Oral Dysplasia and Potentially Malignant Disorders

Question 1

Oral cancer red flags

Answer 1

Non-homogenous
Non-healing
Indurated
Exophytic
>3 week duration

Question 2

RF for oral cancer

Answer 2

Alcohol
Smoking
HPV
Poor OH
Betel nut/ tobacco
Socio-economic background
Low fruit/ vege

Question 3

What is OED

Answer 3

Abnormal growth
Only histological diagnosis

Question 4

Architectural changes of dysplasia

Answer 4

Irregular epithelial stratification
Loss of polarity of basal cells
Drop shaped rete ridges
Increased number of mitotic figures
Abnormally superficial mitoses

Question 5

Cytological features

Answer 5

Abnormal variation in nuclear size
Abnormal variation in nuclear shape
Abnormal variation in cell size
Abnormal variation in cell shape
Increased nuclear cytoplasmic ratio
Atypical mitotic figures
Increased number and size of nucleoli
Hyperchromasia

Question 6

Dysplasia grading system

Answer 6

Normal
Low grade
High grade
Cancer

Question 7

OED molecular markers

Answer 7

Signalling pathways:
EGFR
Cell cycle:
Ki67, p53, pRB
Immortalization: Telomerase
Apoptosis:
p53, p21
Angiogenesis:
VEGF

Question 8

Basal hyperplasia

Answer 8

Increased basal cell numbers
Architecture (regular stratification, larger basal compartment)
NO CELLULAR ATYPIA

Question 9

Mild Dysplasia

Answer 9

Architecture changes in lower 3rd
Mild atypia
Pleomorphism
Hyperchromatism
Basal cell hyperplasia

Question 10

Moderate Dysplasia

Answer 10

Architecture changes into middle 3rd
Moderate atypia
Pleomorphism
Hyperchromatism

Question 11

Severe Dysplasia

Answer 11

Architecture changes into upper 3rd
Severe atypia
Numerous mitoses
Loss of polarity
Hyperchromatism

Question 12

Carcinoma-In-Situ

Answer 12

Theoretic concept
Malignant but non-invasive
Abnormal architecture
Pronounced atypia

Question 13

Management of OED

Answer 13

Mild/ Low grade:
Monitored for at least 5 years

Moderate/ Severe:
Removal of lesion via OMFS

Question 14

What is OPMD?

Answer 14

Mucosal abnormality with statistically increased risk of developing oral cancer

Question 15

Types of OPMD?

Answer 15

Leukoplakia
Proliferative Verrucous Leukoplakia
Erythroplakia
Oral submucous fibrosis
OLP
OLTR
Keratosis
Palatal lesions in reverse smokers
Oral Lupus Erythematous
Dyskeratosis Congenita
Oral GvsHD

Question 16

Leukoplakia

Answer 16

Descriptive word
White patch not attributed to any disorder
Long term monitoring
Can be homogenous/ non-homogenous

Question 17

Differential diagnosis for leukoplakia?

Answer 17

Frictional keratosis
Biting
OLP
Pseudomembranous candidiasis
Leukoedema
Nicotine stomatitis
Papilloma

Question 18

Proliferative Verrucous Leukoplakia

Answer 18

Distinct form of multifocal oral leukoplakia
Progressive
Highest risk of OPMD

Question 19

PVL stages

Answer 19

Early stages:
Elephant foot pattern with peaks of keratin formation on surface
Late stages:
Acanthosis
Well developed papillary architecture
Lichenoid immune response

Question 20

Erythroplakia

Answer 20

Fiery red patch that cannot be be characterised as any other definable disease
Solitary lesion
High risk of change

Question 21

Oral submucous fibrosis

Answer 21

Progresses to fibrosis of lamina propria
Function limiting
Burning to spicy foods