Oral Cavity and Sinuses Flashcards
Candidiasis (moniliasis, thrush): location, presentation, who
- oral
- white patch clinically, easily removed by scraping
- diabetes or immunocompromised associated
Tumor-like conditions
- pyogenic granuloma/lobular capillary hemangioma
- mucoceles
Pyogenic granuloma/lobular capillary hemangioma
- benign reactive process
- nodular growth on the mucosal surface
- not a granulomatous process*
Mucoceles
- obstruction of oral mucosa mucous glands
- leads to inflammation
- caused by trauma
- cystic dilation of ducts filled with mucin
Potentially premalignant lesions
- leukoplakia (white patch)
- erythroplasia (red patch)
Leukoplakia (white patch)
- can be benign or dysplastic/carcinoma
- cannot be removed by scraping
- irritation, inflammation can cause leukoplakia reaction
- must always be considered potentially pre cancerous unless proven otherwise (malignancy 1-15%)
Erythroplakia (red patch)
- more likely to be associated with malignancy, up to 50%
Leukoplakia (white patch): histology of benign disease
- hyperkeratosis
- mucosal epithelial hyperplasia
- orderly maturation
- no distortion of architectural order
Leukoplakia or erythroplakia with severe dysplasia
- architectural disorder
- nuclear irregularity
- nuclear pleomorphism
Squamous carcinoma of lip/skin: etiology, survival, differentiation
- etiology: sun (UV)
- survival: best
- differentiation: well
Squamous carcinoma: floor of mouth, anterior tongue, hard palate: etiology, survival, differentiation
- etiology: ETOH, smoking
- survival: intermediate, poor
- differentiation: variable
Squamous carcinoma of oropharynx: etiology, survival, differentiation
- etiology: HPV
- survival: favorable
- differentiation: variable
Result of oropharyngeal cancer being associated with HPV
- better survival than non-HPV associated carcinomas
- nearly exclusively seen in men
Oral cavity/oropharyngeal squamous carcinoma: treatment
- surgical: surgical margins guided by intra operative frozen sections
- post op radiation/chemoradiation given for metastatic or incompletely resected tumor
Salivary gland sialadenitis
- acute and chronic forms
- can be secondary to obstruction of a major excretory duct
Chronic sialadenitis
- duct obstruction–inflammation–tissue destruction: acinic atrophy, ductal metaplasia, duct dilation, chronic inflammation (lymphocytes), fibrosis (few cells)
Autoimmune sialadenitis
- sjogren’s syndrome
Sjogren’s syndrome
- autoimmune multi organ process
- affects lacrimal and salivary glands
- dry eyes, dry mouth
- pathologic finding: lympho-plasmacytic infiltration
Sjogren’s syndrome: histologic finding
- inflammatory FOCUS
Salivary gland tumors: general info
- uncommon
- large number of types of tumors
- major glands: parotid, submandibular, sublingual
- parotid gland: 85% of salivary gland tumors
Salivary gland tumors: facts
- 65-80% of parotid tumors are benign
- smaller the gland, more likely the tumor will be malignant
- most salivary gland tumors are slow growing
- all salivary gland tumors are treated primarily by surgical removal
Benign salivary tumors
- pleomorphic adenoma
- warthin’s tumor (papillary cystadenoma lymphomatosum)
Pleomorphic adenoma: frequency, sit
- frequency: most common tumor
- site: usually parotid, may occur in any salivary gland
Pleomorphic adenoma: cell involvement
- mixed tumor: epithelial cells (ducts, acini); mesenchymal cells (myoepithelial, chondroid, myxoid)
Salivary gland tumors: treatment
- total excision of parotid gland hampered by facial nerve (separates superficial and deep lobes)
- most pleomorphic adenomas occur in superficial lobe
- facial nerve at risk of surgical treatment of histologically benign process
Pleomorphic adenoma: behavior
- conservative surgical therapy, recurrence if not completely removed
- rarely, epithelial or both epithelial/mesenchymal cells become malignant
Pleomorphic adenoma: malignant transformation
- carcinoma ex pleomorphic adenoma: epithelial malignancy
- carcinosarcoma: epithelial & mesenchymal malignancy
Warthin’s tumor (papillary cytadenoma lymphomatosum): frequency, site, microscopic, behavior
- frequency: second most common salivary gland tumor, older population usually men SMOKERS
- site: parotid, maybe bilateral; arise from epithelial cells in parotid LNs
- microscopic: epithelial (oncocytes) overlie lymphoid follicles
- behavior: no recurrence but may have multiple or new tumors
Herpetic stomatitis (cold sore)
- HSV type I
- oral cavity, lips
- virus survives in dormant state in nerves
- can become more extensive with involvement of brain in immunosuppressed patients
Malignant salivary gland tumors
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
- acinic cell carcinoma
Mucoepidermoid carcinoma: site, microscopic
- site: parotid & minor salivary glands
- microscopic: mucus cells & squamous epithelial cells
Mucoepidermoid carcinoma: how to tell it involves squamous cells
- intercellular bridges
Mucoepidermoid carcinoma: special stain
- mucicarmine stain: stains for mucus
Mucoepidermoid carcinoma: differentiation epithelial cell atypia
- high epithelial cell atypia = high grade tumor
Mucoepidermoid carcinoma: behavior
- depends on degree of differentiation
- low grade >90%, 5 years; high grade 20-40%, 5 years
Adenoid cystic carcinoma: site, microscopic, behavior
- site: major and minor gland, myoepithelial cells participate
- microscopic: cribiform pattern, “swiss cheese”, perineural invasion
- behavior: indolent course often marked by recurrence
Adenoid cystic carcinoma: treatment
- surgical removal, with attention to free margins and negative margins of nerves
- indolent course marked by recurrence, tumor is often fatal, but fatalities may occur 15-20 years after initial presentation
- recurrences related to PERINEURAL invasion*
Acinic cell carcinoma: site, microscopic
- site: parotid
- microscopic: recreates salivary gland acinus
Acinic cell carcinoma: histological features
- no duct structures
- Zymogen granules
Acinic cell carcinoma: treatment, behavior
- treatment: surgical removal, attention to free margins
- behavior: slow growing, 80-90% 5 years
Paranasal sinus: inflammatory reaction
- allergic rhinitis
Allergic rhinitis (hay fever)
- many allergens responsible, pollens
- IgE mediated
- repeated exposure–thick mucosa, nasal/sinus polyps
Nasal sinus - fungal diseases
- invasive fungal sinusitis
- allergic fungal sinusitis
- fungus ball
Invasive fungal sinusitis
- aspergillus or mucorales (BAD) species
- seen in immunocompromised, hematologic malgnancies, diabetic ketoacidosis
- vascular invasion by fungi common resulting in necrosis and hemorrhage
Invasive fungal sinusitis: course, treatment
- course: fatal infection many times b/c of extension into brain
- treatment: immediate surgical removal of infected tissue
Allergic fungal sinusitis: definition, presentation, histology
- altered immune response to fungal agents (atopic)
- rhinorrhea, pressure in sinus, headaches
- histology: mucin, EOSINOPHILS, degenerated epithelial cells
Allergic fungal sinusitis: organisms
- Aspergillus
- Dematiaceous: alternaria, bipolaris, curvularia (ABC-D)
Fungus ball
- unilateral sinus obstruction and pain
- masses of fungal organisms in sinus (aspergillus species)
- treatment: removal of fungal mass
