Oral and Oesophageal Pathology

Question 1

Reflux oesophagitis

Answer 1

Inflammation of the oesophagus due to refluxed low pH gastric content

Question 2

What can cause reflux oesophagitis?

Answer 2

Defective sphincter mechanism +/- hiatus hernia, abnormal oesophageal motility, increased intra-abdominal pressure

Question 3

Microscoping imaging in reflux oesophagitis

Answer 3

Basal zone epithelial expansion, intraepithelial neutrophils, lymphocytes and eosinophils

Question 4

Complications of reflux oesophagitis

Answer 4

Ulceration, bleeding, stricture, Barrett’s oesophagus

Question 5

Barrett’s oesophagus

Answer 5

Metaplasia - replacement of stratified squamous epithelium by columnar epithelium

Question 6

Cause of Barrett’s oesophagus

Answer 6

Persistent reflux of acid or bile

Question 7

Macroscopic imaging of Barrett’s oesophagus

Answer 7

Red velvety mucosa in lower oesophagus

Question 8

Microscopic imaging of Barrett’s oesophagus

Answer 8

Columnar lined mucosa with intestinal metaplasia

Question 9

Risks of Barrett’s oesophagus

Answer 9

Increased risk of developing dysplasia and carcinoma of the oesophagus

Question 10

What type of WBC is associated with allergic oesophagitis?

Answer 10

Eosinophils

Question 11

Risk factors for allergic oesphagitis

Answer 11

Personal/family history of allergy, asthma, young, male > female

Question 12

Macroscopic view of oesophagus in allergic oesophagitis

Answer 12

Corrugated or ‘spotty’ oesophagus

Question 13

Treatment for allergic oesophagitis

Answer 13

May include steroids/cromoglycate/montelukast

Question 14

Which virus is related to squamous papilloma (benign oesophageal tumour?)

Answer 14

HPV

Question 15

Very rare benign oesophageal tumours

Answer 15

• Leiomyomas
• Lipomas
• Fibrovascular polyps
• Granular cell tumours

Question 16

Malignant oesophageal tumours

Answer 16

Squamous cell carcinoma, adenocarcinoma

Question 17

Squamous cell carcinoma:

• Which gender is most affected?
• High risk areas
• Aetiology

Answer 17

• Males
• North Western France, Northern Italy, South Africa, Brazil, central China
• Vitamin A deficiency, zinc deficiency, tannic acid, smoking, alcohol, HPV, oesophagitis, genetic

Question 18

Aetiology for adenocarcinoma

Answer 18

Males, caucasians, obesity

Question 19

In which part of the oesophagus is adenocarcinoma most commonly found?

Answer 19

Lower 1/3rd

Question 20

Pathogenesis of adenocarcinoma

Answer 20

Chronic reflux oesophagitis → Barrett’s oesophagus → low grade dysplasia → high grade dysplasia → adenocarcinoma

Question 21

Mechanisms of metastases of carcinoma of the oesophagus

Answer 21

Direct invasion, lymphatic permeation, vascular invasion

Question 22

General symptoms of malignancy due to effects of metastases

Answer 22

Anaemia, weight loss, loss of energy

Question 23

High sites for oral squamous cell carcinoma

Answer 23

Floor of mouth, lateral border of and ventral tongue, soft palate, retromolar pad, tonsillar pillars

Question 24

Aetiology of oral squamous cell carcinoma

Answer 24

Tobacco, alcohol, betel quid, nutritional deficiencies, post transplant, history of primary oral SCC

Question 25

Histopathological features relating to prognosis of SCC

Answer 25

Tumour diameter, depth of invasion, pattern of invasion, lymphovascular invasion, neural invasion, involvement of surgical margins, metastatic disease

Question 26

Treatment for SCC

Answer 26

Surgery +/- adjuvant therapy