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GI Week 1 - WLB > Oral & Esophageal Pathology - Nelson > Flashcards

Oral & Esophageal Pathology - Nelson Flashcards

1
Q

Define oral cavity canker sore.

A

AKA = Aphthous Ulcers

  • very common, shallow, superficial mucosal ulcerations
  • usually painful and often recurrent
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2
Q

Define mucosal (irritation) fibroma.

A
  • reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue
  • typically secondary to chronic irritation
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3
Q

Define squamous papilloma.

A
  • Exophytic papillary proliferation of squamous mucosa with fibrovascular core.
  • Some are associated with HPV infection; others may represent reaction to trauma/irritation.
  • Some squamous papillomas can undergo malignant transformation to in-situ and invasive squamous cell carcinoma.
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4
Q

Define pyogenic granuloma.

A
  • polypoid red lesion
    • composed of lobular reactive proliferation of capillaries (eruptive hemangioma)
  • Usually occurs on the gingiva in children, young adults, pregnant women
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5
Q

Define glossitis.

A
  • Inflammation of the tongue:
    • beefy-red appearance of the tongue
    • encountered in certain deficiency states, such as vitamin B12 deficiency
  • Red appearance is secondary to atrophy of the papillae of the tongue and thinning of the mucosa
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6
Q

Define geographic tongue or benign migratory glossitis.

A
  • migratory “map like” appearance of the tongue
  • due to focal loss of the papillae with formation of smooth red patches
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7
Q

Describe the appearance of hairy leukoplakia.

A
  • White, confluent patches of “fluffy” hyperkeratosis on the lateral sides of the tongue.
  • Unlike thrush (candida infection), the lesion cannot be scraped off.
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8
Q

What is the clinical significance of hairy leukoplakia?

A
  • Occurs in immunocompromised individuals
    • HIV infection
    • treated cancer patients
    • organ transplant patients
  • Secondary to EBV infection
  • ***May be the first presenting sign of HIV infection.
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9
Q

Describe the appearance of leukoplakia.

A
  • white patch or plaque in the oral cavity that cannot be scraped off (i.e. not candidiasis)
  • cannot be characterized clinically or pathologically as any other disease
    • (e.g. not lichen planus).
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10
Q

What is the clinical significance of leukoplakia?

A
  • Approximately 5-25% of leukoplakia demonstrates precancerous squamous dysplasia in addition to squamous hyperplasia and hyperkeratosis.
  • These lesions are typically seen in adults, most often associated with tobacco use (cigarettes, cigars, pipes, chewing tobacco).
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11
Q

Describe the appearance of erythroplakia.

A

red, velvety patch in the oral cavity that may be flat or slightly eroded

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12
Q

What is the clinical significance of erythroplakia?

A
  • Incidence of precancerous dysplasia is much higher if erythroplakia is present
  • These lesions are typically seen in adults, most often associated with tobacco use (cigarettes, cigars, pipes, chewing tobacco).
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13
Q

Describe the appearance of actinic cheilitis.

A
  • Actinic keratosis of the lip!
    • Leukoplakic lesion of the lower lip with loss of the distinct demarcation between the lower lip vermilion border and the skin of the lip
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14
Q

What is the clinical significance of actinic cheilitis?

A

preneoplastic lesion => could lead to squamous cell carcinoma

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15
Q

What are the similar key risk factors for the development of oral cavity, oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma?

A
  • Tobacco use
  • Alcohol use
  • Oncogenic HPV
  • Exposure to sunlight (lower lip)
  • Pipe smoking (lower lip)
  • Old age
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16
Q

What are the key risk factors for nasopharyngeal squamous cell carcinoma?

A
  • EBV
  • HPV
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17
Q

Why are inverted sinonasal papillomas more likely to recur than other sinonasal papillomas?

A

to due its inverted growth pattern

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18
Q

What is the most common site of metastases for oral cavity and pharyngeal squamous cell carcinoma?

A
  • Local metastasis is typically to the ***cervical neck lymph nodes***
  • Distant metastasis typically to mediastinal lymph nodes, lungs, liver, and bone.
  • Often, the first presenting sign is an enlarged cervical neck lymph node involved by SCC.
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19
Q

Define xerostomia.

