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Module 7 > Oral Pathology > Flashcards

Oral Pathology Flashcards

1
Q

What types of specimen are sent for histopathological investigation?

A

Biopsy - Incisional
Biopsy - Excisional
Resection

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2
Q

What is a fixed specimen preserved in?

A

10% neutral buffered formalin

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3
Q

How is a fresh specimen preserved?

A

Frozen

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4
Q

What is the process once a specimen is received at pathology?

A
  1. Logged in and assigned unique pathology number
  2. Macroscopic description and cut-up by pathology (photos & decalcification)
  3. All biopsy/appropriate blocks taken from resection specimen and placed in cassettes
  4. Processing - fixation then dehydration of tissue in alcohols
  5. Embedding - hot paraffin wax to form tissue blocks
  6. Microtome used to cut sections - 4um thickness
  7. Sections floated in waterbath, mounted on slide, stained and coverslip placed
  8. Slides examined
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5
Q

What stains are used routinely?

A

Haematoxylin and Eosin (H&E)

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6
Q

What other investigations may be used in addition to light microscopy?

A

Immunofluorescence
In situ hybridization
Electron microscopy
Cytogenetic and molecular genetic analysis

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7
Q

What is hyperplasia?

A

the abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue

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8
Q

What is hypertrophy?

A

the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells

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9
Q

What is atrophy?

A

a decrease in cell size by loss of cell substance

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10
Q

What is metaplasia?

A

reversible change in which one adult cell type is replaced by another adult cell type

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11
Q

What is hyperkeratosis?

A

thickening of the stratum corneum

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12
Q

What is orthokeratosis?

A

the formation of an anuclear keratin layer, as in normal keratinised stratified squamous epithelium

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13
Q

What is parakeratosis?

A

the persistence of nuclei in the cells of a keratin layer

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14
Q

What is dyskeratosis?

A

premature keratinization of epithelial cells that have not reached the keratinizing surface layer

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15
Q

What is acanthosis?

A

increased thickness of prickle cell layer

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16
Q

What is acantholysis?

A

the loss of intercellular adhesion between keratinocytes

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17
Q

What is epithelial dysplasia?

A

alteration in differentiation, maturation and architecture of adult epithelial cells

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18
Q

What is ulceration?

A

mucosal/skin defect with complete loss of surface epithelium

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19
Q

What is apoptosis?

A

programmed cell death

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20
Q

What is necrosis?

A

cell death by injury or disease

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21
Q

What are developmental white lesion?

A

Fordyce granules

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22
Q

What are hereditary white lesions?

A

White sponge naevus
Pachyonychia congenita
Dyskeratosis congenita

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23
Q

What are normal white lesions?

A

leukodema

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24
Q

What ate traumatic white lesions?

A

Mechanical/frictional
Chemical
Thermal

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25
Q

What are dermatological white lesions?

A

Lichen planus
Lupus erythematosus

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26
Q

What are some infective white lesions?

A

candidosis
syphillitic leukoplakia
oral hairy leukoplakia

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27
Q

What are some idiopathic white lesions?

A

leukoplakia
proliferative verrucous leukoplakia

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28
Q

what are some neoplastic white lesions?

A

dysplastic lesions
squamous cell carcinoma

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29
Q

What is the inheritance pattern of white sponge naevus?

A

autosomal dominant

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30
Q

what is the appearance of white sponge naevus?

A

ill-defined white patched with ‘shaggy’ surface, often bilateral

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31
Q

where is white sponge naevus found?

A

any part of oral mucosa, esp buccal

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32
Q

what mutation causes white sponge naevus?

A

mutations in keratins 4/13

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33
Q

what is the histopathology of white sponge naevus?

A

hyperparakeratosis and acanthosis of epithelium
basket-weave appearance

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34
Q

what is the treatment of white sponge naevus?

A

no tx required

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35
Q

what is lichen planus?

A

common chronic inflammatory disease of skin and mucous membranes

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36
Q

who is most affected by lichen planus?

A

middle aged and over
females > males

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37
Q

what is the pathogenesis of lichen planus?

A

T cell-mediated immunological damage to the basal cells of epithelium

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38
Q

what is the most common oral site of lichen planus?

A

buccal mucosa

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39
Q

what are the different appearances of lichen planus?

A

reticular
atrophic
plaque-like
papular
erosive
bullous

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40
Q

what is the histopathology of lichenoid inflammation?

A

hyperorthokeratosis/hyperparakeratosis of the epithelium which may acanthotic or atrophic,
saw-tooth rete ridges

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41
Q

what is an OMPD?

A

oral potentially malignant disorder

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42
Q

what is an example of an OMPD?

A

lichen planus

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43
Q

what is the frequency of malignant change in lichen planus?

A

0.1-10%

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44
Q

what are the clinical features of oral hairy leukoplakia?

A

white, shaggy appearance on lateral tongue
asymptomatic

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45
Q

what virus causes oral hairy leukoplakia?

