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Oral Path > Oral Path Final deck > Flashcards

Oral Path Final deck Flashcards

1
Q

Define Hamartoma…

A

Disorganized overgrowth of normal tissue in its normal location

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2
Q

Define Choristoma…

A

Growth of normal tissue in an abnormal location

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3
Q

Define Neoplasm…

A

Growth of abnormal tissue, may be either benign or malignant

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4
Q

What are some characteristics of a Benign lesion?

A

-Bilateral -Rapid onset (ulceration, soft tissue swelling) -Pain -Growth around native structures - Slow expansion (osseous) - Smooth root resorption

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5
Q

What are some characteristics of malignant lesion?

A
  • Unilateral - Chronic, persistent (ulceration) - Absence of pain/presence of paresthesia - Invasion/destruction of native structures - Cortex destruction - Spiking root resorption
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6
Q

Define Adenoma…

A

Usually a benign neoplasm: Pleomorphic adenoma, oncocytoma

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7
Q

Define Carcinoma…

A
  • Malignant neoplasm derived from epithelial cells - Surface (skin, mucosal): Basal cell carcinoma - Glandular: Adenocarcinoma
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8
Q

Define Sarcoma…

A

Malignant neoplasm derived from cells of mesodermal origin: Liposarcoma, fibrosarcoma

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9
Q

Define Metastasis…

A
  • Spread of disease from one part of the body to another - Tumor implants are discontinuous with the primary tumor
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10
Q

What are the 4 differentials for the gum bump differential?

A
  1. Fibroma 2. Pyogenic Granuloma (Lobular Capillary Hemangioma) 3. Peripheral Ossifying Fibroma 4. Peripheral Giant Cell Granuloma POF AND PGCG OCCUR ONLY ON THE GINGIVA!
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11
Q

What are the 4 Human Papilloma Virus Differential?

A
  1. Squamous Papilloma 2. Verruca Vulgaris 3. Condyloma Acuminata (High risk types 16 & 18) 4. Heck’s Disease (Multifocal Epithlial Hyperplasia)
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12
Q

What is the differential list for Multilocular Radiolucent Lesions?

A

MACHO! M: Myxoma A: Ameloblastoma C: Central Giant Cell Lesion H: Hemangioma (Vascular Malformation) O: Odontogenic Keratocyst Also may be included: - Dentigerous Cyst - Glandular Odontogenic Cyst

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13
Q

What is the differential for Mixed Radiolucent/Radiopaque Differential Diagnosis?

A
  • Adenomatoid Odontogenic Tumor - Calcifying Odontogenic Cyst - Ameloblastic Fibro-Odontoma - Calcifying Epithelial Odontogenic Tumor - Ossifying Fibroma - Fibrous Dysplasia - Desmoplastic Ameloblastoma
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14
Q

Define Odontogenic Cyst…

A

Cysts lined by odontogenic epithlium

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15
Q

Which odontogenic cysts are inflammatory? Can you name 3?

A
  1. Periapical (radicular) cyst 2. Residual periapical (radicular) cyst 3. Buccal bifurcation cyst
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16
Q

Which odontogenic cysts are developmental…there’s a lot!

A
  1. Dentigerous Cyst 2. Eruption Cyst 3. Odontogenic Keratocyst 4. Orthokeratinized Odontogenic Cyst 5. Gingival (alveolar) cyst of the newborn 6. Gingival Cyst of the Adult 7. Lateral Periodontal Cyst 8. Calcifying Odontogenic Cyst 9. Glandular Odontogenic Cyst
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17
Q

What are the 4 tumors of Odontogenic Epithelium?

A
  1. Ameloblastoma 2. Adenomatoid Odontogenic Tumor 3. Calcifying Epithelial Odontogenic Tumor 4. Squamous Odontogenic Tumor
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18
Q

What are some Mesenchymal Odontogenic Tumors? Can you name 3?

A
  1. Odontogenic Myxoma 2. Central Odontogenic Fibroma 3. Cementoblastoma
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19
Q

What are some mixed epithelial/mesenchymal odontogenic tumors?

A
  1. Ameloblastic Fibroma 2. Fibroodontoma 3. Odontoma (considered a hamartoma)
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20
Q

Define Leukoplakia…

A

White patch that cannot be wiped off, clinical descriptions, not a diagnosis

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21
Q

Define Erythroplakia…

A
  • Red patch or plaque-like lesion that cannot be clinically or pathologically diagnosed as any other condition - Often represents malignant change: Up to 90% of erythroplakic lesions represent severe epithelial dysplasia, carcinoma in situ, or SCCa
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22
Q

Define Erythroleukoplakia…

A
  • AKA speckled leukoplakia - Frequently dysplasia or carcinoma in situ on biopsy
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23
Q

Sharply demarcated leukoplakia is concerning for…

A

Dysplasia!

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24
Q

What percentage of erythropakic lesions represent severe epithelial dysplasia, carcinoma in situ, or squamous cell carcinoma?

A

90%!

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25
Q

What is the evolution of Proliferative Verrucous Leukoplakia look like?

