Oral Path II-Exam 2 THE.LAST.TEST.EVER. Flashcards
Please give me the Diff Dx AND most likely culprit of a 14yo male who was concerned becasue of unsightly pigmented spots on his lips and buccal mucosa..(diffuse pigmentation on palms and souls of feet, family hx, and GI polyps)
1.Peutz-Jeghers Syndrome(*likely culprit) 2. Addison’s Disease 3.Hemochromatosis
Side note-what are three common etiologies (drugs/health conditions) for multifocal pigmentation?
1.Anti-malarial drugs 2.AIDS 3.Smoking
Whats the Diff Dx (and likely culprit) for a 28yo male presenting with a small, slightly raised pigmented lesion on his left buccal mucosa? He was unaware of its presence.
- Melanotic Macule 2.Nevus(*likely culprit) 3.Melanoma
Diff Dx (4) and likely Dx: A 39 y/o male presents with a small pigmented spot on his lower lip. Over the next 6mo the lesion increased to include almost HALF of the vermillion boarder. The lesion was mostly FLAT and had NO palpable nodules…
1.Melanoma (*most likely) 2.Nevus 3.Melanotic Macule 4.Hemangioma
What are the ABCDs of Melanoma? What is the standard for each?
A-asymmetry, B-boarders(regular/irregular), C-Color(variation), D-diameter (6mm or more)
What are the three major types of melanoma? Which type comprises 70% of the melanoma lesions?
- Superficial Spreading (70%) 2. nodular melanoma 3.lentigo (len-tie-go)
Diff Dx: a 52 yo male is referred to you in a state of panic, and ENT said he has melanoma. You see a 1cm blueish pigmented area on his R buccal mucosa…
1.Amalgam tattoo(clinical dx) 2.Melanotic Macule 3.Hemangioma
What are two clinical tools you can use to differentiate an amalgam tattoo from other pigmented lesions?
1.an x-ray will show radiopaqueness 2.see if the lesion blanches (diascopy)
Diff Dx (5 please): A 52 year old male had a small, slightly elevated bluish nodule on the vermilion border of his upper lip. Asympomatic, unknown duration
1.Varix (varicose vein) 2.Hemangioma 3.Kaposi’s Sarcoma 4.Melanoma 5.Melanotic Macule
What is a clinical tool that can help you differentiate between a verix and a melanoma?
diascopy-if it blanches it is a verix
Diff Dx (4) & Prov Clin Dx: 22 year old white male comes to your office complaining of a sore on the side of his tongue. 2 cm area of ulceration, firm but extremely painful on palpation. The patient also has several small, TENDER but enlarged LYMPH NODES on that side.
1.Non-Hemogeneous Leukoplakia 2.Traumatic or Apthous Ulcer (Provisional Clin Dx) 3.Squamous Cell Carcinoma 4. TB
What are TENDER, enlarged lymph nodes typically a sign of?
inflammation…hard, asymptomatic lymph nodes tend to indicate cancer
Ulcers are TAN in color because _______ migrates to the surface of the lesion. This is SPECIFICALLY not a _______ coloration.
Fibrinogen…white (white indicates dead cells)
Tough w/o seeing the picture, but Diff Dx (4 plz): An 86 year old white female complained of LOOSE TEETH. Clinical examination revealed a poor state of oral hygiene with CALCULUS on many of the teeth. The tissues were INFLAMMED and EDEMATOUS. The tissues were especially bad in the left mandibular cuspid-premolar area where there were also erosions and ulceration.
1.Periodontitis 2.Squamous Cell Carcinoma 3.Tuberculosis 4.Deep Fungal Infection (ended up being SCC)
DiffDx&ProvClinDx: This 68 year old FARMER developed an ulceration on the skin below his left eye. The lesion was umbilicated, with a central ulcerated depression and rolled elevated borders. He stated the lesion had been present for a COUPLE YEARS.
1.Kerato-Acanthoma(really a reactive lesion that should go away w/in6mo-yr) 2.Squamous Cell Carcinoma 3.Basal Cell Carcinoma**ProvClinDx*80% of skin cancers)
What is the most common form of Basal Cell Carcinoma? What is the recurrence rate of a BCC after excision?
