Oral Cavity Pathology Flashcards
What is this?
Aphthous ulcers (canker sores)
Describe canker sores
More common in the first two decades of life, are extremely painful, and are typically recurrent
What are some associations of canker sores?
Tend to be familial, and may be associated with celiac disease, IBD, and Behcet Disease
What is this?
HSV lesions. Most people harbor HSV-1 latently and asymptomatically, but the virus can eb reactivated to form ‘cold sores’
What things can cause a herpes reactivation?
trauma, allergies, UV light (Sunburn), URTI, pregnancy, extremes of temperature
What is the most common fungal infection of the oral cavity?
Candidiases (candida albicans is a normal component of the oral flora and only produces disease under certain circumstances)
What are the main forms of oral candidiasis?
-pseudomembranous (below) aka thrush
erythematous
hyperplastic
What is this?
erythematous candidiasis
Describe candidiasis
Usually associated with superficial, curdlike, gray to white inflammatory membranes that are friable
What is this?
Oral fibromas, submucosal nodular fibrous tissue masses formed when chronic irritation results in reactive CT hyperplasia.
They are most common on the buccal mucosal
How are oral fibromas handled?
surgical excision
What is this?
Pyogenic granulomas, pedunculated masses usually found in children, young adults, and pregnant women. These tend to grow quickly but are benign
What is leukoplakia?
white patches or plaques that CANNOT be scraped off and cannot be classified clinically or pathologically as any other disease
What is the prognosis of oral leukoplakia?
Until proved otherwise, all leukoplakia must be considered precancerous to SSC (although only 5-25% are)
What is erythroplakia?
red, eroded areas of the mouth that are usually flat or depresses and are associated with a much greater risk of malignant transformation than leukoplakia
What pts commonly get leuko- and erythroplakia?
ages 40-70
-tobacco users
How is leukoplakia look histologically?
hyperkeratosis with loss of cell maturation
Approximately 95% of cancers of the oral cavity are ________
SCCs (with the remaining being adenocarcinomas)
Overview of OSCC
- agressive with a 5yr survivial of only 50%
- those with singular lesions at diagnosis are likely to have others or develop one within 5 yrs (secondary tumors are often deadly- surveillance is CRITICAL)
How do OSCCs arise?
two pathways:
- persons who are chronic alcohol and tobacoo users (and betal quid and paan chewing in Asia) get p53, p63, and NOTCH1 mutations
- occurs in the tonsillar crypts or the base of the tongue are harbor oncogenic HPV-16 and overexpress p16, a cyclic-dependent kinase inhibitor
T or F. The prognosis for pts. with HPV-positive tumors is better than for those with HPV-negative tumors
OSCC
OSCC
Xerostomia is most common in which pts?
20% 70+ yo
What drugs typically cause xerostomia?
anticholinergics
antidepressants, antipsychotics
antiHTNs like CCBs
sedatives
analgesics
antihistamines
What is Sialadenitis?
inflammation of the salivary glands
What is the most common cause of viral sialadenitis?
mumps, a paramyxovirus (mainly enlarges the parotids)
What is this?
A mucocele, the most common inflammatory lesion of salivary glands resulting from either blockage or rupture of salivary ducts with leakage of saliva into surrounding CT stroma.
These tend to swell, especially around meals
What are the most common causes of bacterial sialadenitis?
most commonly affects the submandibular glands and is caused by Staph aureus and Strep viridans
T or F. The likelihood that a salivary gland tumor is malignant is inversely proportional to the size of the gland
T. In the parotid gland only 15-30% are malignant while 70-90% are in the sublingual glands (the smallest)
What is the most common benign tumor of the salivary glands?
Pleomorphic adenomas- painless, slow-growing, mobile masses common in the parotids
Pleomorphic adenomas tend to overexpress _____
the transcription factor PLAG1
What is the prognosis of pleomorphic adenomas?
good but they tend to recur if not completely excised. Note that carcinomas can rarely arise from these are termed carcinomas ex pleomorphic adenoma or malignant mixed tumors- more likely the longer the tumor grows and these are extremely agressive
What is this?
Pleomorphic adenoma, marked by a rounded, well-demarcated mass that are mostly encapsulated
What is the most common malignant salivary tumor?
Mucoepidermoid carcinomas, occuring mostly in the parotids
What mutation is common with mucoepidermoid carcinomas?
MAML2
How do mucoepidermoid carcinomas behave?
they are circumscribed but lack capsules allowing for infiltration and clinical course depends on the histologic grade
What is a dentigerous cyst?
these form around the crown of an unerupted tooth and are thought to be the result of a degeneration of the dental follicle (primordial tissue that makes the enamel surface of teeth).
These occur at the third molar
