Oral medicine questions Flashcards
What is this method of analysis?
- Direct immunofluorescence
- basket weave pattern
- this is pemphigus vulgaris
What would the pathologist report of IF of pemphigus vulgaris?
- Basket weave pattern on IF
- C3 and IGg antibodies
What are the main histopathological features of pemphigus vulgaris? (3)
- supra-basal split
- Tzank cells present
- acantholysis ( loss of coherence between epidermal cells due to the breakdown of intercellular bridges)
what is pemphigus vulgaris ?
- it is an autoimmune blistering disease that begins in the mouth
- seen as clear-fluid fill blisters that burst and then spread
- it is fatal without treatment
Why would pemphigus vulgaris occur?
- autoimmune conditions
- Type 2 hypersensitivity reaction causing antibodies to form against desmosomes
What is similar to pemphigus clinically but have different histopathology?
- Bullous pemphigoid - sub basal split
- Drug induced pemphigus
What is the clinical appearance/features of pemphigus?
- superficial clear fluid filled blisters
- burst and spread
- can affect skin
- fatal
What medications is used to treat pemphigus vulgaris? (3)
- immune modulators - azathioprine
- topical steroids - betamethasone
- systemic steroids - prednisolone
- monoclonal antibody therapy
List risk factors for oral squamous cell carcinoma? (8)
- tobbaco use - smoking or smokeless
- betel quid - chewing habit
- alcohol use
- Viruses - HPV, HSV , EBV , HHV-8
- Poor diet and nutrition
- Poor oral hygiene
- immunodeficiency
- socioeconomic factors
How would you grade dysplasia histopathologically ?
Hyperplasia
Mild
moderate
severe
carcinoma in situ
* based on cytological and architectural changes
How does hyperplasia appear histopathologically?
*Increase in cell numbers; no cellular atypia
* regular stratification
* basement compartment is larger
How does carcinoma in situ appears?
- malignant but not invasive
- abnromal architecture involving full thickness of epithelium
- Severe atypia and mitosis
What intervention for cancer other than surgery?
- chemotherapy ± radiotherapy
- immunotherapy medication
After removal of a malignant lesion in the tongue, how would you restore its function?
Using Reconstructive surgery
* By taking tissue from somewhere elase in the body , for example thighs or foreaerm
* this is then transplanted in the tongue area to replace lost tissue (blood vessels connected to new tissue)
If the tumour invades bone and muscles what grade would this be?
High grade or Stage IV
Patient attends with redness at the corner of their mouth, what is your diagnosis?
Angular cheilitis
What is angular cheilitis?
inflammatory skin condition of variable aetiology (bacterial or fungal) occurring at the angle of the mouth which can be present as redness
What microorganisms are involved in angular cheilitis?
- candida albicans
- staphylococcus aureus
What type of sample should be taken for angular cheilitis ?
swab the commissure of the mouth
Name an immunological disease that can increase risk of candida infections? and why?
HIV
* patient is immunocompromised which allows harmless organisms to become pathogenic and cause infection
* impaired immune function due to low levels of CD4 + T cells
Name one GI disease that increase candida infections?
Crohn’s disease
* impaired nutrient absorption
* also due to immunosuppressive therapy making the body more suceptible to pathogens
Name other diseases that can be associated with angular cheilitis ?
- intra oral - oral candidiasis and denture induced stomatitis
- extra-oral - OFG orofacial granulomatosis
Why is miconazole is prescribed to a patient with angular cheilitis when histological sampling is not available?
- Because it is a broad spectrum antifungal with antibacterial properties so can work against both caninda and gram positive cocci species bacteria such S. aureus
- to confirm diagnosis as if this treats the condition then it is angular cheilitis
What 2 instructions should be given to a patient who wears a denture and have angular cheilitis?
- do not wear denture overnight
- denture hygiene instructions
- clean dentures after eating , before bed and in the morning with soft brush and soapy warm water
- clean with denture cleaning solutions according to manufacturer guidelines
- clean mouth with softbrush and toothpaste or CHX mouthwash
What is trigeminal neuralgia?
A condition that cause pain usually on one side of the face characterised by stabbing sharp pain due to irritation of the trigeminal nerve
How does trigeminal neuralgia occur?
- compression of the trigeminal nerve leading to demylination of the trigeminal nerve
- Can also be attributed to other causes such as multiple sclerosis , tumours, infections and trauma
What special investigations would you do for trigeminal nerve?