A

EBV and HIV

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46
Q

what is the histopathology of hairy leukoplakia?

A

thickened, hyperparakeratotic epithelium
band of ‘ballooned’ pale cells in upper prickle cell layer

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47
Q

what is a leukoplakia?

A

white plaques of questionable risk, once other specific conditions and other OPMDs have been ruled out

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48
Q

how can leukoplakias be described?

A

homogenous white plaque
nodular / verrucous

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49
Q

what type of cancer can proliferative verrucous leukoplakia degenerate into?

A

verrucous carcinoma
squamous cell carcinoma

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50
Q

what kinds of red patches are idiopathic?

A

geographic tongue
erythroplakia

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51
Q

what kinds of red patched are neoplastic?

A

dysplastic lesions
squamous cell carcinoma

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52
Q

what does median rhomboid glossitis look like?

A

red patch on midline of posterior aspect of anterior 2/3 of dorsal tongue

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53
Q

what is the histopathology of median rhomboid glossitis?

A

loss of lingual papillae
parakeratosis and acanthosis of squamous epithelium
candidal hyphae in parakeratin and neutrophils
chronic inflammatory infiltrate in connective tissue

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54
Q

how do you treat median rhomboid glossitis?

A

antifungal medication

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55
Q

what is the appearance of erythroplakia?

A

red velvety appearance, smooth or nodular

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56
Q

where is erythroplakia most common?

A

soft palate, floor of mouth, buccal mucosa

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57
Q

what is erythroleukoplakia?

A

speckled leukoplakia - leuko and erythroplakia

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58
Q

are erythroplakias prone to malignant transformation?

A

high likelihood - 50%

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59
Q

what are the exogenous causes of oral pigmentation?

A

superficial staining (food, drink, tobacco)
black hairy tongue
foreign bodies (amalgam tattoo)
heavy metal poisoning
drugs - NSAIDs, antimalarials, chlorhexidine

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60
Q

what is the histopathology of amalgam tattoo?

A

pigment dispersed in connective tissue as fine brown/black granules
associated with collagen and elastic fibres and basement membranes

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61
Q

What is a melanotic macule?

A

well-defined small flat brown/black lesion

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62
Q

what causes a melanotic macule?

A

increased activity of melanocytes

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63
Q

where are melanotic macules most commonly found?

A

buccal mucosa, palate and gingiva

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64
Q

Why are melanotic macules frequently excised?

A

to confirm diagnosis and exclude melanoma

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65
Q

what is the histopathology of melanotic macules?

A

increased melanin pigment in basal keratinocytes

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66
Q

what is the histopathology of mucosal melanoma?

A

highly pleomorphic neoplasms, cells appear epithelioid or spindle-shaped

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67
Q

what is the treatment for mucosal melanoma?

A

surgical resection
adjuvant radiotherapy

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68
Q

what is an ulcer?

A

localised surface defect with loss of epithelium exposing underlying inflamed connective tissue

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69
Q

what are causes of infective ulceration?

A

bacterial, fungal, viral (HSV, VZV, CMV, coxsackie)

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70
Q

What are causes of traumatic lesions?

A

mechanical
chemical
thermal
factitious injury
radiation

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71
Q

what drugs can cause ulceration?

A

nicorandil (angina)
NSAIDs

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72
Q

name an idiopathic cause of ulceration?

A

recurrent aphthous stomatitis

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73
Q

what systemic disease can have associated ulcer?

A

haematological
GI disease
HIV

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74
Q

what dermatological disease has associated ulcers?

A

lichen planus
discoid lupus erythematous
immunobullous disease

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75
Q

what are neoplastic causes of ulceration?

A

oral SCC
salivary neoplasms
metastases

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76
Q

what is the histopathology of ulcers?

A

loss of surface epithelium, inflamed fibrinoid exudate and inflamed granulation tissue

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77
Q

what are the 2 histological classifications of vesicles/bullae?

A
  1. intraepithelial
  2. subepithelial
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78
Q

what are 2 types of intraepithelial vesicles?

A

non-acantholytic (viral infections eg HSV)
acantholytic (desmosomal breakdown)

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79
Q

how are non-acantholytic vesicles formed?

A

virus targets and replicates within epithelial cells
leads to cell lysis
groups of infected cells breakdown to form vesicles within epithelium
infected cells infect nearby normal cells and an ulcer forms when the full thickness of the epithelium is involved and destroyed

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80
Q

what is a cause of acantholytic lesions?

A

pemphigus - autoimmune disease

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81
Q

what causes pemphigus vulgaris?

A

autoantibodies to desmosomal protein (desmoglein 1 or 3) produced
bullae form in skin and mucous membranes then rupture to leave ulcers

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82
Q

what is the tx for pemphigus

A

steroids

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83
Q

describe the histopathology of pemphigus

A

characteristic intraepithelial bullae produced by acantholysis
Tzanck cells found lying free within the bullae fluid
Tombstone-like basal cells remain attached to basement membrane

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84
Q

how is pemphigus vulgaris diagnosed?

