Oral and Esophageal Pathology Flashcards
Define oral cavity canker sore
an apthous ulcer….a very common shallow superficial mucosal ulceration usually painful and recurrent
etiology uncertain but probably stress, celiacs or IBS
What is a mucosal fibroma
Also called an irritation fibroma…it’s a reactive proliferation of squamous mucosa and underlygin subepithelial fibrous tissue
typically secondary to chronic irritation
What is a squamous papilloma
It’s an exophytic papillary proliferation of squamous mucosa with a fibrovascular core
some associated with HPV, others associated with trauma/irritation
note that some can undergo malignant transofmraiton to in-situ and invasive SCC
What is a pyogenic granuloma
a polypoid red lesion composed of lobular reactive proliferation of capillaries
basically an eruptive hemangioma in the oral cavity
usually occurs on the giniva in chidlrne, young adults and pregnant women
What is glossitis
Two definitions:
- inflammation of the tongue
- used to describe the beefy-red appearance of the tongue encountered in certain deficiency states - red is secondary to atrophy of the papillae and thinning of mucosa revealing blood vessels
What is geographic tongue?
also called benign migratory glossitis
it’s a mgratory “map-like” appearance of the tongue due to focal loss of the papillae.
What is fordyce’s granules?
it’s heterotopic colections of sebaceous glands in the oral cavity
they’re not supposed to be there
show up as yellow granules
Describe the appearance of hairy leukoplakia
It’s a white, confluent patch of fluffy hyperkeratosis on the LATERAL side of the tongue - won’t scrape off
What is the clinical significance of hairy leukoplakia?
It occurs in immunocompromised individuals with EBV infection
(can be the first presenting sign of HIV infection, although it’s the EBV that’s causing it directly)
Describe the appearance of leukoplakia?
a white patch or plaque in the oral cavity that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease
Descibe the appearance of erythroplakia?
a red, velvety patch in the oral cavity
may be flat or slightly eroded
What’s the clinical significance of leukoplakia and erythroplakia?
5-25% of leukoplakia and even more erythroplakia demonstrate precancerous squamous dysplasia in addition to squamous hyperplasia and hyperkeratosis
Describe actinic cheilitis.
It’s a leukoplakic lesion of the lower lip with loss of the vermillion border…it’s basically actinic keratosis of the lip
What can actinic cheilitis develop into?
Like actinic keratosis it can be a precursor to squamous cell carcinoma of the lip
What are the key risk factors for the development of oral, oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma
smoking tobacco both is worse! HPV sunlight for the SCC of lower lip
What ‘s the key risk factor for nasopharyngeal squamous cell carcinoma?
EBV infection
Explain why inverted sinonasal papillomas are more likely to recur than other sinonasal papillomas
Instead of growing outward, it grows inward, so it’s harder to resect all of it out and is more likely to recur
Teenage boy with recurrent nasal obstruction and epistaxis…what do you think of?
nasopharyngeal angiofibroma
Describe the most common site of metastases for oral cavity and pharyngeal squamous cell carcinoma
cervical lymph nodes
distant mets to the mediastinal LNs, lungs, liver, and bone
Define xerostomia
dry mouth due to decrease in production of saliva
Define sialadentis
defined as inflammation fo the salivary glands
What is a common cause of sialadentis
many causes - trauma, bacterial or viral infections (mumps) and autoimmune disease (sjogrens). Also from sialolithiasis which causes obstruction and secondary bacterial infections with staph aureus
What is LESA?
Lymphoepithelial sialadenitis or Mikulicz disease
It’s an autoimmune disease involving the salivary glands with xerostomia and keratoconjuncitivit sicca
you get polyclonal lymphoid inflammation of the salivary gland leading to gland enlargment and a characteristic lymphoepithelial lesions
What is the more common causes of xerostomia?
sjogren’s syndrome
previous radiation therapy
drug side effect
Describe the cause and appearance of a mucocele
results from either blockage or traumatic injury to a MINOR salivary gland with leakage of contents into the surrounding CT
presents as a fluid-filled mucosal nodule with varying degrees of inflammation
note - ranula is the term for damage to the sublingual duct specifically
What’s the most common neoplasm of the salivary glands? Benign or malignant?
pleomorphic adenoma - benign
Second most common? Benign or malignant?