A
  • Characterized by multiple, persistent, keratotic plaques that over time progress to SCC - Verrucous hyperplasia leads to… - Verrucous Carcinoma that leads to… - Invasive squamous cell carcinoma - Lesions rarely regress dispite therapy
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26
Q

Define Dysplasia…

A
  • Abnormal tissue development - Rapid cell turn over - Immature epithelial cells, lack of maturation - Can be mild, moderate, or severe (thirds of epithelium)
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27
Q

What is Squamous Cell Carcinoma in situ…

A
  • Dysplastic change involving the full-thickness of epithelium - Latin (in site) - Not extending beyond the focus or level of origin - No invasion by definition
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28
Q

Oral Squamous Cell Carcinoma is most commonly found in these 2 locations…

A
  1. Tongue: posterior lateral most common 2. Floor of mouth (midline near frenum) Most likely location intraorally (versus oropharynx) to demonstrate early metastasis to cervical lymph nodes. Leukoplakia in this area also has a higher chance of containing dysplasia/carcinoma
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29
Q

What is the vitality of teeth associated with buccal bifurcation cysts?

A

Vital

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30
Q

What is the tx for buccal bifurcation cyst

A

curettage, do not ext

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31
Q

What is the most common dev odontogenic cyst

A

dentigerous

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32
Q

What teeth are dent cysts most commonly associated with

A

impacted thirds and impacted canines

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33
Q

If an impacted tooth has a pericoronal radiolucency greater that ??? mm you should be concerned about more serious entities

A

3mm

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34
Q

Whats the tx for dentigerous cysts

A

Ext and send tissue to pathology

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35
Q

What is an eruption cyst

A

overlying soft tissue impacted tooth, may appear blue or red

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36
Q

What is the treatment for an eruption cyst

A

none, usually spontaneously resolve.

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37
Q

What are some details concerning OKC growth and expansion

A

May grow large and cause expansion but more often tracks up the mandible ramps if in Max can grow into sinuses

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38
Q

What is the tx for OKCs

A

Must be completely removed, high recurrence rate with curettage (30%) can do peripheral osteotomy or marsupialization to shrink cyst prior to surgery

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39
Q

What are multiple OKCs suggestive of

A

Nevoid Basal Cell Carcinoma Syndrome

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40
Q

How do orthokeratinized Odontogenic Cysts compare to OKs

A

Histologically similar not usually as large associated with thirds recurrence rate with curettage low (2%)

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41
Q

Are gingival cysts of the newborn common

A

yes

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42
Q

Tx for gingival cysts of the newborn

A

none, spontaneously resolve by 3 months

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43
Q

Lat periodontal cyst facts

A

Associated with vital teeth bone window with simple enucleation usually curative

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44
Q

where are lat periodontal cysts most likely to occur

A

Man canine/premolar area (similar to gingival cyst of the adult)

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45
Q

Where are calcifying odontogenic cysts usually found

A

Max=man, often in the anterior

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46
Q

Which ddx do Calcifying Odontogenic Cysts fall under

A

Mixed, can be multilocular

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47
Q

Whats an interesting histologic feature of Calcifying Odontogenic cysts

A

Ghost cell formation

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48
Q

Tx for Calcifying odontogenic cyst

A

Enucleates easily (peels out of bone), low recurrence rate

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49
Q

Glandular odontogenic cyst locations

A

Propensity for mandible, premolar incisor region, crosses midline

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50
Q

Tx for glandular odontogenic cyst

A

can be aggressive so resection may be necessary

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51
Q

What can glandular odontogenic cysts be misdiagnosed as

A

intraossseous mucoepidermoid carcinoma

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52
Q

Where do nasopalatine duct cyst appear

A

ant max midline, either palatal or facial of 8/9 (teeth vital)

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53
Q

Tx for nasopalatine duct cyst

A

simple curettage

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54
Q

What is a nasolabial cyst

A

soft tissue cyst in the nasolabial fold that elevates ala.

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55
Q

What is the nasolabial cyst remnants of

A

Nasolacrimal duct

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56
Q

What gender is more likely to have nasolabial cyst

A

females

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57
Q

Tx for nasolabial cyst

A

surgical excision

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58
Q

Tx for developmental inclusion cyst of the neonate

A

none, resolve spontaneously

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59
Q

Types of dev inclusion cysts of the newborn

A

Epstein pearl and john nodules

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60
Q

Where can a thyroglossal duct cyst be found

A

Midline of the new, anywhere from the foramen cecum (base of tongue) down to thyroid usually attached to hyoid bone and moves when pt swallows

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61
Q

What is the tx for Thyroglossal duct cyst

A

Sistrunk procedure:rem cyst and involved portion of hyoid bone

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62
Q

Where can a branchial cleft cyst be found

A

Lateral neck common, but can be anywhere from ear down to clavicle along SCM.

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63
Q

What does branchial cleft cyst appear as in histology

A

Lymphoepithelia cyst

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64
Q

Epidermal inclusion cysts are filled with what

A

keratin-stinky. its can complain of periodic smelly drainage if cyst is continuous with skin surface

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65
Q

How many germ cell layers does an epidermal inclusion cyst have

A

1

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66
Q

Multiple Epidermal inclusion cysts are consistent with

A

Gardner syndrome

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67
Q

Where are dermoid cysts found

A

midline of body, often floor of mouth or inner cants of the eye

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68
Q

How many germ layers are in a dermoid cyst

A

2, epidermoid and mesodermal

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69
Q

describe look and location of oral lymphoepithelial cyst

A

yellowish module, 1 cm on lateral posterior tongue or tonsillar area, soft palate.

