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Histopathology > Oral mucus membranes and pathology > Flashcards

Oral mucus membranes and pathology Flashcards

1
Q

Main functions of mucous membranes

are:

A
  1. Absorption
  2. Excretion
  3. Protection
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2
Q

 Masticatory mucosa location

A

keratinized
• Gingiva
• Hard palate

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3
Q

 Lining mucosa location

A 
non-keratinized 
•  Alveolar mucosa 
•  Buccal mucosa 
•  Floor of the mouth 
•  Ventral surface of the tongue 
•  Soft palate
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4
Q

 Specialized mucosa location

A

contains tastet buds

• Dorsal surface of the tongue

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5
Q

layers of the oral mucus membrane

A
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6
Q

Mucoperiosteum

A

Defined as a periosteum with a mucosal
surface, i.e., close approximation of mucous membrane
(epithelium and lamina propria) with the periosteum of
bone to form an apparent single layer.

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7
Q

label

A
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8
Q

organization of the epithelial layer of oral mucosa

A 
 Stratum Corneum 
 Stratum Granulosum 
 Stratum Spinosum 
 Stratum Basale (a.k.a.) Stratum Germinativum 
OR
 Keratin Layer 
 Granular Cell Layer 
 Spinous Cell Layer 
 Basal Cell Layer
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9
Q

label the epithelial layer

A
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10
Q

epithelial rete pegs

A

invagination of epithelial layer into conn tissue papilla

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11
Q 
epithelium characterisitics
rests on?
attatchements of cells? 
vasculature?
cell vs matrix abundance?
polarity of cells?
A

 Rests on a basement membrane
 Exhibits one or more specialized intercellular
attachments (desmosomes, tonofilaments)
 Avascular (gets all nutrients from dermis)
 Exhibits a high degree of cellularity and relatively
low volume of extracellular matrix
 May exhibit cellular polarity
• Cells exhibit apical, basal, and lateral borders
• Polarity is expressed in the distribution of
cytoplasmic organelles

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12
Q

terms for the stratum corneum regarding form

A

Orthokeratosis
Parakeratosis
Hyperkeratosis
Dyskeratosis

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13
Q

Orthokeratosis

A

Orthokeratosis
• Refers to normal keratin formation with clinically
normal presentation.

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14
Q

 Parakeratosis

A

Retention of pyknotic nuclei in the stratum corneum

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15
Q

 Hyperkeratosis

A

• Abnormal thickening of the stratum corneum. May

exhibit aberrant patterns of keratinization.

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16
Q

 Dyskeratosis

A

Abnormal keratinization below the level of the stratum
corneum, i.e., keratinization within the stratum
granulosum and/or stratum spinosum.

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17
Q

terms of the epithelial layer

A

 Acanthosis
 Acantholysis
 Metaplasia
 Dysplasia

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18
Q

 Acanthosis

A

Refers to hyperplasia of the epithelial layer, i.e.,

increase in the number of cells

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19
Q

 Acantholysis

A

• Loss of intercellular attachments between epithelial

cells (keratinocytes)

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20
Q

 Metaplasia

A

• A reversible change in which one adult cell type is replaced by another

e.g., transition of columnar to squamous epithelium in
the respiratory tract as a response to smoking.

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21
Q

 Dysplasia

characterized by?

A

• Refers to a disorderly but non-neoplastic growth of tissue including the epithelial layer.

Characterized by pleomorphism, hyperchromatism, and loss of normal spatial orientation

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22
Q

non-keratinocytes of the oral epithelium

A

melanocytes
langerhans
merkels
lymphocytes

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23
Q

gingival dyskeratosis of the masticory mucosa could indicate what?

A

SCC

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24
Q

 Melanocyte

A

• Dendritic morphology (long processes)
• Located in the basal cell layer
• Synthesis of melanin pigment granules
(melanosomes)

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25
Q

Langerhans Cell

A

• Dendritic morphology
• Located in the stratum spinosum
• Characteristic Langerhans granule (tennis racquet)
• Functions as an antigen trap in epithelium and transfers
antigen information to CD4 lymphocytes

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26
Q

 Merkel’s Cell

characterisitc content?

A

 Merkel’s Cell
• Rounded morphology
• Located in the basal cell layer
• Contain characteristic “dense core” granules
• Possibly has tactile sensory functions

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27
Q

Lymphocytes

A

Lymphocytes
• Rounded morphology
• Found in basal and spinous cell layers
• Associated with immune surveillance and antigen
message processing
• Associated with inflammation – both humoral and
cellular response

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28
Q

organization of the basement membrane

A

composed of basal lamina (lamina lucida+densa) and lamina reticularis

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29
Q

lamina lucida composition/contents

A

Bullous Pemphigoid antigen

Type VII collagen (anchoring fibrils)

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30
Q

lamina densa compostion

A

• Type IV collagen
• Type VII collagen (anchoring fibrils)
fibronectin-can induce cellular polarity

