Oral Path 2 Flashcards
True or false… biopsy is mandatory with any leukoplakia
True
Proliferative verrucous leukoplakia is recurrent and warty. It may be associated with HPV ___ and ___. It has a high risk of malignant transformation to ___ and ___
16 and 18
SCC or verrucous carcinoma
Which has a higher risk of malignancy, leukoplakia or erythroplakia?
Erythroplakia
What is actinic cheilitis?
Lip inflammation/crusties due to sun damage (UVB rays especially)
What are the two highest risk sites for cancer lesions?
FOM
Posterior lateral tongue
Malignant neoplasm is a term given to cancer as soon as it invades past the ____
Basement membrane
Verrucous carcinoma is a [slow/fast] growing malignancy. It can be caused by ___ or ___ and ___. What is the treatment of choice?
Tobacco
HPV 16 and 18
Excision
SCC (squamous cell carcinoma) is caused by ___ or inactivation of ____. There is increased incidence of oropharyngeal SCC associated with ___ and ___. The 5-year survival rate is about ___%.
Oncogenes
Tumor suppressor genes
HPV 16 and 18
50%
____ is mucosal atrophy + dysphagia + iron deficiency anemia + increased risk of oral cancer
Plummer-Vinson Syndrome
What is the treatment of choice for SCC?
Excision or radiation
True or false… basal cell carcinoma frequently metastasizes
False, very rarely
Oral melanoma is a malignancy of ___. High-risk sites are the ___ and the ___. 5 year survival rate for skin lesions is greater than ___%, but less than ___% for oral lesions.
Melanocytes
Palate and gingiva
65%
20%
Name three medications that can cause gingival hyperplasia
Calcium channel blockers
Dilantin
Cyclosporine (immunosuppressant)
What is the treatment of choice for gingival hyperplasia?
Gingivectomy
Discontinue drug if possible
Denture-induced fibrous hyperplasia is called ___ if found in the vestibule and called ___ if found on the palate
Epulis fissuratum
Papillary hyperplasia
____ is an entangled submucosal mass of neural tissue and scar. Caused by injury to nerve.
Traumatic neuroma
Where is the most common location of a traumatic neuroma?
Mental foramen
____ = multiple neuromas + medullary thyroid cancer + pheochromocytoma of adrenal gland
Multiple endocrine neoplasia (MEN 2B)
Pyogenic granuloma is a hyperplasia of ____
Capillaries, causing it to be red
Nodular fasciitis is a neoplasm of ____. It is easy to eradicate and rarely recurs
Fibroblasts
____ is a neoplasm of fibroblasts, however it is difficult to eradicate and often recurs
Fibromatosis
A granular cell tumor is a neoplasm of ___. It is named such because these tumor cells have a ___.
Schwann cells
Granular cytoplasm
A granular cell tumor has _____ in the tumor which mimics SCC. Where is it most commonly found?
PEH (pseduoepitheliomatous hyperplasia)
Dorsal tongue
A variant of granular cell tumor is found on the gingiva of newborns. It is called ___ and it has no ___
Congenital epulis
No PEH (pseudoepitheliomatous hyperplasia)
____ is a neoplasm of Schwann cells and has acellular verocay bodies in antoni A tissue
Schwannoma (neurilemmoma)
A neurofibroma is a neoplasm of ___ and ___
Schwann cells and fibroblasts
Neurofibromatosis type 1 (von recklinghausen’s disease) = ___+ ___ + ___ + ___
Multiple neurofibromas
Multiple skin freckles (cafe au lait spots)
Axillary freckles (Crowe’s sign)
Iris freckles (lisch spots)
Note that neurofibromas can transform to neurofibrosarcomas in this syndrome
____ is a neoplasm of smooth muscle cells
Leiomyoma
___ is a neoplasm of skeletal muscle cells
Rhabdomyoma
____ is a neoplasm of fat cells. Intraorally, it is found most commonly ___
Lipoma
Buccal mucosa
_____ is a malignant proliferation of fibroblasts
Fibrosarcoma
____ is also known as a malignant peripheral nerve sheath tumor. It is a malignant proliferation of Schwann cells
Neurofibrosarcoma
Kaposi’s sarcoma is a malignant proliferation of ____. It is caused by HHV___ and most commonly seen as a complication of ___. The lesions are ___ in color.
