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Oral Path > Oral Path Midterm COPY > Flashcards

Oral Path Midterm COPY 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

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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17
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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18
Q

What are some mixed epithelial/mesenchymal odontogenic tumors?

A
  1. Ameloblastic Fibroma
  2. Fibroodontoma
  3. Odontoma (considered a hamartoma)
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19
Q

Define Leukoplakia…

A

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

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20
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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21
Q

Define Erythroleukoplakia…

A
  • AKA speckled leukoplakia

- Frequently dysplasia or carcinoma in situ on biopsy

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22
Q

Sharply demarcated leukoplakia is concerning for…

A

Dysplasia!

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23
Q

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

A

90%!

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24
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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25
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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26
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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27
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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28
Q

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

A

Vital

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29
Q

What is the tx for buccal bifurcation cyst

A

curettage, do not ext

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30
Q

What is the most common dev odontogenic cyst

A

dentigerous

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31
Q

What teeth are dent cysts most commonly associated with

A

impacted thirds and impacted canines

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32
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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33
Q

Whats the tx for dentigerous cysts

A

Ext and send tissue to pathology

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34
Q

What is an eruption cyst

A

overlying soft tissue impacted tooth,

may appear blue or red

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35
Q

What is the treatment for an eruption cyst

A

none, usually spontaneously resolve.

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36
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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37
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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38
Q

What are multiple OKCs suggestive of

A

Nevoid Basal Cell Carcinoma Syndrome

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39
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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40
Q

Are gingival cysts of the newborn common

A

yes

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41
Q

Tx for gingival cysts of the newborn

A

none, spontaneously resolve by 3 months

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42
Q

Lat periodontal cyst facts

A

Associated with vital teeth

bone window with simple enucleation usually curative

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43
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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44
Q

Where are calcifying odontogenic cysts usually found

A

Max=man, often in the anterior

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45
Q

Which ddx do Calcifying Odontogenic Cysts fall under

A

Mixed, can be multilocular

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46
Q

Whats an interesting histologic feature of Calcifying Odontogenic cysts

A

Ghost cell formation

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47
Q

Tx for Calcifying odontogenic cyst

A

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

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48
Q

Glandular odontogenic cyst locations

A

Propensity for mandible, premolar incisor region, crosses midline

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49
Q

Tx for glandular odontogenic cyst

A

can be aggressive so resection may be necessary

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50
Q

What can glandular odontogenic cysts be misdiagnosed as

A

intraossseous mucoepidermoid carcinoma

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51
Q

Where do nasopalatine duct cyst appear

A

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

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52
Q

Tx for nasopalatine duct cyst

A

simple curettage

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53
Q

What is a nasolabial cyst

A

soft tissue cyst in the nasolabial fold that elevates ala.

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54
Q

What is the nasolabial cyst remnants of

A

Nasolacrimal duct

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55
Q

What gender is more likely to have nasolabial cyst

A

females

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56
Q

Tx for nasolabial cyst

A

surgical excision

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57
Q

Tx for developmental inclusion cyst of the neonate

A

none, resolve spontaneously

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58
Q

Types of dev inclusion cysts of the newborn

A

Epstein pearl and john nodules

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59
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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60
Q

What is the tx for Thyroglossal duct cyst

A

Sistrunk procedure:rem cyst and involved portion of hyoid bone

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61
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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62
Q

What does branchial cleft cyst appear as in histology

A

Lymphoepithelia cyst

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63
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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64
Q

How many germ cell layers does an epidermal inclusion cyst have

A

1

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65
Q

Multiple Epidermal inclusion cysts are consistent with

A

Gardner syndrome

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66
Q

Where are dermoid cysts found

A

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

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67
Q

How many germ layers are in a dermoid cyst

A

2, epidermoid and mesodermal

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68
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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69
Q

