Oral Path Midterm COPY Flashcards
Define Hamartoma…
Disorganized overgrowth of normal tissue in its normal location
Define Choristoma…
Growth of normal tissue in an abnormal location
Define Neoplasm…
Growth of abnormal tissue, may be either benign or malignant
What are some characteristics of a Benign lesion?
- Bilateral
- Rapid onset (ulceration, soft tissue swelling)
- Pain
- Growth around native structures
- Slow expansion (osseous)
- Smooth root resorption
What are some characteristics of malignant lesion?
- Unilateral
- Chronic, persistent (ulceration)
- Absence of pain/presence of paresthesia
- Invasion/destruction of native structures
- Cortex destruction
- Spiking root resorption
Define Adenoma…
Usually a benign neoplasm: Pleomorphic adenoma, oncocytoma
Define Carcinoma…
- Malignant neoplasm derived from epithelial cells
- Surface (skin, mucosal): Basal cell carcinoma
- Glandular: Adenocarcinoma
Define Sarcoma…
Malignant neoplasm derived from cells of mesodermal origin: Liposarcoma, fibrosarcoma
Define Metastasis…
- Spread of disease from one part of the body to another
- Tumor implants are discontinuous with the primary tumor
What are the 4 differentials for the gum bump differential?
- Fibroma
- Pyogenic Granuloma (Lobular Capillary Hemangioma)
- Peripheral Ossifying Fibroma
- Peripheral Giant Cell Granuloma
POF AND PGCG OCCUR ONLY ON THE GINGIVA!
What are the 4 Human Papilloma Virus Differential?
- Squamous Papilloma
- Verruca Vulgaris
- Condyloma Acuminata (High risk types 16 & 18)
- Heck’s Disease (Multifocal Epithlial Hyperplasia)
What is the differential list for Multilocular Radiolucent Lesions?
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
What is the differential for Mixed Radiolucent/Radiopaque Differential Diagnosis?
- Adenomatoid Odontogenic Tumor
- Calcifying Odontogenic Cyst
- Ameloblastic Fibro-Odontoma
- Calcifying Epithelial Odontogenic Tumor
- Ossifying Fibroma
- Fibrous Dysplasia
- Desmoplastic Ameloblastoma
Define Odontogenic Cyst…
Cysts lined by odontogenic epithlium
Which odontogenic cysts are inflammatory? Can you name 3?
- Periapical (radicular) cyst
- Residual periapical (radicular) cyst
- Buccal bifurcation cyst
What are the 4 tumors of Odontogenic Epithelium?
- Ameloblastoma
- Adenomatoid Odontogenic Tumor
- Calcifying Epithelial Odontogenic Tumor
- Squamous Odontogenic Tumor
What are some Mesenchymal Odontogenic Tumors? Can you name 3?
- Odontogenic Myxoma
- Central Odontogenic Fibroma
- Cementoblastoma
What are some mixed epithelial/mesenchymal odontogenic tumors?
- Ameloblastic Fibroma
- Fibroodontoma
- Odontoma (considered a hamartoma)
Define Leukoplakia…
White patch that cannot be wiped off, clinical descriptions, not a diagnosis
Define Erythroplakia…
- 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
Define Erythroleukoplakia…
- AKA speckled leukoplakia
- Frequently dysplasia or carcinoma in situ on biopsy
Sharply demarcated leukoplakia is concerning for…
Dysplasia!
What percentage of erythropakic lesions represent severe epithelial dysplasia, carcinoma in situ, or squamous cell carcinoma?
90%!
What is the evolution of Proliferative Verrucous Leukoplakia look like?
- 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
Define Dysplasia…
- Abnormal tissue development
- Rapid cell turn over
- Immature epithelial cells, lack of maturation
- Can be mild, moderate, or severe (thirds of epithelium)
What is Squamous Cell Carcinoma in situ…
- Dysplastic change involving the full-thickness of epithelium
- Latin (in site)
- Not extending beyond the focus or level of origin
- No invasion by definition
Oral Squamous Cell Carcinoma is most commonly found in these 2 locations…
- Tongue: posterior lateral most common
- 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
What is the vitality of teeth associated with buccal bifurcation cysts?
