Oral and Oesophageal Pathology

Question 1

What are the two inflammatory disorders of the oesophagus

Answer 1

Acute oesophagitis RARE 
-corrosive following chemical ingestion 
-infective in immunosuppressed patients 
Chronic oesophagitis COMMON 
-reflux disease 'reflux oesophagitis' 
- rare causes - Crohn's disease

Question 2

What is Reflux oesophagitis

Answer 2

Chronic oesophagitis
inflammation ue to refluxed low pH gastric content
May be due to defective sphincter mechanism +- hiatus hernia
can be caused by increases intra abdominal pressure (pregnancy)

Question 3

Microscopic features of reflux oesophagitis

Answer 3

Basal zone epithelial expansion (hyperplasia)

Intra epithelial neutrophils, lymphocytes and eosinophils

Question 4

Complications of reflux oesophagitis

Answer 4

Ulceration (bleeding)
Stricture (narrowing/tightening)
Barrett’s oesophagus “replacement of stratified squamous epithelium by columnar epithelium”

Question 5

What causes Barett’s oesophagus

Answer 5

Persistent reflux of acid or bile
May be due to expansion of columnar epithelium from gastric of submucosal glands
May be due to differentiation from oesophageal stem cells
Red velvety mucosa in lower oesophagus

Question 6

Dangers of Barrett’s oesophagus

Answer 6

Unstable mucosa (continuing damage)
Increased risk of developing dysplasia and carcinoma
requires surveillance

Question 7

What is Allergic oesophagitis

Answer 7

Eosinophilic oesophagitis

Looks like corrugated or ‘spotty’ oesophagus

Question 8

What causes allergic oesophagitis

Answer 8

Increased eosinophils in blood causing eosinophilic inflammation
Linked with asthma, personal/family history of allergy
more likely in males than female

Question 9

How would you treat allergic oesophagitis

Answer 9

Steroids
chromoglycate
montelukast

Question 10

What is a squamous papilloma

Answer 10

A rare benign oesophageal tumour
asymptomatic
HPV related

Question 11

What are some very rare benign oesophageal tumours

Answer 11

Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours

Question 12

What are the malignant oesophageal tumours

Answer 12

Squamous cell carcinoma

Adencarcinoma

Question 13

List some causes of squamous cell carcinomas

Answer 13

Vitamin A, Zinc, deficiencies 
Tannic acid/strong tea 
Smoking, alcohol 
HPV 
Oesophagitis 
Genetic

Question 14

What makes you more likely to develop an adenocarcinoma

Answer 14

Obesity
More common in males
More common in Caucasians
common in lower 1/3 of oesophagus

Question 15

How does an adenocarcinoma develop

Answer 15

• Genetic factors/reflux/other causes lead to
• Chronic reflux oesophagitis leading to
• barret’s oesophagus leadng to
• low grade dysplasia then
• high grade dysplasia
• adenocarcinoma

Question 16

What is the mechanism of carcinoma metastases

Answer 16

Direct invasion
Lymphatic permeation
Vascular invasion

Question 17

How does a oesophageal carcinoma present

Answer 17

Dysphagia due to tumour obstruction 
General symptoms of malignancy 
-anemia 
-weight loss 
-loss of energy 
due to effects of metastasis

Question 18

How do oral squamous cell carcinomas present

Answer 18

White, red, speckled ulcer/lump

Often on floor of mouth, lateral border and ventral tongue, soft pallet and tonsillar pillars

Question 19

What causes squamous cell carcinomas in the mouth

Answer 19

Tobacco 
Alcohol 
Betel quid chewing
Viral/HPV  
Chromic infections 
Genetics 
Post transplant

Question 20

How are SCCs graded

Answer 20

By degree of differentiation
Well differentiated- very obviously squamous by with keratnization and ‘prickles’
Moderately differentiated
Poorly differentiated - may be difficult to identify tumour cells as epithelial

Question 21

What features of the SCC relate to it’s prognosis

Answer 21

1. tumour diameter
2. depth of invasion
3. pattern of invasion
4. Lymphovascular invasion
5. neural invasion
6. involvement of surgical margins
7. metastatic disease
8. Spread of lymph node metastases

Question 22

Treatment for SCC

Answer 22

Surgery

+/- adjuvant treatment (suppresses secondary tumour formation)