Oral Path Marathon II Flashcards
Tumefaction is another name for…
Swelling
Hyperplasia that can grow quite large but doesn’t have unlimited growth potential:
Reactive Tumors
Reactive Tumors are not…
Neoplasms
*unlimited growth potential
Reactive Lesions make up ____% of Biopsied lesions in the dental office
20%
The most common tumor of the Oral Mucosa:
Fibroma
Hyperplasia of fibrous connective tissue:
Fibroma
Fibroma incidence is higher in the _____ but occurs almost anywhere
Usually ______, smooth surfaced, normal color, asymptomatic
Cheek
Sessile (fixed)
2 Fibroma Variants:
Giant cell fibroma
Peripheral odontogenic (ossifying) fibroma
Increases incidence in Gingiva, also on the Tongue but to a lesser extent, and children, often confused with Papillomas
Giant Cell Fibroma
Giant Cell Fibroma is a fibrous CT tumor containing plump ________ Fibroblasts that are ______ nucleated
stellate
bi/tri
Giant Cell Fibroma contains what cells?
Peripheral Giant Cell Granuloma contains what cells?
stellate, multinucleated Fibroblasts
multinucleated Giant Cells
Reactive folds of hyperplastic fibrous CT along Border of ill-fitting Denture:
Hyperplastic response of Palatal Mucosa to ill-fitting Denture:
*2 names for each
Inflammatory Fibrous Hyperplasie (Epulis Fissuratum)
Inflammatory Papillary Hyperplasia (Papillomatosis)
Papillary hyperplasia + inflammation +/- psudoepitheliomatous hyperplasia =
Inflammatory Papillary Hyperplasia (Papillomatosis)
*ill-fitting denture to Palate
Only on Gingiva (more in Anterior), any age, asymptomatic, red/brown/purple
pedunculated or sessile
2:1 female to male
Peripheral Giant Cell Granuloma
Peripheral Giant Cell Granuloma is a tumor of well vascularized fibrous CT w/ numerous _______ cells
multinucleated Giant cells
The body’s basic reparative tissue:
Granulation tissue
Giant Cells?
red/ulcerated pedunculated/sessile 2-4 decades Mostly in Gingiva but can occur anywhere (including skin) "pregnancy tumor" reactive lesion of granulation tissue
Pyogenic Granuloma
*misnomer
Pyogenic Granuloma is a reactive lesion of _______ tissue and often occurs during _______
Granulation
Pregnancy
If a Pyogenic Granuloma occurs in extraction sockets it is called…
Epulis Granulomatosa
Hyperplastic granulation tissue, Fibroblasts w/ Delicate Collagen
vascularized
Pyogenic Granuloma
Occurs anywhere, but if on Gingiva
Odontogenic and Pus
*pulpal/periodontal in origin
Parulis
“Gum Boil”
Exclusively 1-2 decades
Female 2:1
Mx 5:1
Papillary w/ edema
Localized juvenile spongiotic gingival hyperplasia
*red/papillary/gingival
Localilzed Juvenile Spongiotic Gingival Hyperplasia is red, ______, and gingival
Papillary
Overgrowth of Blood Vessels:
Hemangioma
Hemangioma is often ________
____% in the Head and Neck
Females __:__
developmental
60%
3:1
Rapid proliferation of Endothelial Cells at birth/short after
Most common tumor in infancy (5-10%)
Hemangioma
Hemangioma Tx: most of it naturally _______
Laser pulse, excision, sclerosing agents, and what 2 drugs?