Vital
What is the tx for buccal bifurcation cyst
curettage, do not ext
What is the most common dev odontogenic cyst
dentigerous
What teeth are dent cysts most commonly associated with
impacted thirds and impacted canines
If an impacted tooth has a pericoronal radiolucency greater that ??? mm you should be concerned about more serious entities
3mm
Whats the tx for dentigerous cysts
Ext and send tissue to pathology
What is an eruption cyst
overlying soft tissue impacted tooth,
may appear blue or red
What is the treatment for an eruption cyst
none, usually spontaneously resolve.
What are some details concerning OKC growth and expansion
May grow large and cause expansion but more often tracks up the mandible ramps
if in Max can grow into sinuses
What is the tx for OKCs
Must be completely removed, high recurrence rate with curettage (30%)
can do peripheral osteotomy or marsupialization to shrink cyst prior to surgery
What are multiple OKCs suggestive of
Nevoid Basal Cell Carcinoma Syndrome
How do orthokeratinized Odontogenic Cysts compare to OKs
Histologically similar
not usually as large
associated with thirds
recurrence rate with curettage low (2%)
Are gingival cysts of the newborn common
yes
Tx for gingival cysts of the newborn
none, spontaneously resolve by 3 months
Lat periodontal cyst facts
Associated with vital teeth
bone window with simple enucleation usually curative
where are lat periodontal cysts most likely to occur
Man canine/premolar area (similar to gingival cyst of the adult)
Where are calcifying odontogenic cysts usually found
Max=man, often in the anterior
Which ddx do Calcifying Odontogenic Cysts fall under
Mixed, can be multilocular
Whats an interesting histologic feature of Calcifying Odontogenic cysts
Ghost cell formation
Tx for Calcifying odontogenic cyst
Enucleates easily (peels out of bone), low recurrence rate
Glandular odontogenic cyst locations
Propensity for mandible, premolar incisor region, crosses midline
Tx for glandular odontogenic cyst
can be aggressive so resection may be necessary
What can glandular odontogenic cysts be misdiagnosed as
intraossseous mucoepidermoid carcinoma
Where do nasopalatine duct cyst appear
ant max midline, either palatal or facial of 8/9 (teeth vital)
Tx for nasopalatine duct cyst
simple curettage
What is a nasolabial cyst
soft tissue cyst in the nasolabial fold that elevates ala.
What is the nasolabial cyst remnants of
Nasolacrimal duct
What gender is more likely to have nasolabial cyst
females
Tx for nasolabial cyst
surgical excision
Tx for developmental inclusion cyst of the neonate
none, resolve spontaneously
Types of dev inclusion cysts of the newborn
Epstein pearl and john nodules
Where can a thyroglossal duct cyst be found
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
What is the tx for Thyroglossal duct cyst
Sistrunk procedure:rem cyst and involved portion of hyoid bone
Where can a branchial cleft cyst be found
Lateral neck common, but can be anywhere from ear down to clavicle along SCM.
What does branchial cleft cyst appear as in histology
Lymphoepithelia cyst
Epidermal inclusion cysts are filled with what
keratin-stinky. its can complain of periodic smelly drainage if cyst is continuous with skin surface
How many germ cell layers does an epidermal inclusion cyst have
1
Multiple Epidermal inclusion cysts are consistent with
Gardner syndrome
Where are dermoid cysts found
midline of body, often floor of mouth or inner cants of the eye
How many germ layers are in a dermoid cyst
2, epidermoid and mesodermal
describe look and location of oral lymphoepithelial cyst
yellowish module, 1 cm on lateral posterior tongue or tonsillar area, soft palate.
