Oral and oesophageal pathology Flashcards
Lining of normal oesophagus?
Stratified squamous epithelium
Categories of inflammatory disorders affecting the oesophagus?
Acute oesophagitis - rare and is corrosive following chemical ingestion; infectons of the oesophagus are rare unless immunocompromised, e.g: candidiases, herpes, CMV
Chronic oesophagitis - common and is a reflux disease (reflux oesophagitis); rare causes include Crohn’s disease and radiation
Definition of reflux oesophagitis?
Inflammation of oesophagus due to refluxed low pH gastric contents
Causes of reflux oesophagitis?
Defective sphincter mechanism can occur due to a hiatus hernia (loss of LOS mechanism)
Abnormal oesophageal motility
Increased intra-abdominal pressure, e.g: pregnancy or obesity
Microscopic appearance of reflux oesophagitis?
Reflux damages superficial squamous epithelium; there is a compensatory basal call hyperplasia and elongation of the connective tissue papillael also, there is inflammatory cell exudation, e.g: intra-epithelial neutrophils, lymphocytes and eosinophils
Complications of reflux oesophagitis?
Ulceration (bleeding)
Stricture and difficulty swallowing
Barrett’s oesophagus
What is Barrett’s oesophagus?
Metaplastic change of stratified squamous epithelium to columnar epithelium (gastric epithelium affords more protection against acid), due to chronic reflux of acid or bile
This protective response allows faster regeneration
Two methods of development of Barrett’s oesophagus?
Expansion of columnar epithelium from gastric glands or from submucosal glands
Differentiation from oesophageal stem cells
Clinical management of Barrett’s oesophagus?
Increased risk of developing dysplasia and adenocarcinoma of the oesopahgus; must be monitored
What is allergic oesophagitis?
AKA eosinophilic oesophagitis
Clinical diagnosis of allergic oesophagitis?
Personal/family history of atopic issues, often in children and young adults (part. males) and these people do not improve when treated for reflux
Eosinophils infiltrate the squamous epithelium and there will be increased eosinophils in blood and a large number of intra-epithelial eosinophils
Oesophageal pH studies are negative for reflux and inflammation favours the proximal oesophagus
Appearance of allergic oesophagitis?
Corrugated (ridged)/spotty oesophagus
Treatment of allergic oesophagitis?
Steroids (not in children)
Chromoglycate
Montelukast
Types of oesophageal tumours?
Benign (rare):
Epithelial
Stromal
Lymphoid
Malignant:
Squamous cell carcinoma (more common in males)
Adenocarcinoma (gland-forming)
Most common benign oesophageal tumour?
Epithelial tumours, like squamous cell papilloma; it is asymptomatic and sometimes it is HPV-related
Other types of benign oesophageal tumours?
Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours
Risk factors associated with squamous cell carcinoma of oesophagus?
Smoking Alcohol HPV Oesophagitis Genetic Tannic acid/strong tea Vitamin A and zinc deficiency
Pathogenesis of squamous cell carcinoma?
- Normal
- GORD
- Severe dysplasia
Which type of cancer is associated with Barret’s oesophagus?
Adenocarcinoma (more common than SCC due to increase in Barret’s oesophagus)
Pathogenesis of oesophageal adenocarcinoma?
- Genetic factors, reflux disease and other factors lead to chronic reflux oesophagitis
- Barrett’s oesophagus (intestinal metaplasia) develops
- Low grade and then high grade dysplasia (precancerous changes)
- Adenocarcinoma produces dysphagia (urgent endoscopy)
Mechanisms of metastases?
Direct/local invasion - many produce fistulas
Lymphatic permeation - regional lymph nodes at mediastinum and also left gastric nodes
Vascular invasion - may spread to sieve-like organs, e.g: the liver
Symptoms of oesophageal carcinoma?
Dysphagia due to tumour obstruction
General symptoms of malignancy:
Anaemia
Weight loss
Loss of energy
Most common type of oral cancer?
Oral squamous cell carcinoma (SCC)
Presentation of oral SCC?
White, red, speckled, ulcer lump
High risk sites inc. the floor of mouth, ventral and lateral aspects of the tongue and the retromolar trigone (behind mandibular 3rd molar tooth); rarely, they can be of the hard palate or dorsum of the tongue
Risk factors of oral SCC?
Tobacco and alcohol
? Viral causes, e.g: HPV
? Chronic infections
Nutritional deficiencies
? Genetics
Post Transplant
Patients with a history of primary oral SCC have increased risk of developing new second primary
How is oral SCC graded?
By differentiation:
Well-differentiated tumour cells very obviously squamous with ‘prickles’ and keratinization
Moderately differentiated
Poorly differentiated, may be difficult to identify tumour cells as epithelial
Histopathological features assoc. with a poorer prognosis of oral SCC?
Poorer differentiation of tumour cells
Increased tumour diameter and depth of invasion
Presence of neural or lymphovascular invasion
Metastatic disease
Extracapsular spread of lymph node metastases
Generally, the prognosis worsens with the most posterior tumours
Staging of Oral SCC?
TNM staging