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70
Q

What is an oral lymphoepithelial cyst

A

ectopic tonsillar/lymphoid tissue

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71
Q

Tx for oral lymphoepithelial cyst

A

Simple excision

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72
Q

Tx for ameloblastoma

A

Agressive and must be completely rem with resection of up to 1 cm into clear margins

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73
Q

common location of ameloblastoma

A

can occur anywhere but post man most common

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74
Q

What is the only clincally relevant histologic subtype of ameloblastoma

A

Desmoplastic ameloblastoma

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75
Q

where is desmoplastic ameloblastoma often found

A

Ant Maxilla

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76
Q

What is a desmoplastic ameloblastoma similar to radiographically

A

benign fibre-osseous lesion, ground glass

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77
Q

What is the text book presentation of adenomatoid odontogenic tumor

A

2/3: ant max, female, young, impacted canine

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78
Q

Tx for Adenomatoid odontogenic tumor

A

usually shells out of bone in large pieces, if completely removed no recurrence

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79
Q

Where are calcifying epithelial odontogenic tumors most likely found

A

post mandible

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80
Q

What do CEOTs produce histologically and radiographically

A

Amyloid like material concentric calcifications called leisegang rings

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81
Q

tx of Calcifying epithelial odontogenic tumors

A

conservative excision with low recurrence rates

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82
Q

Where can you find central odontogenic fibromas

A

Ant Max, post man

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83
Q

What is the classical presentation of central odontogenic fibroma in max

A

Palatal notch

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84
Q

Tx for central odontogenic fibroma

A

enucleation, low recurrence

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85
Q

Central odontogenic fibroma radiographically presents as

A

RL but can have RO flecks

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86
Q

What radiographic feature defines odontogenic myxoma

A

thin separations at right angles to each other. thin wispy septations

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87
Q

Tx for odntogenic myxoma

A

Resection difficult as they grow large with a jelly like consistency with myxoid fingers into surrounding bone that isn’t visible on imaging, conservative resection needed

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88
Q

Who is most likely to have cementoblastoma

A

young adults,kids

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89
Q

where are cementoblastomas most commonly found

A

post man

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90
Q

Clinical presentation of cementoblastoma

A

painful and expansile

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91
Q

What happens to teeth associated with cementoblastomas

A

must be ext

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92
Q

radiographic presentation of cementoblastoma

A

RO, or mixed with RL rim, attached to tooth roots

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93
Q

Odontomas are an example of

A

harmartoma

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94
Q

What are the types of odontoma

A

compound complex

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95
Q

Compound odontomas def

A

still has three separate layers, usually ant max

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96
Q

Complex odontoma

A

unrecognizable as tooth, usually in posterior

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97
Q

what demographic is common for ameloblastic fibroma/fibro-odontoma

A

Kids in 1st or second decades. Any mixed or RL session ddx in kid should include this

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98
Q

growth facts about Ameloblastic fibroma/fibro odontoma

A

grow large, can displace teeth

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99
Q

tx for ameloblastic fibroma/fibro-odontoma

A

conservative excision, may need resection if recurs

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100
Q

Which locations have SCCs that are p16+

A

Soft palate, oropharynx larynx, base of tongue

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101
Q

What does p16+ indicate

A

a specific mutated pathway that may be HPV induced.

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102
Q

what are features of p16+ tumors

A

more aggressive respond better to therapy

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103
Q

What common variants of SCC are found in the soft palate/oropharynx/larynx/base of tongue

A

Non keratinizing SCC and basaxoid SCC

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104
Q

Tradition risk factors (smoking alcohol) are least associated with SCC in this intramural site

A

gingiva

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105
Q

Which gender is more likely to have SCC on gingiva

A

females

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106
Q

What is verrucous carcinoma

A

A less aggressive less invasive variant of SCC

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107
Q

Do verrucous carcinoma metastasize

A

no, if does likely represents transformation to conventional SCC

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108
Q

what are the three major salivary glands

A

parotid, submandibular, sublingual

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109
Q

what do myoepithelial cells do

A

contract to assist in expulsion of glad secretory product

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110
Q

what are features of the parotid

A

serous two lobes separated by facial nerve empties into stepsons duct contains lymph nodes lateral to facial nerve

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111
Q

Submandibular gland

A

80/20 serous/mucinous whitens duct 3-6 lymph nodes adjacent to gland

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112
Q

Sublingual gland

A

mucinous

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113
Q

Where do mucoceles not occur

A

upper lip

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114
Q

What happens to a mucocele during salivation

A

likely to expand

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115
Q

Mucocele tx

A

if excised take surrounding minor glands too to decrease chance of recurrence

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116
Q

what is a ranula

A

mucocele on the floor of the moth that may grow large.

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117
Q

what are some ddx of ranula

A

dermoid cyst, cystic hygroma

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118
Q

Where are sialoliths most likely to be found

A

submandibular gland in the tortuous whartons duct, but can be found in parotid and minor glands

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119
Q

What are possible causes of sialadentitis

A

stone blockage autoimmune (IgG4 chronic sclerosis sialadentitis) sjogren syndrome

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120
Q

Describe necrotizing sialometaplasia

A

chronic non healing ulcer that can grow large but often quicker onset than SCC, often on the palate biopsy often incites resolution

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121
Q

Necrotizing sialometaplasia can mimic

A

mucous, and SCC

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122
Q

what is the most common location of saliva gland neoplasia

A

parotid followed by minor salivary glands

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123
Q

Bengin v malignant stats in parotid

A

bening 2x malignant

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124
Q

benign v malignant stats in submandibular

A

benign more common

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125
Q

benign v malignant stats in sublingual

A

neoplasms less common but when present usually malignant

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126
Q

Where are minor salivary gland neoplasms most likely

A

palate followed by lips

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127
Q

benign v malignant stats in minor salivary glands

A

malignant more likely (palate 50/50)