What is an oral lymphoepithelial cyst
ectopic tonsillar/lymphoid tissue
Tx for oral lymphoepithelial cyst
Simple excision
Tx for ameloblastoma
Agressive and must be completely rem with resection of up to 1 cm into clear margins
common location of ameloblastoma
can occur anywhere but post man most common
What is the only clincally relevant histologic subtype of ameloblastoma
Desmoplastic ameloblastoma
where is desmoplastic ameloblastoma often found
Ant Maxilla
What is a desmoplastic ameloblastoma similar to radiographically
benign fibre-osseous lesion, ground glass
What is the text book presentation of adenomatoid odontogenic tumor
2/3: ant max, female, young, impacted canine
Tx for Adenomatoid odontogenic tumor
usually shells out of bone in large pieces, if completely removed no recurrence
Where are calcifying epithelial odontogenic tumors most likely found
post mandible
What do CEOTs produce histologically and radiographically
Amyloid like material
concentric calcifications called leisegang rings
tx of Calcifying epithelial odontogenic tumors
conservative excision with low recurrence rates
Where can you find central odontogenic fibromas
Ant Max, post man
What is the classical presentation of central odontogenic fibroma in max
Palatal notch
Tx for central odontogenic fibroma
enucleation, low recurrence
Central odontogenic fibroma radiographically presents as
RL but can have RO flecks
What radiographic feature defines odontogenic myxoma
thin separations at right angles to each other. thin wispy septations
Tx for odntogenic myxoma
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
Who is most likely to have cementoblastoma
young adults,kids
where are cementoblastomas most commonly found
post man
Clinical presentation of cementoblastoma
painful and expansile
What happens to teeth associated with cementoblastomas
must be ext
radiographic presentation of cementoblastoma
RO, or mixed with RL rim, attached to tooth roots
Odontomas are an example of
harmartoma
What are the types of odontoma
compound
complex
Compound odontomas def
still has three separate layers, usually ant max
Complex odontoma
unrecognizable as tooth, usually in posterior
what demographic is common for ameloblastic fibroma/fibro-odontoma
Kids in 1st or second decades. Any mixed or RL session ddx in kid should include this
growth facts about Ameloblastic fibroma/fibro odontoma
grow large, can displace teeth
tx for ameloblastic fibroma/fibro-odontoma
conservative excision, may need resection if recurs
Which locations have SCCs that are p16+
Soft palate, oropharynx larynx, base of tongue
What does p16+ indicate
a specific mutated pathway that may be HPV induced.
what are features of p16+ tumors
more aggressive
respond better to therapy
What common variants of SCC are found in the soft palate/oropharynx/larynx/base of tongue
Non keratinizing SCC and basaxoid SCC
Tradition risk factors (smoking alcohol) are least associated with SCC in this intramural site
gingiva
Which gender is more likely to have SCC on gingiva
females
What is verrucous carcinoma
A less aggressive less invasive variant of SCC
Do verrucous carcinoma metastasize
no, if does likely represents transformation to conventional SCC
what are the three major salivary glands
parotid, submandibular, sublingual
what do myoepithelial cells do
contract to assist in expulsion of glad secretory product
what are features of the parotid
serous
two lobes separated by facial nerve
empties into stepsons duct
contains lymph nodes lateral to facial nerve
Submandibular gland
80/20 serous/mucinous
whitens duct
3-6 lymph nodes adjacent to gland
Sublingual gland
mucinous
Where do mucoceles not occur
upper lip
What happens to a mucocele during salivation
likely to expand
Mucocele tx
if excised take surrounding minor glands too to decrease chance of recurrence
what is a ranula
mucocele on the floor of the moth that may grow large.
what are some ddx of ranula
dermoid cyst, cystic hygroma
Where are sialoliths most likely to be found
submandibular gland in the tortuous whartons duct, but can be found in parotid and minor glands
What are possible causes of sialadentitis
stone blockage
autoimmune (IgG4 chronic sclerosis sialadentitis)
sjogren syndrome
Describe necrotizing sialometaplasia
chronic non healing ulcer that can grow large but often quicker onset than SCC, often on the palate biopsy often incites resolution
Necrotizing sialometaplasia can mimic
mucous, and SCC
what is the most common location of saliva gland neoplasia
parotid followed by minor salivary glands
Bengin v malignant stats in parotid
bening 2x malignant
benign v malignant stats in submandibular
benign more common
benign v malignant stats in sublingual
neoplasms less common but when present usually malignant
Where are minor salivary gland neoplasms most likely
palate followed by lips
benign v malignant stats in minor salivary glands
malignant more likely (palate 50/50)
Aggressiveness of salivary gland malignancies
may be slow and not very agressive
What are concerning clinical features of salivary gland neoplasms
facial nerve paresthesia or paralysis, ulceration
what is the most common benign salivary gland neoplasm
pleomorphic adenoma
most common malignant salivary gland neoplasm
mucoepidermoid carcinoma
Location of pleomorphic adenoma
Parotid, then minor glands
Demographics of a warthin tumor pt
older male, smoker
where do warthin tumors present
parotid, often bilaterally though not necessarily at the same time
Canalicular adenoma are found where
75% in upper lip, other in ant buccal mucosa. may be multi factorial
Mucoepidermoid carcinoma are found where
anyloction but the parotid and palate more common
clinical features of mucoep
bluish nodule that may be ulcerated.
