Nelson Pathology Flashcards
Define aphthous ulcers
Canker sore!
Common, superficial mucosal ulceration
Arises in relation to stress
Often reoccurs
What is a mucosal fibroma?
Reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue
Typically secondary to chronic irriation
What is pyogenic granuloma?
Polypoid red lesion
lobular reactive proliferation of capillaries (eruptive hemangioma)
Pyogenic granulomas are common in what populations?
Gingiva in children, young adults, and pregnant women
What is glossitis?
Inflammation of the tongue
“red beefy tongue”
What causes the red appearance in glossitis?
Atrophy of the papillae of the tongue and thinning of the mucosa
What is geographic tongue?
“map like” appearance of tongue
Due to focal loss of the papillae with formation of smooth red patches
Intraepithelial neutrophilic inflammation is present
Describe the appearance of hairy leukoplakia and its clinical significance
White patches of “fluffy” hyperkeratosis on the lateral sides of the tongue
May be the first presenting sign of HIV!
How do you distinguish hairy leukoplakia from thrush?
Hairy leukoplakia CANNOT be scraped off!!!
Leukoplakia appearance and clinical significance
White patch or plaque in the oral cavity that cannot be scarped off and cannot be characterized clinically or pathologically as any other disease
Erythroplakia appearance and clinical significance
Red, velvety patch in oral cavity that may be flat or slightly eroded
Typical in adults, associated with tobacco
High incidence of precancerous dysplasia
Actinic cheilits appearance and clinical significance
Leukoplakic lesion of lower lip with loss of distinct demarction between the lower lip vermilion border and the skin of the lip
Define squamous papilloma
Exophytic papillary proliferation of squamous mucosa with fibrovascular core
*can undergo malignant transformation to in-situ and invasive squamous cell carcinoma
What are the key risk factors for squamous cell carcinoma?
Smoking
Drinking
Oncogenic HPV
What is the most common site of metastases for oral cavity and pharyngeal squamous cell carcinoma?
Local- cervical neck lymph nodes
Distant- mediastinal lymph nodes
What is often the first presenting sign of squamous cell carcinoma?
Enlarged cervical neck lymph node!
Why are inverted sinonasal papillomas more likely to recur than other sinonasal papillomas?
Inverted sinonsasal papilloma recurrence is due to its inverted growth pattern
What is Xerostomia? Causes?
Dry mouth due to decrease in saliva production
Causes: Sjogren’s Syndrome, radiation therapy, medication side effect
What is sialadenitis? Causes?
Inflammation of the salivary glands
Causes include trauma, infection, autoimmmune disease
What is a sialolithiasis?
Stone in the salivary duct
*can lead to obstruction and secondary bacterial infection
Describe a mucocele. What can cause it?
Results from blockage or trauma to a minor salivary gland, with leakage of content into surrounding connective tissue stroma
Fluid filled mucosal nodule with inflammation
What is LESA? Causes?
Autoimmune disease involving salivary glands
50% have Sjogren’s syndrome, can be associated with HIV
Describe key clinical features and microscopic appearance of pleomorphic adenoma
Benign tumor
Tumor is a mix of epithelial cells with a mesenchymal matrix of myxoid, hayline and chondroid tissue
Painless, discrete masses, well circumscribed that have small extensions/protrusions
Describe key clinical features and microscopic appearance of Warthin tumor
Benign tumor
Encapsulated- papillary, cystic lesion with a dual layer of bland epithelium
8 times greater risk in smokers
Almost always in parotid gland
Describe key clinical features and microscopic appearance of mucoepidermoid carcinoma
Mixture of squamous cells, mucus-sereting cells and intermediate cells
Appear encapsulated but infiltrate at the margins microscopically
Describe key clinical features and microscopic appearance of adenoid cystic carcinoma
Slow growing
Predilection for neural invasion
Common in minor salivary glands
Often spreads after removal
Most common benign salivary gland tumor?
Pleomorphic Adenoma
Most common malignant salivary tumor?
Mucoepidermoid Carcinoma
Which salivary gland is most often involved by salivary gland neoplasms?
Parotid Gland
Define esophageal atresia
Ending of the esophagus
Define esophageal stenosis
Can be congenital
Usually due to injury and inflammation from chronic gastroesophageal reflux, irradiation, or caustic injury
Define tracheoesophageal fistula
Esophagus enters the trachea
What is the difference between esophageal mucosal webs and Schatzki rings?
Rings are like webs but thicker and circumferential
Zenker’s Diverticulum
Not a true diverticulum!
Outpouching of mucosa/submucosa through a weakened posterior cricopharyngeus muscle
Located above the upper esophageal sphincter
Mallory-Weiss Syndrome
Presence of longitudinal mucosal lacerations in the distal esophagus and proximal stomach
Usually associated with severe retching or vomiting
History of heavy alcohol use leading to vomiting in 40-80% of patients
Can cause upper GI bleeding
Define hiatal hernia
Separation of the diagphragmatic crura and protrusion of the stomach into the thorax through the defect
What is the most common type of hiatal hernia?
Type 1 = the sliding type
What are the 3 most common types of infectious esophagitis that can occur in immunocompromised patients?
Candida Esophagitis
Herpes Simplex esophagitis
Cytomegovirus esophagitis
Eosinophilic esophagitis: pathogenic mechanism, microscopic appearance, clinical presentation
Some type of allergy to food but pathogenesis is not understood
Biopsies show high eosinophilic inflammation with basal epithelial hyperplasia -** absence of acute inflammation
May present with:
food impaction
Dysphagia
GERD symptoms
Define Barrett’s esophagus
Conversion of normal squamous mucosa of the esophagus to metaplastic columnar epithelium as a result of chronic GERD
State the major complication of Barrett’s esophagus
Increased risk of esophageal glandular dysplasia and adenocarcinoma
Risk factors for esophageal adenocarcinoma
Barrets esophagus
Long standing GERD
Increased risk with glandular dysplasia
Risk factors for esophageal squamous cell carcinoma
Alcohol Tobacco Esophageal injury Achalasia Frequent consumption of hot beverages
Most common cause of esophageal squamous papillomas?
Strong association with HPV
Most common benign mesenchymal tumor of the esophagus?
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