A

Dry mouth due to decrease in the production of saliva

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20
Q

Define sialadentis.

A

inflammation of the salivary glands

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21
Q

Define LESA.

A
  • Lymphoepithelial sialadenitis
    • AKA= Mikulicz disease
    • Autoimmune disease involving the salivary glands
    • polyclonal lymphoid inflammation of the salivary gland, leading to gland enlargement and characteristic lymphoepithelial lesion
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22
Q

What are the common causes of xerostomia, sialadentis, and LESA?

A
  • trauma
  • bacterial or viral infections (e.g. mumps)
  • Autoimmune disease (Sjogren’s syndrome)
  • previous radiation therapy
  • side effect of prescribed medications
  • HIV
23
Q

What does a mucocele look like?

A
  • Presents as a fluid filled mucosal nodule with varying degrees of inflammation.
    • A ranula is a mucocele that arises when the sublingual duct is damaged.
    • Ranulas can become quite large and dissect into the neck (plunging ranula).
24
Q

What causes a mucocele?

A
  • Results from either:
    • blockage (retention mucocele)
    • traumatic injury (extravasation mucocele) to a minor salivary gland
    • with leakage of contents into the surrounding connective tissue stroma.
25
Q

What are the key clinical features of pleomorphic adenoma?

A
  • Most common salivary gland tumor; usually found in the parotid gland.
  • Tumors typically present as painless, discrete masses.
  • While seemingly well circumscribed, they have small extensions or protrusions such that simple enucleation of the tumor will lead to a recurrence rate of 25%.
26
Q

What are the microscopic features of pleomorphic adenoma?

A
  • Benign tumor consisting of a mix of proliferating epithelial (ductal and myoepithelial) cells
    • associated with a mesenchymal matrix of myxoid, hayline, and chondroid (cartilaginous-like) tissue.
    • It may be that all neoplastic tissue elements in this tumor may be of ductal or myoepithelial origin
      • hence the term pleomorphic adenoma.
27
Q

What are the key clinical features a Warthin tumor?

A
  • Second most common salivary gland tumor, found almost always in the parotid gland.
    • Multifocal in 10% and 10% are bilateral.
    • Smokers have 8x the risk of developing this tumor than nonsmokers.
28
Q

What are the microscopic features of a Warthin tumor?

A
  • Benign tumor → well encapsulated with a distinct microscopic appearance
    • papillary, cystic lesion with a dual layer of bland, neoplastic, eosinophilic (oncocytic) epithelium
    • associated with reactive lymphoid stroma
29
Q

What are the key clinical features mucoepidermoid carcinoma?

A
  • Most common malignant salivary gland tumor
  • Most common malignant salivary gland tumor in children.
  • Approximately 60-70% occur in the parotid gland.
30
Q

What are the microscopic features of mucoepidermoid?

A
  • Composed of a variable mixture of squamous cells, mucus-secreting cells, and intermediate cells.
  • While tumors grossly appear encapsulated, they often infiltrate at the margins microscopically.
31
Q

What are the key clinical features of adenoid cystic carcinoma?

A
  • Slow growing
  • Often relentless salivary gland carcinoma with predilection for neural invasion
  • Can occur in the major salivary glands
    • approximately 50% occur in the minor salivary glands
    • (most common malignant tumor of the minor salivary glands)
32
Q

What are the microscopic features of adenoid cystic carcinoma?

A
  • tumor cells create a cribriform pattern enclosing secretions
  • perineural invasion by tumor cells.
33
Q

What is Plummer-Vinson Syndrome?

A
  • Triad:
    • Combination of iron-deficiency anemia
    • glossitis
    • esophageal dysphagia associated with esophageal webs
34
Q

What is the most common benign and the most common malignant salivary gland tumors?

A
  • Most common benign: Pleomorphic Adenoma
  • Most common malignant: Mucoepidermoid Carcinoma
35
Q

Which salivary gland is most often involved by salivary gland neoplasms?