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128
Q

Aggressiveness of salivary gland malignancies

A

may be slow and not very agressive

129
Q

What are concerning clinical features of salivary gland neoplasms

A

facial nerve paresthesia or paralysis, ulceration

130
Q

what is the most common benign salivary gland neoplasm

A

pleomorphic adenoma

131
Q

most common malignant salivary gland neoplasm

A

mucoepidermoid carcinoma

132
Q

Location of pleomorphic adenoma

A

Parotid, then minor glands

133
Q

Demographics of a warthin tumor pt

A

older male, smoker

134
Q

where do warthin tumors present

A

parotid, often bilaterally though not necessarily at the same time

135
Q

Canalicular adenoma are found where

A

75% in upper lip, other in ant buccal mucosa. may be multi factorial

136
Q

Mucoepidermoid carcinoma are found where

A

anyloction but the parotid and palate more common

137
Q

clinical features of mucoep

A

bluish nodule that may be ulcerated.

138
Q

what stain is used to highlight mucous cell in mucoep

A

mucicarmine special stain

139
Q

three grades of much ep

A

low intermediate high

140
Q

DDX in the palate

A

necrotizing sialometaplasia, MEC, SCC

141
Q

where does acidic cell carcinoma present most commonly

A

parotid

142
Q

where is adenoid cystic carcinoma found most

A

minor glands, palat and sinonasal

143
Q

Who typically gets adenoid cystic carcinoma

A

middle age, 40’s, male

144
Q

how would you describe the growth and metastasis of adenoid cystic carcinoma

A

slow relentless growth with metastases along skip lesions along nerves. difficult to resect

145
Q

What other treatments needed for neoplasms

A

neck dissection, chemo, radiation dependent on lymph node mets, and on grade of umor

146
Q

what is freys syndrome

A

damage to auriculptemporal branch of facial nerve during parotid surgery resulting in gustatory sweating

147
Q

Multiple osteomas are seen in..

A

Gardners syndrome

148
Q

Where are osteopath primarily distributed

A

craniofacially

149
Q

Are tori/exostosis osteomas

A

no, they are developmental/reactive

150
Q

what is the etiology of condensing osteitis

A

reactive bone sclerosis due to inflammation of a usually non vital tooth, can regress following resolution of imflammation

151
Q

facts about idiopathic osteosclerosis

A

vital teeth, no def etiology

152
Q

what is the typical patient for osteoporotic marrow defects

A

middle aged female

153
Q

likely site of osteoporotic marrow defect

A

body of man, can be site of prev ext

154
Q

what is usually found when entering a marrow deffect

A

normal bone marrow

155
Q

predilections of idiopathic bone cavity

A

young, man, male, maybe trauma

156
Q

Findings upon entering an idiopathic bone cavity

A

nothing, bleeding incited usually causes healing

157
Q

radiologic finding of idiopathic bone cavity

A

scallops around tooth roots

158
Q

where are aneurysmal bone cysts more commonly found

A

long bones

159
Q

growth of ABCs

A

rapid expansion and can be aggressive

160
Q

predilections of ABCs

A

young females

161
Q

Types of ABCs

A

primary and secondary

162
Q

primary ABCs are associated with

A

neoplastic genetic mutation

163
Q

secondary ABCs association

A

another entity such as central giant cell lesion

164
Q

most common sites to metastasize to bone

A

BLT with a Kosher pickle breast, lungs, thyroid, kidney, and prostate

165
Q

most common form of bone malignancy

A

bone mets

166
Q

where are osteosarcomas most commonly found

A

long bones: proximal tibia/distal femur in pubescent boys

167
Q

Gnathic osteosarcoma demographics

A

average 35 yo

168
Q

what are the radiographic hallmarks of osteosarcoma

A

asymmetric widening of pal bone formation in soft tissue bone formation above alveolar crest spiking root resorption sun burst only in 25% of cases

169
Q

what is the tx for osteosarcoma

A

radical resection

170
Q

Which type of benign fibro osseous lesion is reactive

A

cemento osseous dysplasia

171
Q

which type of benign fibroosseous lesion is neoplastic

A

ossifying fibroma

172
Q

which type of benign fiber osseous lesion is developmental

A

fibrous dysplasia

173
Q

whats the requirement to call COD florid

A

at least two quadrants are affected

174
Q

whats the concern for COD in edentulous pts

A

the masses sequester and create opportunity for infections

175
Q

tx for central ossifying fibroma

A

neoplastic with unlimited growth potential so needs to be completely removed

176
Q

where are central ossifying fibromas most likely found

A

mandible

177
Q

what is a hallmark radiographic feature of central ossifying fibroma

A

downward bowing of the inferior border of the mandible

178
Q

what is different about juvenile active ossifying fibroma

A

more aggressive rapid growth thats more common in Max.can also occur in the ethmoid bones and other craniofacial bones

179
Q

what gene is responsible for fibrous dysplasia

A

GNAS1 gene mutation

180
Q

types of fibrous dysplasia

A

monostotic, polysotic, syndromic polystotic may just affect craniofacial bones

181
Q

what syndromes are associated with fibrous dysplasia

A

mccune albright FD, café au lait pigmentations (coast of Maine), endocrinopathies) jaffe lichtenstein FD, café au lait pigmentations

182
Q

tx of Fibrous dysplasia

A

Growth often continues through adolescence, then slows/stops in adulthood. Lesions may need to be debulked periodically.

