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GI > Oral and Esophageal Pathology > Flashcards

Oral and Esophageal Pathology Flashcards

1
Q

Oral Canker Sore (Aphthous Ulcers)

A
  • -Common, shallow, superficial mucosal ulcerations
  • -Painful and recurrent
  • -Regress within several weeks
  • -Can be associated with IBD, celiac disease
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2
Q

Mucosal fibroma (irritation fibroma)

A
  • -Proliferation of squamous mucosa and underlying subepithelial fibrous tissue
  • -Usually secondary to chronic irritation
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3
Q

Squamous papilloma

A
  • -Exophytic papillary proliferation of squamous mucosa w/fibrovascular core
  • -May be associated w/HPV infection, trauma/irritation
  • -Can become invasive squamous cell carcinoma
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4
Q

Pyogenic granuloma

A
  • -Polypoid, red lesion, lobular reactive proliferation of capillaries (eruptive hemangioma)
  • -Usually on gingiva of children, young adults, pregnant women
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5
Q

Glossitis

A
  • -Inflammation of tongue.
  • -Beefy red appearance (Vit B12 deficiency)
  • -Secondary to atrophy of papillae of tongue and thinning of mucosa.
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6
Q

Plummer-Vinson Syndrome

A

Iron deficiency anemia, glossitis, esophageal dysphagia (associated wi/esophageal webs)

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7
Q

Geographic tongue (benign migratory glossitis)

A
  • -Migratory, “map-like” appearance
  • -Patches will migrate over tongue.
  • -From focal loss of papillae w/formation of smooth red patches.
  • -Usually asymptomatic, may have mild burning sensation
  • -Tends to run in families
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8
Q

Microscopic appearance of geographic tongue

A

Intraepithelial neutrophilic inflammation present

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9
Q

Bisphosphonate-related osteonecrosis of the jaw**

A
  • -Bisphosphonate medications (Fosamax) used to treat osteoporosis
  • -Side effect is focal mandibular and maxillary osteonecrosis, sometimes following minor trauma
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10
Q

Hairy leukoplakia

A
  • -White, confluent patches of “fluffy” hyperkeratosis (thickening of keratin layer)
  • -White plaques to raised white lesions of vertical corrugations
  • -Lateral sides of tongue
  • -Lesions can’t be scraped off
  • -Occurs in immunocompromised ind. secondary to EBV
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11
Q

Clinical significance of hairy leukoplakia

A

May be first presenting sign of HIV

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12
Q

Leukoplakia

A

–White patch/plaque in oral cavity that can’t be scraped off or characterized by another disease

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13
Q

Histological features of leukoplakia

A

–Hyperkeratosis with or without parakeratosis, often irregular epithelial hyperplasia with or without dysplasia

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14
Q

Clinical significance of leukoplakia

A

5-25% demonstrate precancerous squamous dysplasia (along w/squamous hyperpasia and hyperkeratosis)

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15
Q

Erythroplakia

A

–Red, velvety patch in oral cavity that can be flat or slightly eroded

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16
Q

Clinical significance of erythroplakia

A

–Higher incidence of precancerous dysplasia higher than in leukoplakia

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17
Q

Erythroplakia histology

A

Evidence of dysplasia and/or carcinoma

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18
Q

Erythroplakia and leukoplakia risk factors

A
  • -Adults

- -Tobacco use

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19
Q

Actinic Cheilitis

A

–Leukoplakic lesion of lower lip with loss of distinct demarcation between lower lip border and skin of lip

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20
Q

Histologic features of actinic cheilitis

A

–Disordered maturation of epithelium w/cytologic atypia, increased mitotic activity, hyperkeratosis, connective tissue solar changes, increased hyperchromatia

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21
Q

Risk factors for oral cavity squamous cell carcinoma

A
  • -Tobacco and EtOH use (especially if both used)
  • -Oncogenic HPV (better outcome if P16)
  • -Exposure to sunlight and pipe smoking
  • -Middle-aged adults and older
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22
Q

Typical first presenting symptom of oral cavity SCC

A

Enlarged cervical neck lymph node

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23
Q

Laryngeal SCC risk factors

A
  • -Tobacco smoke and EtOH use

- -HPV

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24
Q

Typical presenting sign of laryngeal SCC

A

Hoarseness, and can metastasize to cervical lymph nodes

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25
Q

Nasopharyngeal SCC risk factors

A
  • -EBV

- -Rare tumor in US, common in African children and Southern China (in adults)