- Trigeminal nerve reflex testing - clenching
- OPT to rule out dental cause then MRI
- Use CT if MRI is contraindicated
- Blood tests - FBC, U&E’s , blood glucose and liver function test ( in case of confirmed diagnosis and tx with carbamazepine)
What neurological disorders can cause trigeminal neuralgia?
- multiple sclerosis
- brain tumour compressing on the trigeminal nerve
What is the first line drug management for trigeminal neuralgia?
Carbamazepine 100mg
send 20 tablets
1 x twice daily
What blood tests should be done before starting carbamazepine?
- liver function test
- Urea and electrolytes test
- Full blood count - haematinics
What are the side effects of carbamazepine? (7)
- liver dysfunction
- Thrombocytopenia
- Paraesthesia
- Electrolyte imbalance
What are the indications for surgery for treating trigeminal neuralgia? (4)
- Reaching the maximum dose of the drug treatment
- Very young patients on many drugs
- If medication is contraindicated with the medical history
Name types of surgical interventions that can be carried out for trigeminal neuralgia?
- Peripheral neurectomy
- Trigeminal nerve balloon comression
- Microvascular decompression
- Radio-surgery gamma knife
What is paget’s disease?
a chronic (long-lasting) disorder that causes bones to grow larger and become weaker than normal
What are the clinical signs of paget’s disease (6)
- localised pain and tenderness
- focal temperature due to hyperaemia and hypervascularity
- bilateral Increased bone size
- bowing deformities
- decreased range of motion
- denture become ill fitting
- facial asymmetry
- nerve compression
What are the radiographic signs of Paget’s disease? (5)
- Hypercementosis
- loss of lamina dura
- osteoporotic circumscripta
- radiolucent regions resembling cysts
- cotton wool appearance due to sclerotic and lytic lesions
What is albrights disease?
a genetic condition that affects bone growth, skin pigmentation and the body’s hormone balance can be polystotic or monostotic
What are the clinical signs of Albright’s disease? (7)
- skin pigmentation
- bone hard tissue expanding around teeth
- facial asymmetry
- endocrine hyperfunction
- slow growing
- Asymptomatic
- early puberty
determined at timing of gene mutation
What are the radiographic signs of albright’s disease? (3)
- regular bone fractures
- bone deformities
- craniofacial fibrous dysplasia
What is Cherubism?
a disorder characterized by abnormal bilateral growth of bone tissue in the jaw caused by a genetic condition (autosomal dominant)
What are the clinical signs of Cherubism? (4)
- painless bilateral enlargement of the bone
- round face and swollen cheeks
- dental malocclusion
- grow until the age of 7 then regress after puberty
What are the radiographic signs of cherubism?
- Multicystic and Multilocular lesions ( posterior of mandible and maxilla)
- mandible or maxilla is replaced by fibrous tissue
- obliterated facial sinuses
Histopathology include vascular giant cell lesions
What are the types of orofacial pain?
- Nociceptive
- Neuropathic
What is sjogren’s syndrome?
- It is a chronic autoimmune disease where immune cells attack exocrine glands causing dry mouth and dry eyes
- it affects secretion production at the mucous membranes
What are the three types of Sjogren’s syndrome?
- Partial Sjogren’s - sicca syndrome - dry eyes and mouth
- Primary Sjogrens - not associated with CT disease
- Secondary Sjogren’s - Associated with CT disease
Which connective tissue disease can be associated with Sjogren’s syndrome? (3)
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Scleroderma
What antibodies are linked with Sjogren’s syndrome?
Anti-la and Anti-ro
What investigations do you carry out for Sjogren’s syndrome?
- Schrimer’s test
- Fluorescein tear film test
- unstimulated whole salivary flow test
- Salivary ultrasound scan
- MRI for major salivary gland’s
- labial gland biopsy
- Radio-neucleotide assessment
What oral symptoms are gained subjectively from the patient regarding sjogren’s syndrome according to AECG?
- daily feeling of dry mouth for more than 3 months
- recurrent swelling in salivary gland as an adult
- frequently drink liquid to aid swallowing dry food
What ocular symptoms are mentioned in AECG regarding sjogren’s syndrome?