Warthin tumor
Most common malignant?
Mucoepidermoid carcinoma
What is the microscopic appearance and key clinical features of pleomorphic adenoma?
mix of proliferating epithelial cells with a mesenchymal matrix of myxoid, hyaline and chrondoid tissue
usually present as painless discrete masses that are seemingly well circumscribed but with small extensions that make recurrent rate of 25%
What is the microscopic appearance and key clinical features of a warthin tumor?
well-encapsulated
distinct papillary, cystic lesion with a DUAL LAYER of bland, neoplastic eosinophilic epithelium associated with a reactive lymphoid stroma
What is the microscopic appearance and key clinical features of a mucoepidermoid carcinoma?
variable mixture of squamous cells, mucus-secreting cells and intermediate cells
grossly appear encapsulated, but htey infiltrate at margins microscopically
What is the microscopic appearance and key clinical features of an adenoid cystic carcinoma
It’s a slow-growing often relentless salivary gland carcinoma with predilection for neural invasion
note that half occur in the minor salivary glands
half disseminate to other organs decades after removal
What salivary gland is most often involved by salivary gland neoplasms?
parotid
Define esophageal atresia
esophagus that ends in a blind end - usually associated with tracheoesophageal fistulas
Define esophageal stenosis
narrowing of the esophagus
What are common causes of esophageal stenosis?
can be congenital, but it’s usually due to injury and inflammation from chronic GERD, irradiation or caustic injury
Describe the difference between esophageal mucosal webs and schatzki rings?
Webs are protrusions of mucosa into the lumen that can cause obstruction - usually upper esophagus
Schatzki rings are webs but thicker and CIRCUMFERENTIAL in the lower esophagus
Define zenker’s diverticulum? Where is it located?
an outpouching of mucosa and submucosa thorugh a weakened posterior cricopharyngeus muscle
located above the upper esophageal sphincter
Define mallory-weiss syndrome.
A longitudinal mucosal laceration in the distal esophagus and proximal stomach, usually associated with severe retching or vomitign from heavy alcohol use
presents with hematemesis
can progress to Boerhaave syndrome if it tears all the way into the mediatinum - air gets in and travels up under the skin
Define hiatal hernia. What’s the most common type?
separation of diaphragatic crura with protrusion of the stomach into the thorax
most are acquired and sliding type
List the three most common types of infectious esophagitis that occur in immunocompromised patients.
candida
herpes simplex
CMV
Describe the suspected pathogenic mechanism of eosinophilic esophagitis>
probably a food allergy triggering eosinophilia
Describe the microscopic appearnce of eosinophilic esophagitis
over 20 eosinophils per high power field in biopsy
gross appearance has rings and white sloughing - feline ringing
What’s the clinical presentation of eosinophilic esophagitis?
person with hx of allergies and asthma with persistent difficulty swallowing
What’s the major complication of GERD?
Barrett’s esophagus - conversion of normal squamous mucosa to metaplastic olumnar epithelium with goblet cells - makes it look like the intestine
What is the major complication of Barrett’s esophagus?
risk of esophageal landular dysplasia and adenocarcinoma
What are the risk factors for esophageal adenocarcinoma?
95% arise from barret’s and GERD
What are the risk factors for esophageal squamous cell carcinoma?
alcohol and tobacco caustic injury achalasia tylosis plummer-vinson hot tea HPV
What’s the most common cause of esophageal squamous papillomas?
it’s a benign squamous neoplasm with an association with HPV
What’s the most common benign mesenchymal tumor of the esophagus?
Leiomyoma
What combination makes Plummer-Vinson syndrome?
iron deficiency anemia
glossitis
esophageal webs with dysphagia