Endothelial cells
8
AIDS
Purple
____ is a malignant proliferation of smooth muscle cells
Leiomyosarcoma
Mucous extravasation phenomenon is caused by trauma to ___
Salivary duct
What is the difference between a mucous retention cyst and a mucous extravasation phenomenon?
Mucous retention cysts histologically are true cysts as they are lined with epithelium.
Caused by blockage of a salivary duct by a sialolith
Necrotizing sialometaplasia is a [slowly/rapidly] expanding ulcerative lesion. It is usually due to ___ necrosis of minor salivary glands in response to trauma or local anesthesia. What is the treatment of choice?
Rapidly
Ischemic
It will heal on its own in 6-10 weeks
A sinus retention cyst is also called ____. It is caused by….
What is the treatment of choice?
Antral pseudocyst
Blockage of glands in sinus mucosa
None
Which expands faster, sinus retention cyst or a sinus mucocele?
Sinus retention cyst
Sarcoidosis is due to a [hyper/hypo] immune response resulting in granulomas. It may be triggered by ___. It is primarily a pulmonary disease but also affects ___ and ___
Hyperimmune
Mycobacteria
Salivary glands (resulting in xerostomia) and mucosa
___ syndrome = erythema nodosum + bilateral hilar lymphadenopathy + arthritis
Lofgren’s
____ syndrome = anterior uveitis + parotid gland enlargement + facial nerve palsy + fever; also called uveoparotid fever
Heerfordt
What is the treatment of choice for sarcoidosis?
Corticosteroids
Sjögren’s syndrome is autoimmune and is ___ mediated. It affects salivary and tear glands. What is the treatment of choice?
Lymphocyte
Treat the symptoms
What is the difference between primary and secondary Sjögren’s syndrome?
Primary = keratoconjunctivitis sicca (dry eyes) and xerostomia
Secondary = above plus another autoimmune disease (usually RA)
_____ is the most common benign salivary gland tumor. It is a firm, rubbery swelling. It is composed of what cell type?
Pleomorphic adenoma
Mixture of cell types (epithelial and CT), why it is also called mixed tumor
Where are the most common locations for a pleomorphic adenoma?
Palate for minor salivary glands
Ear for parotid gland
A pleomorphic adenoma is described as a ___ ___ swelling
Firm, rubbery
Monomorphic adenomas are composed of a single cell type. Name 4 different monomorphic adenomas
Basal cell adenoma
Canalicular adenoma
Myoepithelioma
Oncocytic tumor
Warthin’s tumor is composed of ___ (which are ___) and ___. It is usually found in the ___ gland of older men.
Oncocytes (whic are epithelial cells with excessive number of mitochondria)
Lymphoid cells
Parotid
Salivary gland diseases that are malignant are most common in which location?
Palate
What is the most common salivary gland malignancy? What cells is it composed of?
Mucoepidermoid carcinoma
Mucous and epithelial cells
What is the second most common salivary gland malignancy for minor glands?
Polymorphous low-grade adenocarcinoma
Adenoid cystic carcinoma has a ___ or ___ microscopic pattern. 5-year survival rate is __%, whereas the 15 year survival rate it ___%
Cribriform or Swiss cheese
70%
10%
True or false… all lymphoid neoplasms are malignant by nature
True
____ lymphoma has reed sternberg cells, which are malginant ___ cells.
Hodgkin’s
B
Non-hodgkin’s lymphoma is a neoplasm of __ or __ cells.
B or T
____ is a type of B cell non-hodgkins lymphoma (NHL) with bone marrow involvement, swelling, pain, tooth mobility, lip paresthesia, and halts root development
Burkitt’s lymphoma
_____ involves neoplasm of antibody-secreting B cells (AKA ___ cells). Multiple _____ are usually found radiographically in the skull. ____ is found due to accumulation of complex ___ proteins that develop from antibody light chains. This disease has a poor prognosis
Multiple myeloma
Plasma
Punched-out radiolucencies
Amyloidosis
Amyloid
____ is a neoplasm of bone marrow cells (lymphocytes, NK cells, granulocytes, and megakaryocytes). Classification is based on….