Nodulo-Ulcerative form…25%
Diff Dx: This 22 year old African-American male presented with a chief complaint of an ulcer on his TONGUE. Clinical examination revealed a SMALL, slightly ELEVATED ULCER on the mid-dorsum of his tongue. The lesion had been present for one week.
1.Syphilis (primary-chancre)(provclindx)2.Squamous Cell Carcinoma 3.Traumatic Ulcer
What are the three lesions that characterize the three phases of Syphilis?
1.Chancre 2.rash 3.Gumma
Diff Dx: This 20 y/o in pain, ULCERATION on the lateral and ventral surfaces of his tongue. Started as a small break in the tongue mucosa and had slowly ENLARGED over a period of several WEEKS. He related that he had experienced NIGHT SWEATS and had LOST WEIGHT.
1.Squamous Cell Carcinoma 2. TB (**NIGHT SWEATS) 3.hiv/AIDS/fungal infection assoc w aids
What two cell types are commonly present in a granulomatous inflammation (like in TB)?
T-lymphocyts and Macrophages
Diff Dx (4): This 43 year old white female developed “BLISTERS” of her hard palate over the last couple days. She now has multiple small ULCERS of her HARD PALATE.
1.Nicotinic Stomatitis 2.Physical/Chemical Injury 3.Hypersensitivity 4. Herpes (after dental tx)
If you have a patient who ALWAYS has a recurrent/activated Herpes outbreak after a dental appointment, what is a possible prophylaxis that can be used?
2gm of VALTREX 12hrs before appointment, and then again after the appointment
What is the main SITE difference between Apthous Ulcer and Herpes?
AU-NON-keratinized tissue, Herpes-Keratinized tissue (the first outbreak can happen anywhere, but recurrent is usually confined to keratinized tissue)
Whats the Provisional clinical diagnosis?? This 4th year dental student developed a small cluster of VESICLES on the VERMILLION BIRDER of his lower lip. The night before, he stated that his lip itched…What is the eitology and pathogenesis (healing time)?
Herpes Labialis…HSV 1, 1-2weeks should be gone
Diff Dx(4)&ProvClinDx: A 25 year old white female presents to your office complaining of PAIN in her left CHEEK. Clinical examination reveals a 1cm ULCERATION of the posterior buccal mucosa. The ulcer had a WHITE surface and was surrounded by an ERYTHEMATOUS border. She stated the lesion had been present for 4 days
1.Traumatic Ulcer 2.Apthous Ulcer(**ProvClinDx) 3.Behcet’s Syndrome (autoimmune attack on blood vessles) 4.Crohn’s Disease
What are two possible treatments for an apthous ulcer? When are these taken?
High potency steroids (Fluo-cin-o-mide or Triamcinolone) taken at prodrome
DiffDx&ProvClinDx: The parents of this 14 year old boy bring their son to your office because of the unsightly appearance of his GUMS. Clinical examination reveals a GENERALIZED OVERGROWTH of his gingival tissues. The growth is FIRM to palpation.
3 classics-dilantin, nifedipine, leukemia…SO….1.ProvClinDx=Drug (dilantin-anti-epileptic or nifedipine-Calcium channel blocker) induced gingival hyperplasia 2.LEUKEMIA 3.Hereditary, Autosomal Dominant Syndromes
What is one of the biggest factors for the increased incidence of drug-induced gingival hyperplasia?
hygeine
Diff Dx&ProvClinDx: A 79 year old white female had her remaining teeth removed in December for the fabrication of complete dentures. She was lost to follow-up during the holidays but returned in mid-January. At that time she was found to have a 2cm yellowish-red MASS growing from an extraction socket of her left posterior mandible. She is currently being treated for GASTRIC CARCINOMA.
1.Metastatic Malignancy (provclindx)2.Peripheral Giant Cell Granuloma 3.Pyogenic Granuloma (ACTUAL final dx, post histo) (debris in extraction site causing immune response)
DiffDx (4)&ProvClinDx: This 19 year old African-American male woke up one morning with a raised LUMP of his lower labial mucosa. He stated that prior to coming in, the lesion seemed to CHANGE SIZE, going up and down. The lesion was 2cm, SOFT and COMPRESSABLE.