183
Q

central giant cell lesions share same histology with…

A

Cherubism, hyperparathyroidism, ABCs

184
Q

Whats cherubism

A

Kids, multiple quadrants of CGCL; often resolve in adulthood, sometimes not.

185
Q

Hyperparathyroidism

A

Stones: nephroliathiasis Bones Subperiosteal resorption of the phalanges of the index & middle fingers Loss of lamina dura around teeth “Ground glass” appearance of bone Brown tumor: identical to central giant cell lesion microscopically Usually affect mandible, clavicle, ribs, & pelvis UL/ML RL Severe form: osteitis fibrosa cystica (central degeneration & fibrosis) If secondary to renal dz ⇒ renal osteodystrophy Groans: secondary to duodenal ulcers Moans (psychic): mental status changes (lethargy, confusion, dementia)

186
Q

What types of skin pathology are Benign, not pre-malignant?

A
  • Solar Lentigo
  • Seborrheic Keratosis
187
Q

What is this?

A

Solar Lentigo

188
Q

What is this?

A

Seborrheic Keratosis

190
Q

What is this?

A

Basal Cell Carcinoma

  • Pearly papule
  • Rolled borders and telangiectasias
  • Most common cancer
  • It does NOT occur intraorally or on mucosa
  • Strictly a skin cancer
  • Doesn’t tend to matastasize
191
Q

What is this?

Is it pre-malignant?

A
  • Actinic Keratosis
  • Yes!
192
Q

What is this?

Is it pre-malignant?

A
  • Actinic Keratosis
  • Yes!
193
Q

What is this?

A
  • Squamous Cell Carcinoma
  • Can Metastasize
195
Q

What 2 skins lesions are Pre-malignant?

A
  • Actinic Keratosis
  • Cheilitis
196
Q

What is this?

A

Subungual Melanoma

197
Q

Oral melanoma can be…

A

Amelanotic

202
Q

What 2 entities are often a result of chronic, long-term exposure to sun?

A

BCC & SCC

203
Q

What are the A, B, C, D, E’s of melanoma?

A
  • Assymetry
  • Border
  • Color
  • Diameter
  • Evolution
204
Q

What is wegners granulomatosis

A

autoimmune disorder of unknown etiology resulting in systemic vasculitis and necrotizinf granulomatous lesions of the respiratory tract

205
Q

What is the most characteristic oral manifestation of wegeners granulomatosis

A

Strawberry gingivitis florid granular hyperplasia (bumpy hemorrhagic and friable) reported boine destruction and tooth mobility

206
Q

What are you looking for in indirect immunoflourescence for Wegener

A

c-ANCA clasic anti neutrophil cytoplastic antibodies diffuse cytoplasmic staining pattern

207
Q

IN Wegner what are you looking for with ELISA (Enzyme linked immunosorbent assay

A

ID antibodies against proteinase 3 confirms positive indirect immunoflourescence

208
Q

What are the halmarks of hyperparathyroidism

A

Stones bones groans moans brown tumor

209
Q

In hyperparathyroidism what does Stones mean

A

Kidney stones metastatic calcification within other soft tissue: blood vessel walls sclera, dura, subcutaneous

210
Q

In hyperparathyroidism what does bones mean

A

subperiosteal resorption of phalanges loss of lamina dura around tooth roos alterations of bony trabecular pattern (ground glass)

211
Q

What is a brown tumor

A

Name derived from gross apearance due to hemorrhage and hemosiderin well delineated, uni or multilocular radiolucencies mandible clavicles pelvis ribs histology is identical to central giant cell lesion

212
Q

What is osteitis fibrosa cystica

A

central fibrosis/degredation of brown tumors

213
Q

What is renal osteodystrophy

A

end stage renal disease with striking jaw enlargement ground glass appearance can cause secondary hyperparathyroidism

214
Q

Whats the def of amyloidosis

A

a heterogenous group of conditions characterized by the deposition of an extracellular proteinaceous substance (amyloid)

215
Q

How is amyloidosis classified

A

organ limited systemic

216
Q

what is an amyloid nodule

A

solitary asymptomatic submucosal deposit composed of aggregates of immunoglobulin light chains focal collections of monoclonal plasma cells may be responsible not associated with systemic alteration this type is RARE in oral soft tissues

217
Q

amyloidosis and multiple myeloma

A

shared in 15-20% of cases

218
Q

Symptoms of systemic amyloidosis

A

inisital non specific skin lesions then smooth surfaced firm waxy papules/plaques on eyelid retroauricular region, neck, lips Macroglossia difuse or nodular enlargement of tongue (may be ulcerated) Xerostomia and xerophtalmia if amyloid deposits in the lacrimal and salivary glands

219
Q

What organ system is associated with systemic amyloidosis

A

end stage renal disease/dialysis

220
Q

what is direct immunofluorescence

A

a way to stain tissues to search for antibodies by making them flourese. used to detect auto immune disease

221
Q

how do you take a biopsy for immunoflouresence

A

• Submit half in Michel’s solution – ammonium sulfate solution; transport medium, not a fixative like formalin; allows for “fresh” tissue

222
Q

what are good terms for intramural changes due to vesiculobullous conditions

A

desquamative gingivitis and desquamative mucosa

223
Q

where is separation in pemphigus vulgaris

A

intraepithelial. the antibodies attack desmosomes

224
Q

what is the positive nikolsky sign and what does it indicate

A

– Formation of bullae on previously unaffected skin after application of firm, lateral pressure – Characteristic of pemphigus vulgaris