Leukemia
Cell lineage (myeloid or lymphoid) and whether the disease is acute or chronic.
List the types of leukemia in which is most common form youngest to oldest.
ALL > CML > AML > CLL
What are the three main clinical signs of leukemia?
Bleeding (platelets)
Fatigue (RBCs)
Infection (WBCs)
What is the most common odontogenic cyst?
Periapical cyst (radicular cyst)
A periapical cyst is always associated with a ___ tooth at the ___
Nonvital
Apex
Necrotic pulp causes periapical inflammation. Acute leads to ___. Chronic leads to ___
Abscess
Granuloma
The ____ from ___ within pocket of inflammation encapsulate the lesion resulting in the formation of a periapical cyst
Epithelial rests of malassez
Hertwig’s epithelial root sheath
What is the treatment for a periapical cyst?
RCT
Apicoectomy
Extraction with curettage
A dentigerous cyst is called an eruption cyst if…
The lesion occurs over an erupting tooth in children
A dentigerous cyst is a radiolucency attached to the ___ of an impacted tooth. They are found most commonly with which teeth?
CEJ
Canines and third molars
In a dentigerous cyst there is an accumulation of fluid between the crown and the ___
Reduced enamel epithelium
Where are lateral periodontal cysts found most commonly?
Mandibular premolar region
True or false… lateral periodontal cysts are always associated with a vital tooth
True
What is the soft tissue counterpart of the lateral periodontal cyst? Does it have a radiolucency?
Gingival cyst of the adult
No radiolucency because no bone is involved
Gingival cysts of the newborn found on the lateral palate are called ___ is they are found on the midline of the palate they are called ___
Bohn’s nodules
Epstein’s pearls
Gingival cysts of the newborn are derived from…
Rests of dental lamina
What is the treatment of choice for gingival cysts of newborn?
None, they will involve as infant ages
What is a primordial cyst?
Develops where a tooth would have formed
Most common at mandibular third molar region
Treatment is removal
What is the other name for an OKC (odontogenic keratocyst)?
Keratocystic odontogenic tumor
Keratocystic odontogenic tumors are aggressive and recurrent. They are found most commonly ____. They are lined with [thin/thick] corrugated ___ epithelium
In posterior ascending ramus of mandible
Thin
Parakeratinized
____ = multiple OKC (KCOTs), multiple Basel cell carcinomas, calcified falx cerebri. It is often fatal. It is also called nevoid basal cell carcinoma
Gorlin syndrome
What is the treatment of KCOT (OKCs)
Aggressive enucleation
What is associated with Gorlin syndrome?
Multiple OKCs (odontogenic keratocyst/keratocystic odontogenic tumors)
Multiple Basel cell carcinomas
Calcified falx cerebri
Fatal
AKA nevoid basal cell carcinoma
What is the other name for the Gorlin cyst?
Calcifying odontogenic cyst
Which type of cyst/tumor involves Ghost cells? What are they?
Calcifying odontogenic cyst
Empty space where nucleus was and keratin fills it, can undergo calcification and little radiodensities detected radiographically
The ameloblastoma is [malignant/benign] and [aggressive/docile]
Benign
Aggressive
What is the classical differential diagnosis for multilocular radiolucency in posterior mandible?
Ameloblastoma
KCOT (OKC)
CGCG
COF
What is the other name for the CEOT (calcifying epithelial odontogenic tumor)?
Pindborg tumor
Which odontogenic tumor has a radiolucent appearance with “driven snow” calcifications?
CEOT
The ___ tumor has an amorphous pink amyloid with concentric calcifications termed ____
CEOT
Liesegang rings
True or false.. even after surgical excision the CEOT has a poor prognosis.
False. It has a good prognosis
Which odontogenic tumor contains epithelial duct-like spaces and enameloid material. It is mostly in the anterior maxilla and over impacted canines. With surgical excision it has a good prognosis.