1.Mucocele(*ProvClincDx) 2.Hemangioma 3.Lipoma 4.Cyst
What is the treatment for a mucocele?
excise the gland that is blocked and causing the problem
DiffDx&ProvClinDx: This 68 year old female requested removal of a BUMP on her cheek because she occasionally bit it. Your examination revealed a 1-1.5 cm FIRM nodule in the right buccal mucosa. The lesion was SESSILE and the mucosa overlying the lesion was of NORMAL COLOR.
1.Fibroma (*ProvClinDx) 2.Lipoma 3.Traumatic Neuroma (ALL BENIGN) (4.leiomyoma 5.rhabdomyoma)
What is the tissue of origin for a fibroma, lipoma, and neuroma?
Mesenchymal origin
Are fibromas neoplasms or hyperplasias?
No, more along the line of a hyperplasia (tumor just means swelling so it can incorporate both neoplasms and hyperplasias)
DiffDx (4plz): This 57 year old white male was found to have a 2 cm RAISED, REDDISH lesion of the left lateral border of his tongue. He stated the lesion had been present for “some time.” What is the likely GENERAL origin for this?
All vascular in nature: 1.Hemangioma 2.Kaposi’s Sarcoma 3.Varix 4.Hematoma (determined histologically to be a HEMANGIOMA-just a large vascular area)
WILL BE ON EXAM (Yay! My case!!) (WHAT ARE THE BIG 4?!?!) What was the HistoDx and cause???: This 14 year old white female presented with a LOCALIZED OVERGROWTH of her gingiva. A 4 x 5 cm mass, with surface ulceration, was seen on the anterior right maxilla. The lesion was painless and had been present a couple weeks.
1.Fibroma 2.Pyogenic Granuloma 3.Peripheral Ossifying Fibroma 4. Peripheral Giant Cell FIbroma….histodx is Peripheral Giant Cell Granuloma (likely caused by calculus or invasive restoration on a tooth in the area)
Are the big 4 for the LOCALIZED gingival overgrowth neoplasms or reactive lesions? What is a special consideration when excising them?
Reactive (immune response)…look closely for calculus or overhanging margins that may be causing the lesion
ProvClinDx: One of your patients returns on recall exam after two years. After removing her dentures, you notice that her HARD PALATE is ERYTHEMATOUS and has multiple small PEBBLY ELEVATIONS
Papillary Hyperplasia
How is papillary hyperplasia distinguished from atrophic candidosis?
papillary hyperplasia-pebbly/raised (ill-fitting) vs atropic candidosis-flat and red (not taking the denture off)
DiffDx&ProvClinDx: This 58 year old white female was referred to your office for the fabrication of NEW dentures. You notice that along the facial borders of the lower denture there are large folds of FIRM tissue.
1.Epilus Fissuratum (*ProvClinDx) 2.Irritant Fibroma 3.Carcinoma
Whats the difference between papillary hyperplasia an epilus fissuratum?
Epilus Fissuratum-Asymptomatic and smooth caused by an ill fitting denture. Generally need to be excised. papillary hyperplasia-pebbly/raised
DiffDx(4)&ProvClinDx:This 26 year old white female had a white, exophytic papillary lesion on the right dorsal surface of her tongue. The lesion was pedunculated and the patient stated it had been present for several months.
- Papilloma (caused by HPV…*ProvClinDx) 2.Verruca Vulgaris 3.Condylomata Acuminatum 4.Verruciform Xanthoma
_______ is a lesion that loses biologic GROWTH CONTROL and has some degree of AUTONOMY
Neoplasm
______: a mass supported or attached by an elongated stalk of tissue; greatest diameter of the lesion is much larger than the diameter of the base
Pedunculated
_______: a mass that is not supported by a stalk, attached directly by its base; broad surface area of attachment to underlying tissue; the base is the greatest diameter of the lesion
Sessile
________: growth outward beyond the surface epithelium
Exophytic
DiffDx&ProvClinDx: A 67 year old female developed a crusted lesion of the left side of her lower lip about a year ago. She stated that she thought her lip was WHITE in that area previously. The lesion had continued to EXPAND. It is now a 1-1.5 cm ULCERATED nodule. On palpation, it is firm and fixed to surrounding tissue.