involutes
steroids, Systemic Propanolol
Sturge-Weber Angiomatosis, aka…
Encephalotrigeminal angiomatosis
Nonheriditary developmental, congenital
Vascular proliferation brain/face
Large purplish lesions identical to port-wine stains
Ipsilateral Common
Sturge-Weber Angiomatosis
encephalotrigeminal angiomatosis
Sturge-Weber and port wine stains are due to somatic activation mutations in _______- which encodes _______
This is a member of the ____ class of ____ protein alpha that mediates G-protein to downstream receptors
(difference is when mutation occurs)
GNAQ, G-alpha-q
q class, G protein
Leptomingeal angioma of cerebral cortex
Sturge-Weber
Developmental overgrowth of Lymphatic Vessels:
Lymphangioma
Tx for Lymphangioma
b/c the don’t ______
Excision
Involute
Head and Neck
0-5 yrs
Tongue
pebbly if superficial, more diffuse deeper
called a Cystic Hygroma if large/deep/neck
Lymphangioma
Pathologic new growth of tissue - Uncontrolled - no regression if caused by stimulus and the stimulus was removed
Neoplasm
T/F
You can usually differentiate if a Neoplasm is epithelial/mesenchymal or benign/malignant
True
2 kinds of Epithelial Neoplasms (etiologies):
HPV etiology
Keratoacanthoma
3 Types of HPV derived Epithelial Neoplasms:
Papilloma (soft palate)
Verruca vulgaris (common wart - HPV 2)
Condyloma Acuminatum (veneral - HPV 6/11)
Exophytic, pedunculated, pink/white Epithelial Neoplasm w/ HPV etiology on the Palate:
Papilloma
Sun Exposed areas will create Reactive (not Neoplastic) tumor
increased in older patients with ___% on the lips
Natural History is involution/healing
Keratocanthoma
10%
Neoplasms can be ______ or ________
Epithelial
Mesenchymal
3 types of Mesenchymal Neoplasms:
CT
Muscle
Nerve
Most _____ Neoplasms look identical clinically and present as asymptomatic, slowly growing Submucosal Masses
Mesenchymal
3 CT derived Mesenchymal Neoplasms:
Fibroma
Lipoma
Verruciform xanthoma
A benign neoplasm of fat
yellowish, very common in skin, less Orally
Lipoma
Reactive lesion, often in Hard Palate or Gingiva
Oral, but can be in skin/genitals
Irregular
Pink to White
Verruciform Xanthoma
Papillary hyperplasia in which CT papiiae contain phagocytic cells that have engulfed Lipid
Verruciform Xanthoma
xanthoma = engulfed lipid cells
Benign neoplasm of Smooth Muscle, common in the Uterus
*rare orally, red to purple
Leiomyoma
angioleiomyoma, vascular leiomyoma
Benign neoplasm of Skeletal Muscle, often in the Heart, rare orally (but in tongue)
Rhabdomyoma
Once thought to originate from Muscle, but now Nerve (possibly sheath)
Tongue
Fixed
Granular Cell Tumor
*Myoblastoma
Granular Cell Tumors have large ____ cells with granular cytoplasm
1/2 cause overlying epithelium to react, stimulating Carcinoma, this is called?
polygonal
pseudoepitheliomatous hyperplasia (PEH)
Congenital Tumor of the Anterior Alveolar Ridge
Congenital Epulis of the newborn
Congenital Epulis of the Newborn occurs 2:1 in the _______ and F:M :
Mx
10:1
Identical Cells to Granular Cell Tumor but no Nerve markers
No PEH (pseudoepitheliomatous hyperplasia)
May regress if incompletely excised
Congenital Epullis of the Newborn
Aberration of healing following Trauma to Nerve (not real Neoplasm)
Lateral/Anterior ______, lower lip, mental foramen,
Palpation produced ______
Traumatic Neuroma
Tongue
Pain
Benign Neoplasm in Nerve composed of Schwann Cells, Axons, and Fibrous Tissue
Most are _____ but can occur anywhere
Neurofibroma
asymptomatic
Developmental form of Neurofibromatosis, can affect Pigmentation, central/peripheral NS….
Von Recklinghausens Disease of the Skin
Von Recklinghausen’s Disease of the Skin can cause what skin pigmentation?
