Oral Cavity Flashcards
How can we divide lesions of the oral cavity?
- Inflammations
- Viruses: HSV, HFMD
- Bacteria
- Fungi: Candida Albicans (moniliasis) - Oral Ulcers
- Neoplasms and Precancerous Conditions
- Leukoplakia
- Squamous Cell Neoplasms
What are 8 causes of mouth ulcers?
- Trauma
- Recrueent Aphthous Ulcers
- Infections (Herpes Simplex, Herpes Zoster, Candidiasis, HFMD)
- Blood Dyscrasias (Folic Acid, VB12 Deficiency)
- IBD
- Mucocutaneous Diseases (Lichen Planus, Pemphigus vulgaris, Erythema multiforme, SLE)
- Cytotoxic Chemotherapy
- Neoplasms (Squamous Cell Carcinoma)
What are apthous ulcers?
Common, recurrent, painful superficial ulceration of oral mucosa
When is apthous ulcers common?
First 2 decades
Do apthous ulcers exist single or multiple>
Both
What are the causes of apthous ulcers?
Unknown etiology, may be associated with immunologic disorders
How long does it take to resole apthous ulcers?
7-10 days
What is leukoplakia? Two definitions please.
A white patch or plaque that cannot be scraped off, and cannot be characterised clinically or pathologically as any other disease
Thickened, keratotic, hyperplastic mucosa with dull whitish appearance
What percenatges of leukoplakia is precancerous?
5-25%
What is erythroplakia and what is its significnace?
Red velvety area that is much less common that leukoplakia. Risk of malignant transformation is much higher.
Where can leukoplakia be found in the oral cavity?
- Buccal Mucosa
- Floor of mouth
- Ventral Tongue
- Palate
- Gingiva
What are the spectrum of changes possible in leukoplakia?
Hyperkeratosis to dysplasia to carcinoma
What are the differential diagnoses of. leukoplakia?
- Candidiasis
- Lichen Planus
What are 6 types of tumours of the oral cavity/oropharynx?
- Tumurs of squamous epithelium
- of glandular eputhelium
- of soft tissue
- of melanogenic system
- disputed or uncertain histogenesis
- unclassified tumours
How to classify tumours of squamous epithelium of oral cavity
benign
- squamous cell papilloma
malignant
- squamous cell carcinoma (‘classic’ HPV negative keratinising SCC)
- HPV positive squamous cell carcinoma
How does squamous cell papilloma present?
Clinically:
1. Exophytic, warty, cauliflower-like lesions that can be solitary or multiple located on uvula, palate, tongue, gingiva, lower lips, buccal mucosa
Histologically:
1. Papillary projections of delicate fibrovascular cores surfaced by mature squamous epithelium
How to treat squamous cell papilloma?
Local Excision
How does HPV negative SCC present?
Clinically:
1. Lesions on lower lips>Tongue (anterior2/3/lateral border)>floor of mouth>cheek>palate
Histologically:
1. High N/C ratio
2. Pleomorphic
3. Infiltrate to underlying stroma
4. Keratin Pearls
5. Fibrotic stroma with inflammation
What age and gender is common for HPV negative SCC?
50-70, male
What is the method of spread of HPV negative SCC
Local infiltration with mets to neck lymph nodes
What is HPV negative SCC associated with?
Leukoplakia with Dysplasia
What are risk factors for HPV neg SCC?
Tobacco, alcohol, betel nut, chronic irritation, actinic damage
How to treat HPV neg SCC?
Local Excision with removal of neck lymph nodes
What is the cause of HPV related SCC?
HPV type 16 and 18
Which SCC (HPV related or HPV neg) has better prognosis
HPV related
Risk factor for SCC (HPV related)
Oral Sexual Contact
NOT alcohol or tobacco
Where does HPV related SCC present?
Oropharynx (tonsils, base of tongue, adenoids)
Posterior Pharyngeal Wall
Who gets HPV related SCC?
Younger, Caucasians, Higher SES
Key histological difference between HPV related and HPV neg SCC?
HPV related has minimal keratinisation
What are 3 classifications of salivary gland diseases?
- Inflammations
- Trauma
- Viral: Mumps
- Bacterial : s. aureus, strep viridans
- autoimmune: sjogren - Sialolithiasis
- ductal obstruction (submandibular glands) - Neoplasms
What is the order of salivary glands that are most affected to the least?
