Oral cavity and GI tract - DONE Flashcards
1
Q
Salivary glands general description:
A
- Capsule
- Tubuloalveolar
- Exocrine function
2
Q
Parotid gland:
A
predominantly serous
3
Q
Submandibular gland:
A
mucous
4
Q
Minor salivary glands location:
A
numerous (hundreds) in lips, in the submucosa of oral cavity
5
Q
Salivary glands % of all tumors:
A
- Parotid -> 65-80% of all tumors
- Submandibular - > 10% of all tumors
- Minor salivary glands -> remainder
6
Q
Salivary glands % of tumors are malignant:
A
- Parotid -> 15-30%
- Submandibular - > 40%
- Minor salivary glands -> 50% (70-90% of sublingual)
7
Q
Who usually get Salivary gland tumors?
A
F > M (Wärthin in males)
8
Q
When does the Salivary gland tumors appear?
A
- Benign appear in 5th-7th decade
- Malignant later
Parotid: swelling in front and below the ear
9
Q
How are the Salivary gland tumors upon diagnosis?
A
4-6 cm in diameter, mobile in palpation (exception: neglected malignant)
- Generally malignant grow faster
10
Q
Mixed tumor =
A
Pleomorphic adenoma
11
Q
Where does most of the Pleomorphic adenoma (Mixed tumor) appear?
A
60% of tumors in the parotid
* Rare in minor salivary glands
12
Q
What increases the risk of Pleomorphic adenoma (Mixed tumor)?
A
Radiation increases the risk
13
Q
Pleomorphic adenoma (Mixed tumor) - Macroscopically:
A
- Rounded, well-demarcated, firm mass
- <6 cm in greatest dimension
- Encapsulated (in small salivary glands capsule not fully developed)
- Expansile growth with small protrusions into surroundings -> enucleation difficult
14
Q
Pleomorphic adenoma (Mixed tumor) - Microscopically:
A
- Mixture of ductal (epithelial) and myoepithelial cells, (both epithelial and mesenchymal differentiation)
- Epithelial elements dispersed throughout the matrix along with varying degrees of myxoid, hyaline, chondroid (cartilaginous), and even osseous tissue
- In some tumors the epithelial elements predominate; in others they are present only in widely dispersed foci
- Islands of well-differentiated squamous epithelium may also be present
- No difference in biologic behavior between the tumors composed largely of epithelial elements and those composed largely of seemingly mesenchymal elements
15
Q
Warthin tumor =
A
Adenolymphoma
16
Q
Where does the Adenolymphoma (Warthin tumor) occur?
A
Almost exclusively in the parotid gland
- 10% are multifocal
- 10% bilateral
17
Q
What is the 2nd most common salivary gland neoplasm?
A
Adenolymphoma (Warthin tumor)
18
Q
Risk factors of Adenolymphoma (Warthin tumor):
A
Smokers have eight times the risk of nonsmokers for developing these tumors
19
Q
Adenolymphoma (Warthin tumor) - Macroscopically:
A
- Round to oval, encapsulated, pale gray mass
- Narrow cystic spaces filled with a mucinous/serous secretion
- 2 to 5 cm in diameter
- Usually arising in the superficial parotid gland (palpable)
20
Q
Adenolymphoma (Warthin tumor) - Microscopically:
A
- Spaces lined by a double layer of neoplastic epithelial cells resting on a dense lymphoid stroma (sometimes germinal centers)
- Polypoid projections of the lymphoepithelial elements
- Surface palisade of columnar cells having an oncocytic appearance; Deep layer of cuboidal to polygonal cells
- Sometimes foci of squamous metaplasia
21
Q
Where can Warthin tumors arise?
A
Warthin tumors can arise within cervical lymph nodes - a finding that should not be mistaken for metastases.
22
Q
Recurrence rates of Warthin tumors after resection?
A
Recurrence rates of only 2% after resection
23
Q
Who usually gets Esophageal squamous cell carcinoma?
A
- In adults over age 45
- M:F = 4:1
24
Q
What are the risk factors of Esophageal squamous cell carcinoma?
A
- alcohol and tobacco use
- poverty
- caustic esophageal injury
- achalasia, tylosis (95% in age of 70)
- Plummer Vinson syndrome
- frequent consumption of very hot beverages
- previous radiation
25
When do people usually get Esophageal squamous cell carcinoma?
50% of ESCC occur in the middle third
26
How does Esophageal squamous cell carcinoma begin?
Begins as an in situ lesion termed squamous dysplasia
27
What does the early lesions of Esophageal squamous cell carcinoma appear like?
Early lesions appear as small, gray-white, plaque-like thickenings
28
What is the level of differentiation of Esophageal squamous cell carcinoma?