1/2 inherited as ______ trait, the other 1/2 _____ mutations
Most on Chromosome _____
cafe-au-lait spots
autosomal dominant, somatic
17
*Remember, this is a neurofibroma
Von Recklinghausen’s Disease of the Skin causes freckling, cafe au lait spots, or defects in the iris called…
___% of pts develop malignancy in their neurofibromas
Lisch spots
1-5%
Benign encapsulated neural neoplasm arising withing the sheath of a peripheral nerve
Painless, often Freely Moveable
Neurilemmoma (Schwannoma)
Antoni A Neurilemmoma, _____ areas of replicated basement membrane material surrounded by ______ nuclei
Antoni B Neurilemmoma, haphazardly arranged _____ Schwann cells in loose _____
Acellular, Schwann cell
spindled, stroma
Neural Crest Tumor in Jaws (rarely extragnathic)
Melanotic Neuroectodermal tumor of Infancy
Melanotic Neuroectodermal Tumor of Infancy is mostly Congenital and occurs where?
Rapidly growing, pigmented, Radiolucent, produces _____ in serum/urine
Tx is aggressive _______
___% recur
Anterior Jaws, Mx
VMA - vanilymandelic acid
curettage
10-20%
MEN3:
Multiple Endocrine Neoplasia Type 3
Multiple Endocrine Neoplasia Type 3, 95% of pts have mutation on the _____ gene
This is a ProtoOncogene on chromosome _____
50/50 autosomal dominant/_____
RET
10
somatic
3 Examples of MEN3 neoplasms:
*remember, this is a Mesenchymal neoplasm of the Nerve
Mucosal neuromas
Medullary carcinoma of thyroid
Pheochromocytoma of adrenal medulla
Pigmented lesions we focus on are _____ lesions
melanocytic
Common mole, aka…
Nevi (nevus)
Nevus cells are pigmented lesions that migrate from _____ to skin and occasionally mucous membranes
Neural Crest Cells
Nevi can be congenital: _% of newborns
Acquired: genetic influence, avg person has about ____
1%
15
4 types of Nevi:
Junctional
Intradermal
Compound
Blue
Junctional Nevus: flat macule, in the ____ epithelium at junction btwn epithelium/CT
Intradermal Nevus: Nodule (+/- hair) in the dermis or ______
Compound Nevus: nodule, combo of…
Blue Nevus: ____ nevus in deep _____
Basal Epithelium
Lamina Propria
Junctional/Intradermal
Dentritic, CT
Reactive proliferation of intraepithelial dentritic melanocytes
- increased in blacks, cheeks
- resolves if irritant removed
Melanocanthoma
Freckle:
Ephelis
Localized overproduction of Melanin of flat macules, increased in Head and Neck
Ephelis
T/F
Freckles (Ephelis) are an increase number of cells
False
*increased overproduction of Melanin
From Chronic UV damage, not seen intraorally
increases after 40, 90% of elderly have them
Flat, evenly discolored, multiple
Actinic/Senile Lentigo
*aka Age Spots, Liver Spots
A big freckle that isn’t sun related:
female:male = :
avg size:
Melanotic Macule
2: 1
6. 8 mm
Melanotic Macule occurs ___% in the Lower Lip
also common in palate and ______
___% multiple
33%
gingiva
15%
A malignancy of melanin-producing cells
Malignant Melanoma
Malignant Melanomi is the ____ most common skin cancer
but incidence in increasing
3rd
The likelihood of a White person developing Malignant Melanoma is less than 1 in 100 throughout life
True
Malignant Melanoma happens ___% in the Head and Neck
___% in the extremities
__% Intraorally
25%
40%
less than 1%
Risk factor for Malignant Melanoma:
Sun exposure
Clinical Features of Malignant Melanoma A:
B:
C:
D:
Asymmetry
Borders
Color - red/tan/brown/black
Diameter (growth, greater than 6mm)
2 Biologic Growth phases Malignant Melanoma:
Radial
Vertical
% of Radial Malignant Melanoma:
75-85%
5 types of Melanoma:
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
Oral
70% of Cutaneous melanomas
more in trunk (28% in head and neck)
Superficial Spreading Melanoma
Superficial spreading malanoma has a short ____ phase, develops nodules, goes _____
radial
vertical
15% of cutaneous melanoma
30% head/neck
Nodular Melanoma
Nodular Melanom has almost no _____ growth
it is rarely ______
Radial
amelanotic
5-10% of cutaneous melanoma
Lentigo maligna melanoma
Lentigo maligna melanoma increases with age (sun) and has an extremely long _____ growth phase
This is called _______ and may last for ____ years
*ultimately develops vertical growth
Radial
Hutchinson’s freckle, 15-20 years
Small subset of Melanomas affecting palms, soles, sublingual and mucous membranes
Acral lentiginous melanoma
Most Oral Melanom has _____ growth (more than 50%)
most often found in what 2 places?