Parotid > Submandibular > Sublingual > Minor
State 2 benign neoplasms of the salivary glands. Which is more common?
Pleomorphic adenoma (50%) > Warthin Tumour (5-10%)
State 4 malignant neoplasms of the salivary glands and the order in which they are most common to the least.
Mucoepidermoid Carcinoma (15%) > Adenocarcinoma (10%) > Adenoid Cystic Carcinoma (5%) > Acinic Cell Carcinoma (5%)
How can one tell what the likelihood that a salivary gland tumour is malignant?
Likelihood of malignancy is inversely proportional to the size of the gland
How does pleomorphic adenoma present?
Clinically: Painless, slow-growing mass in front of and below the ear (parotid)
Cut Section: Lobulated, unencapsulated knobbly mass with solid, firm, whittish translucentm chondroid cut surface
Histologically: Epithelial components (ducts, squamous metaplasia), myoepithelial components, chondromyxoid components
What is the cut section appearance of warthin tumour?
Oval, Round, Encapsulated Mass
Soft pale grey with spaces filled with milky secretions
What is the histological appearance of warthin tumour
Spaces lined by double layer of epithelial cells
Dense lymphoid stroma with germinal centres
Which age and gender is predisposed to warthin tumour?
Male, 5th-7th decade
Where does warthin tumour occur?
parotid, superficial lobe
what percentage of warthin tumour is bilateral and multifocial?
10%, 10%
5 types of esophagial pathologies?
- Congenital Anomalies
- atresia
- tracheo-esophageal fistula - Motor Dysfunction
- achalasia
- hiatus hernia - Esophageal Varices
- Esophagitis
- Neoplasms
What is esophageal varices associated with, and what are suggestive symptoms?
- Portal hypertension secondary to cirrhosis
Hematemesis and melena
Symptoms of hiatus hernia (5)
- Reflux esophagitis = Pain
- Hematemesis = Peptic Ulceration
3, Dysphagia = Sclerosis and Strictures - Columnar Metaplasia = Barrett Esophagus
- Dysplasia = Adenocarcinoma
5 causes of esophagitis?
- Reflux esophagitis
- GERD
- Barrett Esophagus - Infections
- HSV, CMV, Candida, Bacteria, Parasites - Pill, Drug, Toxin-related
- Cytotoxic Chemotherapy
- Radiation
What are symptoms of GERD?
Heartburn, Sore throat, Cough
What are risk factors for GERD?
Age, BMI, Tobacco
What is the pathophysiology of GERD?
Transient Lower Esophageal Sphincter Relaxation; Reflux of gastric/duodenal fluids into the esophagus = inflammation; squamous cells secrete cytokines in response to acids and bile salts that trigger lymphocytes and polymorphs
For GERD:
a) Endoscope View:
b) Histology:
a) 50% normal; hyperemia, erosions, strictures
b) Basal Zone hyperplasia, elongated lamina propria papillae, intraepithelial polymorphs, lymphocytes, eosinophils
What happens in Barret Esophagus?
Distal squamous mucosa replaced by columnar metaplasia (more proximal Squamo-columnar junction)
What is the criteria for diagnosing Barrett’s Esophagus?
Endoscopy: Columnar Epithelium above GE junction
Histology: Intestinal Metaplasia (goblet cells)
What can result from Barret’s Esophagus?
- Ulceration, bleeding, scarring with stricture
- Dysplasia
- Adenocarcinoma (Red, velvety look to distal esophagus –> Columnar metaplasia/intestinal metaplasia –> Dysplasia –> Adenocarcinoma
Types of esophageal neoplasms?
Squamous Cell Carcinoma
Adenocarcinoma
Leiomyoma (benign mesenchymal tumour of smooth muscle)
Who gets squamous cell carcinoma of esophagus?
Older, Male
How does Squamous Cell Carcinoma of esophagus spread
Submucosal lymphatics; local extension into mediastinum
If upper 1/3: cervical
If middle 1/3: Mediastinal
If lower 1/3: Gastric & Celiac
Risk factors for SCC of esophagus?
Alcohol, Tobacco, Radiation
How does SCC of esophageal look like?
Circumferential, ulcerated, polypoid