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26
Q

Patterns of Nasopharyngeal SCC

A

Keratinizing, nonkeratinizing, undifferentiated carcinoma

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27
Q

Inverted sinonasal papillomas

A

Benign neoplasms arising from sinonasal mucosa and are composed of squamous or columnar epithelial proliferation

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28
Q

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

A

Inverted growth pattern consisting of thickened epithelial nests arising from the surface and growing down into the stroma
–Malignant transformation can occur

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29
Q

Most common sites of metastases for oral cavity SCC

A

Cervical neck lymph nodes (local). Distant–mediastinal lymph nodes, lungs, liver, bone

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30
Q

Xerostomia

A
  • -Dry mouth from decrease in saliva production

- -Causes: Sjogren’s syndrome, previous radiation therapy, side effect of prescribed medications

31
Q

Sialadentis

A
  • -Inflammation of salivary glands

- -Causes: trauma, bacterial or viral infection, autoimmune disease (Sjogren’s)

32
Q

Sialolithiasis

A

–Stone in salivary duct that can cause obstruction and secondary bacterial infection (due to staph aureus or strep viridans)

33
Q

LESA (Lymphoepithelial sialadenitis or Mikulicz disease)

A
  • -Autoimmune disease involving salivary glands

- -50% of cases are salivary gland manifestations of Sjogren’s syndrome

34
Q

Pathologic features of LESA

A

–Polyclonal lymphoid inflammation of salivary gland–> gland enlargement and lymphoepithelial lesion

35
Q

What do you need to distinguish LESA from?

A

Primary lymphoma of salivary gland

36
Q

Causes of mucocele

A
  • -Retention mucocele: blockage of minor salivary gland

- -Extravasation mucocele: traumatic injury of minor salivary gland

37
Q

Mucocele appearance

A
  • -Fluid-filled mucosal nodule w/varying degrees of inflammation
  • -Leakage of contents into surrounding connective tissue stroma
38
Q

Ranula

A

Mucocele that occurs when sublingual duct damage. Can be quite large and dissect into neck

39
Q

Pleomorphic adenoma

A
  • -Most common salivary gland tumor
  • -Usually in parotid gland (but can occur in both major and minor salivary glands)
  • -Benign tumor
40
Q

Microscopic appearance of pleomorphic adenoma

A

–Mix of proliferating epithelial (ductal and myoepithelial) cells assocaited with mesenchymal matrix of myxoid, hyaline, chondroid tissue

41
Q

Key clinical features of pleomorphic adenoma

A
  • -Painless, discrete masses
  • -Seem well-circumscribed, but have extensions
  • -Carcinoma can arise in pleomorphic adenoma (rare though)
42
Q

Warthin tumor (papillary cystadenoma lyphomastosum)

A
  • -2nd most common salivary gland tumor
  • -Almost always in the parotid gland
  • -Multifocal and bilateral
  • -Smokers have 8x higher risk
43
Q

Warthin tumor microscopic appearance

A

Well-encapsulated, papillary, cystic lesion() w/dual layer of bland, neoplastic, eosinophilic epithelium. Associated with reactive lymphoid stroma*

44
Q

Mucoepidermoid carcinoma

A
  • -Most common MALIGNANT salivary gland tumor
  • -most common malignant salivary gland tumor in children
  • -60-70% in parotid gland, can occur at any age
  • -High grade tumors have survival rate of 50%
45
Q

Mucoepidermoid carcinoma microscopic appearance

A

Mixture of squamous cell, mucus-secreting cells, intermediate cells, clear vacuolated cells containing mucin.
–OFten infiltrate margins, even though they grossly appear encapsulated

46
Q

Adenoid cystic carcinoma

A
  • -Slow growing, relentless, predilection for NEURAL INVASION
  • -Can occur in major glands, 50% occur in minor salivary glands
  • -Can reoccur decades after removal
  • -Most common malignant tumor of minor salivary glands
47
Q

Adenoid cystic carcinoma microscopic appearance

A

Cribiform pattern enclosing secretions

48
Q

Most common benign salivary gland tumors

A
  • -Pleomorphic adenoma 50%
  • -Warthin tumor
  • -Oncocytoma
  • -Other (basal cell and canicular adenoma)
49
Q

Most common malignant salivary gland tumors

A
  • -Mucoepidermoid carcinoma (15%)
  • -Adenocarcinoma (NOS) (10%)
  • -Acinic cell carcinoma (5%)
  • -Adenoid cystic carcinoma (5%)
  • -Malignant mixed tumor (3-5%)
50
Q

Esophageal stenosis

A
  • -Can be congenital

- -Usually due to injury and inflammation from chronic gastroesophageal reflux, irradiation or caustic injury