What is an oral lymphoepithelial cyst

A

ectopic tonsillar/lymphoid tissue

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70
Q

Tx for oral lymphoepithelial cyst

A

Simple excision

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71
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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72
Q

common location of ameloblastoma

A

can occur anywhere but post man most common

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73
Q

What is the only clincally relevant histologic subtype of ameloblastoma

A

Desmoplastic ameloblastoma

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74
Q

where is desmoplastic ameloblastoma often found

A

Ant Maxilla

75
Q

What is a desmoplastic ameloblastoma similar to radiographically

A

benign fibre-osseous lesion, ground glass

76
Q

What is the text book presentation of adenomatoid odontogenic tumor

A

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

77
Q

Tx for Adenomatoid odontogenic tumor

A

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

78
Q

Where are calcifying epithelial odontogenic tumors most likely found

A

post mandible

79
Q

What do CEOTs produce histologically and radiographically

A

Amyloid like material

concentric calcifications called leisegang rings

80
Q

tx of Calcifying epithelial odontogenic tumors

A

conservative excision with low recurrence rates

81
Q

Where can you find central odontogenic fibromas

A

Ant Max, post man

82
Q

What is the classical presentation of central odontogenic fibroma in max

A

Palatal notch

83
Q

Tx for central odontogenic fibroma

A

enucleation, low recurrence

84
Q

Central odontogenic fibroma radiographically presents as

A

RL but can have RO flecks

85
Q

What radiographic feature defines odontogenic myxoma

A

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

86
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

87
Q

Who is most likely to have cementoblastoma

A

young adults,kids

88
Q

where are cementoblastomas most commonly found

A

post man

89
Q

Clinical presentation of cementoblastoma

A

painful and expansile

90
Q

What happens to teeth associated with cementoblastomas

A

must be ext

91
Q

radiographic presentation of cementoblastoma

A

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

92
Q

Odontomas are an example of

A

harmartoma

93
Q

What are the types of odontoma

A

compound

complex

94
Q

Compound odontomas def

A

still has three separate layers, usually ant max

95
Q

Complex odontoma

A

unrecognizable as tooth, usually in posterior

96
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

97
Q

growth facts about Ameloblastic fibroma/fibro odontoma

A

grow large, can displace teeth

98
Q

tx for ameloblastic fibroma/fibro-odontoma

A

conservative excision, may need resection if recurs

99
Q

Which locations have SCCs that are p16+

A

Soft palate, oropharynx larynx, base of tongue

100
Q

What does p16+ indicate

A

a specific mutated pathway that may be HPV induced.

101
Q

what are features of p16+ tumors

A

more aggressive

respond better to therapy

102
Q

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

A

Non keratinizing SCC and basaxoid SCC

103
Q

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

A

gingiva

104
Q

Which gender is more likely to have SCC on gingiva

A

females

105
Q

What is verrucous carcinoma

A

A less aggressive less invasive variant of SCC

106
Q

Do verrucous carcinoma metastasize

A

no, if does likely represents transformation to conventional SCC

107
Q

what are the three major salivary glands

A

parotid, submandibular, sublingual

108
Q

what do myoepithelial cells do

A

contract to assist in expulsion of glad secretory product

109
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

110
Q

Submandibular gland

A

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

111
Q

Sublingual gland

A

mucinous

112
Q

Where do mucoceles not occur

A

upper lip

113
Q

What happens to a mucocele during salivation

A

likely to expand

114
Q

Mucocele tx

A

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

115
Q

what is a ranula

A

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

116
Q

what are some ddx of ranula

A

dermoid cyst, cystic hygroma

117
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

118
Q

What are possible causes of sialadentitis

A

stone blockage
autoimmune (IgG4 chronic sclerosis sialadentitis)
sjogren syndrome

119
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

120
Q

Necrotizing sialometaplasia can mimic

A

mucous, and SCC

121
Q

what is the most common location of saliva gland neoplasia

A

parotid followed by minor salivary glands

122
Q

Bengin v malignant stats in parotid

A

bening 2x malignant

123
Q

benign v malignant stats in submandibular

A

benign more common

124
Q

benign v malignant stats in sublingual

A

neoplasms less common but when present usually malignant

125
Q

Where are minor salivary gland neoplasms most likely

A

palate followed by lips

126
Q

benign v malignant stats in minor salivary glands

A

malignant more likely (palate 50/50)

127
Q

Aggressiveness of salivary gland malignancies

A

may be slow and not very agressive

128
Q

What are concerning clinical features of salivary gland neoplasms

A

facial nerve paresthesia or paralysis, ulceration

129
Q

what is the most common benign salivary gland neoplasm

A

pleomorphic adenoma

130
Q

most common malignant salivary gland neoplasm

A

mucoepidermoid carcinoma

131
Q

Location of pleomorphic adenoma

A

Parotid, then minor glands

132
Q

Demographics of a warthin tumor pt

A

older male, smoker

133
Q

where do warthin tumors present

A

parotid, often bilaterally though not necessarily at the same time

134
Q

Canalicular adenoma are found where

A

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

135
Q

Mucoepidermoid carcinoma are found where

A

anyloction but the parotid and palate more common

136
Q

clinical features of mucoep

A

bluish nodule that may be ulcerated.