radial
palate, Mx gingiva
Excise Malignant Melanoma w/ a minimum of a ___ margin
+/- lymph nodes, chemo, radiation, etc
1 cm
Most important factor influencing survival of Malignant Melanomas
survival is ___% over 10 years
Oral melanomas survival is ____ over 5 years
Depth of invasion
79%
less than 20%
*oral much much worse Prognosis
T/F
Antimalarials, Antimicrobials, Psychotropics, and Chemotherapeutics can cause Pigmentation
True
Multifocal pigmentation includes Addisons, Peutz-Jeghers, McCune Albright, and Smoker’s melanosis
True
4 Drugs that can cause Multifocal Pigmentation:
Antimalarials
Antiarrythmics (quinidine)
Tranquilizers (thorazine)
cis-platinum
Adrenocortical insufficiency that triggers hypothalamus to stimulate ant pit to over-produce ACTH and MSH (Melanin Stimulating Hormone)
Addison’s Disease
*multifocal pigmentation
Peutz-Jeghers Syndrome is ______ (heritability)
Affects skin, intestine, oral and perioral freckles
autosomal dominant
*multifocal pigmentation
Neurofibromatosis and McCune Albright syndroms (polyostotic fibrous dysplasia) cause _____
cafe au lait spots
*multifocal pigmentation
Smoker’s melanosis is a type of _________
increased on palate/gingiva
multifocal pigmentation
melanoma, kaposi’s sarcoma, petechiae, ecchymosis, purpura
multifocal pigmentation
Odontogenesis starts with _________ growing into the _______ and producing tooth germ, a portion of which is the enamel organ
ectoderm (epithelilum)
dental lamina (jaw)
Pathologic Cavity lined by Odontogenic Epithelium and filled with fluid or semisolid material
Odontogenic Cyst
Odontogenic can by Inflammatory or not
True
2 types of Inflammatory Odontogenic Cysts:
The rest are _______
Radicular cyst, buccal bifurcation cyst
Developmental
A cyst arising from degeneration of enamel organ prior to tooth formation.
This aborts odontogenesis resulting in radiolucency in place of a missing tooth
Primordial Cyst
Primordial Cysts most often occur in what tooth?
Mn 3M
Cyst resulting from the separation of the follicle from around the crown of a developing tooth
Dentigerous Cyst
*aka follicular cyst
Dentigerous Cyst happen at any age, most often in the Mandibular ______
and the Maxillary ______
3M
Canines
Dentigerous cysts are expansive and symptomatic
False
*asymptomatic, usually no expansion
Dentigerous cysts usually are lateral and unerupted crowns, creating a radiolucency where?
Pericoronal
*from CEJ around crown
Stratified Squamous epithelium w/out Keratinization
*originally ameloblast, but now reduced enamel epithellium
Dentigerous Cyst
Tx Dentigerous Cyst for Mn3M
for Canine:
Extraction
may be able to decompress and pull orthodontically
2 Variants of Dentigerous Cysts:
Eruption
Lateral
A Dentigerous Cyst has high Neoplastic Potential
False
*exceedingly rare
3 types of the Exceedingly Rare Dentigerous Cyst Neoplasms:
Ameloblastoma
Squamous cell carcinoma
Mucoepidermoid carcinoma
2 Types of Periodontal Cysts:
Which most common?
