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MODHIII - Unit 3 > Oral Cavity and Sinuses > Flashcards

Oral Cavity and Sinuses Flashcards

1
Q

Candidiasis (moniliasis, thrush): location, presentation, who

A
  • oral
  • white patch clinically, easily removed by scraping
  • diabetes or immunocompromised associated
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2
Q

Tumor-like conditions

A
  • pyogenic granuloma/lobular capillary hemangioma

- mucoceles

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3
Q

Pyogenic granuloma/lobular capillary hemangioma

A
  • benign reactive process
  • nodular growth on the mucosal surface
  • not a granulomatous process*
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4
Q

Mucoceles

A
  • obstruction of oral mucosa mucous glands
  • leads to inflammation
  • caused by trauma
  • cystic dilation of ducts filled with mucin
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5
Q

Potentially premalignant lesions

A
  • leukoplakia (white patch)

- erythroplasia (red patch)

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6
Q

Leukoplakia (white patch)

A
  • 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%)
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7
Q

Erythroplakia (red patch)

A
  • more likely to be associated with malignancy, up to 50%
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8
Q

Leukoplakia (white patch): histology of benign disease

A
  • hyperkeratosis
  • mucosal epithelial hyperplasia
  • orderly maturation
  • no distortion of architectural order
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9
Q

Leukoplakia or erythroplakia with severe dysplasia

A
  • architectural disorder
  • nuclear irregularity
  • nuclear pleomorphism
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10
Q

Squamous carcinoma of lip/skin: etiology, survival, differentiation

A
  • etiology: sun (UV)
  • survival: best
  • differentiation: well
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11
Q

Squamous carcinoma: floor of mouth, anterior tongue, hard palate: etiology, survival, differentiation

A
  • etiology: ETOH, smoking
  • survival: intermediate, poor
  • differentiation: variable
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12
Q

Squamous carcinoma of oropharynx: etiology, survival, differentiation

A
  • etiology: HPV
  • survival: favorable
  • differentiation: variable
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13
Q

Result of oropharyngeal cancer being associated with HPV

A
  • better survival than non-HPV associated carcinomas

- nearly exclusively seen in men

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14
Q

Oral cavity/oropharyngeal squamous carcinoma: treatment

A
  • surgical: surgical margins guided by intra operative frozen sections
  • post op radiation/chemoradiation given for metastatic or incompletely resected tumor
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15
Q

Salivary gland sialadenitis

A
  • acute and chronic forms

- can be secondary to obstruction of a major excretory duct

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16
Q

Chronic sialadenitis

A
  • duct obstruction–inflammation–tissue destruction: acinic atrophy, ductal metaplasia, duct dilation, chronic inflammation (lymphocytes), fibrosis (few cells)
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17
Q

Autoimmune sialadenitis

A
  • sjogren’s syndrome
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18
Q

Sjogren’s syndrome

A
  • autoimmune multi organ process
  • affects lacrimal and salivary glands
  • dry eyes, dry mouth
  • pathologic finding: lympho-plasmacytic infiltration
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19
Q

Sjogren’s syndrome: histologic finding

A
  • inflammatory FOCUS
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20
Q

Salivary gland tumors: general info

A
  • uncommon
  • large number of types of tumors
  • major glands: parotid, submandibular, sublingual
  • parotid gland: 85% of salivary gland tumors
21
Q

Salivary gland tumors: facts

A
  • 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
22
Q

Benign salivary tumors

A
  • pleomorphic adenoma

- warthin’s tumor (papillary cystadenoma lymphomatosum)

23
Q

Pleomorphic adenoma: frequency, sit

A
  • frequency: most common tumor

- site: usually parotid, may occur in any salivary gland

24
Q

Pleomorphic adenoma: cell involvement

A
  • mixed tumor: epithelial cells (ducts, acini); mesenchymal cells (myoepithelial, chondroid, myxoid)
25
Q