A

direct immunofluorescence (DIF) studies used in conjuction with routine histopathology to confirm diagnosis

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85
Q

what are examples of subepithelial vescicles/bullae?

A

pemphigoid
erythema multiforme
dermatitis herpetiformis
epidermolysis bullosa acquisita

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86
Q

what is pemphigoid

A

group of autoimmune diseases:
- bullous pemphigoid
- mucous membrane pemphigoif
- linear IgA disease
- drug induced pemphigoid

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87
Q

how do gingival mucous membrane pemphigoid lesions present?

A

desquamative gingivitis

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88
Q

what causes mucous membrane pemphigoid lesions?

A

autoantibodies to basement membrane components (usually BP180, less often integrins, laminin and type VII collagen)

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89
Q

what is the histopathology of mucous membrane pemphigoid?

A

separation of full thickness epithelium from connective tissue producing subepithelial bullae with a thick roof
infiltration of neutrophils and eosinophils around and within bulla

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90
Q

what is epidermolysis bullosa acquisita?

A

acquired autoimmune blistering dermatosis with subepithelial bullae

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91
Q

what is epidermolysis bullosa?

A

formation of skin bullae which heal with scarring

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92
Q

what are the 3 variants of epidermolysis bullosa?

A

simplex (intraepithelial)
junctional (subepithelial)
dystrophic (subepithelial)

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93
Q

what is oral submucous fibrosis?

A

chronic, progressive, oral potentially malignant condition

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94
Q

what is oral submucous fibrosis associated with?

A

betel quid/areca nut

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95
Q

how does oral submucous fibrosis present?

A

clinically pale coloured mucosa, firm to palpate
increasing submucosal fibrosis leading to very marked trismus

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96
Q

what is the histopathology of oral submucous fibrosis?

A

submucosal deposition of dense collagenous tissue
decreased vascularity
marked epithelial atrophy
variable rates of dysplasia

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97
Q

what is chronic candidiasis/chronic hyperplastic candidosis?

A

persistent white patch on oral mucosa that cannot be removed by scraping

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98
Q

what is the most common site for chronic candidiasis/chronic hyperplastic candidosis?

A

buccal mucosa adjacent to commissure of lips

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99
Q

what is the histopathology of chronic candidiasis/chronic hyperplastic candidosis?

A

hyperparakeratosis
prominent, irregular acanthosis
numerous neutrophils in parakeratin, forming microabscessed
candidal hyphae in parakeratin
marked inflammation in parakeratin and prickle cell layers

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100
Q

what is epithelial dysplasia?

A

atypical epithelial alterations limited to the surface squamous epitelium

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101
Q

what are the histological features epithelial dysplasia?

A
  1. nuclear and cellular pleomorphism
  2. alteration in nuclear/cytoplasmic ratio
  3. nuclear hyperchromatism
  4. prominent nucleoli
  5. increased and abnormal mitoses
  6. loss of polarity of basal cells
  7. basal cell hyperplasia
  8. drop-shaped rete pegs
  9. irregular epithelial stratification or disturbed maturation
  10. abnormal keratinisation
  11. loss/reduction of intercellular adhesion
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102
Q

how is epithelial dysplasia graded?

A

mild - disorganisation, increased proliferation and atypia of basal cells
moderate - more layers of disorganised basaloid cells, atypia, suprabasal mitoses
severe - very abnormal, affects full thickness of epithelium

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103
Q

what is the histopathological difference between dysplasia and OSCC

A

in dysplasia the atypical cells are confined to the surface

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104
Q

what is the management of epithelial dysplasia?

A

modify risk factors
high risk sites
antifungal tx
excision
close clinical review
rebiopsy

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105
Q

what are the risk factors of oral cancer?

A

tobacco
alcohol
betel quid/pan/areca nut
previous oral cancer
exposure to UV light
poor diet
immune suppression

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106
Q

what are the high risk sites for oral cancer?

A

lateral/ventral tongue
FOM
retromolar trigone

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107
Q

what are low risk sites for oral cancer?

A

hard palate
dorsum of tongue

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108
Q

what additional detection tests can be used for oral cancer?

A

toludine blue
autofluorescence
chemiluminescence
vizlite plus

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109
Q

how is SCC diagnosed?

A

incisional biopsy

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110
Q

what is the histopathology of SCC?

A

cytologically malignant squamous epithelium, invasion and destruction of local tissues

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111
Q

how is SCC graded?

A

degree of differentiation:
well-differentatied - tumour cells very obvious
moderately
poorly - may be difficult to identify tumour cells as epithelial

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112
Q

what is the tx for SCC?

A

surgery
adjuvant therapy
monoclonal antibodies

113
Q

What does TNM stand for when staging cancer?

A

T - extent of primary tumour
N - absence or presence and extent of regional lymph node metastasis
M - category describes the absence or presence of distant metastasis

114
Q

describe a T4a lip tumour?