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31
Q

lamina reticularis composition

A
  • Reticulin connective tissue
  • Type I collagen
  • Type III collagen
  • Elastin connective tissue
32
Q

Relationships of Cytoskeletal Components to the Basal Lamina (attachments)

A

Cytoplasm of Cell
“tonofilaments”

Hemidesmosome
Bullous Pemphigoid Antigen 1 (BPAG1)
Bullous Pemphigoid Antigen 2 (BPAG2)

Lamina Lucida
BPAG1 & BPAG2
Type VII collagen (Anchoring Fibrils )

Lamina Densa
Type IV Collagen
Type VII Collagen (Anchoring Fibrils )
Fibronectin

Lamina Reticularis of the Lamina Propria 
Type I Collagen 
Type III Collagen 
Reticulin (precursor of elastin) 
Elastin
33
Q

how the kinds of attachments work toghether

A

work to dissipate forces, reduce trauma to a single area

34
Q

specialized cell attachments found at the mucus mem

A

 Desmosome (Macula Adherens)
 Hemidesmosome
 Intermediate Junction (Zonula Adherens)
 Tight Junction (Zonula or Macula Adherens)
 Gap Junction (Communication Junction)

35
Q

Protein components of desmosomes:

A 
 Desmoplakin I & II 
 Evoplakin 
 Periplakin 
 Plakoglobin 
 E-cadherin (Desmoglein) 
 P-cadherin (Desmocolin)
36
Q

cellular attachments and inflam

A

can be lost due to inflam

37
Q

lamina propia cell populations (permanent and transient)

A 
 Permanent or Resident Cell Population 
•  Fibroblast 
•  Monocyte>Histiocyte>Macrophage 
•  Basophil>Mast Cell 
•  Plasma Cell 
•  Endothelial Cell 
 Transient or Labile Cell Population 
•  Neutrophils 
•  Lymphocytes
38
Q

• Fibroblast function at lamina propria

A

Secrets collagen and elastin

39
Q

• Histiocyte function at lamina propria

A

Resident precursor of functional macrophage

40
Q

Monocyte function at lamina propria

A

Blood-borne precursor of functional macrophage

41
Q

Macrophage function at lamina propria

A

Phagocytic cell capable of antigen processing

42
Q

Mast Cell function at lamina propria

A

Secretes inflammatory mediators, e.g., histamine,

heparin

43
Q

Plasma Cell function at lamina propria

A

Synthesis of immunoglobulins (antibodies)

44
Q

Neutrophil function at lamina propria

A

Phagocytic cell capable of neutralizing antigens and

killing bacteria.

45
Q

Lymphocyte function at lamina propria

A

Humoral and cell-mediated immune response

46
Q

Endothelial function at lamina propria

A

Lining of blood and lymphatic vessels

47
Q

epithelium found at the ginigval sulucus

A

sulcular (gingival), junctional, and keratinized (masticory)
sulcular and junctional separated by the free gingival groove
bottom of pocket=junctional epithelium

48
Q

junctional epi derived from?

A

remnant of the primary cuticle

49
Q

junctional epi in perio disease

A

calculus and plaque can cause attachment loss and apical migration

50
Q

label

A
51
Q

gingival pigmentation

A

varies depending on activity of melanocytes

52
Q

size of the attached gingiva

A

also variable among pts

53
Q

lips histology

A

parakeratinized
capillary loops present
mucus secreting glands

54
Q

Filiform Papillae

A 
• “Hair-like” papillae 
• Most numerous 
• Highly keratinized 
• Found over the entire 
 dorsal surface of the 
tongue
55
Q

Fungiform Papillae

A 
• “Fungus-like” papillae 
• Small round, red surface 
projections (color is due 
to a highly vascular 
connective tissue core) 
• May contain taste buds 
• Commonly found at the 
tip of the tongue
56
Q

Foliate Papillae, additional function?

A

“Leaf-like” papillae
• May contain taste buds
• Contains lymphoid nodules with germinal centers
• Forms part of Waldeyer’s Ring
• Located on the posterior lateral margins of the
tongue

57
Q

Circumvallate Papillae

A 
• “Walled” papillae 
• Generally 6-8 in number 
• Lightly keratinized 
• Located just anterior to the 
sulcus terminalis on the 
posterior dorsal tongue surface 
• Papillae sulcus is cleared of 
taste stimuli by serous salivary 
glands of von Ebner
58
Q

papillae responses to different tastes

A

The different papillae respond to all types of taste stimuli
but display bias in their sensitivity:
• Circumvallate papillae tend to be more sensitive to
bitter compounds
• Fungiform papillae respond best to salt and sweet
stimuli
• Foliate papillae show a bias for sweet

59
Q

von ebners glands

A

wash away stimuli from the taste cells, located at the base of the papilla

60
Q

tatse buds

A

line all papilla except filiform

contain taste cells of neuroepithelial origin

61
Q

what are taste cells

A

specialized epithelial cell, i.e.,

neuroepithelial

62
Q

Nerve supply for taste:

A

• Anterior 2/3 of tongue: Facial nerve (C-VII) via the
chorda tympani branch
• Posterior 1/3 of tongue: Glossopharyngeal (C-IX)
• Soft Palate: Facial nerve (C-VII) via the greater
petrosal branch
• Walls of the pharynx & epiglottis: Vagus nerve (C-X)
• Taste fibers from all three nerves converge in the
tractus solitarius in the brain ste

63
Q

coffee coated tongue

A

due to coffee coating the papillae

64
Q

lichenoid rxns of the tongue

A

ulcerative and hypertrophic

many possible stimuli such as drug induced

65
Q 
Lichen Planus
etiology?
cells involved?
result?
induced by?
treatment?
A

unknown etiology,
T-lymphocyte infiltrates with Langerhans cell hyperplasia are characteristic.
Consequently, cell-mediated immune injury to basal cells is suspected.
possibly stress induced, treat with steroids to reduce immune response

66
Q

candidasis

A

white appearence
fungal infection of the tongue, treat with a anti-fungal agent
can be wiped off but leaves a red spot
usually asymptomatic

67
Q

fissured tongue/focal hyperplasia

A

thickened tongue, unknown etiology

connected with xerostomia

68
Q

hairy tongue

A

filiform papillae abnormal growth pattern, delayed sheddding of the keratinized layer
can be removed with tongue scrape

69
Q

geogrpahic tongue

A

Not considered a patholgy

benign inflammation and degranulation

70
Q

Hyperkeratosis, precancerous?

A

Thickening of the stratum corneum, often with aberrant keratinization, is considered precancerous

71
Q

Leukoplakia

A

A white plaque of the oral mucous membranes that cannot be removed by scraping and cannot be classified histologically as another disease entity.

Until proven otherwise, leukoplakia should be considered precancerous.

72
Q

Squamous Cell Carcinoma (SCCA)

A

 Oral cancer accounts for about 3% of all cancers
 The highest incidence of SCCA is in middle aged
African-American males
 The overall male-to-female gender ratio of occurrence
is 3:1
 The most common site for oral SCCA is the posterior
lateral border of the tongue. The floor of the mouth
and ventral tongue surface are also common sites.

73
Q

Strong relationships exist between SCCA and:

A
  • Tobacco smoking
  • Chewing tobacco
  • Alcohol consumption
  • Phenol exposure
  • Oncogenic viruses (Human Papilloma Virus or HPV)
  • Immunosuppression (e.g., AIDS)
  • Oncogenes and tumor suppressor genes
74
Q 
Histopathology of SCCA is characterized by:
arises from?
lesions exhibit?
what kind of responses occur?
pearls?
A

• The lesion arises from dysplastic surface epithelium

alterations in size, shape, and organization of the cellular components, including nuclear pleomorphism.

• Lesion exhibits invasive islands and cords of malignant squamous epithelial cells.

• There is often a strong inflammatory or immune cell
response to the invading epithelium, and focal areas of necrosis may be present.

• Abnormal production of keratin in the form of “keratin pearls” (i.e., a round focus of concentrically layered keratinized cells) is a frequent finding.

75
Q

Mucosal Pemphigoid (a.k.a. Benign Mucous Membrane
Pemphigoid or BMMP, or Cicatricial Pemphigoid):
kind of disorder?
Ag?
characterized by?
age group/sex?
additional effect outside the mouth?

A
  • Autoimmune disease=destroys adhesion of epithelim
  • Antigen is the adhesin protein epiligrin found in the lamina lucida
  • Characterized by linear accumulations of IgG and C3 along the basement membrane
  • Affects older adults in the 50-60 year old range
  • Females affected more often than males by a ratio of 2:1
  • Cicatricial: BMMP involvement of the conjunctiva of the eye results in scarring (symblepharon). eye scarring
76
Q

Ectodermal Dysplasia:

sweat/salivary glands?

A

A syndrome involving abnormal or lack of development of ectodermal structures such as hair, eyebrows, eye lashes, and teeth.
hypohydrosis=no sweat glands
lack of salivary glands=xerostomia

77
Q 
Peripheral Ossifying Fibroma
cancerous/arises from? 
occurs where?
age group? 
sex bias? 
histology? 
treatment?
A

 Considered to be reactive rather than neoplastic in nature (NOT CANCEROUS). The lesion is thought to represent the maturation of a pyogenic granuloma.

 Occurs exclusively on the gingiva.

 Predominantly a lesion of teenagers and young adults with peak prevalence between the ages of 10 and 19 yrs.

 60% to 65% of cases occur in females.

 Histology reveals a gingival mass with islands of calcified material (derived from periosteum).

 Recommended treatment is surgical excision
 Lesion is likely to recur if excision is not extensive and complete

Histopathology (12 decks)

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