Salivary gland tumors: treatment

A
  • 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
26
Q

Pleomorphic adenoma: behavior

A
  • conservative surgical therapy, recurrence if not completely removed
  • rarely, epithelial or both epithelial/mesenchymal cells become malignant
27
Q

Pleomorphic adenoma: malignant transformation

A
  • carcinoma ex pleomorphic adenoma: epithelial malignancy

- carcinosarcoma: epithelial & mesenchymal malignancy

28
Q

Warthin’s tumor (papillary cytadenoma lymphomatosum): frequency, site, microscopic, behavior

A
  • 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
29
Q

Herpetic stomatitis (cold sore)

A
  • HSV type I
  • oral cavity, lips
  • virus survives in dormant state in nerves
  • can become more extensive with involvement of brain in immunosuppressed patients
30
Q

Malignant salivary gland tumors

A
  • mucoepidermoid carcinoma
  • adenoid cystic carcinoma
  • acinic cell carcinoma
31
Q

Mucoepidermoid carcinoma: site, microscopic

A
  • site: parotid & minor salivary glands

- microscopic: mucus cells & squamous epithelial cells

32
Q

Mucoepidermoid carcinoma: how to tell it involves squamous cells

A
  • intercellular bridges
33
Q

Mucoepidermoid carcinoma: special stain

A
  • mucicarmine stain: stains for mucus
34
Q

Mucoepidermoid carcinoma: differentiation epithelial cell atypia

A
  • high epithelial cell atypia = high grade tumor
35
Q

Mucoepidermoid carcinoma: behavior

A
  • depends on degree of differentiation

- low grade >90%, 5 years; high grade 20-40%, 5 years

36
Q

Adenoid cystic carcinoma: site, microscopic, behavior

A
  • site: major and minor gland, myoepithelial cells participate
  • microscopic: cribiform pattern, “swiss cheese”, perineural invasion
  • behavior: indolent course often marked by recurrence
37
Q

Adenoid cystic carcinoma: treatment

A
  • 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*
38
Q

Acinic cell carcinoma: site, microscopic

A
  • site: parotid

- microscopic: recreates salivary gland acinus

39
Q

Acinic cell carcinoma: histological features

A
  • no duct structures

- Zymogen granules

40
Q

Acinic cell carcinoma: treatment, behavior

A
  • treatment: surgical removal, attention to free margins

- behavior: slow growing, 80-90% 5 years

41
Q

Paranasal sinus: inflammatory reaction

A
  • allergic rhinitis
42
Q

Allergic rhinitis (hay fever)

A
  • many allergens responsible, pollens
  • IgE mediated
  • repeated exposure–thick mucosa, nasal/sinus polyps
43
Q

Nasal sinus - fungal diseases

A
  • invasive fungal sinusitis
  • allergic fungal sinusitis
  • fungus ball
44
Q

Invasive fungal sinusitis

A
  • aspergillus or mucorales (BAD) species
  • seen in immunocompromised, hematologic malgnancies, diabetic ketoacidosis
  • vascular invasion by fungi common resulting in necrosis and hemorrhage
45
Q

Invasive fungal sinusitis: course, treatment

A
  • course: fatal infection many times b/c of extension into brain
  • treatment: immediate surgical removal of infected tissue
46
Q

Allergic fungal sinusitis: definition, presentation, histology

A
  • altered immune response to fungal agents (atopic)
  • rhinorrhea, pressure in sinus, headaches
  • histology: mucin, EOSINOPHILS, degenerated epithelial cells
47
Q

Allergic fungal sinusitis: organisms

A
  • Aspergillus

- Dematiaceous: alternaria, bipolaris, curvularia (ABC-D)

48
Q

Fungus ball

A
  • unilateral sinus obstruction and pain
  • masses of fungal organisms in sinus (aspergillus species)
  • treatment: removal of fungal mass

MODHIII - Unit 3 (20 decks)

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