A

invades through cortical bone, inferior alveolar nerve, FOM or skin

115
Q

describe a T4a oral cavity tumour

A

invades through cortical bone of the mandible or maxillary sinus, or invades skin of face

116
Q

describe a T4a lip and oral cavity tumour

A

invades masticator space, pterygoid plates, skull base, encases internal carotid artery

117
Q

what are the clinical features of acute periradicular periodontitis?

A

history of pain
grossly carious/heavily restored tooth
previous trauma

118
Q

what is the histopathology of acute periradicular periodontitis?

A

acute inflammatory changes;
- vascular dilation
- neutrophils
- oedema

119
Q

what are the tx options for acute periradicular periodontitis?

A

XLA or RCT

120
Q

what are the clinical features of acute periapical absces?

A

pain
swelling/sinus

121
Q

what is the histopathology of acute periapical abscess?

A

central collection of pus
adjacent zone of preserved neutrophils
surrounding membrane of sprouting capillaries and vascular dilation and occasional fibroblasts

122
Q

what are the tx options for acute periapical abcesses?

A

drainage
XLA
RCT

123
Q

what are the clinical features of chronic periradicular periodontitis?

A

non-vital tooth, maybe previous RCT
often minimal symptoms
apical radiolucent lesion

124
Q

what is the histopathology of chronic periradicular periodontitis?

A

chromic inflammatory changes
- lymphocytes
- plasma cells
- macrophages
- granulation tissue progressing to fibrosis
- resorption of bone

125
Q

what are the tx options for chronic periradicular periodontitis?

A

XLA
RCT
RCT retreatment
Periradicular surgery

126
Q

what is periapical granuloma?

A

a mass of inflamed granulation tissue at the apex of a non-vital tooth

127
Q

what can happen to a periapical granuloma?

A

undergo cystic change - become radicular cyst

128
Q

what is the histopathology of periapical granuloma?

A

inflamed granulation tissue
multinucleated giant cell
proliferation of cell rests of Malassez
haemosiderin and cholestrol deposits
resorption of adjacent bone/tooth

129
Q

what are the tx options for periapical granuloma?

A

XLA
RCT
RCT retx
periradicular surgery

130
Q

what is the histopathology of pericoronitis?

A

acute and chronic inflammatory changed including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue

131
Q

what is the tx option for pericoronitis?

A

irrigation
XLA opposing tooth
antibiotics if systemically unwell

132
Q

what is a cyst?

A

a pathological cavity having fluid or semi-fluid content
lined wholly or in part by epithelium
not due to accumulation of pus

133
Q

what ate odontogenic cysts?

A

derived from epithelial residues of tooth-forming organ

134
Q

what are non-odontogenic cysts?

A

derived from sources other than tooth forming organ

135
Q

what do teeth develop from?

A

odontogenic epithelium and neural crest derived ectomesenchyme

136
Q

what odontogenic remnants are there after development?

A

dental lamina - glands of Serres
root sheath - cell rests of Malassez

137
Q

what are the 2 types of odontogenic cysts?

A

developmental
inflammatory

138
Q

what are the 2 types of inflammatory odontogenic cysts?

A
  1. radicular cyst (apical, lateral, residual)
  2. inflammatory collateral cyst (paradental, mandibular buccal bifurcation cyst)
139
Q

what are radicular cysts?

A

most common jaw cyst
arise from epithelial proliferation and cyst formation within some periapical granulomas
must be associated with a non-vital tooth

140
Q

describe the radiograohic appearance of a radicular cyst

A

well-circumscribed unilocular radiolucent lesion seen at apex

141
Q

what is the pathogenesis of radicular cysts?

A

proliferation of epithelium (cell rests of malassez) in response to inflammation
cyst enlarges due to osmotic pressure
local bone resorption

142
Q

what is the histopathology of radicular cysts?

A

chronically inflamed fibrous capsule
wholly/partially lined by non-keratinized stratified squamous epithelium
mucous metaplasia and ciliated cells may be seen
hyaline/rushton bodies
cholestrol clefts and haemosiderin

143
Q

what is the tx for radicular cysts?

A

small cysts may resolve after RCT/XLA/periradicular surgery
enucleation
marsupialisation for very large lesions

144
Q

what is a lateral radicular cyst?

A

radicular cyst arising from a lateral root canal branch of a non-vital tooth

145
Q

what is a residual cyst?

A

radicular cyst that persists after XLA of the associated non-vital tooth

146
Q

what are the 2 types of inflammatory collateral cysts?

A

Paradental - lower 8’s
Mandibular buccal bifurcation cyst - lower 6/7’s

147
Q

what condition may cause paradental cysts to arise?

A

long-standing pericoronitis

148
Q

what are the clinical features of mandibular buccal bifurcation cysts?

A

painless swelling
associated tooth tilted buccally with deep perio pocket
well-demarcated buccal radiolucency

149
Q

what are some developmental odontogenic cysts?

A

odontogenic keratocyst
dentigerous cyst
eruption cyst

150
Q

what direction do odontogenic keratocysts expand?

