Oral and Oesophageal Pathology Flashcards
What are some inflammatory disorders of the oesophagus?
Acute Oesophagitis- rare
Chronic Oesophagitis - common
What is acute Oesophagitis??
Corrosive - following chemical ingestion
Infective in immunocompromised patients - e.eg candidiasis, herpes
What is chronic Oesophagitis?
Reflux disease - ‘reflux oesophagitis’
Describe what reflux ‘reflux oesophagitis is… GORD?
Inflammation of the oesophagus due to refluxed low pH gastric content
What might cause reflux oesophagitis?
Might be caused by a defective sphincter +/- hiatus hernia
Abnormal oesophageal motility
Increased intra-abdominal pressure (pregnancy, obesity)
What might you see down the microscope in reflux oesophagitis?
Basal zone epithelial expansion - hyperplasia
Intraepithelial neutrophils, lymphocytes and eosinophils
Elongation of papillae as cell type changes to deal with acid
What might be some complications of reflux?
Ulceration - bleeding
Stricture
Barretts Oesophagus
What is Barretts Oesophagus?
Replacement of stratified squamous epithelium by columnar epithelium - pre malignant condition, mucosa becomes unstable and it can undergo dysplastic change easily
What is metaplasia?
Metaplasia is a reversible change in which one adult cell type (epithelial or mesenchymal) is replaced by another adult cell type.
Why does metaplasia occur in barrett’s oesophagus?
Due to president reflux of acid or bile
Protective response, faster regeneration
How might you describe the appearance of Barrett’s Oesophagus?
Red velvety mucosa in the lower oesophagus
What is the increased risk in Barrett’s Oesophagus?
Increased risk of developing dysplasia and carcinoma of the oesophagus
What is Allergic Oesophagitis also know as?
‘Eosinophillic’ oesophagitis
This is where the oesophagus becomes inflamed with a particular type of white blood cell called an eosinophil.
What are some of the common associations with allergic oesophagitis?
Personal/family history of allergy Asthma Young Males > females pH probe negative for reflux Increased eosinophils in blood Corrugated (feline) or ‘spotty’ oesophagus
What would be characteristic of allergic oesophagitis?
Large number of intraepithelial eospinphils
What might treatment of allergic oesophagitis include?
Steroids
Chromoglycate
Montelukast
What benign oesophageal tumour can you get?
Squamous papilloma
- rare, papillae, assymtomatic, HPV related
What other type of benign oesophageal tumour can you get?
Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours
What are the 2 main types of malignant oesophageal tumours that you can get?
Squamous cell carcinoma
Adenocarcinoma
Describe more about squamous cell carcinomas?
Commoner in Eastern males
Aetiology - smoking, alcohol, HPV, Vit A deficiency, Tannic acid/strong tea…
40% in middle
15% in the upper third
Describe more about adenocarcinoma of the oesophagus?
Commoner in caucasians
Mostly the lower 1/3rd of oesophagus
Commoner in males
Obesity linked
Describe the pathogenesis of adenocarcinoma of the oesophagus?
Genetic factors, Reflux disease, Others
Chronic reflux oesophagitis
Barretts Oesophagus (Intestinal metaplasia)
Low Grade dysplasia
High Grade dysplasia
Adenocarcinoma
What might adenocarcinoma produce?
Obstruction and dysphagia
What are some mechanisms of metastases in relation to carcinoma of the oesophagus?
Direct invasion
Lymphatic permeation
Vascular invasion
What might carcinoma of the oesophagus present with?
Dysphagia
Anaemia
Weight loss, lethargy
What is the most common type of oral cancer?
Squamous cell carcinoma - variable presentation - white, red, speckled, ulcer lump
Describe TNM staging?
T= greatest diameter of tumour, structures invaded N= lymph node status M= metastasis
What might the treatment be?
Surgery
Chemoradiation
Palliation
