Oral and esophageal (1.7) Flashcards
What conditions often have canker sores (aphthous ulcers)?
Celiac disease
Inflammatory Bowel Disease
What is a fibroma (irritation fibroma)?
A fibroma is a proliferation of squamous mucosa and underlying subepithelial fibrous tissue d/t a chronic irritation
What is a pyogenic granuloma?
A pyogenic granuloma is a polypoid red lesion
What are pyogenic granulomas composed of?
Pyogenic granulomas are lobular reactive proliferations of capillaries…eruptive hemangioma
Who is most likely to develop a pyogenic granuloma?
Children, young adults, and pregnant women
Where are pyogenic granulomas most likely to occur?
Pyogenic granulomas occur in the gingiva
What causes the beefy-red appearance of glossitis?
Certain deficiency states like vitamin B12… secondary to atrophy of the papillae and thinning of the mucosa
A patient has glossitis, iron deficiency anemia, and esophageal dysphagia associated with esophageal webs: what is the name of the syndrome?
Plummer-Vinson syndrome
Why is benign migratory glossitis often referred to as geographic tongue?
Because the of the map-like appearance of the tongue
Is geographic tongue bad?
Geographic tongue is usually asymptomatic…there can be a mild burning sensation
What causes geographic tongue?
Mostly unknown…possible genetic component
What is a heterotopic collection of sebaceous glands in the oral cavity?
Fordyce’s Granules
What is squamous papilloma?
An exophytic papillary proliferation of squamous mucosa with a fibrovascular core
What are associated with squamous papilloma?
HPV infection
Trauma/irritation
Hairy leukoplakia:
White, fluffy patches on lateral sides of tongue… cannot be scraped off
Secondary to EBV infection in an immunocompromised person
What does leukoplakia…NOT hairy leukoplakia… just leukoplakia, look like?
White patch/plaque in oral cavity (not necessarily tongue)
Cannot be scraped off or characterized as anything else
Who gets leukoplakia?
Adult tobacco users
What is the concern with leukoplakia?
Precancerous squamous dysplasia (5-25%…less than erythroplakia)
Squamous hyperplasia and hyperkeratosis
What does erythroplakia look like?
Red, velvety patch…may be flat or slightly rounded
Who gets erythroplakia?
Adult tobacco users
What is the concern with erythroplakia?
Precancerous dysplasia…more so than with leukoplakia (erythroplakia is red because of blood supply)
What does actinic cheilosis look like?
Actinic cheilosis is a leukoplakic lesion of the lower lip that causes a loss of distinct demarcation between lip and skin
What are some histological features of actinic cheilosis?
Disordered maturation of the epithelium with cytologic atypia
Increased mitotic activity
Orthokeratosis
Dermal solar changes
What are the common risk factors for oral cavity, oropharyngeal, hypopharyngeal, and laryngeal SCC?
Tobacco use
EtOH use
HPV
What is the biggest risk factor for nasopharyngeal SCC?
EBV
A patient has oral cavity or pharyngeal SCC, where are the most likely locations for metastases?
Cervical neck lymph nodes (typical presenting sign)
Mediastinal lymph nodes, lungs, liver, bone
What is xerostomia?
Dry mouth due to decreased saliva production
What are some possible causes of xerostomia?
Sjogren’s syndrome
Previous radiation therapy
Some medications
What is sialadenitis? What can be seen?
Inflammation of the salivary gland
There is a bulge/nodule/bump/etc
What are some possible causes of sialadenitis?
Trauma
Bacterial or viral infection (mumps)
Autoimmune disease (Sjogren’s)
What is the name of an autoimmune disease against salivary glands that produces a bulge/nodule/bump/etc?
Lymphoepithelial sialadenitis (LESA)
What is a possible cause of LESA?
Sjogren’s
What is a mucocele?
A mucocele is a fluid filled mucosal nodule caused by a minor salivary gland leaking
What are three types of mucocele?
Retention mucocele (caused by obstruction) Extravastion mucocele (caused by trauma) Ranula (mucocele of the sublingual gland)
What is the most common salivary gland tumor? What gland does it usually occur in?
