Oral and esophageal (1.7) Flashcards by Tricia MD

What conditions often have canker sores (aphthous ulcers)?

Celiac disease

Inflammatory Bowel Disease

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What is a fibroma (irritation fibroma)?

A fibroma is a proliferation of squamous mucosa and underlying subepithelial fibrous tissue d/t a chronic irritation

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What is a pyogenic granuloma?

A pyogenic granuloma is a polypoid red lesion

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What are pyogenic granulomas composed of?

Pyogenic granulomas are lobular reactive proliferations of capillaries…eruptive hemangioma

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Who is most likely to develop a pyogenic granuloma?

Children, young adults, and pregnant women

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Where are pyogenic granulomas most likely to occur?

Pyogenic granulomas occur in the gingiva

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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

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A patient has glossitis, iron deficiency anemia, and esophageal dysphagia associated with esophageal webs: what is the name of the syndrome?

Plummer-Vinson syndrome

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Why is benign migratory glossitis often referred to as geographic tongue?

Because the of the map-like appearance of the tongue

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Is geographic tongue bad?

Geographic tongue is usually asymptomatic…there can be a mild burning sensation

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What causes geographic tongue?

Mostly unknown…possible genetic component

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What is a heterotopic collection of sebaceous glands in the oral cavity?

Fordyce’s Granules

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What is squamous papilloma?

An exophytic papillary proliferation of squamous mucosa with a fibrovascular core

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What are associated with squamous papilloma?

HPV infection

Trauma/irritation

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Hairy leukoplakia:

White, fluffy patches on lateral sides of tongue… cannot be scraped off

Secondary to EBV infection in an immunocompromised person

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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

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Who gets leukoplakia?

Adult tobacco users

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What is the concern with leukoplakia?

Precancerous squamous dysplasia (5-25%…less than erythroplakia)
Squamous hyperplasia and hyperkeratosis

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What does erythroplakia look like?

Red, velvety patch…may be flat or slightly rounded

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Who gets erythroplakia?

Adult tobacco users

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What is the concern with erythroplakia?

Precancerous dysplasia…more so than with leukoplakia (erythroplakia is red because of blood supply)

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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

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What are some histological features of actinic cheilosis?

Disordered maturation of the epithelium with cytologic atypia
Increased mitotic activity
Orthokeratosis
Dermal solar changes

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What are the common risk factors for oral cavity, oropharyngeal, hypopharyngeal, and laryngeal SCC?

Tobacco use
EtOH use
HPV

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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