A

anterior-posterior direction

151
Q

How do odontogenic keratocysts appear radiographically?

A

Well-defined radio lucent uni or multilocular lesion

152
Q

What is the aetiology of odontogenic keratocysts?

A

Arise from remnants of dental lamina (glands of serres)
Associated with mutation or inactivation of PTCH1 gene, chromosome 9, activates SHH signalling pathway resulting in aberrant cell proliferation of epithelium

153
Q

What is Gorlin syndrome?

A

Naevoid basal cell carcinoma syndrome

154
Q

What happens in Gorlin syndrome?

A

Multiple odontogenic keratocysts
Basal cell naevi
Skeletal abnormalities
Multiple basal cell carcinomas

155
Q

What is the histopathology of odontogenic keratocyst?

A

Keratinised stratified squamous epithelial lining
Corrugated appearance of surface parakeratin layer
Well-defined, palisaded basal cell layer
Keratin debris in lumen

156
Q

What are the tx options for odontogenic keratocysts?

A

Marsupialization
Enucleation
Marsupialization and enucleation
Enucleation and Carnoy’s solution
Enucleation and cryotherapy
Resection

157
Q

What are the clinical features of a dentigerous cyst?

A

Encloses all or part of crown of unerupted teeth
Attached to amelocemental junction
Well-circumscribed unilocular radiolucency associated with crown of unerupted tooth

158
Q

What is the histopathology of a dentigerous cyst?

A

Thin, non-keratinised squamous cell epithelial lining
Mucous metaplasia
Fibrous capsule

159
Q

What are the tx options for dentigerous cyst?

A

Enucleation
Exposure/transplantation/extraction of associated tooth

160
Q

What are the clinical features of an eruption cyst?

A

Dentigerous cyst arising in extra-alveolar location
Typically in children
Deciduous and permanent molars
Presents as bluish swelling

161
Q

What are the clinical features of lateral periodontal cysts?

A

Arise adjacent to vital teeth
Canine and premolar region of mandible
Usually symptom free
Well-circumscribed radiolucency in PDL

162
Q

What is the histopathology of lateral periodontal cysts?

A

Thin, non-keratinised squamous or cuboidal epithelium
Focal thickenings/plaques
Uninflamed fibrous wall

163
Q

What is the tx for lateral periodontal cysts?

A

Enucleation

164
Q

What is a botryoid odontogenic cyst?

A

Very rare multi cystic variant of lateral periodontal cyst

165
Q

Where would you typically find a glandular odontogenic cyst?

A

Anterior mandible

166
Q

What is the radiographic appearance do glandular odontogenic cysts have?

A

Multilocular radiolucency

167
Q

What is the histopathology of glandular odontogenic cysts?

A

Cystic lumen lined by epithelium of various thickness with mucous cells and glandular structures

168
Q

What is the histopathology of calcifying odontogenic cysts?

A

Unicystic
Lined by epithelium which is ameloblastoma-like
Palisaded basal layer with overlying stellate reticulum-like layer

169
Q

What are the clinical features of orthokeratinised odontogenic cysts?

A

Wide age range, peak 30-40
Male predilection
90% mandible
Painless swelling of jaw
Well-defined unilocular radiolucency

170
Q

What is the histopathology of orthokeratinised odontogenic cysts?

A

Uninflamed fibrous wall
Lined by stratified squamous epithelium
Prominent granular cell layer and orthokeratinised

171
Q

Where are non-odontogenic cysts derived from?

A

Sources other than tooth-forming organ

172
Q

Name 3 non-odontogenic cysts

A

Nasopalatine duct cyst
Surgical ciliated cyst
Nasolabial cyst

173
Q

What are the clinical features of a nasopalatine duct cyst?

A

Uncommon
Originates from epithelium of nasopalatine duct in incisive canal
Occur anywhere in nasopalatine canal, mostly palatal end
Usually 50-60s

174
Q

What are the symptoms of nasal palatine duct cysts?

A

Swelling in midline of anterior palate
Salty taste

175
Q

How do nasopalatine duct cysts present radiographically?

A

Rounded or heart-shaped radiolucency in midline of anterior hard palate

176
Q

What is the histopathology of nasopalatine duct cysts?

A

Epithelial lining either stratified squamous, respiratory, cuboidal or columnar
Fibrous connective tissue capsule
Neurovascular bundles and mucous glands may be seen in capsule

177
Q

What is the treatment for nasapalatine duct cysts?

A

Enucleation
Recurrence unlikely

178
Q

What are the clinical features of surgical ciliated cysts?

A

Mostly in posterior maxilla
May be asymptomatic or present with pain and swelling
Develop after sinus/nasal mucosa implanted in the jaw following trauma or surgery

179
Q

What is the histopathology of surgical ciliated cysts?

A

Cyst lined by respiratory epithelium (pseudostratified columnar epithelium)
Fibrous connective tissue capsule which may be inflamed

180
Q

What are the clinical features of nasolabial cysts?