Pleomorphic adenoma is the most common salivary gland tumor
Pleomorphic adenoma is most likely to occur in the parotid gland
What is the microscopic appearance of pleomorphic adenoma?
Mix of proliferating appearance
Mesenchymal matrix of myxoid, hyaline, and chondroid tissue
What are some gross features of pleomorphic adenoma?
Usually a discreet, painless mass that seems well circumscribed (but isn’t…still rarely becomes a carcinoma)
What is the second most common salivary gland tumor? What gland does it usually form in?
Warthin tumor
The parotid gland
What is the microscopic appearance of Warthin tumor?
Papillary, cystic lesion (dual layer of bland, neoplastic, eosinophilic epithelium
Associated with reactive lymphoid stroma
Well encapsulated
What is warthin tumor associated with?
Warthin tumor is associated with reactive lymphoid stroma
Smokers
What is the most common MALIGNANT salivary gland tumor (in adults AND kids)?
Mucoepidermoid carcinoma
What are some microscopic features of mucoepidermoid carcinoma?
Mixture of squamous cells, mucus-secreting cells, and intermediate cells
Appear encapsulated, but aren’t…infiltrate at margins
What is the most common malignant tumor of the MINOR salivary glands?
Adenoid cystic carcinoma
What are some features of adenoid cystic carcinoma?
It is slow growing
Its 5-year survival rate starts at 70% and then gets cut in half every five years
What are esophageal mucosal webs?
Protrusions of mucosa –> possible obstruction
Usually in upper esophagus
What are some differences between esophageal mucosal webs and Schatzki rings (esophageal rings)?
Schatzki rings are thicker and circumferential, may contain muscularis propria, occur in the lower esophagus
What is Zenker’s diverticulum?
An outpouching of mucosa and submucosa through a weakened posterior cricopharyngeus muscle (above the UES)
Is Zenker’s diverticulum a true diverticulum?
No…can become large enough to accumulate food and cause problems
What is Mallory-Weiss syndrome?
Longitudinal mucosal lacerations in the distal esophagus/proximal stomach
What causes Mallory-Weiss syndrome?
Chronically drinking until you throw up
What is a hiatal hernia? What is the most common type?
The stomach protrudes into the thorax through a separation of diaphragmatic crura
Sliding type (type 1)…herniation of the gastric cardia
What is a type 2 hiatal hernia?
Paresophageal type…herniation of the gastric fundus
A person is immunocompromised, what are the three most likely causes of infectious esophagitis?
Candida esophagitis
Herpes simplex esophagitis
CMV esophagitis
What is the proposed pathology to eosinophilic esophagitis?
Food allergies…eosinophilic–>think allergies
Besides eosinophilic inflammation, what else is seen with eosinophilic esophagitis?
Basal epithelial hyperplasia
No acute inflammation
What are the signs and symptoms of eosinophilic esophagitis in adults/teenagers?
Food impaction
Persistent dysphagia
Unresponsive GERD
What are the signs and symptoms of eosinophilic esophagitis in children?
Feeding disorders Vomiting Abdominal pain Dysphagia Food impaction
What change occurs with chronic GERD that is defined as Barrett’s esophagus?
Transition from normal squamous mucosa to metaplastic columnar epithelium
What is needed to be seen to diagnose Barrett’s esophagus? What tests need to be done?
Columnar metaplasia AND intestinal metaplasia
Biopsy (histologic evidence) and endoscopy
What are some concerns with Barrett’s esophagus?
Esophageal glandular dysplasia
Adenocarcinoma (less than half of the patients)
What is the primary risk factor for adenocarcinoma?
Barrett’s esophagus…although only half of the people with Barrett’s esophagus develop adenocarcinoma, 95% of the people who develop adenocarcinoma have Barrett’s esophagus
What are the risk factors for esophageal SCC?
EtOH Tobacco Caustic esophageal injury Achalasia Tylosis (genetic disorder...also see thickening of palms and soles) Plummer-Vinson syndrome Frequent hot beverages Possibly HPV
What is the most common cause of esophageal squamous papilloma?
HPV
What is the most common benign mesenchymal tumor of the esophagus?
Leiomyoma