Most squamous cell carcinomas are moderately to
| well-differentiated
29
Describe the symptomatic tumors of Esophageal squamous cell carcinoma?
Symptomatic tumors are generally very large at diagnosis and have already invaded the esophageal wall
30
Esophageal squamous cell carcinoma - Clinical features
* Dysphagia, odynophagia (pain on swallowing), and obstruction
* Progressively increasing obstruction by altering patients diet from solid to liquid foods -> extreme weight loss and debilitation
* Hemorrhage and sepsis may accompany tumor ulceration
31
What is the survival rate of Esophageal squamous cell carcinoma?
Overall 5-year survival: 9%
32
What causes the first symptoms of Esophageal squamous cell carcinoma
Occasionally, the first symptoms are caused by aspiration of food via a tracheoesophageal fistula
33
What is the lifetime risk of getting Chronic gastric ulcer, peptic ulcer disease
Lifetime risk: 10% males, 4% females
34
What causes Chronic gastric ulcer, peptic ulcer disease?
Develops on the basis of chronic gastitis
35
What are the main risk factors of Chronic gastric ulcer, peptic ulcer disease?
- Helicobacter pylori infection:
* 85-100% of duodenal ulcers
* 65% of gastric ulcers
- NSAIDs (aspirin, ibuprofen)
36
What are the other risk factors of Chronic gastric ulcer, peptic ulcer disease?
- Zollinger-Ellison syndrome
- cigarette smoking
- high-dose corticosteroids
- alcoholic cirrhosis
- chronic obstructive pulmonary disease
- chronic renal failure
- hyperparathyroidism (hypercalcemia: ↑gastrin)
37
Where is the localization of Chronic gastric ulcer, peptic ulcer disease?
- 95-98% proximal duodenum and stomach (3-4:1)
* Duodenum: bulb
* Stomach: lesser curvature (interface of body and antrum)
38
Is the Chronic gastric ulcer, peptic ulcer disease solitary or not?
80% solitary
39
Describe the classic peptic ulcer:
The classic peptic ulcer is a round to oval, sharply punched-out defect (heaped-up margins: cancers)
40
Chronic gastric ulcer, peptic ulcer disease (alot)
- The base of peptic ulcers is smooth and clean as a result of peptic digestion of exudate (blood vessels may be evident)
- In active ulcers the base may have a thin layer of fibrinoid debris underlaid by a predominantly neutrophilic inflammatory infiltrate
- Beneath this, active granulation tissue infiltrated with mononuclear leukocytes and a fibrous or collagenous scar forms the ulcer base
- Vessel walls within the scarred area are typically thickened and are occasionally thrombosed
- Scarring may involve the entire thickness of the wall and pucker the surrounding mucosa into folds that radiate outward
41
Chronic gastric ulcer, peptic ulcer disease - Clinical features (alot)
* Epigastric burning or aching pain
* The pain tends to occur 1 to 3 hours after meals during the day, is worse at night, and is relieved by alkali or food
* Iron deficiency anemia
* Nausea, vomiting, bloating, and significant weight loss
* Penetrating ulcers: the pain is occasionally referred to the back, the left upper quadrant, or the chest (may be misinterpreted as cardiac!)
42
Chronic gastric ulcer, peptic ulcer disease - Complications:
- Hemorrhage (15-20%)
* In almost 1/3 of patients a first sign
- Perforation (5-10%)
- Obstruction
- Cancer ???
43
What comprises over 90% of all gastric cancers?
Adenocarcinoma
44
Gastric cancer / Carcinoma ventriculi - symptoms:
```
Early symptoms resemble those of chronic gastritis
including:
- dyspepsia
- dysphagia
- nausea which leads to late diagnosis
```
45
Gastric cancer / Carcinoma ventriculi - symptoms:
```
Early symptoms resemble those of chronic gastritis
including:
- dyspepsia
- dysphagia
- nausea which leads to late diagnosis
```
46
Gastric cancer / Carcinoma ventriculi - survival:
The overall 5-year survival is less than 30%
47
Gastric cancer - types:
* Diffuse (M:F=1:1, incidence similar in different countries)
* Intestinal (M:F=2:1, 2nd most common cancer death cause worldwide)
48
Diffuse type of stomach cancer - risk factors?
- Germline mutationsin CDH1, which encodes Ecadherin, a protein that contributes to epithelial intercellular adhesion
- BRCA2 (breast cancer type 2 susceptibility gene) mutations
49
Intestinal type of gastric cancer - risk factors:
- Helicobacter pylori infection
- Smoking
- Alcohol consumption
- Autoimmune atrophic gastitis
- Genetic factors (FAP, others)
- Partial gastrectomies
50
Gastric adenocarcinomas classification depends on:
- most importantly, gross and histologic morphology
| - location in the stomach
51
Most gastric adenocarcinomas involve.......