- Persistent troublesome of dry eyes for more than 3 months
- Tear substitute used more than 3 times a day
- Recurrent sensation of sand in the eyes
What is an abnormal result for UWS test?
less than 1.5ml in 15 minutes
What is abnormal schrimer’s test result?
less than 5mm in 5 minutes
How many positive criteria should there be AECG to confirm sjogren’s ?
4 or more positive criteria including number 5 and 6
Describe preventative measures for Sjogren’s syndrome?
- Lialise with rheumatologist - multi-system disease
- consider immune modulating treatment
hydroxychloroquine and methotrexate - Diet advice , F toothpaste 5000ppm , OHI advice
Symptomatic management of Sjogren’s ?
- Salivary stimulants - pilocarpine
- Salivary substitutes - biotene gel , saliva orthana
- Artificial tears
What are the histopathological features of sjogren’s syndrome?
Minor
* Focal lymphocytic sialodentitis
* Focal collection of lymphocytes 50+ in each collection
Major
* Atrophy of acini
* Myoepithelial islands
What is the most diagnostic feature in the ACR-EULAR criteria for Sjogren’s ?
Positive labial gland biopsy
Name oral complications associated with sjogren’s syndrome? (5)
- Caries
- Poor denture retention
- Infection risk - candida
- loss of function - speech and swallowing
- Salivary lymphoma risk - non hodgkin lymphoma - unilateral
What are the causes of xerostomia other than sjogren’s syndrome? (5)
- dehydration
- medications
- head and neck radiotherapy ± chemotherapy
- Smoking
- Salivary gland tumours
What features in a parotid gland swelling makes you suspect a malignancy? (6)
- Localised and firm
- Painless
- Unilateral
- Fixed to underlying structures
- Fast growing
- Causes obstruction of the gland
Late stage will have pain and possible facial palsy
Where would you most commonly find a salivary gland neoplasm?
- Parotid gland 80% of all tumours - 15% malignant
- Submandibular 10% of all tumours - 30% malignant
- Sublingual 0.5% of all tumours - 80% malignant
- Minor salivary 10% of all tumours - 45% malignant
Most tumours in parotid and most malignancy rate is in sublingual
What is ectodermal dysplasia?
- A group of conditions where there is abnormal development of the skin, hair, nails, teeth or sweat glands
What are the symptoms of ectodermal dysplasia? (9)
- hypodontia and peg shaped teeth
- large forehead
- low nasal bridge
- thin hair
- abnormal nails
- poor functioning sweat glands
- cleft lip ± palate
- learning difficulties
- decreased skin pigmentation
What is an ulcer?
- it is the loss of the full thickness of epithelium
- where you can see underlying connective tissue and fibrin may be deposited on the surface
- can only be diagnosed histologically
What is an erosion?
- It is the partial thickness loss of epithelium
- can be diagnosed histologically
How would you differ between recurrent major and minor aphthous ulcers?
- Minor
Size = less than 10mm
Shape = round or oval with a red margin and yellow base
Number = 1-20 per crop
Histology = non-keratinised mucosa
Heals without scarring with 1-2 weeks
Commonly affects children - Major
Size = more than 10mm
Shape - oval or irregular
Number = less than 5 at a time
may affect keratinised or non keratinised mucosa
may take up to months to heal (6-12 weeks) and may heal with scarring
What is herptiform aphous ulcers?
- rarest form of apthous ulcers
- multiple small ulcers on non keratinised mucosa
- heal within 2 weeks without scarring
- Affect non keratinised mucosa
- not associated with HSV but look similar to primary herpatic gingivostomatitis in the early stages
What are the potential problems associated with recurrent aphthous stomatitis? (6)
- infections
- dehydration
- malnutrition
- problems with wearing dentures
- may affect speech and mastication
- painful
What are the causes of recurrent apthous stomatitis? (9)
Multifactorial including
* nutritional deficiencies - B12, iron, folate
* Stress - smoking - infections
* Systemic diseases - Crohn’s , ceoliac disease
* Hormonal imbalance : more in females
* Immune dysfunction : CD8 > CD4 at ulcer stage
* Genetics - HLA type A2 and B1w
* Trauma
* Allergies - SLS toothpaste
* metabolic such as growth in teenagers and children
What systemic diseases might be associated with apthous ulcers? (7)
- Coeliac
- Crohn’s disease
- Ulcerative colitis
- orofacial granulomatosis
- Menorrhagia
- Chornic GI blood loss
- pernicious anaemia - B12 deficiency
How is recurrent apthous stomatitis treated?
