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GI-week 1 > Oral cavity and esp path > Flashcards

Oral cavity and esp path Flashcards

1
Q

define Aphthous ulcers (canker sores), what is it assocaited with?

A

very common, shallow, superficial mucosal ulcerations, usually painful and often recurrent. associated with celiac disease or inflammatory bowel disease. Typically spontaneously regress within several weeks.

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2
Q

Define mucosal fibroma, what is it assocaited with>

A

reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue, typically secondary to chronic irritation.

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3
Q

Define pyogenic granuloma, who gets it?

A

polypoid red lesion, composed of lobular reactive proliferation of capillaries (eruptive hemangioma). Usually occurs on the gingiva in children, young adults, pregnant women.

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4
Q

Peripheral giant cell granuloma happens where and is composed of what?

A

reactive lesion of the gingiva composed of fibroangiomatous proliferation with numerous multinucleated giant cells. Grossly can look like pyogenic granuloma.

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5
Q

What is glossitis? What else is it used to describe? What is it due to

A

defined as inflammation of the tongue, but also used to describe the beefy-red appearance of the tongue encountered in certain deficiency states, such as vitamin B12 deficiency.

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6
Q

What is plummer vinson syndrome

A

Combination of iron-deficiency anemia, glossitis, and esophageal dysphagia associated with esophageal webs

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7
Q

What is the redness due to in glossitis?

A

is secondary to atrophy of the papillae of the tongue and thinning of the mucosa

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8
Q

What does a geographic tongue look like? What is it due to?

A

migratory “map like” appearance of the tongue, due to focal loss of the papillae

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9
Q

What are the symptoms of geographic tongue?

A

asymptomatic, but some may experience a mild burning sensation

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10
Q

whats present microscopically on a geopgraphic tongue?

A

intraepithelial neutrophilic inflammation

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11
Q

what are fordyce’s granules

A

heterotopic collections of sebaceous glands in the oral cavity.

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12
Q

What does hairy leukoplakia present with?

A

White, confluent patches of “fluffy” hyperkeratosis on the lateral sides of the tongue. Unlike thrush (candida infection), the lesion cannot be scraped off.

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13
Q

Who gets hairy leukoplakia

A

immunocompromised-may be 1st sign of HIV, secondary to EBV infection

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14
Q

Sqaumous papilloma is assocaited with?

A

HPV

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15
Q

What percent of leukoplakia demonstrates precancerous squamous dysplasia in additoon to addition to squamous hyperplasia and hyperkeratosis?

A

5-25%

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16
Q

Define erthroplakia

A

defined as a red, velvety patch in the oral cavity that may be flat or slightly eroded.

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17
Q

What is the precancer rate in erythroplakia?

A

much higher than leukoplakia, high rate precancerous dysplasia!

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18
Q

Erythroplakia and leukoplakia are often seen in patients with what kind of lifestyle choices

A

TOBACCO USE! q

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19
Q

What are the histological findings of leukoplasia?

A

leukoplakic lesion include hyperkeratosis with or without parakeratosis, often with irregular epithelial hyperplasia with or without dysplasia

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20
Q

What does erthyroplakia look like on histology?

A

dysplasia and/or carcinoma that may include severe dysplasia

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21
Q

Where does actinic cheilitis occur? What is it ?

A

Leukoplakic lesion of the lower lip with loss of the distinct demarcation between the lower lip vermilion border and the skin of the lip
SUN ASSOCIATED

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22
Q

What are the histololgical changes of actinic chelilitis

A

cytologic atpia,
increased mitotic activity
orthokeratosis
connective tissue solar changes

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23
Q

What are the similar risk factors for the developmenting oral cavity, oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma?

A

Smoking, drinking, HPV, exposure to sunlight/pipe smoke, middle age older adults,

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24
Q

What might be the first sign of squamous cell carcionma

A

enlarged cervical lymph node

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25
Q

whats the survival rate of SCC?

A

80% 5-year survival, advanced stage lesions 19% 5-year survival

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26
Q

patietns with SCC in the oropharynx do better with or without HPV?

A

WITH! , hpv can be detected in tumors,

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27
Q

What is a major risk factor for nasopharyngeal squamous cell carcinoma

A

EBV, first presentation might be metastasis in cervical lymph nodes

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28
Q

Who gets Nasopharyngeal angiofibromas? Clinical appearance?

A

in young adolescent males and men before the age of 25. Most common clinical complaints are persistent nasal obstruction and epistaxis.

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29
Q

Sinonasal (Schneiderian) papillomas benign or cancerous?