- the gastric antrum
| - lesser curvature > greater curvature
52
Intestinal type:
- bulky tumors (exophytic mass or an ulcerated)
| - glandular structures
53
Diffuse type:
- diffuse infiltrative growth pattern
- signet-ring cells
- desmoplastic reaction (thickened wall - linitis plastica)
54
Ileitis terminalis Crohn
Inflammatory bowel disease
| - Crohn disease and ulcerative colitis
55
Ileitis terminalis Crohn - Pathogenesis:
- Genetic factors. (family members; in Crohn disease the concordance rate for monozygotic twins is approximately 50%)
- Mucosal immune responses. Immunosuppression - basic IBD therapy
- Epithelial defects
- Microbiota: metronidazole can be helpful in management of Crohn disease
56
What has:
- skip lesions
- transmural inflammation
- ulcerations
- fissures
Crohns disease
57
What has:
- continous colonic involvment, beginning in rectum
- pseudopolyp, ulcer
Ulcerative colitis
58
TABLE PAGE 7
difference between CD and UC
59
What causes CD and UC?
CD and UC result probably from a combination of defects in host interactions with intestinal microbiota, intestinal epithelial dysfunction, and aberrant mucosal immune responses
60
CD =
Crohns disease
61
UC =
Ulcerative colitis
62
Crohns disease - Clinical features:
* Clinical manifestations – extremely variable
* Most patients: mild diarrhea, fever, abdominal pain (20% pain in lower right quadrant – mimics appendicitis)
* Active disease – asymptomatic periods of weeks months
* Reactivation – stress, dietary change, smoking (strong association of onset, but cessation does not cause remission)
* Anemia, protein loss, vitamin B12 malabsorption
* Perforations, fistulas
63
Ulcerative colitis - Clinical features:
- Extra-intestinal manifestation
- Uveitis, polyarthritis, ankylosing spondylitis, erythrema nodosum, clubbing of fingertips (may develop before disease is recognized)
- Pericholangitis, primary sclerosing cholangitis (more commonly associated with UC)
- Increased risk of colonic adenocarcinoma
64
Which one of CD and UC has an increased risk of colonic adenocarcinoma?
Ulcerative colitis (UC)
65
Crohn disease:
- Terminal ileum, ileocecal valve, cecum
- Fissures, thickenning of wall, mesenteric fat extends on serosal surface (creeping fat)
- Ulcerations, Paneth cell metaplasia
- Noncaseating granulomas (35%)
66
Crohn disease - earliest lesion:
Earliest lesion: aphthous lesion
67
Crohn disease - appearance:
Patchy distribution: cobblestone appearance
68
Crohn disease - Microcopic feature of active process:
Microcopic feature of active process:
| abundant neutrophils in crypts epithelium (crypt abscesses)
69
What has a cobblestone appearance?
Crohn disease
70
What has aphthous lesion in early lesions?
Crohn disease
71
What is the 2nd cause of cancer related death in western countries?
Colonic adenocarcinoma
72
Colonic adenocarcinoma - Risk factors - diet:
- Low fiber intake, high carbohydrates and fat intake
73
Who usually gets Colonic adenocarcinoma (risk factors)?
M slightly higher incidence than F
74
Colonic adenocarcinoma - Risk factors:
- Genetic disorders (~5%) : familial adenomatous polyposis –all patients develop colon cancer), hereditary non-polyposis colorectal cancer (Lynch syndrome)
- Inflammatory bowel disease
75
Sporadic colon cancers (90-95%) (alot):
- APC/WNT/β-katenin pathway: left side of colon. Tubular, villous adenoma -> typical adenocarcinoma
- MSH2,MLH1 pathway: right side of colon. Sessile serrated adenoma -> mucinous carcinoma (poorer prognosis)
76
Location for colon cancer:
- Rectosigmoid (50% of cases)
- Ascending colon (15% of cases)
- Descending colon (15% of cases)
- Transverse colon and cecum (each 10%)
77
Screening tests for colon cancer:
- Fecal occult blood test (NOT very sensitive or specific)
- colonoscopy
- Serum carcinoembryonic antigen (CEA) – used to detect recurrences
78
Which screening tests is used to detect recurrences?
Serum carcinoembryonic antigen (CEA)
79
Clinical findings in colon cancer (Left-sided):
Left-sided: change in bowel habits; constipation or diarrhea with or without bleeding
80
Clinical findings in colon cancer (Right-sided):
Right-sided: tend to bleed; blood in the stool and iron deficiency ANEMIA are more likely
81
Clinical findings in colon cancer (Sites of metastasis):
Sites of metastasis: liver and lungs or bone