137
Q

what stain is used to highlight mucous cell in mucoep

A

mucicarmine special stain

138
Q

three grades of much ep

A

low intermediate high

139
Q

DDX in the palate

A

necrotizing sialometaplasia, MEC, SCC

140
Q

where does acidic cell carcinoma present most commonly

A

parotid

141
Q

where is adenoid cystic carcinoma found most

A

minor glands, palat and sinonasal

142
Q

Who typically gets adenoid cystic carcinoma

A

middle age, 40’s, male

143
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

144
Q

What other treatments needed for neoplasms

A

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

145
Q

what is freys syndrome

A

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

146
Q

Multiple osteomas are seen in..

A

Gardners syndrome

147
Q

Where are osteopath primarily distributed

A

craniofacially

148
Q

Are tori/exostosis osteomas

A

no, they are developmental/reactive

149
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

150
Q

facts about idiopathic osteosclerosis

A

vital teeth, no def etiology

151
Q

what is the typical patient for osteoporotic marrow defects

A

middle aged female

152
Q

likely site of osteoporotic marrow defect

A

body of man, can be site of prev ext

153
Q

what is usually found when entering a marrow deffect

A

normal bone marrow

154
Q

predilections of idiopathic bone cavity

A

young, man, male, maybe trauma

155
Q

Findings upon entering an idiopathic bone cavity

A

nothing, bleeding incited usually causes healing

156
Q

radiologic finding of idiopathic bone cavity

A

scallops around tooth roots

157
Q

where are aneurysmal bone cysts more commonly found

A

long bones

158
Q

growth of ABCs

A

rapid expansion and can be aggressive

159
Q

predilections of ABCs

A

young females

160
Q

Types of ABCs

A

primary and secondary

161
Q

primary ABCs are associated with

A

neoplastic genetic mutation

162
Q

secondary ABCs association

A

another entity such as central giant cell lesion

163
Q

most common sites to metastasize to bone

A

BLT with a Kosher pickle

breast, lungs, thyroid, kidney, and prostate

164
Q

most common form of bone malignancy

A

bone mets

165
Q

where are osteosarcomas most commonly found

A

long bones: proximal tibia/distal femur in pubescent boys

166
Q

Gnathic osteosarcoma demographics

A

average 35 yo

167
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
168
Q

what is the tx for osteosarcoma

A

radical resection

169
Q

Which type of benign fibro osseous lesion is reactive

A

cemento osseous dysplasia

170
Q

which type of benign fibroosseous lesion is neoplastic

A

ossifying fibroma

171
Q

which type of benign fiber osseous lesion is developmental

A

fibrous dysplasia

172
Q

whats the requirement to call COD florid

A

at least two quadrants are affected

173
Q

whats the concern for COD in edentulous pts

A

the masses sequester and create opportunity for infections

174
Q

tx for central ossifying fibroma

A

neoplastic with unlimited growth potential so needs to be completely removed

175
Q

where are central ossifying fibromas most likely found

A

mandible

176
Q

what is a hallmark radiographic feature of central ossifying fibroma

A

downward bowing of the inferior border of the mandible

177
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

178
Q

what gene is responsible for fibrous dysplasia

A

GNAS1 gene mutation

179
Q

types of fibrous dysplasia

A

monostotic, polysotic, syndromic

polystotic may just affect craniofacial bones

180
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

181
Q

tx of Fibrous dysplasia

A

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

182
Q

central giant cell lesions share same histology with…

A

Cherubism, hyperparathyroidism, ABCs

183
Q

Whats cherubism

A

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

184
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)

Oral Path (16 decks)

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