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GIT > Oral Cavity > Flashcards

Oral Cavity Flashcards

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1
Q

How can we divide lesions of the oral cavity?

A
  1. Inflammations
    - Viruses: HSV, HFMD
    - Bacteria
    - Fungi: Candida Albicans (moniliasis)
  2. Oral Ulcers
  3. Neoplasms and Precancerous Conditions
    - Leukoplakia
    - Squamous Cell Neoplasms
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2
Q

What are 8 causes of mouth ulcers?

A
  1. Trauma
  2. Recrueent Aphthous Ulcers
  3. Infections (Herpes Simplex, Herpes Zoster, Candidiasis, HFMD)
  4. Blood Dyscrasias (Folic Acid, VB12 Deficiency)
  5. IBD
  6. Mucocutaneous Diseases (Lichen Planus, Pemphigus vulgaris, Erythema multiforme, SLE)
  7. Cytotoxic Chemotherapy
  8. Neoplasms (Squamous Cell Carcinoma)
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3
Q

What are apthous ulcers?

A

Common, recurrent, painful superficial ulceration of oral mucosa

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4
Q

When is apthous ulcers common?

A

First 2 decades

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5
Q

Do apthous ulcers exist single or multiple>

A

Both

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6
Q

What are the causes of apthous ulcers?

A

Unknown etiology, may be associated with immunologic disorders

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7
Q

How long does it take to resole apthous ulcers?

A

7-10 days

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8
Q

What is leukoplakia? Two definitions please.

A

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

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9
Q

What percenatges of leukoplakia is precancerous?

A

5-25%

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10
Q

What is erythroplakia and what is its significnace?

A

Red velvety area that is much less common that leukoplakia. Risk of malignant transformation is much higher.

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11
Q

Where can leukoplakia be found in the oral cavity?

A
  1. Buccal Mucosa
  2. Floor of mouth
  3. Ventral Tongue
  4. Palate
  5. Gingiva
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12
Q

What are the spectrum of changes possible in leukoplakia?

A

Hyperkeratosis to dysplasia to carcinoma

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13
Q

What are the differential diagnoses of. leukoplakia?

A
  1. Candidiasis
  2. Lichen Planus
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14
Q

What are 6 types of tumours of the oral cavity/oropharynx?

A
  1. Tumurs of squamous epithelium
  2. of glandular eputhelium
  3. of soft tissue
  4. of melanogenic system
  5. disputed or uncertain histogenesis
  6. unclassified tumours
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15
Q

How to classify tumours of squamous epithelium of oral cavity

A

benign
- squamous cell papilloma

malignant
- squamous cell carcinoma (‘classic’ HPV negative keratinising SCC)
- HPV positive squamous cell carcinoma

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16
Q

How does squamous cell papilloma present?

A

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

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17
Q

How to treat squamous cell papilloma?

A

Local Excision

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18
Q

How does HPV negative SCC present?

A

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

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19
Q

What age and gender is common for HPV negative SCC?

A

50-70, male

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20
Q

What is the method of spread of HPV negative SCC

A

Local infiltration with mets to neck lymph nodes

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21
Q

What is HPV negative SCC associated with?

A

Leukoplakia with Dysplasia

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22
Q

What are risk factors for HPV neg SCC?

A

Tobacco, alcohol, betel nut, chronic irritation, actinic damage

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23
Q

How to treat HPV neg SCC?

A

Local Excision with removal of neck lymph nodes

24
Q

What is the cause of HPV related SCC?

A

HPV type 16 and 18

25
Q

Which SCC (HPV related or HPV neg) has better prognosis

A

HPV related

26
Q

Risk factor for SCC (HPV related)

A

Oral Sexual Contact

NOT alcohol or tobacco

27
Q

Where does HPV related SCC present?

A

Oropharynx (tonsils, base of tongue, adenoids)
Posterior Pharyngeal Wall

28
Q

Who gets HPV related SCC?

A

Younger, Caucasians, Higher SES

29
Q

Key histological difference between HPV related and HPV neg SCC?

A

HPV related has minimal keratinisation

30
Q

What are 3 classifications of salivary gland diseases?

A
  1. Inflammations
    - Trauma
    - Viral: Mumps
    - Bacterial : s. aureus, strep viridans
    - autoimmune: sjogren
  2. Sialolithiasis
    - ductal obstruction (submandibular glands)
  3. Neoplasms
31
Q

What is the order of salivary glands that are most affected to the least?