- Correct underlying cause
Blood tests
nutritional deficiencies
remove traumatic cause
SLS free toothpaste if allergic and dietary avoidance
Treat systemic disease - Medications
Topical : Benzydamine gel (pain) , betamethasone MW , beclomethasone inhaler , doxycylcline MW, CHX mouthwash, hydrocotisone pallets
Systemic :
Systemic steroids - prednisolone
immunosuppressants - azathioprine
DMARD - adalimumab
immune modulation - thalidomide
What medications might cause oral ulceration? (4)
- potassium chanel blockers
- NSAIDs
- DMARDS (disease modifying anti-rheumatic drugs)
- Bisphosphonates
What would microcytic blood tests show?
- MCV less than 80Fl
What 3 GI conditions might cause microcytic anaemia?
- coeliac disease
- Crohn’s
- ulcerative colitis
- gastric or colonic carcinoma
What common conditions cause microcytic anaemia but require further blood tests? (5)
- iron deficiency
- thalassaemia
- lead poisoning
- anaemia of chronic disease
- congenital sideroblastic anaemia
What oral conditions can be associated with microcyctic anaemia?
- Recurrent apthous ulcers
- Lichen planus
- Oral dysaesthesia
- Angular cheilitis
- Candidiasis
What are the treatment options for microcytic anaemia?
- Correct underlying cause
Further blood tests to correct deficiencies - Fe supplement
diagnose and treat cause of blood loss (acute or chronic)
Mennorhagia - contraceptive pills or hormone therapy - Severe cases - blood transfusion of RBC
- Prevention - Diet advice and supplement advice
Generalised white plaques that scrape off easily leaving an erthmatous base , what is your diagnosis?
Pseudomembranous candidosis
What local conditions might cause pseudomembranous candidosis? (5)
- Steroid inhaler use
- broad spectrum antibiotic use
- Poor OH
- Xerostomia
- Dentures
What medical conditions might contribute to pseudomembranous candidosis?
- Diabetes
- HIV
- Hypothyroidism - weaken the immune system
What are the advantages and disadvantages of oral swab for microbiology testing?
- Simple and site specific
- Can be easily contaminated and uncomfortable
What are the advantages and disadvantages of oral rinse?
- Comfortable and records the whole mouth
- Not site specific , difficult to standardise , some patients find the rinse process hard to do
With what drugs does fluconazole interact with and describe the interaction?
- Warfarin - increases the anticoagulant effect of warfarin , and increase the likelihood of a catastrophic bleed - increase INR
- Statins (simvastatin) - increase the exposure to statins leading to an increased risk of hepatotoxicity
Classed as severe interaction
What information is required on a lab sheet for sampling? (9)
- patient details
- GDP , GMP details
- Patient history (MH DH SH)
- Clinical prescription of the problem
- Provisional diagnosis
- Test previously done and test required to be done
- Antibiotic use - previous, current , resistant
- Date and time of sample
- referring clinician name and signature
Patient attends with denture stomatitis
What features do you notice about the palatal tissues?
- Eythmatous denture bearing area
- Inflammation - swelling , oedema
- Papillary hyperplasia
What are the classifications of denture induced stomatotitis?
- Newton type 1 = localised inflammation and erythema
- Newton type 2 = diffuse inflammation with erythema at denture bearing area without hyperplasia
- Newton type 3 = granular inflammation, erythema and papillary hyperplasia
What might be the causes of denture stomatitis? (6)
- xerostomia
- poor oral/denture hygiene
- wearing denture overnight
- immunosuppression
- steroid inhaler use
What is denture induced stomatitis?
It is a condition characterised by inflammation in the oral mucosa on the denture bearing area caused by candida (fungal) overgrowth.
What is your first line management of denture induced stomatitis? (4)
- Denture hygiene advice
- Denture wearing advice
- Tissue conditioner on denture bearing area to allow healing
- Adjust dentures if they are causing problems
What denture hygiene/wearing advice would you give to a patient presenting with denture induced stomatitis? (5)
- Brush palate daily with soft brush
- Clean denture by soaking CHX mouthwash or sodium hypochlorite for 15 mins twice daily
- Leave denture out of the mouth as much as possible
- Apply tissue conditioner to the area to allow tissue to heal when wearing the denture
- Rinse mouth after inhaler use
What is the second line treatment for denture induced stomatitis?