AOT (adenomatoid odontogenic tumor)
The odontogenic myxoma is also called a ___. It is filled with a myxoma to us connective tissue with is pulp-like with little collagen, it is often referred to as ___
Myxofibroma
Slimy stroma
____ has a messy radiolucency with unclear borders and a honey comb pattern. It is filled with slimy stroma
Odontogenic myxoma
True or false… the odontogenic myxoma has a very poor prognosis and near 100% recurrence
False.. with surgical excision it only has a moderate recurrence
The COF (central odontogenic fibroma) is dense collagen with strands of epithelium. It can be central (___) or peripheral (___)
Bone, well-defined multilocular radiolucency
In the gums
(Note that it is often located in posterior mandible)
Ameloblastic fibroma mostly occurs in which population? Where is it most commonly located?
Children and teens
Posterior mandible
What is the difference between compound and complex odontomas?
Compound = mostly in anterior, bunch of miniature teeth
Complex = mostly posterior, conglomerate mass
____ = multiple odontomas + intestinal polyps
Gardner syndrome
What is Gardner syndrome?
Multiple odontomas + intestinal polyps
_____ is composed of fibroblastic stroma in which foci of mineralized products are formed
Central = bone, well-circumscribed radiolucency
Peripheral = gum
Central ossifying fibroma
What is different about the juvenile form of central ossifying fibroma?
Aggressive variant
Rapid growth
Younger patients
____ has a ground-glass apperance. Usually stops growing after puberty.
Fibrous dysplasia
_____syndrome = polyostotic fibrous dysplasia + cutaneous cafe au lait spots + endocrine abnormalities like precocious puberty
McCune-Albright Syndrome
What 3 things make up McCune Albright Syndrome?
Polyostotic fibrous dysplasia
Cutaneous cafe au lait spots
Endocrine abnormalities like precocious puberty
What is the treatment of choice for fibrous dysplasia?
Surgical recontoruing for cosmetics
____ is composed of fibroblasts and multinucleated giant cells. It is anterior mandible favored.
Central giant cell granuloma
What is the difference between the central giant cell granuloma and peripheral giant cell granuloma?
Central = in bone. Radiolucency with thin wispy septations
Peripheral = gum, red-purple gingival mass
The ___ is a pseudocyst composed of blood-filled spaces. It is a multilocular radiolucency and is expansile. Posterior mandible is favored.
Aneurysmal bone cyst
Treatment is excision
____ causes multiple bone lesions that look like central giant cell granulomas resulting from excessive levels of parathyroid hormone
Hyperparathyroidism
___ is assocaited with hyperparathyroidism due to excess osteoclast activity
Brown tumor
In hyperparathyroidism there is elevated ____ due to too much breakdown of bone
Alkaline phosphatase
Von recklinghausen’s disease of BONE is the result of ___
Hyperparathyroidism (not to be confused with von recklingausen’s disease aka neurofibromatosis)
Cherubism is assocaited with multiple ___
Giant cell lesions symmetrically and bilaterally
Stops growing after puberty
Langerhans cell disease, AKA ____, is a rare type of cancer. Here, there is a discrete punched out “ice cream scoop” radiolucencies that lead to floating teeth.
Idiopathic histiocytosis
_____ is a progressive metabolic disturbance of many bones (spine, femur, skull, jaws) causing symmetrical enlargement. Usually in adults older than 50. There are elevated levels of alkaline phosphatase due to breakdown of bone. There is a “___” appearance. Pts may complain that dentures or hats become too tight
Paget’s disease
Cotton wool
What is the treatment for Paget’s disease?
Bisphosphanates
Calcitonin
What are the most common initiating causes of acute osteomyelitis?
Infection and inflammation usually begins in ___ space involving the __ bone and spreads to ___ bone, __, and ___
Odontogenic infection and trauma
Medullary
Cancellous
Cortical
Periosteum
Soft tissue
Name four symptoms of acute osteomyelitis
Deep and intense pain
High or intermittent fever
Paresthesia or anesthesia of IAN
Tooth is NOT loose!
True or false… acute osteomyelitis causes teeth to loosen
False. This is caused by periodontitis
What is the radiographic appearance of chronic osteomyelitis?
