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
2
Q
Define mucosal (irritation) fibroma.
A
- reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue
- typically secondary to chronic irritation
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.
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
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
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
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.
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.
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).
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).
11
Q
Describe the appearance of erythroplakia.
A
red, velvety patch in the oral cavity that may be flat or slightly eroded
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).
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
14
Q
What is the clinical significance of actinic cheilitis?
A
preneoplastic lesion => could lead to squamous cell carcinoma
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
16
Q
What are the key risk factors for nasopharyngeal squamous cell carcinoma?
A
- EBV
- HPV
17
Q
Why are inverted sinonasal papillomas more likely to recur than other sinonasal papillomas?
A
to due its inverted growth pattern
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.
19
Q
Define xerostomia.
A
Dry mouth due to decrease in the production of saliva
20
Q
Define sialadentis.
A
inflammation of the salivary glands
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
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
What are the key clinical features of pleomorphic adenoma?
* 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
What are the microscopic features of pleomorphic adenoma?
* 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
What are the key clinical features a Warthin tumor?
* 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
What are the microscopic features of a Warthin tumor?
* 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
What are the key clinical features mucoepidermoid carcinoma?
* Most common malignant salivary gland tumor
* Most common malignant salivary gland tumor in **children**.
* Approximately 60-70% occur in the **parotid** gland.
30
What are the microscopic features of mucoepidermoid?
* 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
What are the key clinical features of adenoid cystic carcinoma?
* 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
What are the microscopic features of adenoid cystic carcinoma?
* tumor cells create a cribriform pattern enclosing secretions
* perineural invasion by tumor cells.
33
What is Plummer-Vinson Syndrome?
* Triad:
* Combination of iron-deficiency anemia
* glossitis
* esophageal dysphagia associated with esophageal webs
34
What is the most common benign and the most common malignant salivary gland tumors?
* Most common benign: Pleomorphic Adenoma
* Most common malignant: Mucoepidermoid Carcinoma
35
Which salivary gland is most often involved by salivary gland neoplasms?
parotid gland
36
Define esophageal atresia.
esophagus ends in a blind-ended pouch rather than connecting normally to the stomach
37
Define esophageal stenosis.
* 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
Define tracheoesophageal fistula.
abnormal connection (fistula) between the esophagus and the trachea
39
What are the differences between esophageal mucosal webs and Schatzki rings?
* 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
What is Zenker’s diverticulum?
* 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
What is Mallory-Weiss Syndrome?
* the presence of longitudinal mucosal lacerations in the distal esophagus and proximal stomach
* usually associated with severe retching or vomiting
42
What is a hiatal hernia?
* 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
What is the most common type of hiatal hernia?
* 95% of hiatal hernias are of the sliding type
* (Type 1) AKA= hourglass hiatal hernia
44
What are the three most common types of infectious esophagitis that can occur in immunocompromised patients?
1. Candida esophagitis
2. Herpes simplex esophagitis
3. Cytomegovirus (CMV) esophagitis
45
What is the suspected pathogenic mechanism of eosinophilic esophagitis?
* 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
What is the microscopic appearance of eosinophilic esophagitis?
* Greatly increased eosinophilic inflammation (\>15 eosinophils/HPF)
* Basal epithelial hyperplasia
* in the absence of acute inflammation
47
What is the clinical presentation of eosinophilic esophagitis?
* 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
What is Barrett’s esophagus?
* conversion of the normal squamous mucosa of the esophagus to metaplastic columnar epithelium as a result of chronic GERD
49
What is the major complication of Barrett's esophagus?
* Barrett’s esophagus confers an increased risk of esophageal glandular dysplasia and adenocarcinoma
* most patients with Barrett’s esophagus do not develop adenocarcinoma.
50
What are the risk factors for esophageal adenocarcinoma?
* Barrett’s esophagus
* long-standing GERD
* glandular dysplasia
51
What is the most common cause of esophageal squamous papillomas?
HPV
52
What is the most common benign mesenchymal tumor of the esophagus?
Leiomyoma
53
What are the risk factors for esophageal squamous cell carcinoma?
* 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