A

Very rare
Mainly 40s-50s
Arise in upper lip below nose, lateral to midline
Slow growing, distorts nostril
Painless unless infected

181
Q

Where do nasolabial cysts develop from?

A

The remnants of the embryonic nasolacrimal ducts or the lower anterior portion of the mature duct

182
Q

What is the histopathology of nasolabial cysts?

A

Cystic lesion with fibrous capsule
Usually pseudostratified columnar epithelium lining

183
Q

What is the treatment for nasolabial cysts?

A

Excision

184
Q

What are the soft tissue cysts?

A

Salivary mucocoele
Epidermis cyst
Dermoid cyst
Lymphoepithelial cyst
Thyroglossal cyst

185
Q

What are the clinical features of an epidermoid cyst?

A

Painless swelling
Often follow trauma or surgery
More common on skin

186
Q

What is the histopathology of an epidermoid cyst?

A

Cystic lesion with thin cyst wall
Keratinising stratified squamous epithelium lining
Abundant keratin debris in lumen
No skin appendages in cyst wall

187
Q

What are the clinical features of a dermoid cyst?

A

Developmental lesion
Various locations in head and neck
Floor of mouth is most common oral site
Present as painless swelling in midline

188
Q

what is the histopathology of dermoid cysts?

A

same as epidermoid cyst with keratinized stratified squamous lining
keratin debrin within cyst lumen
must alos have skin appendages in cyst wall

189
Q

what are the clinical features of a lymphoepithelial cyst?

A

developmental lesion
uncommon but do occur in oral cavity
FOM most common
painless small swelling
yellowish colour

190
Q

What is the histopathology of a lymphoepithelial cyst?

A

thin keratinized stratified squamous epithelium
keratin debris in cyst lumen
lymphoid tissue in cyst wall

191
Q

what are the clinical features of a thyroglossal duct cyst?

A

derived from embryonic thyroglossal duct
most arise near hyoid bone
midline swelling
painless

192
Q

what is the histopathology of a thyroglossal duct cyst?

A

cystic lesion lined by stratified squamous epithelium/ciliated columnar epithelium/nonciliated columnar epithelium

193
Q

what is the tx for thryoglassal duct cysts?

A

excision - sistrunk procedure
removal of mid third of hyoid bone

194
Q

what are the clinical features of ameloblastoma?

A

30-60 years
posterior mandible
swelling
slow growing, locally aggressive

195
Q

what is the histopathology of ameloblastoma?

A

well-organised peripheral layer of tall, columnar cells with nuclei at opposite pole to basement membrane (reversed polarity)
or
core of loosely arranged cells resembling stellate reticulum

follicular (islands of epithelial cells)
or
plexiform (long strands of epithelial cells)

196
Q

what is the tx for ameloblastoma?

A

complete excision with margin of uninvolved tissue
longterm follow-up

197
Q

why are maxillary ameloblastomas more dangerous?

A

readily spread through base of skull
difficult to excise
potentially lethal

198
Q

what are the clinical features of adenomatoid odontogenic tumours?

A

majority in canine region
associated with unerupted permanent teeth
unilocular radiolucency, may mimic dentigerous cyst

199
Q

what is the histopathology of adenomatoid odontogenic tumours?

A

odontogenic epithelium arranged in solid nodules or rosette-like structures
duct-like structures
eosinophilic amorphous material
minimal fibrous stroma

200
Q

what is an odontoma?

A

developmental malformations of dental tissues
once fully calcified do not develop further
usually in young pts

201
Q

what does a compound type odontoma look like?

A

fibrous capsule enclosing many separate, tooth-like structures (denticles/odontoids)

202
Q

what is a complex type odontoma?

A

irregular mass of hard and soft dental tissues, haphazzard arrangement with no resemblance to a tooth and often forming a cauliflower-like mass

203
Q

what is the tx for odontomas?

A

enucleation

204
Q

what are the clinical features of cementoblastoma?

A

formation of cementum-like tissue in connection with root of tooth
mandible > maxilla
painful swelling
tooth remains vital

205
Q

how does cementoblastoma present radiographically?

A

well-defined radiopaque or mixed-density lesion

206
Q

what is the histopathology of cementoblastoma?

A

dense masses of acellular cementum-like material
fibrous, sometimes vascular stroma
tumour blends with root of tooth - helps distinguish lesion from bone tumours

207
Q

what is an osteoma?

A

benign slow-growing tumour consisting of well-differentiated mature bone

208
Q

how does an osteoma present?

A

usually solitary lesions, multiple can occur as a feature of Gardner syndrome

209
Q

what is Gardner syndrome?

A

a rare AD disorder

210
Q

what is the histopathology of a compact type osteoma?

A

mass of dense lamellar bone with few marrow spaces

211
Q

what is the histopathology of cancellous type osteoma?

A

interconnecting traberculae enclosing fatty or fibrous marrow

212
Q

what are haematolymphoid tumours?

