Nelson Pathology-Oral and Esophageal Pathology

Question 1

Apthous Ulcers (Canker sores)

Answer 1

• Shallow, superficial mucosal ulcerations
• Painful, will recur
• Single ulceration w/ an erythematous halo surrounding a yellowish fibrinopurulent membrane

Question 2

Irritation Fibroma

Answer 2

Secondary to chronic irritation, like wearing dentures

• Reactive proliferation of squamous mucosa and underlying supepithelial fibrous tissue
• Firm nodule covered by granules

Question 3

Pyogenic Granuloma

Answer 3

Polypoid red lesion composed of lobular reactive proliferation of capillaries
-Gingiva of children, young adults and pregnant women

Question 4

Glossitis

Answer 4

• Inflammation of tongue
• Beefy-red appearance of the tongue that you see in deficiency states
• Associated w/ Plummer-Vinson Syndrome

Question 5

Plummer-Vinson Syndrome

Answer 5

Combo of IDA, glossitis, and esophageal dysphagia caused by esophageal webs

Question 6

Geographic Tongue

Answer 6

Patches will migrate over time over the tongue

• Migratory “map like” appearance of the tongue, due to focal loss of the papillae w/ formation of smooth red patches
• Patients p/w mild burning sensation

Question 7

Squamous Papilloma

Answer 7

• Exophytic papillary proliferation of squamous mucosa w/ fibrovascular core (hyperplastic)
• Some associated w/ HPV
• Can undergo malignant transformation to in-situ and invasive squamous cell carcinoma

Question 8

Hairy Leukoplakia (Appearance and clinical significance)

Answer 8

Appearance: White confluent patches of “fluffy” hyperkeratosis on the lateral sides of the tongue cannot be scraped off
Clinical: EBV infection causes hairy leukoplakia; may be first presenting sign of an HIV infection

Question 9

Leukoplakia (Appearance and clinical significance)

Answer 9

Appearance: Hyperkeratosis (white plaque) that cannot be scraped off
Clinical: can demonstrate precancerous squamous dysplasia; more often in smokers

Question 10

Erythroplakia (Appearance and Clinical)

Answer 10

Appearance: Red, velvety patch in the oral cavity that may be flat or eroded
Clinical: Higher chance than leukoplakia to be precancerous; more often in smokers

Question 11

Actinic Cheilitis (Appearance and Clinical)

Answer 11

Appearance: Leukoplakic lesion of the lower lip w/ loss of the distinct demarcation b/w the lower lip vermillion border and the skin of the lip
Clinical: Preneoplastic lesion that can lead to squamous carcinoma

Question 12

What are the similar risk factors for the development of oral cavity, oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma?

Answer 12

• Smoking and Drinking

- HPV

Question 13

Risk factor for Nasopharyngeal SCC?

Answer 13

Common in Africa and South China

-EBV association

Question 14

Why are inverted sinonasal papillomas more likely to recur than other sinonasal papillomas?

Answer 14

• Thickened epithelial nests arising from the surface and growing down into the stroma
• Greater likelihood that would leave some behind, leading to a greater chance of recurrence

Question 15

Where is the most common site of metastases for oral cavity and pharyngeal SCC

Answer 15

Local: cervical neck lymph nodes
Distant: mediastinal lymph nodes, lungs, liver and bone

Question 16

Xerostomia (Define and causes)

Answer 16

Dry mouth due to decrease in production of saliva

Causes: Sjogren’s, previous radiation, med side effects

Question 17

Sialadentis (Define and causes)

Answer 17

Inflammation of the salivary glands

Causes: Trauma, mumps, Sjogren’s

Question 18

LESA (Define and causes)

Answer 18

• Lymphoepithelial sialadentitis
• Autoimmune disease involving the salivary glands
• Causes: Sjogren’s and HIV

Question 19

Cause and appearance of a mucocele

Answer 19

Cause: blockage or traumatic injury to a minor salivary gland w/ leakage of mucous contents into the surrounding CT stroma

Question 20

Pleomorphic Adenoma (Micro and Clinical)

Answer 20

• Most common salivary gland tumor that is most commonly found in the parotid gland (mixed tumor)
• Clinical: painless, discrete masses; firm, freely moveable
• Well circumscribed but have small extensions or protrusions which make total resection difficult
• High chance of recurrence