Diffuse mottled radiolucency
What is sequestra?
Piece of dead bone assocaited with chronic osteomyelitis
what is Garre’s osteomyelitis?
Chronic osteomyelitis with proliferative periosteitis (onion skin)
What is the treatment for chronic osteomyelitis?
Antibiotics and debridement
What is focal sclerosing osteomyelitis (AKA condensing osteitis)?
Bone sclerosis resulting from low-grade inflammation like chronic pulpitis
The body forms sclerotic bone to wall off the infection
Treatment = addressing the cause (RCT)
True or false… diffuse sclerosing osteomyelitis is the same as condensing osteitis but on a wider scale. It may lead to jaw fracture and osteomyelitis. What is the treatmet?
True
Antibiotics and address the cause
BRONJ has a much higher risk of development with ___ administration rather than ___
IV
Oral
What is the treatment for BRONJ?
Chlorhexidine rinse***
Antibiotics
Conservative surgery
What is the most common symptom of oral malignancies?
Numb lip
_____ is sarcoma of the jaws where new bone is produced by tumor cells. It exhibits a sunburst pattern. 5 year survival is 25-40%. What is the treatment?
Osteosarcoma
Resection and chemotherapy
____ is sarcoma of the jaws where new cartilage is produced by tumor cells. It is most common in which location?
Chondrosarcoma
The condyle
___ is sarcoma of long bones involving “round cells”. It seldom affects the jaws. Most common in children and involves swelling.
Ewing’s sarcoma
Metastatic carcinoma involves pain, swelling, and especially paresthesia. I’ll-defined changes are noted. List the most common to least common areas in which the cancer originated.
Breast
Lung
Kidney
Colon
Prostate
True or false.. white sponge nevus is hereditary
True
____ is a hereditary condition that causes skin (and mucosa) to be fragile and blister easily
Epidermolysis Bullosa
Hereditary Hemorrhagic Telangiectasia, (AKA ____) is associated with telangiactasias, which are ____. There is abnormal capillary formation on skin, mucosa, and viscera. It is associated with ____. ___ is a frequent presenting sign.
Older-Weber-rendu Syndrome
Red macule or papules, dilated or broken capillary
Iron-deficiency anemia
Epistaxis (nose bleeds)
Cleidocranial dysplasia is inherited in ____. What are two key characteristics?
Autosomal dominant
Missing clavicles
Supernumerary teeth
Ectodermal dysplasia is inherited by ___. What are two key characteristics?
X-linked recessive
Missing teeth
Hypoplastic hair or nails
Osteopetrosis is autosomal dominant or recessive. It is also called ___ and ___. Describe this condition.
Albergs-Schoenberg disease
Marble bone disease
Lack of bone remodeling and resorption leads to “stone bone”
Amelogenesis imperfecta is hereditary. It involves intrinsic alteration of ___ in which teeth? True or false… thin to no enamel yet dentin and pulp are normal
Enamel
All teeth in primary and permanent dentitions
True
What is the treatment for amelogenesis imperfecta?
Full-coverage crowns for cosmetics
Dentinogenesis imperfecta involves intrinsic alteration of ___ of which teeth? What do the teeth look like?
Denting
All teeth from both dentitions
Short roots, bell-shaped crowns, and obliterated pulps
Bulbous crowns in radiographs due to constricted DEJ
blue sclera
Blue sclera is assocaited with…
Dentinogenesis imperfecta
And osteogenesis imperfecta
Dentin dysplasia involves intrinsic alteration of dentin that affects all teeth from both dentitions. How does it look different from dentogenesis imperfecta?
Chevron pulps and short roots (or thistle pulps)
Note that teeth are not good for restoration
Type 1 dentin dysplasia is associated with ___
Type 2 dentin dysplasia is assocaited with ___
Short roots
“Chevron pulps”
_____ involves a quadrant of teeth with short roots, open apices, and enlarged pulp chambers. The teeth are called “ghost teeth”
Regional odontodysplasia
What is the treatment for teeth with regional odontodysplasia?
Extract affected teeth
