accumulate food → creates a mass → painful swallowing, halitosis, regurgitation, and diverticulitis
*Not a true diverticulum
What is Mallory Weiss Syndrome?
Longitudinal mucosal lacerations in the distal esophagus and proximal stomach
Usually assoc. w/ severe vomiting
Hx of heavy alcohol use leading to vomiting (40-80% of pts)
Can cause upper GI bleeding
What is a hiatal hernia?
Separation of diaphragmatic crura and protrusion of the stomach into the thorax through the defect
Can be congenital but most are acquired (50% >50 yrs old have hiatal hernia)
Sx range: similar to GERD, ulceration, stricture, and hematemesis
What is the MC type of hiatal hernia?
95% of hiatal hernias are the sliding type (Type 1)
What are the three MC types of infectious esophagitis that can occur in immunocompromised pts?
- Candida esophagitis,
- Herpes simplex esophagitis, and
- cytomegalovirus (CMV) esophagitis
What is the suspected pathogenic mechanism of eosinophilic esophagitis?
Thought to be some type of allergic reaction to food allergens but underlying pathogenesis not completely understood
Many pts have other allergies such as allergic rhinitis, atopic dermatitis, or asthma
What is the microscopic appearance of eosinophilic esophagitis?
Bx shows ↑ eosinophilic inflam. w/ basal epithelial hyperplasia w/ absence of acute inflam.
What is the clinical presentation of eosinophilic esophagitis and how does it differ in adults and children?
Sx of adults and teens:
Food impaction
Persistent dysphagia
GERD Sx that fail to respond to medical intervention
Sx of children: Feeding disorders, vomiting, abdominal pain, dysphagia, and food impaction
What is Barrett’s esophagus?
Characterized by conversion of normal esophageal squamous mucosa → metaplastic columnar epithelium
Results from chronic GERD (seen in 10% of pts w/ symptomatic GERD)
How do you diagnose Barrett’s esophagus?
BOTH endoscopic & histologic evidence of metaplastic columnar epithelium
What is the major complication of Barrett’s esophagus?
↑risk of esophageal glandular dysplasia & adenocarcinoma (rare complication)
What are the RF for esophageal adenocarcinoma?
Pt’s w/ glandular dysplasia
95% of cases arise from Barrett’s esophagus and long-standing GERD
What are the RFs for esophageal squamous cell carcinoma?
o Alcohol or tobacco use
o Caustic esophageal injury
o Achalasia
o Tylosis (genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles)
o Plummer-Vinson syndrome
o Frequent consumption of very hot beverages
o HPV infection (very rare)
What is the MCC of esophageal squamous papillomas?
HPV
What is the MC benign mesenchymal tumor of the esophagus?
Leiomyoma