A

Parotid > Submandibular > Sublingual > Minor

32
Q

State 2 benign neoplasms of the salivary glands. Which is more common?

A

Pleomorphic adenoma (50%) > Warthin Tumour (5-10%)

33
Q

State 4 malignant neoplasms of the salivary glands and the order in which they are most common to the least.

A

Mucoepidermoid Carcinoma (15%) > Adenocarcinoma (10%) > Adenoid Cystic Carcinoma (5%) > Acinic Cell Carcinoma (5%)

34
Q

How can one tell what the likelihood that a salivary gland tumour is malignant?

A

Likelihood of malignancy is inversely proportional to the size of the gland

35
Q

How does pleomorphic adenoma present?

A

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

36
Q

What is the cut section appearance of warthin tumour?

A

Oval, Round, Encapsulated Mass
Soft pale grey with spaces filled with milky secretions

37
Q

What is the histological appearance of warthin tumour

A

Spaces lined by double layer of epithelial cells
Dense lymphoid stroma with germinal centres

38
Q

Which age and gender is predisposed to warthin tumour?

A

Male, 5th-7th decade

39
Q

Where does warthin tumour occur?

A

parotid, superficial lobe

40
Q

what percentage of warthin tumour is bilateral and multifocial?

A

10%, 10%

41
Q

5 types of esophagial pathologies?

A
  1. Congenital Anomalies
    - atresia
    - tracheo-esophageal fistula
  2. Motor Dysfunction
    - achalasia
    - hiatus hernia
  3. Esophageal Varices
  4. Esophagitis
  5. Neoplasms
42
Q

What is esophageal varices associated with, and what are suggestive symptoms?

A
  1. Portal hypertension secondary to cirrhosis

Hematemesis and melena

43
Q

Symptoms of hiatus hernia (5)

A
  1. Reflux esophagitis = Pain
  2. Hematemesis = Peptic Ulceration
    3, Dysphagia = Sclerosis and Strictures
  3. Columnar Metaplasia = Barrett Esophagus
  4. Dysplasia = Adenocarcinoma
44
Q

5 causes of esophagitis?

A
  1. Reflux esophagitis
    - GERD
    - Barrett Esophagus
  2. Infections
    - HSV, CMV, Candida, Bacteria, Parasites
  3. Pill, Drug, Toxin-related
  4. Cytotoxic Chemotherapy
  5. Radiation
45
Q

What are symptoms of GERD?

A

Heartburn, Sore throat, Cough

46
Q

What are risk factors for GERD?

A

Age, BMI, Tobacco

47
Q

What is the pathophysiology of GERD?

A

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

48
Q

For GERD:
a) Endoscope View:
b) Histology:

A

a) 50% normal; hyperemia, erosions, strictures
b) Basal Zone hyperplasia, elongated lamina propria papillae, intraepithelial polymorphs, lymphocytes, eosinophils

49
Q

What happens in Barret Esophagus?

A

Distal squamous mucosa replaced by columnar metaplasia (more proximal Squamo-columnar junction)

50
Q

What is the criteria for diagnosing Barrett’s Esophagus?

A

Endoscopy: Columnar Epithelium above GE junction
Histology: Intestinal Metaplasia (goblet cells)

51
Q

What can result from Barret’s Esophagus?

A
  1. Ulceration, bleeding, scarring with stricture
  2. Dysplasia
  3. Adenocarcinoma (Red, velvety look to distal esophagus –> Columnar metaplasia/intestinal metaplasia –> Dysplasia –> Adenocarcinoma
52
Q

Types of esophageal neoplasms?

A

Squamous Cell Carcinoma
Adenocarcinoma
Leiomyoma (benign mesenchymal tumour of smooth muscle)

53
Q

Who gets squamous cell carcinoma of esophagus?

A

Older, Male

54
Q

How does Squamous Cell Carcinoma of esophagus spread

A

Submucosal lymphatics; local extension into mediastinum
If upper 1/3: cervical
If middle 1/3: Mediastinal
If lower 1/3: Gastric & Celiac

55
Q

Risk factors for SCC of esophagus?

A

Alcohol, Tobacco, Radiation

56
Q

How does SCC of esophageal look like?

A

Circumferential, ulcerated, polypoid

GIT (3 decks)

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