A

solitary plasmacytoma of bone
localised proliferation of monoclonal plasma cells involving bone

213
Q

what are haematolymphoid tumours?

A

solitary plasmacytoma of bone
localised proliferation of monoclonal plasma cells involving bone

214
Q

what are the clinical features of ossifying fibroma?

A

slow, painless expansion of bone
30-40s
F>M

215
Q

what is the histopathology of ossifying fibroma?

A

well-demarcated or rarely encapsulated benign lesion
fibrous tissue containing varying amounts of metaplastic bone and mineralised masses resembling cementum

216
Q

what is the tx for ossifying fibroma?

A

complete excision
continues to enlarge if left untreated

217
Q

what is a familial gigantiform cementoma?

A

rare form of fibro-osseous lesion of jaws
early onset of fast frowing multifocal/multiquadrant expasive lesions

218
Q

what is fibrous dysplasia of bone?

A

fibro-osseous lesion of growing bones
may involve one or several bones (monostotic or polystotic)

219
Q

what is monostotic fibrous dysplasia?

A

painless bony swelling, facial asymmetry
radiographically - orange-peel/ground glass effect

220
Q

what is the histopathology of fibrous dysplasia?

A

irregularly shaped slender trabeculae of woven bone lying in a very cellular fibrous tissue

221
Q

what is cemento-osseous dysplasia?

A

fibro-osseous lesion occurring in tooth-bearing areas of jaws
replacement of normal bone by fibrous tissue and metaplastic bone

222
Q

what are the 3 forms of cemento-osseous dysplasia?

A

periapical - apical incisor region of mandible
focal - associated with a single tooth
florid - multifocal/multiquadrant

223
Q

what is osteochondroma?

A

bony projection with a cap of cartilage

224
Q

what are the features of central giant cell granuloma?

A

localised benign lesion
aggressive
<30 years
F>M
asymptomatic

225
Q

what is the histopathology of central giant cell granuloma?

A

large numbers of multi-nucleate, osteoclast-like giant cells
in vascular fibrous stroma

226
Q

what is cherubism?

A

rare inherited AD, causing distension of jaws

227
Q

what is the histopathology of cherubism?

A

lesions consist of mainly cellular and vascular fibrous tissue containing varying numbers of multinucleate giant cells

228
Q

what are the clinical features of osteogenesis imperfecta?

A

easily fractures, osteoporotic bone
affected teeth appear as in DI
malocclusion may be a problem

229
Q

what is osteopetrosis?

A

marble bone disease
increase in bone density

230
Q

what is cleidocranial dysplasia?

A

defective formation of clavicles
delayed closure of fontanelles
delayed eruption
supernumerary teeth

231
Q

what causes acromegaly?

A

prolonged and excessive secretion of growth hormone

232
Q

how does radiation affect bone?

A

affects vascularity by causing proliferation of the intima of the blood vessels

233
Q

what are the 3 phases of Paget’s disease

A
  1. initial predominately osteolytic phase
  2. active stage of mixed osteolysis and osteogenesis
  3. predominately osteoblastic or sclerotic phase
234
Q

what is the histopathology of Paget’s disease?

A

irregular pattern of reversal lines
many osteoblasts and osteoclasts
fibrosis of marrow spaces and increased vascularity

235
Q

what are the clinical features of fibrous epulis?

A

pedunculated or sessile firm mass on gingiva, often between 2 teeth
pink in colour
wide age range

236
Q

what is the histopathology of fibrous epulis?

A

nodular lesion
hyperplastic surface epithelium
cellular fibroblastic granulation tissue and collagen bundles

237
Q

what are the clinical features of pyogenic granuloma/pregnancy epulis?

A

soft red/purple swelling
often ulcerated
wide age range

238
Q

what is the histopathology of pyogenic granuloma?

A

nodular
surface epithelium ulcerated
underlying vascular proliferation
oedematous fibrous stroma

239
Q

what is the tx for pregnancy epulis?

A

good OH and perio tx, lesion regress post-partum

240
Q

what are the clinical features of giant-cell epulis/peripheral giant-cell granuloma

A

soft purple gingival swelling
gum of teeth anterior to molars

241
Q

what is the histopathology of giant-cell epulis/peripheral giant-cell granuloma?

A

collections of lots of multinucleated osteoclast-like giant cells in rich vascular and cellular stroma
narrow zone of fibrous tissue with dilated blood vessels separates lesion from overlying epithelium

242
Q

what is the tx for giant-cell epulis/peripheral giant-cell granuloma?

A

excision
curettage of underlying bone to reduce chance of recurrence

243
Q

what are the clinical features of a fibroepithelial polyp?

A

pink smooth mucosal polyp
very common
buccal mucosa, lip, tongue
FEP under denture = leaf fibroma

244
Q

what is the histopathology of fibroepithelial polyp?

A

polypoid lesion with core of dense scar-like fibrous tissue
overlying stratified squamous epithelium may be hyperplastic
little inflammation

245
Q

what are the clinical features of denture irritation hyperplasia?

