Oral and Oesophageal pathology Flashcards
What is acute oesophagitis?
Corrisve following chemical ingestion
Infection in immunocompromised patients (candidtis, herpes, CMV)
What is chronic oesophagitis?
Relfux disease - reflux oesophagitis
Rare causes include crohn’s disease
What is the definition of reflux oesophagitis?
Inflammation of oesophagus due to refluxed low pH gastric content
What can cause reflux oesophagitis?
May be due to defective sphinter mechanism +/- hiatus hernia
Abnormal oesophageal motility
Increased inta-abdominal pressure (regnancy)
What does reflux oesophagitis look like microscopically?
Basal zone epithelial expansion
Intraepithelial neutrophils, lymphocytes and esoinophils
What are complications of reflux?
Ulceration (bleeding)
Stricutre
Barrett’s oesophagus (replacement of stratified squamous epithelium by columnar epithelium)
Why does metaplasia occur in barrett’s oesphagus?
Presistent reflux of acid or bile
May be due to expansion of columnar epithelium drom gastric glands or from submucosal glands
May be due to differentiation from oesophageal stem cells
Protective response, faster regeneration
What is barrett’s oesphagus?
Unstable mucosa that is at high risk of developing dysplasia and carcinoma of the oesophagus
Requires surveilllance
What is allergic oesphagitis?
Eosinophilic oesophagitis, occurs in people with a family history of allergy or asthm
Who does allerigic oesophagitis tend to affect?
Young
Males more than females
How is allergic oesphagitis diagnosed?
pH probe for reflux
Increased eosinophils in the blood
Corrugated (feline) or spotty oesophagus
How can allergic oesophagitis be treated?
Steroids/chromoglycate/montelukast
What are examples of benign oesophageal tumours?
Squamous papilloma Rare, papillary, assymptomatic, HPV related Leiomyomas Lipomas Fibrovascular polyps Granular cell tumours
What are examples of malignant oesophageal tumours?
Squaomous cell carcinoma
Adenocarcinoma
Who does squamous cell carcinoma affect?
Commoner in males
High risk in NW France, N italy, Iran, S. Africa, brazil, central china
What causes squamous cell carcinoma?
Vitamin A and Zinc deficiency Tannic acid/strong tea Smoking, alcohol HPV Oesophagitis Genetic
Who is likely to get adenocarcionma of the oesophagus?
Commoner in caucasians
Incidence increasing in Europe and USA
Commoner in males/obesity
Commonest in lower 1/3rd of oesophagus
What is the pathogenesis of adenocarcinoma of the oesophagus?
Genetic factors, reflux disease, others Chronic reflux oesphagitis Barretts oesophagus Low grade dysplasia High grade dysplasia Adenocarcinoma
What are the mechanisms of metastases in carcionma of the oesophagus?
Direct invasion
Lymphatic permeation
Vascular invasion
What does carcinoma of the oesophagus present with?
Dysphagia (due to tumour obstruction)
General symptoms of malignancy - anaemia, weight loss, loss of energy
What is the presentation of oral squamous cell carcionma?
White, red, speckled, ulcer, lump
Where are the high risk sites for oral squamous cell carcionma?
High risk sites include floor of mouth, laeral border of ventral tongue, soft palate, retomolar pad/tonsillar pillars
What causes oral cancer?
Tobacco Alcohol Betel quid Viral Chronic infections Nutritional deficiencies Post ransplant
How is the prognosis calculated for a SCC?
Tumour diametes Depth of invasion Pattern of invasion Lymphovascular invasion Nueral invasion by tumour Involvement of surgical margins Metastatic disease Extracapsular spread of lymph node metastases
How are oral cancers treated?
Surgery +/- adjuvant therapy