1.Melanoma 2.Squamous Cell Carcinoma (*provclindx) (was Actinic Keratosis-or-leukoplakia) 3.Deep Fungal Infections
ON EXAMDiffDx(4)&ProvClinDx: A 63 year old ALCOHOLIC. 5 cm mass of the left LATERAL border of his TONGUE. Although the mass is predominantly EXOPHYTIC, it is FIXED to the deeper musculature of the tongue. The surface is ULCERATED and necrotic.
1.Squamous Cell Carcinoma (clinprovdx) 2.Fibrosarcoma 3.leiomyosarcoma 4.rhabdomyosarcoma
WHAT IS THE ONE FACTOR THAT DISTINGUISHES BENIGN NEOPLASMS FROM MALIGNANT???
METASTASIS
DiffDx&ClinProvDx: A 56 year old white female developed a WHITISH, EXOPHYTIC, papillary growth of the attached GINGIVA around a lower premolar. The lesion had been present for about a year, but was not painful. She thought that it seemed to be getting larger. She also reported that she occasionally dipped a little snuff (for the past 48 years).
- Verrucous Carcinoma (snuff dipper’s cancer) (provclindx) 2.Squamous cell Carcinoma 3.Papilloma 4.non-homogenious leukoplakia
How is Verrucous Carcinoma different from Squamous Cell Carcinoma?
Verrucous carcinoma is low grade and rarely metasitsize and its distinguished by its verrucous (wart like/pebbly form)…its a form of squamous cell carcinoma!
DiffDx(5): A 53 year old African-American male. Slightly RAISED, 1cm mass in the substance of the right lateral border of his TONGUE. The lesion is FIRM and somewhat FIXED to surrounding structures. The surface mucosa is of NORMAL COLOR but shows the loss of papillae. He was UNAWARE of the lesion and therefore doesn’t know how long it had been present.
1.Fibroma 2.Neurofibroma 3.Lipoma 4.Granular Cell Tumor (nervous tissue) (*what it ended up being) 5.Leiomyoma (BENIGN, mesenchymal tumors)
So benign, mesenchymal tumors can be tricky because they can cause epithelial changes to look like malignancies…what is the term for this occurrence?
Pseudoepitheliomatuous hyperplasia :) say that 10x fast. (happens in our granular cell tumors)
DiffDx(4): A 9 year old male presented with a MASSIVE 10 cm mass of the right MAXILLARY mucobuccal fold. The lesion had grown RAPIDLY over the past 4 weeks.
1.Rhabdomyosarcoma (*turned out to be the case) 2.Osteosarcoma 3.Chondrosarcoma 4.AdenoCarcinoma
What is the difference between a sarcoma and a carcinoma?
sarcoma-mesenchymal in nature, carcinoma-epithelial in nature
Name the malignancy of fibrous connective tissue
fibrosarcoma
Name the malignancy of bone
osteosarcoma
Name the malignancy of glandular tissue
adeno*Carcoma
Name the malignancy of adipose tissue
liposarcoma
Name the malignancy of white blood cells
leukemia
DiffDx: A 27 year old African-American male had a painless, freely MOVABLE, 2-3 cm nodule in his UPPER LIP. He stated that although the lesion was SLOWLY growing, it had been present about 8 months.
1.Canalicular Adenoma (benign salivary glad tumor) 2.Pleomorphic Adenoma 4.Schwannoma (ended up being the case)
What microscopic feature allows something to be freely movable?
capsulated
DiffDx: A 15 year old white female had noticed a BUMP in the ROOF of her mouth for about a month. Clinical examination revealed a firm 2-3 cm SUBMUCOSAL mass in the posterior-lateral hard palate on the right. The overlying mucosa was INTACT.
1.Canalicular Adenoma (benign minor salivary gland tumor) 2.Pleomorphic Adenoma (*ended up being the case) 3.Neurofibroma
What is the most common location we see a benign minor salivary gland tumor?
posterior, lateral hard palate
DiffDx: A 56 year old female developed a RAPIDLY growing mass of her right posterior-lateral HARD PALATE. The lesion was about 4 cm in diameter, ULCERATED, and PAINFUL.
1.Squamous Cell Carcinoma 2. Adenoid Cystic Carcinoma (*ended up being the case) 3.fibrosarcoma
What is the classic histo characateristic of an adenoid cystic carcinoma? What is it NOTORIOUS for?
“swiss cheese”…notorious for perineural invasion