Question 21

Warthin Tumor

Answer 21

• 2nd most common salivary gland tumor, almost always in the parotid
• Benign, well encapsulated w/ a distinct micro appearance
• ->Papillary, cystic lesion w/ a dual layer of bland, neoplastic, eosinophilic (oncocytic) epithelium

Question 22

Mucoepidermoid Carcinoma

Answer 22

• Most common malignant salivary gland tumor in adults and children
• Variable mix of mucous and squamous components; nests of each type
• Clinical: Low grade tumors good prognosis; high grade tumors are very aggressive

Question 23

Adenoid Cystic Carcinoma

Answer 23

• Slow growing but predisposed for NEURAL INVASION
• Occur in minor salivary glands
• Most common malignant tumor of minor salivary glands
• Cribiform appearance enclosing secretions

Question 24

Most common benign salivary gland tumors?

Answer 24

Pleomorphic Adenoma

Warthin Tumor

Question 25

Most common malignant salivary gland tumor?

Answer 25

``` Mucoepidermoid carcinoma (parotid) Adenoid Cystic Carcinoma (minor) ```

Question 26

What salivary gland is most involved in salivary gland neoplasms?

Answer 26

Parotid gland

Question 27

Esophageal stenosis

Answer 27

Can be congenital; more commonly due to GERD

Question 28

Tracheoesophageal fistula

Answer 28

Type C most common patter; Esophageal atresia w/ distal TE fistula

Question 29

Esophageal Webs

Answer 29

- Protrusions of mucosa that can cause obstruction - Seen in upper esophagus - Associated w/ Plummer-Vinson Syndrome

Question 30

Schatzki Rings

Answer 30

- Esophageal rings - Thicker and circumferential forms of webs - may contain muscularis propia - Located in lower esophagus

Question 31

Zenker's Diverticulum

Answer 31

- Located above the UES as an outpouching of mucosa and the submucosa through a weakened posterior cricopharyngeus muscle - ONLY involves mucosa and submucosa - Can accumulate food and produce a mass - Can cause odonyphagia, halitosis, regurgitation and diverticulitis

Question 32

Mallory-Weiss Syndrome

Answer 32

- Longitudinal mucosal lacerations in the distal esophagus and proximal stomach - Severe retching or vomiting after drinking a bunch of alcohol

Question 33

What is the complication of Mallory-Weiss Syndrome?

Answer 33

Boerhaave Syndrome: Transmural rupture of the distal esophagus w/ pneumomediastinum

Question 34

Hiatal hernia

Answer 34

Results from separation of the diaphragmatic crura and protrusion of the stomach into the thorax through the defect - Can be acquired later in life >50 yrs - Symptoms: inflammation (GERD), ulceration, stricture and hematemesis

Question 35

Most common type of a hiatal hernia?

Answer 35

Sliding Type | -Gastric cardia slides int the defect

Question 36

Three most common types of infectious esophagitis that can occur in immunocompromised

Answer 36

1. Candida 2. Herpes simplex 3. CMV

Question 37

Pathogenesis of eosinophilic esophagitis

Answer 37

- some type of allergic reaction to food allergens - mild eosinophilia seen in 40-50% of patients - Mucosa shows burrows, concentric rings and is studded w/ whitish-gray nodular plaques and exudates

Question 38

Microscopic appearance of eosinophilic esophagitis

Answer 38

Increased eosinophilic inflammation w/ basal epithelial hyperplasia w/o acute inflammation going on

Question 39

Clinical presentation of eosinophilic esophagitis

Answer 39

Food impaction, persistent dysphagia, GERD, symptoms that fail to respond to therapy

Question 40

Risk factors for esophageal adenocarcinoma

Answer 40

H/o Barrett's and longstanding GERD

Question 41

Risk factors for esophageal squamous cell carcinoma

Answer 41

Alcohol and tobacco use, plummer-vinson syndrome, frequent hot beverage consumption

Question 42

Most common cause of esophageal squamous papillomas

Answer 42

HPV

Question 43

Most common benign mesenchymal tumor of the esophagus

Answer 43

Leiomyoma