what stain is used to highlight mucous cell in mucoep
mucicarmine special stain
three grades of much ep
low intermediate high
DDX in the palate
necrotizing sialometaplasia, MEC, SCC
where does acidic cell carcinoma present most commonly
parotid
where is adenoid cystic carcinoma found most
minor glands, palat and sinonasal
Who typically gets adenoid cystic carcinoma
middle age, 40’s, male
how would you describe the growth and metastasis of adenoid cystic carcinoma
slow relentless growth with metastases along skip lesions along nerves. difficult to resect
What other treatments needed for neoplasms
neck dissection, chemo, radiation dependent on lymph node mets, and on grade of umor
what is freys syndrome
damage to auriculptemporal branch of facial nerve during parotid surgery resulting in gustatory sweating
Multiple osteomas are seen in..
Gardners syndrome
Where are osteopath primarily distributed
craniofacially
Are tori/exostosis osteomas
no, they are developmental/reactive
what is the etiology of condensing osteitis
reactive bone sclerosis due to inflammation of a usually non vital tooth, can regress following resolution of imflammation
facts about idiopathic osteosclerosis
vital teeth, no def etiology
what is the typical patient for osteoporotic marrow defects
middle aged female
likely site of osteoporotic marrow defect
body of man, can be site of prev ext
what is usually found when entering a marrow deffect
normal bone marrow
predilections of idiopathic bone cavity
young, man, male, maybe trauma
Findings upon entering an idiopathic bone cavity
nothing, bleeding incited usually causes healing
radiologic finding of idiopathic bone cavity
scallops around tooth roots
where are aneurysmal bone cysts more commonly found
long bones
growth of ABCs
rapid expansion and can be aggressive
predilections of ABCs
young females
Types of ABCs
primary and secondary
primary ABCs are associated with
neoplastic genetic mutation
secondary ABCs association
another entity such as central giant cell lesion
most common sites to metastasize to bone
BLT with a Kosher pickle
breast, lungs, thyroid, kidney, and prostate
most common form of bone malignancy
bone mets
where are osteosarcomas most commonly found
long bones: proximal tibia/distal femur in pubescent boys
Gnathic osteosarcoma demographics
average 35 yo
what are the radiographic hallmarks of osteosarcoma
asymmetric widening of pal bone formation in soft tissue bone formation above alveolar crest spiking root resorption sun burst only in 25% of cases
what is the tx for osteosarcoma
radical resection
Which type of benign fibro osseous lesion is reactive
cemento osseous dysplasia
which type of benign fibroosseous lesion is neoplastic
ossifying fibroma
which type of benign fiber osseous lesion is developmental
fibrous dysplasia
whats the requirement to call COD florid
at least two quadrants are affected
whats the concern for COD in edentulous pts
the masses sequester and create opportunity for infections
tx for central ossifying fibroma
neoplastic with unlimited growth potential so needs to be completely removed
where are central ossifying fibromas most likely found
mandible
what is a hallmark radiographic feature of central ossifying fibroma
downward bowing of the inferior border of the mandible
what is different about juvenile active ossifying fibroma
more aggressive rapid growth thats more common in Max.can also occur in the ethmoid bones and other craniofacial bones
what gene is responsible for fibrous dysplasia
GNAS1 gene mutation
types of fibrous dysplasia
monostotic, polysotic, syndromic
polystotic may just affect craniofacial bones
what syndromes are associated with fibrous dysplasia
mccune albright
FD, café au lait pigmentations (coast of Maine), endocrinopathies)
jaffe lichtenstein
FD, café au lait pigmentations
tx of Fibrous dysplasia
Growth often continues through adolescence, then slows/stops in adulthood. Lesions may need to be debulked periodically.
central giant cell lesions share same histology with…
Cherubism, hyperparathyroidism, ABCs
Whats cherubism
Kids, multiple quadrants of CGCL; often resolve in adulthood, sometimes not.
Hyperparathyroidism
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)