A

parotid gland

36
Q

Define esophageal atresia.

A

esophagus ends in a blind-ended pouch rather than connecting normally to the stomach

37
Q

Define esophageal stenosis.

A
  • narrowing or tightening of the esophagus that causes swallowing difficulties
  • can be congenital
  • usually due to injury and inflammation from chronic gastroesophageal reflux, irradiation, or caustic injury
38
Q

Define tracheoesophageal fistula.

A

abnormal connection (fistula) between the esophagus and the trachea

39
Q

What are the differences between esophageal mucosal webs and Schatzki rings?

A
  • Webs: protusions of mucosa that can cause obstruction;
    • usually seen in the upper esophagus;
    • upper esophageal webs associated with chronic iron-deficiency anemia, glossitis, oral leukoplakia, and spoon nails is known as the Plummer-Vinson syndrome.
  • Rings: like webs but thicker and circumferential
    • may contain muscularis propria
    • located in the lower esophagus
40
Q

What is Zenker’s diverticulum?

A
  • Located above the upper esophageal sphincter as an outpouching of mucosa and submucosa through a weakend posterior cricopharyngeus muscle;
    • not a true diverticulum.
  • This diverticulum can become large enough to accumulate food, producing a mass and symptoms of painful swallowing, halitosis, regurgitation, and diverticulitis.
41
Q

What is Mallory-Weiss Syndrome?

A
  • the presence of longitudinal mucosal lacerations in the distal esophagus and proximal stomach
  • usually associated with severe retching or vomiting
42
Q

What is a hiatal hernia?

A
  • separation of the diaphragmatic crura and protrusion of the stomach into the thorax through the defect
  • can be a congenital condition, but most are acquired later in life
43
Q

What is the most common type of hiatal hernia?

A
  • 95% of hiatal hernias are of the sliding type
    • (Type 1) AKA= hourglass hiatal hernia
44
Q

What are the three most common types of infectious esophagitis that can occur in immunocompromised patients?

A
  1. Candida esophagitis
  2. Herpes simplex esophagitis
  3. Cytomegovirus (CMV) esophagitis
45
Q

What is the suspected pathogenic mechanism of eosinophilic esophagitis?

A
  • Disorder is thought to represent some type of allergic reaction to food allergens but underlying pathogenesis is not completely understood
  • Many patients have other allergies, such as allergic rhinitis, atopic dermatitis, or asthma
46
Q

What is the microscopic appearance of eosinophilic esophagitis?

A
  • Greatly increased eosinophilic inflammation (>15 eosinophils/HPF)
  • Basal epithelial hyperplasia
    • in the absence of acute inflammation
47
Q

What is the clinical presentation of eosinophilic esophagitis?

A
  • Adults/teenagers present with:
    • food impaction
    • persistent dysphagia (difficulty swallowing)
    • GERD symptoms that fail to respond to medical therapy
  • children can present with feeding disorders, vomiting, abdominal pain, dysphagia, and food impaction.
48
Q

What is Barrett’s esophagus?

A
  • conversion of the normal squamous mucosa of the esophagus to metaplastic columnar epithelium as a result of chronic GERD
49
Q

What is the major complication of Barrett’s esophagus?

A
  • Barrett’s esophagus confers an increased risk of esophageal glandular dysplasia and adenocarcinoma
    • most patients with Barrett’s esophagus do not develop adenocarcinoma.
50
Q

What are the risk factors for esophageal adenocarcinoma?

A
  • Barrett’s esophagus
  • long-standing GERD
  • glandular dysplasia
51
Q

What is the most common cause of esophageal squamous papillomas?

A

HPV

52
Q

What is the most common benign mesenchymal tumor of the esophagus?

A

Leiomyoma

53
Q

What are the risk factors for esophageal squamous cell carcinoma?

A
  • Alcohol and tobacco use
  • Caustic esophageal injury
  • Achalasia
  • Tylosis (genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles)
  • Plummer-Vinson syndrome
  • Frequent consumption of very hot beverages
  • Rarely HPV infection

GI Week 1 - WLB (11 decks)

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