Apical Periodontal Cyst (most common)
Lateral Periodontal Cyst
Cyst of Inflammatory Origin secondary to Devitalized Pulp:
Apical Periodontal Cyst
Apical Periodontal Cyst is a _____ cyst
2 types:
Radicular
Lateral radicular cyst, Residual cyst
Rest or Malassez cystic degeneration
Most often seen on what tooth?
Lateral Periodontal Cyst
Mn Canine/PM
Apical Periodontal Cyst
Lateral Periodontal Cyst
Which one is Vital?
Lateral
*apical NOT vital
Polycystic, multilocular, recurring variant on a Lateral Periodontal Cyst:
Botryoid Odontogenic Cyst
2 Types of Gingival Cysts:
Newborn (dental lamina)
Adult
Common, congenital, Gingival Cyst of Newborn are what color?
Tx?
Yellowish elevations
none - will self-marsupialize and heal
Adult Gingival Cyst is attached gingiva, arises from a degeneration of glands of _______
Occurs in what tooth?
Similar to _____
Serres (dental lamina)
Mn Canine/PM
mucocele
Developmental cyst from the dental lamina:
Odontogenic Keratocyst
Odonotogenic Keratocyst are _____ parakeratinized
_____ orthokeratinized
90%
10%
Parakeratinized Odontogenic Keratocyst occurs 2:1 in what arch?
They are clinically _______
Mn
aggressive
Parakeratinized Odontogenic Keratocyst is unilocular/multilocular _______ and mimics other odontogenic cysts
radiolucency
Parakeratinized Odontogenic Keratocyst histologic parakeratotic stratified squamous epithelium lining with well developed _____/______ basal cells
Often daughters of ______ in wall
Tx is conservative, about ____ recur
palisaded/hyperchromatic
microcysts
1/3
5% of pts w/ keratocysts have what Autosomal Dominant disorder?
Basal Cell Nevus-Bifid Rib Syndrome
*nevoid basal cell carcinoma syndrome
Basal Cell Nevus-Bifid Rib Syndrome is a mutation on the tumor suppressor gene _______
Creates a basal cell carcinoma not to be confused with?
calcification of ______, bone anomalies, multiple OKC’s
9q22
sun exposed/elderly
falx cerebri
Keratocysts are known for what 3 things?
Clinical aggression
Recurrence
association w/ basal cell nevus-bifid rib syndrome
The smaller, less aggressive, minimal recurrence, not associated w/ syndrome odontogenic cyst?
Orthokeratinized odontogenic cyst
Asymptomatic Odontogenic cyst, occurs at any age, may be associated with unerupted teeth/odontoma
Calcifying odontogenic cyst
*Gorlin Cyst
Calcyfying Odontogenic Cyst (Gorlin Cyst)_ is fully or partially cystic, contains ____ cells which tend to calcify
Tx is conservative and recurrence is ____
ghost
low
Glandular Odontogenic Cyst occurs more often in what arch?
may be _____, unilocular or multilocular radiolucency,
Shows _____ differentiation (mucous, columnar w/ cilia, lumina)
Recurrence rate:
Mn
Large
Glandular
30-50%
Buccal Bifurcation Cyst, aka…
Paradental Cyst
An inflammatory cyst occurring on the buccal of an erupting tooth:
Happens most often in what demographic?
What tooth?
Buccal Bifurcation Cyst
children
Mn 1M
Unilocular radiolucency involving furcation of the roots:
This is an inflamed cyst lined by ________
Tx enucleation of cyst, no ______
Buccal Bifurcation Cyst
stratified squamous epithelium
extraction