225
Q

what is usually the first sign of hemp vulgarisms

A

• Initial presentation may be oral lesions; 50% of patients have oral lesions 1 year or more before onset of skin lesions

226
Q

what are the results of immunoflourecence in pemp vulgarisms

A

direct and indirect usually positive between epithelial cells. Indirect can also be used to asses tx

227
Q

how do you tx temp vulgaris

A

Systemic corticosteroids (prednisone) • Combined with other immunosuppressive drugs (steroid sparing): azothioprine • High initial dosing schedule, followed by low maintenance doses for long-term control With corticosteroids, 5% to 10% mortality remains, often from long-term steroid use

228
Q

what is cicatricial pemphigoid

A

• Autoimmune • Antibodies directed against components of the epithelial basement membrane (subepithelial splitting) • More common than pemphigus, better prognosis cicatrix means scar

229
Q

what sites are usually affected by cicatricial pemphigoid

A

Oral lesions found in most patients, other sites often found as well (conjunctival, nasal, esophageal, vaginal, laryngeal) • Gingival involvement – desquamative gingivitis, also seen in other conditions

230
Q

what is symblepharon

A

consequence of cicatricial pemphigoid Adhesion between bulbar and palpebral conjunctivae • Subconjunctival fibrosis – early change • Conjunctiva becomes inflamed and eroded • Repeated healing leads to scarring b/w bulbar and palpebral conjunctiva

231
Q

in cicatricial pemphigoid where does separation usually occur

A

between the basement membrane and basal layer of epithelium

232
Q

what is the usual immunoflouresent results with cicatricial pemphigod

A

• Direct immunofluorescence – Continuous linear band along basement membrane zone – 90% of patients – IgG, C3, possibly IgA and IgM • Indirect immunofluorescence – Only 5% of patients

233
Q

Cicatricial Pemphigoid Treatment

A

• Immediately refer to an ophthalmologist • Treatment is varied, individual – Topical agents (if only oral lesions are present) – Systemic agents: corticosteroids plus other immunosuppressives (cyclophosphamide), dapsone, minocycline or niacinamide make sure ophthalmologist i involved

234
Q

what are the two types of lichen planus

A

reticular and eosive

235
Q

what are the immunoflouresent results of oral lichen planus

A

Direct is non specific. positive for fibrinogen along the basal layer

236
Q

when do you treat oral lichen planus

A

when it is symptomatic

237
Q

what is the tx for oral lichen planus

A

if concomitant candida present give 2 weeks of anti fungal. f LP still around give topical corticosteroids Lydex gel. if LP still present be concerned for dsplasia

238
Q

What are the types of erythema multiforme

A

Minor, major TEN

239
Q

Describe presentation of EM minor

A

target lesions of skin

240
Q

what usually is the trigger of EM minor

A

secondary HSV

241
Q

describe presentation of EM major

A

stevens johnson syndrome often in sick pt. Hemorrhagic crusting of lips. Dehydration

242
Q

What is common trigger of EM major

A

usually medication, often a relatively common one such as tylenol

243
Q

What is TEN

A

toxic epidermal necrolysis. its lose skin and must be treated like burn patients. no steroids as they are prone to infection

244
Q

which form of candidiasis is associated tiwh invasion of tissues

A

hyphen form (yeast form is innocuous)

245
Q

What factors determined clinical evidence of infection

A

• Host immune status • Oral environment • C. albicans strain

246
Q

what are the four clinical patterns of candidiasis

A

• Pseudomembranous • Erythematous • Chronic hyperplastic • Mucocutaneous

247
Q

PSEUDOMEMBRANOUS CANDIDIASIS

A

• Best recognized form of candidiasis • Aka “thrush” • White mucosal plaques (cottage cheese) • Plaques can be removed, usually revealing red, irritated tissue

248
Q

Where are the most common sites for pseudomembranous candida

A

• Most common sites are buccal mucosa, dorsum of tongue, and palate

249
Q

what are symptoms of pseudomembranous candidiasis

A

Symptoms may include mild chronic burning, bad taste (salty, bitter), “blisters”

250
Q

What are the predisposing factors for candidiasis

A

Pre-disposing factors • Recent history of broad spectrum antibiotic • Immune dysfunction (HIV, leukemia) • Infants (underdeveloped immune system

251
Q

what are the subtypes of erythematous candida

A

• Acute atrophic candidiasis • Median rhomboid glossitis • Chronic multifocal candidiasis • Angular cheilitis • Denture stomatitis

252
Q

Acute atrophic candidiasis

A

• “Antibiotic sore mouth” – recent course of broad spectrum antibiotics • Burning, scalded sensation • Red, bald tongue due to diffuse loss of filiform papillae

253
Q

Median rhomboid glossitis

A

• Aka central papillary atrophy • Found in adults, consistently associated with c. albicans • Well-outlined erythema in midline of posterior dorsal tongue • Loss of filiform papillae; may be smooth or lobulated • Often asymptomatic, may resolve with antifungal therapy

254
Q

Chronic multifocal candidiasis

A

Involvement of dorsal tongue as well as other areas, usually junction of hard and soft palate (“kissing lesion”) and corners of the mouth

255
Q

Angular cheilitis

A

• Red, fissured, scaling lesions at the mouth corners • Common patient: older, with reduced vertical dimension

256
Q

what bacteria is usually connected with angular chelitis

A

s. aureus

257
Q

Cheilocandidiasis

A

type of angular chelitis Involvement of perioral region, often due to lip or thumb sucking