- Antifungal medication
Fluconazole capsules 50mg - 7 days
Miconazole 20mg for 7 days after lesions heal
Nyastatin oral suspension (in warfarin and statin pts)
1ml after food 4 times daily continue for 48 hours after lesion heals
keratin on a histology slide
melanin on a histology slide
What epithelium is affected in smoker
Keratinised squamous epithelium of the hard palate
What is the clinical presentation of smoker’s keratosis? (3)
- thickened white area on the hard palate with dark brown or grey areas
- Other areas in the mouth can be present with tobacco staining
- Painless
What factors can cause smoker’s keratosis? (4)
- Smoking tobbaco + pipe smoking
- long term drinking of very hot beverges
- Poor oral hygiene
- Chronic inflammation
What histological presentation of smoking keratosis could indicate malignancy? (4)
- Hyperchromatism
- Cellular Atypia
- Dysplasia
- loss of basement membrane integrity
What is the histological features of smoker’s keratosis?
- hyperkeratosis
- Keratinised stratified squamous epithelium
- melanin or melonocytes in basal layer
What clinical presentation of smoker’s keratosis would indicate malignancy? (6)
- Raised rolled border
- Hard (endurated) lesion
- Non-homogenous - exophytic and flat areas
- Ulceration
- Pain or discomofort
- If the lesion grows quickly
What is desquamative gingivitis?
It is a descriptive term of non specific clinical expression in the gingiva such as erythema, ulceration, pain and plaque **as a result of several dermato-mucous disorders. **
* presents as erythmatous, desquamating and painfull gingiva
* may involve the full thickness of the gingivae
What local factors may exacerbate desquamative gingivitis ? (5)
- Smoking
- Plaque build up
- Restorations overhangs
- Partial dentures
- SLS toothpaste
How would you manage desquamative gingivitis?
- Confirm diagnosis and any underlying conditions and manage these appropriately (blood tests , immunofluorescence assay)
- Treat underlying cause - allergy or SLS toothpaste
- Improve oral hygiene as plaque may worsen the condition
- Topical steroid use : betamethasone - can use gum sheild
- Topical tacrolimus immune modulator cream or mouthwash
- Systemic immunosuppressant
What is erythema multiforme?
- It is a spectrum disorder of immunogenic origin skin and mucosa ulceration
- ulcer crops that are very painful affecting eating and drinking
Which disorder is related to erythema multiforme?
Stevens-johnson
What is your treatment options for erythema multiform
Systemic steroids
Systemic aciclovir
Encourage fluid intake - may require IV fluid if cannot eat or drink
What might cause erythema multiforme? (3)
- drugs
- herpes simplex
- mycoplasma
Management options for recurrent erythema multiforme symptoms?
- prophylactic aciclovir daily
- do allergy test to find out trigger
Name local pigmented lesions in oral mucosa? (6)
- Amalgam tattoo - macrophages (melanin) and granulation tissue surrounding amalgam tattoo
- Macule (flat) - increased melanocytes
- Naevus (raised) - increased melanocytes
- vascular malformation (haemangioma)
- mucosal melanoma secondary to metastatic cancers
- pigmented incontinence associated with chronic inflammation
Name general causes of pigmentation in the oral mucosa?
- Race
- medications - contraceptive pills , iron tablets , antimalarials (hydroxychloroquine)
- addison’s disease - increased ACTH causes brown patch
- Infections : HIV , candida
Describe how Addison’s disease may cause oral pigmentation?
- reduced cortisol and aldosterone from adrenal glands causes brown patch due to increased ACTH
What is a vascular malformation?
A benign tumour due abnormal development of blood vessels
What is haemangioma?
- It is part of the hamartoma family which is benign tumour as a result of abnormal formation of blood vessels (endothelial cells) that can be present at birth
- can grow during normal growth and stops when patient stops growing
- 60% are found in the head and neck
- known as strawberry haemangioma
Name 2 types of haemangioma and give 2 histological differences?
- Capillary -
Small vessels (capillaries) - more in number
lined by single layer of thin endothelial cells - Cavernous
Large vessels - less in number
Lined by a thicker wall of endothelial cells
Herpes group viruses associates with oral vesiculation?