A

broad-based, leaf-like folds of tissue related to periphery of badly fitting denture
typically pale, fibrous swelling
may be ulcerated

246
Q

what is the histopathology of denture irritation hyperplasia?

A

hyperplastic fibrous connective tissue
hyperplasia of the overlying epithelium
may show focal ulceration
variable inflammation, often acute and chronic

247
Q

what are the clinical features of papillary hyperplasia of the palate?

A

numerous, small, tightly packed, nodular lesions
involves all or part of denture bearing area of palate

248
Q

what is the histopathology of papillary hyperplasia of the palate?

A

papillary/nodular projections
underlying hyperplastic, chronically inflamed vascular fibrous tissue

249
Q

what is the tx for papillary hyperplasia of the palate?

A

good denture hygiene
antifungals if indicated
rarely surgery

250
Q

what are 2 tumours of adipose tissue?

A

lipoma (benign)
liposarcoma (malignant)

251
Q

what are the clinical features of lipoma?

A

soft smooth swelling
pedunculated or sessile
asymptomatic
yellowish or pink
usually buccal mucosa

252
Q

what is the histopathology of lipoma?

A

well-circumscribed lesion
thin capsule
lobules of mature fat cells
bands (septa) of fibrous tissue

253
Q

what are the clinical features of haemangioma?

A

vascular hamartomous lesion/developmental lesions/benign neoplasm
wide age range, common in children
dark red/purple swelling
blanch on pressure

254
Q

how are hamartomatous lesions removed?

A

cryosurgery

255
Q

what are the 4 variations of Kaposi’s sarcoma?

A

classic
endemic
AIDS-associated
iatrogenic

256
Q

what are the clinical features of Kaposi’s sarcoma?

A

palate and gingivae most common
purplish/red lesion
becomes increasingly nodular
lesions frequently bleed

257
Q

what is the tx for kaposi’s sarcoma?

A

antiretroviral therapy
chemotherapy

258
Q

what is an angiosarcoma?

A

malignant tumour of vascular endothelium

259
Q

where is angiosarcoma commonly found?

A

forehead and scalp of older male patients

260
Q

what are the clinical features of neurofibroma?

A

benign peripheral nerve sheath tumour
smooth painless swelling
rare in mouth
affects tongue, gingivae, salivary glands

261
Q

what is the histopathology of neurofibroma?

A

mixed cellular components incl schwann cells and intraneural fibroblasts
spindle cells with wavy nuclei

262
Q

what is neurilemmoma?

A

schwannoma
benign peripheral nerve sheath tumour
tongue most common site

263
Q

what are the clinical features of traumatic neuroma?

A

reactive lesion after nerve damage, not a tumour
smooth nodule
tongue, lower lip, salivary gland
history of trauma/surgery

264
Q

what is the histopathology of traumatic neuroma?

A

proliferation of nerve bundles
random arrangement

265
Q

what are the 2 smooth muscle tumours?

A

leiomyoma (benign)
leiomyosarcoma (malignant)

266
Q

what are the 2 skeletal muscle tumours?

A

rhabdomyoma (benign)
rhabdomyosarcoma (malignant)

267
Q

where would you likely find a granular cell tumour?

A

tongue, buccal mucosa, FOM, palate

268
Q

what is the histopathology of granular cell tumours?

A

large eosinophillic cells with granular cytoplasm in subepithelial tissue
unencapsulated

269
Q

what is mucoepidermoid carcinoma?

A

most common primary epithelial salivary gland malignant tumour
most frequently affects parotids

270
Q

what is the histopathology of mucoepidermoid carcinoma?

A

tumour unencapsulated and displays infiltrative pattern of growth
3 types of tumour cell:
- mucous-secreting
- epidermoid
- intermediate

271
Q

how does adenoid cystic carcinoma present?

A

slow growing, painful, ulceration of overlying mucosa/skin
prognosis poor

272
Q

what is the histopathology of adenoid cystic carcinoma?

A

tumour consists of epithelial and myoepithelial cells in variable configurations
cyst like spaces within epithelial islands
cribriform, lace-like or swiss cheese pattern
perineural invasion

273
Q

where do acinic cell carcinomas usually arise?

A

as swelling in parotid

274
Q

what is the histopathology of acinic cell carcinomas?

A

non-encapsulated and may have pushing or infiltrative pattern of growth
almost uniform pattern of large tumour cells

275
Q

what is pleomorphic adenoma?

A

benign most common salivary gland tumour
painless, slow growing, ‘rubbery’ lump

276
Q

what is the histopathology of pleomorphic adenoma?

A

well-circumscribed tumour
incomplete fibrous capsule
may be cystic

277
Q

where are most canalicular adenomas found?

A

80% upper lip

278
Q

what is the histopathology of canalicular adenoma?

A

well-circumscribed
two rows of columnar epithelial cells which are alternately closely opposed and widely separated

Module 7 (8 decks)

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