Oral and Oesophageal Pathology Flashcards
what is the anatomical relations of the oesophagus
passes under the bronchus and arch of the aorta and passes through the diaphragm in from of the descending aorta
what is the Z line
the gastro oesophageal junction that joints the stomach to the oesophagus
what cells make up a normal oesophagus
lined by stratified sqaumous epithelium with basal layer and submucosal glands
what is acute oesophagitis
inflammation of the oesophagus due corrosion following chemical ingestion or infection in immunocompromised patients (candidiasis, herpes, CMV- ctyomegaly virus)
what is chronic oesophagitis
reflux disease (reflux oesophagitis)
what is refluc oesophagitis
inflammation of the oesophagus due to refluxed low pH gastric content moving through the GOJ
what can cause reflux oesophagus
defective sphincter mechanism +/- hiatus hernia
abnormal oesophageal motility
increased intra- abdominal pressure (pregnancy, obesity)
what is a hiatus hernia
when the stomach goes through the hiatus in the diaphragm
what is seen microscopically in an reflux oesophagus
basal zone epithelial expansion (basal zone hyperplasia as it tries to regenerate) and accumulation of immune cells- intraepithelial neutrophils, lymphocytes and eosinophils
why are you more likely to develop malignancy in reflux oesophagus
as regeneration of epithelium means cells are mitosing at a higher rate
what are the complications of relfux
ulceration (bleeding) painful and may lead to anaemia
stricture- fibrosis, dysphagia
barretts oesophagus
what is barretts oesophagus
replacement of stratified squamous epithelium by columnar epithelium- metaplasia due to persistent reflux of acid or bile
what is metaplasia
replacement of one cell type with another
what does barretts oesophagus look macroscopically
red velvety mucosa replacing normal mucosa in lower oesophagus extending upwards in irregular fashion
what does barretts oesophagus look like microscopically
normal squamous epithelium replaced by columnar epithelium (which i glandular, has goblet cells that secrete mucous so are more resistant to acid)
columnar lined mucosa with interstitial metaplasia
why is barretts oesophagus unstable
as there is continuing damage- increased risk of developing dysplasia and carcinoma of the oesophagus
what is dysplasia
the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.
what is a more likely cause of squamous cell carcinoma
drinking and smoking
what is allergic oesophagitis
eosinophillic oesophagus- history of allergy/ asthma, pH probe negative for reflux, increased eosinophils in the blood
what does allergic oesophagitis look like macroscopically
corrugated (feline)- looks like a trachea, ridged- or spotty
what does allergic oesophagitis look like microscopically
large numbers of intraepithelial eosinophils
what are the treatments for allergic oesophagitis
steroids, chromoglycate, montelukast
what is a papilloma
a small wart-like growth on the skin or on a mucous membrane, derived from the epidermis and usually benign
what papilloma is associated with the oesophagus
squamous papilloma- assymptomatic, HPV related
what benign are found in the oesophagus
squamous papilloma, leiomyomas, lipomas , fibrovascular polyps, granular cell tumours
what malignant tumours are found in the oesophagus
squamous cell carcinoma, adenocarcinoma (from transformed barretts oesophagus)
what causes squamous cell carcinoma in the oesophagus
vit A, zinc deficiency
tannic acid/ strong tea
SMOKING AND ALCOHOL
HPV
oesophagitis
genetic
what is GORD
gastro-oesophageal reflux disease
why does barretts oesophagus result in metaplasia
is a protective response as allows faster generation
what are the two types of dysplasia
low and high grade
what can adenocarcinomas cause
obstruction and dysphagia (difficulty swallowing)
what can be seen microscopically in tumours
clusters and glands
what are the mechanisms of metastases of oesophagus
direct invasion, lymphatic permeation, vascular invasion (spread via bloodstream)
what can happen in oesophageal carcinomas directly invading surrounding structures
can create fistulas (aspiration pneumonia), septicaemia, haemorrhage
what are the general symptoms of malignancy
anaemia, weight loss, malaise
what does carcinoma of the oesophagus present with
dysphagia
what is a mallory weiss tear
tear or laceration of the right border or near the GOJ
can you get oesophageal varices
yes
what are 90% of oral cancers
squamous cell carcinomas
how do oral cancers present
very variable- white, red, speckled, ulcer, lump
where are the high risk sites of oral cancer
floor of mouth, lateral border/ ventral tongue, soft palate, retromolar pad/ tonsillar pillars
where are oral cancers rare
hard palate, dorsum of tongue
what causes oral cancer
tobacco, alcohol, diet, viral, HPV, infections, nutritional deficiencies, genetics, post transplant
how is oral SSC graded
degree of differentiation:
-well differentiated: very obviously squamous with prickles and keratinistion
-poorly differentiated: may be hard to identify as epithelial
what is the TNM criteria for oral cancer
T- diameter, structures invaded
N- lymph node status
M-metastasis
what is the treatment for oral cancer
surgery, +/- adjuvant therapy (chemotherapy/ radiotherapy)
what is the 5 year survival of oral cancer
40-50%