A

benign

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30
Q

What sinonasal papilloma is more likely to occur

A

inverted, grows from lateral wall

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31
Q

what sinonasal papillomas are assocaited with HPV

A

exophytic (septal), inverted,

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32
Q

whats the most common site of metastases for oral cavity and pharyngeal squamous cell carcinoma

A

cervical LN! Distant metastasis → mediastinal LN, lung, liver, bone. Presenting often w/ cervical neck LN enlargement by SCC

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33
Q

define xerostomia, cause?

A

dry mouth! due to decrease saliva.
Due to Sjogrens sydromem
previous radiation therapy
side effect of prescribed medications.

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34
Q

Define sialadentis, what is it due to?

A

inflammation of salivary glands. Caused by trauma, bacterial/viral infx (mumps), autoimmune (sjogren’s), sialolithiasis (salivary duct stone → secondary bacterial infx = S. Aureus and S. viridans).

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35
Q

Lymphoepithelial sialadenitis (LESA, also known as Mikulicz disease), is what kind of disease?

A

autoimmune involving the salivary glands

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36
Q

What do most causes of LESA present with?

A

salivary gland mainfestations of Sjorgens syndrome, acrimal glands (dry mouth and dry eyes (keratoconjunctivitis sicca)

37
Q

What do you see on LESA path report?

A

polyclonal lymphoid inflammation of the salivary gland, leading to gland enlargement and characteristic lymphoepithelial lesion

38
Q

What has a similar morphology to LESA?

A

HIV-associated sialadenitis (benign lymphoepithelial cysts)

39
Q

On a path report, what do you need to distinguish LESA from?

A

B-cell MALT lymphoma, use flow cytometry to dx

40
Q

Whats the appearance of a mucocole? whats it due to?

A

fluid filled lesion on lower lip due to either blockage or trauma, cyst cavity with mucinous material,

41
Q

What is the most common salivary gland tumor? Where is it found?

A

Pleomorphic Adenoma (mixed tumor), PAROTID GLAND!

42
Q

The cells of the Pleomorphic Adenoma (mixed tumor) can be of what orgin? What else is it assocaited with?

A

ductal or myoepithelial orgin (can be mixed or just one

Also assocaited with mesenchymal matrix of myxoid, hayline, and chondroid (cartilaginous) tissue.

43
Q

is a Pleomorphic Adenoma cancerous or benign?

A

BENIGN

44
Q

What is the clinical signs of Pleomorphic Adenoma

A

Painless, discrete,
well­circumscribed mass w/ small protrusions (enucleation of tumor =
25% recurrence). Rarely cause pleomorphic adenoma (if long duration → poorly differentiated + high grade = carcinoma ex pleomorphic adenoma or malignant mixed tumor

45
Q

Whats the second most common salviary gland tumor? Gland?

A

Warthin tumor (Papillary Cystadenoma Lymphomatosum), parotid

46
Q

Who gets a warthin tumor?

A

smokers

47
Q

Whats warthin tumor look like histologically

A

encapsulated
cystic lesion with dual layer of bland esioniphilic (oncocytic) epithelium
reactive lymphoid stroma

48
Q

whats the most common malignant salivary gland tumor in children

A

Mucoepidermoid carcinoma

49
Q

Where does Mucoepidermoid carcinoma occur?

A

parotid

50
Q

What does Mucoepidermoid carcinoma look like histoligcally?

A

encapsulated but a lot of times infilrate at the margins

Composed of a variable mixture of squamous cells, mucus-secreting cells, and intermediate cells.

51
Q

Whats the survival rate pf Mucoepidermoid carcinoma

A

Course dependent on grade. Low grade recur 15%, 5 yr survival = 90% due to low metastases… high grade recur 25­-30%, w/ 5 yr survival of only 50%.

52
Q

Whats some features of adenoid cystic cacrinoma?

A

slow growing, can invade CNS, can occur in the minor (MOST COMMON MINOR MALIGNANT) and major glands,

53
Q

50% of adenoid cystic carcinomas do what?

A

50% disseminate to lungs, bone, liver, and brain, often decades after removal

54
Q

WHATS THe survival time of adenoid cystic carcinoma?

A

5 yr survival = 60­-70%, 10 yr survival = 30%, 15 yr survival = 15%

55
Q

What is an esphogeal atresia?

A

congenital defect, where the esophagus ends in a blind­ended pouch rather than connecting normally to the stomach. Seen in about 1 in 3,000 live births

56
Q

Define Tracheoesophageal fistula:

A

is an abnormal connection (fistula) between the esophagus and the trachea. Results from abnormal partitioning by the tracheoesophageal septum (esophagus connects to bifurcation of trachea into the primary bronchi).

57
Q

Define esophageal stenosis

A

a narrowing or tightening of the esophagus that causes swallowing difficulties. Can be congenital, but usually due to injury and inflammation from chronic gastroesophageal reflux, irradiation, or caustic injury.