51
Q

Tracheoesophageal fistula

A

Type C most common (esophageal atresia w/distal tracheoesophageal fistula)

52
Q

Esophageal mucosal webs

A

Protrusions of mucosa that can cause obstruction

  • -Usually in upper esophagus
  • -Plummer-Vinson Syndrome
53
Q

Schatzki rings

A
  • -Like esophageal webs, but thicker and circumferential, may contain muscularis propria
  • -Located in lower esophagus
54
Q

Mallory-Weiss Syndrome

A
  • -Presence of longitudinal mucosal lacerations in the distal esophagus and proximal stomach
  • -Usually associated w/severe retching or vomiting
  • -Hx of heavy EtOH use in 40-80%
  • -Can be cause of upper GI bleeding
55
Q

Boehaave Syndrome

A
  • -Transmural rupture of distal esophagus w/pneumomediastinum
  • -Can be complication of Mallory-Weiss Syndrome
56
Q

Zenker’s diverticulum

A
  • -Located above upper esophageal sphincter (*) as outpouching of mucosa through weakened posterior cricopharyngeus muscle
  • -Not true diverticulum
  • -Can accumulate food producing mass and painful swallowing, regurgitation and diverticululitis
  • -Seen on barium study
57
Q

Achalasia

A
  • -Incomplete lower esophageal sphincter relaxation, increased LES tone, aperistalsis of esophagus
  • -Primary: caused from idiopathic degeneration of neurons in esophageal wall myenteric plexus
  • -Secondary: Chaga’s disease, infiltrative malignancy of esophagus, amyloidosis, sarcoidosis
58
Q

Hiatal hernia

A
  • -From separation of diaphragmatic crura and protrusion of stomach into thorax through the defect
  • -Congenital or acquired later in life
  • -Similar symptoms to GERD w/inflammation, ulceration, stricture, hematemesis
59
Q

Most common type of hiatal hernia

A

Sliding type (Type 1) (98% of hiatal hernias)

60
Q

3 most common types of infectious esophagitis in immunocompromised patients

A
  • -Candida
  • -Herpes simplex
  • -CMV
61
Q

Pathogenic mechanism of eosinophilic esophagitis

A
  • -Likely some allergic reaction to food allergens
  • -Mild eosinophilia in 40-50% of patients
  • -Many patients have other allergies
62
Q

Microscopic appearance of eosinophilic esophagitis

A

Increased eosinophilic inflammation (>15 eosinophils/HPF), w/ basal epithelial hyperplasia, in absence of acute inflammation, squamous hyperplasia

63
Q

Clinical presentation of eosinophilic esophagitis in adults

A

Food impaction, persistent dysphagia, and GERD symptoms that fail to resolve to medical therapy

64
Q

Clinical presentation of eosinophilic esophagitis in children

A

Feeding disorders, vomiting, abdominal pain, dysphagia and food impaction

65
Q

Barrett’s esophagus

A
  • -Conversion of normal squamous mucosa of esophagus to METAPLASTIC COLUMNAR EPITHELIUM as result of chronic GERD
  • -Endoscopically recognizable and confirmed pathologically to have intestinal metaplasia (Goblet Cells)
  • -Occurs in 10% of patients with symptomatic GERD
66
Q

Diagnosis of Barrett’s esophagus requires what?

A

Endoscopic and histologic evidence of metaplastic columnar epithelium (endoscopy and biopsy)

67
Q

What does Barrett’s Esophagus have an increased risk for?

A

Esophageal glandular dysplasia and adenocarcinoma

68
Q

Esophageal adenocarcinoma

A
  • -Often arises from Barrett’s esophagus and long-standing GERD
  • -Progression can occur through stepwise acquisition of genetic and epigenetic changes
  • -Amplification of EGFR seen in some tumors
69
Q

Esophageal adenocarcinoma location and symptoms

A
  • -Usually in distal 1/3 of esophagus

- -Pain on swallowing, hematemesis, chest pain, progressive weight loss

70
Q

Treatment for some types of esophageal adenocarcinoma

A

Neoadjuvant radiation and chemotherapy prior to resection (advanced)
Some endoscopic mucosal resection can be used to treat tumors with no or minimal invasion

71
Q

Esophageal squamous cell carcinoma risk factors

A

–EtOH and tobacco use, caustic esophageal injury, achalasia, tylosis, Plummer-VInson syndrome, very hot beverages, and HPV

72
Q

Esophageal squamous papilloma cause (most common)

A

HPV

73
Q

Most common benign mesenchymal tumor of esophagus

A

Leiomyoma

GI (12 decks)

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