- Human Herpes simplex virus (HHS)
- Epstein Barr virus (EBV)
- Varicella zoster virus
- Cytomegalovirus
- Group A coxsackie virus
Name oral mucosal disease caused by coxsackie virus? (RNA virus)
- Hand Foot and Mouth disease
- Herpangina
What oral diseases are caused by Epstein Barr viruses?
- Infectious mononucleosis
- Oral hairy leukoplakia
Which cranial nerve does herpes simplex become resident to on lower lip? (Nerve and branch)
mandibular division of the trigeminal nerve
What can trigger the reactivation of herpes simplex virus? (6)
- Stress
- Infections
- Exposure for ultraviolet light
- hormonal changes during menstruation
- Fatigue
- Immunosuppression
What might cause a pigmented tongue (local) ?
- Smoking
- food colouring
- chromogenic bacteria - black hairy tongue
- medications - hydroxyquinone
- macule
- melanoma
What are the general causes of pigmented tongue? (5)
- Chemotherapy
- Race
- Addison’s disease
- Lead poisoning
- kaposi’s sarcoma
Which HHV virus is related to kaposi’s sarcoma?
HHV-8
What information could you get from clinical examination when you suspect TMD to confirm diagnosis?
- TMJ tenderness and pain
- Clicking, popping, crepitus
- limited mouth opening
- Deviation on opening or closing
- Limited range of movements
- Mom tenderness and hypertrophy
- Signs of parafunctional habits - wear facets , linea alba , scalloped tongue , cheek biting
- inter-incisal opening is also measured (35-55mm)
What does Crepitus indicate in TMJ?
Late degenerative disease
How does this difference occur?
The damage in upper motor neuron to the nerves occur at the level of the brain whereas in lower motor neuron it occurs at a the peripheral nervous system to nerves innervating the muscles and glands
What are the histological features of pleomorphic adenoma?
- Epithelial ductal cells
- Incomplete connective tissue capsule
- Myoepithelial islands
- Cystic spaces
- Chondroid and myxoid tissues
What are the histological signs of Warthin’s tumour?
- Oncocytic epithelium
- Lymphoid stroma
- Cystic spaces
What is the histological sign of an adenoid cystic carcinoma?
Cribiform pattern of basaloid cells
* no capsule present and can be solid or tubular in nature
What is the mechanism of action of CHX?
- Diatonic antimicrobial action
- Positive charge of CHX molecules interact with negative charge of microorganisms surface molecules (phosphate)
- This damages the microbial cell envelope allowing for permeability
- prevents replication of bacteria and can result in cell death through interfering with intracellular activity
What are the 3 stages of clot formation?
- Vasoconstriction
- Platelet plug forms in break
- Formation of fibrin clot ( blood coagulation)
How does Aspirin affect clotting and at what stage?
- Inhibit platelet aggregation ( enzyme COX)
- by altering balance between thromboxane A2 and prostacyclin
- inhibiting the formation of thrombi
Histological features of lichen planus (6)
- Hugging band of lymphocytes
- Basal cell layer liquefaction
- Acantholysis - less of cell to cell adhesion
- Saw tooth rete pegs (elongated)
- Apoptosis (death of cells) - civatte bodies (dead keratinocytes)
- Orthokeratosis
What is plasma cell gingivitis?
It is a rare gingival inflammatory condition where there is a dense infiltrate of plasma cells in the connective tissue leading to inflammation and enlargement of the gingivae
What is the clinical appearance of plasma cell gingivitis? (5)
- Generalised erythema and oedema that can extend from the free gingiva to the attached gingivae
- Normal gingival stippling is lost
- Friable gingivae
- Bleed easily
- Accompanied by cheilitis or glossitis
What is the histological features of plasma cell gingivitis?
Dense plasma cell infiltrate in the connective tissue
What is asthma?
- A condition where there is reversible airway obstruction
Characterised by - inflammation and swelling of airway mucosa
- Excessive mucous secretion
- Smooth muscle contraction
What are the signs and symptoms of asthma? (5)
- Shortness of breath
- Wheezing
- Coughing
- Chest tightness and pain
- Fatigue
What is nikolsky’s sign ?
the separation of the epidermis when probing (shedding)
What is the metastatic cascade?