58
Q

Where is an Esophageal mucosal webs? Where is a esphageal rings?

A

webs are UPPER, rings are lower

59
Q

What are Esophageal mucosal webs?

A

protusions of mucosa that can cause an obstruction- seen in the upper esophagus,

60
Q

Esophageal mucosal webs are assocaited with what other symptoms/syndromes?

A

chronic iron-deficiency anemia, glossitis, oral leukoplakia, and spoon nails is known as the Plummer-Vinson syndrome

61
Q

Whats the difference besides location, of the esphogeal rings to the webs?

A

the rings are thicker and circumferential; may contain muscularis propria

62
Q

Esophageal rings aka?

A

Schatzki rings

63
Q

Where is Zenker’s diverticulum found?

A

Located above the upper esophageal sphincter as an outpouching of mucosa and submucosa through a weakend posterior cricopharyngeus muscle

64
Q

is Zenker’s diverticulum a true divertiuculum?

A

NO

65
Q

What can happen if a Zenker diverticulum gets large enough?

A

food can get stuck ,producing a mass and symptoms of painful swallowing, halitosis, regurgitation, and diverticulitis.

66
Q

Where does Mallory-Weiss syndrome take place? What is it associated with symptom-wise?

A

is associated with longitudinal mucosal lacerations in the distal esophagus and proximal stomach, usually associated with severe retching or vomiting-CAN BE A CAUSE OF UPPER GI BLEED!

67
Q

Who gets Mallory-Weiss syndrome?

A

alcoholics

68
Q

What does a hiatal hernia result from>

A

separation of the diaphragmatic crura and protrusion of the stomach into the thorax through the defect

69
Q

Most hiatal hernias occur when?

A

Later in life- 50% of adults over the age of 50 have hiatal hernia!!! some are congenital

70
Q

What are the symptoms of a hiatal hernia in some patients

A

in about 10% of patients, get symptoms similar to GERD with inflammation, ulceration, stricture, and hematemesis (vomiting blood)

71
Q

What is the most common type of hiatal hernia?

A

sliding type 1

72
Q

What are the most ommon types of infectious esophagitis that can occur in
immunocompromised patients

A

Candida,
Herpessimplex,
Cytomegalovirus(CMV)

73
Q

What are some other causes of esophagitis?

A

Ingestion of corrosive agents (lye strictures), Crohn’s disease, drugs, chemo, skin diseases

74
Q

What kind of inflammation do you see with esophagitis?

A

eosinophilic

with basal epithelial hyperplasia, in the absence of acute inflammation.

75
Q

Eosinophilic esophagitis is though to be due to?

A

allergic reaction to food?

76
Q

clinical presentation of Eosinophilic esophagitis

A

Adults and teenagers may present with food impaction, persistent dysphagia (difficulty swallowing), or GERD symptoms that fail to respond to medical therapy; children can present with feeding disorders, vomiting, abdominal pain, dysphagia, and food impaction.

77
Q

What is the change seen in Barretts esophagus?

A

conversion of the normal squamous mucosa of the esophagus to metaplastic columnar epithelium
confirmed pathologically to hve intestinal metaplasia

78
Q

what is 10% of Barretts esophagus due to?

A

chronic GERD

79
Q

Havign barretts esophagus increases your chances of developing what

A

esophageal glandular dysplasia and adenocarcinoma

80
Q

those who develop Esophageal adenocarcinoma have what other diseases uaually?

A

Barrett’s esophagus and long-standing GERD

81
Q

What puts people at increases risk for developing Esophageal adenocarcinoma

A

glandular dysplasia

82
Q

Amplification of __ can be seem in Esophageal adenocarcinomas

A

EGFR

83
Q

Esophageal adenocarcinomas are usually in what part of the esophagus?

A

distal 1/3

84
Q

Symptoms of a Esophageal adenocarcinomas?

A

pain on swallowing (odynophagia), hematemesis, chest pain, and progressive weight loss.

85
Q

What are some risk factors for Esophageal squamous cell carcinoma (SCC)

A

alcohol and tobacco use, caustic esophageal injury, achalasia, tylosis (genetic disorder characterized by thickening of the palms
and soles), Plummer­Vinson syndrome, and frequent consumption of very hot beverages. Rarely, HPV infection may also be implicated in some SCC.

86
Q

Where are Esophageal squamous cell carcinoma (SCC) located?

A

half of them are located in the middle 1/3, can cause a stricture

87
Q

most common cause of esophageal squamous papillomas?

A

benign squamous neoplasm, usually exophytic, strong association with HPV

88
Q

the most common benign mesenchymal tumor of the esophagus.?

A

Leiomyoma

GI-week 1 (11 decks)

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