258
Q

Denture stomatitis

A

• Aka chronic atrophic candidiasis • Denture-bearing areas under maxillary removable prosthesis • The fungus shows very little invasion into tissue, and lesion is usually asymptomatic • Heavier fungal colonization on denture than tissue

259
Q

CHRONIC HYPERPLASTIC CANDIDIASIS

A

• Aka candidal leukoplakia • White patch cannot be removed by rubbing • May represent secondary candidal infection of a leukoplakic lesion

260
Q

location of chronic hyper plastic candidiasis and description

A

• Usually located on anterior buccal mucosa • May be speckled red and white • Hyphae are present • Diagnosis is confirmed by lesion resolution after antifungal therapy

261
Q

MUCOCUTANEOUS CANDIDIASIS

A

• Seen within a rare group of immune disorders, usually sporadic or autosomal recessive • Candidiasis of mouth, nails, skin, etc from a young age • Thick white, foul-smelling plaques cannot be rubbed off, but can be controlled throughout life by anti-fungals

262
Q

which candida may be associated with iron deficiency anemia

A

MUCOCUTANEOUS CANDIDIASIS

263
Q

Endocrine-candidiasis syndrome:

A

• Hypothyroidism • Hypoparathyroidism • Hypoadrenocorticism (Addison’s) • Diabetes mellitus

264
Q

CANDIDIASIS DIAGNOSIS • Combination of?

A

Clinical presentation • Exfoliative cytology • Biopsy • Level of response to anti-fungal treatment

265
Q

CANDIDIASIS TREATMENT • Mucosal Tissue:

A

• Mycelex troches, 5x/day for 10 days. One in morning, then 30 minutes after each meal, and one more before bed.

266
Q

treatment for candida on Complete dentures:

A

• 1 cup of water plus 1 teaspoon bleach, soak denture overnight

267
Q

tx of candida on partials

A

• NO bleach. Use Nystatin elixir, 480 mL; place cup in refrigerator and instruct the patient to drop FPD’s in cup each night

268
Q

whats a typical patient history who has melanoacanthoma

A

Rapid onset and growth Buccal mucosa most common site • Dark-brown or black pigmentation • Flat or slightly raised Predilection for black females • 3rd to 4th decades

269
Q

Whats the etiology of melanoacanthoma

A

unknown. its considered a reactive lesion

270
Q

how do you tx melanoacanthoma

A

• Incisional biopsy to confirm diagnosis • No further treatment is necessary • May spontaneously regress due to biopsy

271
Q

what are the types of nevi

A

intramucosal, compound junctional

272
Q

whats a intramucosal nevi

A

nevus found in the epithelial tissues

273
Q

what is a compound nevus

A

found in epidermis and dermis

274
Q

what is a junctional nevus

A

one found in-between epithelial and dermal tissues

275
Q

where due blue nevi tend to occur orally

A

on the palate,

276
Q

why are blue nevi blue

A

tyndall effect (physics) the cells tend to be deeper in the connective tissue and epithelial tissue above it reflect the blue light.

277
Q

what are two examples of large congenital blue nevi

A

nevus of ito, nevus of ota

278
Q

Whats pout nether syndrome

A

intestinal polyposis and perioral freckling

279
Q

what are varix

A

abnormally dilated vessel with a torturous course

280
Q

what is classic presentation of superficial lymphangioma

A

midline posterior tongue typical frogs egg vesicles

281
Q

what is epulis granulomatosa

A

Hyperplastic growth of granulation tissue arising in an extraction socket

282
Q

what should you do before biopsy of a suspected hemangioma

A

aspirate for lots of blood

283
Q

what is common tx for congenital hemangiomas

A

often spontaneously resolve toward adult hood but some do require surgical intervention

284
Q

what is the hallmark of storage weber syndrome

A

Nevus flammeus (port wine stain): along 1 or more segments of the trigeminal nerve

285
Q

what can oral storage weber mimic

A

pyogenic granuloma

286
Q

what is the ideal tx for peripheral osseous fibroma and peripheral giant cell granuloma

A

excise down to periosteum, then sc/rp to remove inciting irritant

287
Q

what are names of benign peripheral nerve sheath tumors

A

schwannoma, neurofibroma, traumatic neuroma, palisaded encapsulated neuroma

288
Q

which is the most common benign peripheral nerve sheath tumors

A

neurofibroma

289
Q

where are the most common spots for neurofibroma

A

tongue and buccal of mandible

290
Q

how common are oral schwanoma

A

not only 25% occur in head and neck

291
Q

which nerve sheath tumor are usually painful

A

traumatic neuroma

292
Q

where are most palisaded encapsulated neuromas found

A

nose and cheek 90%

293
Q

what are bilateral commissural mucosal neuromas characteristic of

A

MEN 2B

294
Q

why is a MEN2B dx important early

A

100% of its present with medullary thyroid carcinoma by age 30.

295
Q

What is Mycobacteria?

A

Any mycobacteria other than tuberculosis and leprosy is considered “atypical mycobacerium”

296
Q

What is this?

A

Cervico Actinomycosis

  • Woody induratino to soft tissue
  • Bacteria burrow straight through hard and soft tissue (direct extension)
  • Often create a draining sinus tract extraorally
  • Can mimic malignancy
  • Part of normal flora (tonsils, intraoral); sulfur granules
298
Q

What is this?

A

Median Rhomboid Glossitis

  • Central Papillary Atrophy
  • Often associated with/caused by candida
299
Q

What is this?