- Invasion ,migration and intravasation
- survival in the circulation - immune evasion, CTC clusters, platelet binding
- Arrest in distant organs - trapping , adhesion
- Extravasation - through physical barriers (seeding)
- Micro metastasis - survival on arrival, proliferation (dormancy - survival without growth)
- Macro metastatic growth
CTC = circulating tumour cells clusters
What is sialometaplasia?
- It is a benign inflammatory condition that affects the salivary glands , primarily the minor salivary glands in the hard palate
- Usually caused by blocked blood supply to the glands leading to tissue death
- It can mimic a malignancy
How does sialometaplasia appear histologically? (3)
- surface slough of necrotic tissue (can be clinical sign)
- Hyperplasia
- Squamous metaplasia of the ducts + acini
- Necrosis of salivary acini
What is a mucocele?
- Recurrent swelling found mostly in the lower lip
- due to a damaged or blocked salivary gland
- can burst and recur
- can be superficial or deep
- Types : extravasation and retention
swellings in upper lip are usually neoplastic rather than simple mucocoeles
How does a mucocele appear histologically? (3)
- Macrophage lined cystic cavity
- Surrounded by granulation tissue
- Foam cells present
- Inflammatory cells present
What is a mucocele called in the floor of the mouth?
Ranula
* Usually sublingual extravasation type
What is orofacial granuloma?
- Swelling or Oedema in the oral and facial tissue due to lymphatic obstruction due to an immune reaction
- Associated with type 4 hypersensitivity reaction to certain food
- Linked with Crohn’s (15%), sarcoidosis disease, tuberculosis
What the histological appearance of OFG?
- Increased tissue fluid produced due to inflammation
- Granulomas - cluster of white cells
- Multinucleated giant cells
- Lymphocytes
Dilated lymph and blood vessels due to obstruction
Where does median rhomboid glossitis occur?
- Central papillary atrophy of the tongue
- Affecting the dorsum of the tongue at the midline region
- Anterior to circumvallate papillae
Histological features of median rhomboid papillae
- Caninda hyphae infiltration
- Hyperplastic rete pegs (bulbous)
- Elongated rete pegs
- PMNLs (leukocytes) infiltration
What is a fibrous epulis?
It is a localised swelling arising in the gingivae caused by chronic irritation
How does fibrous epulis appear clinically? (4)
- smooth surface
- rounded swelling
- pink
- pedunculated
How does fibrous epulis appear histologically ?
- Granulation tissue
- Metaplastic bone formation
- Ulceration
What is a fibrous Epulis named on other sites other than the gingiva ?
Fibro-epithelial polyp
* most common in buccal mucosa and inner surface of the lip
What is pyogenic granuloma?
- Overgrowth of granulation tissue
- may be related to extraction sockets or traumatic soft tissue injuries due to failure of normal healing
How does pyogenic granuloma appear histologically?
- Granulation tissue
- Mixed inflammatory infiltrate on fibrovascular background
- Ulceration
- Endothelial cells proliferation
Give an example of a heriditary white patch?
- white spongy naevus ( increased production of keratin)
How does white spongy naevus appear histologically?
- Intracellular oedema in keratin layer
- Parakeratosis
How does smoker’s keratosis appear histologically?
- Hyperkeratosis
- Areas of mild/variable dysplasia
- Melanocytes and macrophages in basal layer
Smoker’s are 6 times more likely to develop leukoplakia
Give differential diagnosis for denture induced hyperplasia? (4)
- leaf fibroma
- papillary hyperplasia of the palate
- Giant cell granuloma
- Pyogenic granuloma
What histological features can be seen in denture induced hyperplasia?
- Pseudoepitheliomatous hyperplasia
- Hyperplastic rete pegs
- Candida involvement
- irregular hyperkeratotic epithelial cells
Same as leaf fibroma - papillary hyperplasia
What is this?
Condyloma Acuminatum which is a benign growth usually appears in mucosal surfaces and mostly affects the genitals , mostly transmitted through sexual activity
Histopathological features of condyloma acuminatum? (5)
- Koilocytosis - hallmark of HPV infection
- Papillamatosis ; Elongated rete pegs
- Inflammatory infiltrate
- Hyperganulosis - hyperplasia of granular layer of epidermis
- Hyperkeratosis - increased keratin
What is your differential diagnosis?
- Squamous cell carcinoma
- Condyloma acuminatum
- Verruca vulgaris
- Verrucous carcinoma
