Neoplasm Flashcards
What are FOUR environmental risk factors for malignant transformation?
- UV light
- smoking
- alcohol
- HPV
What are FIVE architectural features of epithelial atypia (ie. dysplasia)?
- Drop shaped rete pegs
- Single-cell keratinisation (dyskeratosis)
- Superficial mitotic figures
- Loss of polarity of basal cells
- Irregular stratification
What are TWO cytological features of epithelial atypia (ie. dysplasia)?
- Nuclear pleomorphism
- Cellular pleomorphism
(pleomorphism = abnormal size/shape)
What is carcinoma in situ?
Severe epithelial dysplasia but not past the basement membrane
Oral submucous fibrosis:
- Clinical features
- Cause
- Consequence
- Submucosal striated whitening (limited mouth opening in severe cases)
- Tobacco chewing cause
- Also cancer risk
True or false: There is no cancer risk in Syphilis.
False, there is a very high cancer risk in tertiary syphilis.
Leukoplakia:
- Clinical appearance
- Cause
- Types
- Consequence
- A fixed white patch/plaque that cannot be characterised clinically/pathologically as any other disease.
- Obscure: trauma/alcohol/food/infections/tobacco
- Homogenous and speckled
- Speckled has malignancy risk
True or false: Erythroplakia has a cancer risk.
True
Why can’t acute hyperplastic candidiasis be termed candidal leukoplakia while chronic hyperplastic candidiasis can?
In chronic, the white lesion is fixed (not easily scraped off).
Lichen planus:
- Clinical appearance
- Common onset
- Histology
- Management
- Often bilateral, either striated (painless) or atrophic/erosive (painful)
- > 40yo
- Striated (hyperkeratosis, saw-tooth rete pegs), atrophic/erosive (thinning of epithelial layer), both have lots of T-cell involvement causing the destruction (apoptosis of basal keratinocytes)
- Corticosteroids (topical/systemic), CHX for pain
What is the common clinical appearance of gingival lichen planus? What else might you use to differentiate it from other gingival redness?
- Atrophic mostly with straited on interdental papillae
- Lichen planus on the rest of the mouth may be present (or you could just take a biopsy)
True or false: Lichen planus and chronic candidiasis do not have a cancer risk.
False, although cancer risk for them is low.
What is ONE example topical corticosteroid with instructions for treatment of lichen planus.
Betamethasone dipropionate (Diprosone) 0.05% ointment - Apply tid after meals for a max of 6 weeks.
What are THREE risk factors for SCC?
- Smoking (main)
- Alcohol (main - may potentiate smoking risk factor by making mucosa more accessible via atrophy)
- HPV type 16 or 18 (SCC less mutations so easier to treat)
SCC clinical appearance?
Quite variable.
Red, speckled or white patches.
Can be raised nodule or non-healing ulcer with raised borders.
What does it mean when a lesion is less differentiated?
Growth rate is more out of control and differentiation cannot keep up.
What is the grading system for SCC degree of differentiation? What is an example feature?
Grade 1 (Well differentiated) - (moderate) - (poorly) - Grade 4 (Anaplasia - similar to poorly) Example: Are there prickle cells and keratin formed?
Tumour location in the oral cavity can determine risk of spread. How so?
The more posterior the tumour is, the greater chance of spread (more vascularity and lymphatics)
Describe the TNM staging system.
T = size (T1, T2 2-4cm diameter, T3, T4 >4cm and invading local structures) N = condition of regional lymph nodes (N0, N1 ipsilateral, N2 contra/bilateral, N3 fixed) M = metastases (M0, M1)
Stage 1 = T1, N0, M0
Stage 2 = T2, N0, M0
Stage 3 = T3, N0, M0 or N1 with any T
Stage 4 = N2/N3 with any T or M1 with any T/N
Stage 1/2 = >50% 5yr survival
Stage 3 = 15-20%
Stage 4 = <5%
What are THREE dentally relevant side effects of radiotherapy? Which is generally a long term side effect?
- Mucositis
- Xerostomia (caries, candida, taste - long term)
- Osteoradionecrosis
What are the suffixes for benign and malignant lesions?
“oma” = benign (e.g. osteoma)
“carcinoma” (epithelial) or “sarcoma” (mesenchymal) = malignant (e.g. osteosarcoma)
Give examples of benign and malignant fibrous tumours and one fact for each.
Benign
- Solitary fibrous tumour (collagenous)
- Myxoma (myxoid stroma = non-collagenous, lots of ground substance)
Malignant
- Fibrosarcoma (most common malignant mesenchymal tumour in oral/oropharynx with many pts <20yo - painless growth)
Name benign and malignant tumours for:
- Fat
- Muscle
- Endothelium
- Nerve
- Fat (lipoma, liposarcoma)
- Muscle (leiomyoma, leiosarcoma, rhabdomyosarcoma)
- Endothelium (angioma, angiosarcoma)
- Nerve (schwannoma, neurofibroma - both benign)
Do malignant peripheral nerve sheath tumours appear radioopaque or radiolucent?
Radiolucent
Granular cell tumour and granular cell epulis:
- Clinical appearance
- Location
- Histology
Granular cell tumour (found on the tongue)
Granular cell epulis (on newborns alveolar ridge)
Both
- Painless smooth swellings (benign)
- Histology: cells with granular cytoplasm
What is a lymphoma and where would we find non-hodgkin lymphoma vs. hodgkin lymphoma?
Lymphoma = tumour of the lymphoid cells Non-hodgkin = palate, gingiva, tongue Hodgkin = Waldeyer's ring (palatine tonsil), rarely oral cavity
Metastatic tumours generally present as radioopaque or radiolucent?
Radiolucent