A

“Kissing” Lesions

Chronic Multifocal Candidiasis

  • Lesions of posterior tongue and soft palate
  • Especially in patiens who chronically use steroid inhaler
300
Q

What is this?

A

Angular Cheilitis

Often caused by candida

301
Q

What is this?

A

Denture Stomatitis

Much heavier fungal colonization on denture than tissue; treat the denture

302
Q

What is this?

A

Aspergillus

  • Can present as allergic fungal sinusitis
  • Mycetoma (fungal ball in sinus); or as
  • Angioinvasive sinus disease in immunocompromised patients
303
Q

What is this?

A

Mycormycosis

  • Zygomycosis
  • Angioinvasive fungal sinusitis
  • Immunocompromised patients
  • Be wary of paltal ulcerations in uncontrolled diabetics, patient undergoing chemo, etc
  • Rapidly progressive tissue necrosis
304
Q

What is Candidiasis?

A
  • Dimorphic fungus (yeast and hyphal forms)
  • Usually superficial infection
  • Can be invasive in immnocompromised patients
305
Q

What is this?

A

Laryngeal Papillomatosis

  • Caused by HPV 16 and 18
  • Juvenile or adult
  • Can choke off airway
  • Condylomas, with risk for malignant transformation
  • Periodic debulding, sent to pathology to monitor for dysplasia/carcinoma
311
Q

What is HHV-8 associated with?

A

Kaposi’s Sarcoma

313
Q

What are two well known types of high risk types of HPV?

A

16 and 18

Culprit in many oropharyngeal SCC cases

315
Q

HSV I is typically …

A

Oral

316
Q

HSV 2 is typically…

A

Genital

317
Q

HHV - 3 is…

A

Varicella-Zoster (chicken pox/shingles)

318
Q

What is HHV-4?

A

Epstein-Barr Virus

  • Mononucleosis
  • Hodgkin Lymphoma
  • Undifferentiated Naspharyngeal Carcinoma
  • Oral Hairy Leukoplakia
319
Q

What is HHV-5?

A

Cytomegalovirus

  • CMV Infection
  • Seen in immunodeficiency or congenitally
321
Q

How does HSV-1 typically present?

A
  • Tends to occur in kids
  • low-grade fever and mild crusting/bleeding of intraoral/perioral area
322
Q

How does HSV 1 typically present in an adult?

A
  • Tends to be located more posteriorly with severe pharyngitis and high fever
323
Q

What causes cold sores?

A

HSV-1, which does NOT cause apthous

324
Q

What are some common manifestations of Nevoid Basal Cell Carcinoma?

A
  • Multiple OKC’s
  • Basal Cell Carcinomas at a young age
  • Palmar/plantar pits
  • Kyphoscoliosis
  • Bifid ribs
  • Calcified falx cerebri
  • PTCH tumor suppressor gene mutation, chromosome 9
325
Q

What is this?

A

Gardner Syndrome

  • Supernumary teeth
  • Multiple Osteomas
  • Epidermal Inclusion Cysts
  • Desmoid Tumors
  • Colon Polyps with high rate of malignant transformation
  • Buys patients prophylactic colectomy by age 30.
  • APC gene mutation, chromosom 5
326
Q

What is this?

A

McCune - Albright Syndrome

  • Polyostotic Fibrous Dysplasia
  • Multiple endocrinopathies (especially early-onset menses in females)
  • Cafe au lait pigmentations (coast of Maine)
  • Hocket stick deformity to femur
  • GNAS1 gene mutation
328
Q

What is this?

A

Treacher - Collins Syndrome

  • Normal intelligence
  • Hypoplastic Zygomas
  • Conductive Hearing loss (missing external ear)
  • Retruded chin
  • Coloboma
  • Spontaneous mutation in the proband (first person with mutation), then syndrome becomes worse in each successive generation
329
Q

What is this?

A

Crouzon Syndrome

  • Normal intelligence
  • Proptosis
  • Mid-face hypoplasia
  • High arched palate
  • Beaten copper skull films
330
Q

What is this?

A

Apert Syndrome

  • Similar to Crouzon Syndrome
  • Plus Syndactyly and mental deficiency
331
Q

What is this?

A

Neurofirbromatosis I

  • Multiple neurofibromas (bag of worms)
  • Can be extremely large
  • Can undergo malignant transformation
  • Cafe au laid pigmentations (coast of California)
  • Axillary freckling;
  • Lisch nodules of eye
332
Q

What is this?

A

Multiple Endocrine Neoplasia, Type 2B

  • Multiple mucosal neuromas; bilateral commissural neuromas in a kiddo is virtually diagnostic. Don’t miss this!
  • Marfanoid body habitus (tall and thin, long arm length); long thin face.
  • Almost guaranteed to have medullay carcinoma of thyroid; prophylactic thyroidectomy at young age recommended
  • Pheochromocytomas of adrenal cortex. Hypertensive issues
334
Q

What are some objective criteria for Sjogren Syndrome?

A
  • Histologic evidence of lymphoplasmacytic inflammatin within salivary gland parenchyma
  • Decreased salivary and/or eye secretions measured by Lashley cups or Rose-Bengal or Schirmer test;
  • Positive serology for antibodies against SS-A (Ro) and SS-B (La).
  • Also increased risk for lymphoma (MALT lymphoma)
340
Q

When you have bilateral acoutic neuromas, you may have…

A

Neurofibromatosis 2

Oral Path (16 decks)

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