Oral Pathology Flashcards

1
Q

What types of specimen are sent for histopathological investigation?

A

Biopsy - Incisional
Biopsy - Excisional
Resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a fixed specimen preserved in?

A

10% neutral buffered formalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is a fresh specimen preserved?

A

Frozen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What stains are used routinely?

A

Haematoxylin and Eosin (H&E)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is hyperplasia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is atrophy?

A

a decrease in cell size by loss of cell substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is metaplasia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is hyperkeratosis?

A

thickening of the stratum corneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is orthokeratosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is parakeratosis?

A

the persistence of nuclei in the cells of a keratin layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is dyskeratosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is acanthosis?

A

increased thickness of prickle cell layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is acantholysis?

A

the loss of intercellular adhesion between keratinocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is epithelial dysplasia?

A

alteration in differentiation, maturation and architecture of adult epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is ulceration?

A

mucosal/skin defect with complete loss of surface epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is apoptosis?

A

programmed cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is necrosis?

A

cell death by injury or disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are developmental white lesion?

A

Fordyce granules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are hereditary white lesions?

A

White sponge naevus
Pachyonychia congenita
Dyskeratosis congenita

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are normal white lesions?

A

leukodema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What ate traumatic white lesions?

A

Mechanical/frictional
Chemical
Thermal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are dermatological white lesions?
Lichen planus Lupus erythematosus
26
What are some infective white lesions?
candidosis syphillitic leukoplakia oral hairy leukoplakia
27
What are some idiopathic white lesions?
leukoplakia proliferative verrucous leukoplakia
28
what are some neoplastic white lesions?
dysplastic lesions squamous cell carcinoma
29
What is the inheritance pattern of white sponge naevus?
autosomal dominant
30
what is the appearance of white sponge naevus?
ill-defined white patched with 'shaggy' surface, often bilateral
31
where is white sponge naevus found?
any part of oral mucosa, esp buccal
32
what mutation causes white sponge naevus?
mutations in keratins 4/13
33
what is the histopathology of white sponge naevus?
hyperparakeratosis and acanthosis of epithelium basket-weave appearance
34
what is the treatment of white sponge naevus?
no tx required
35
what is lichen planus?
common chronic inflammatory disease of skin and mucous membranes
36
who is most affected by lichen planus?
middle aged and over females > males
37
what is the pathogenesis of lichen planus?
T cell-mediated immunological damage to the basal cells of epithelium
38
what is the most common oral site of lichen planus?
buccal mucosa
39
what are the different appearances of lichen planus?
reticular atrophic plaque-like papular erosive bullous
40
what is the histopathology of lichenoid inflammation?
hyperorthokeratosis/hyperparakeratosis of the epithelium which may acanthotic or atrophic, saw-tooth rete ridges
41
what is an OMPD?
oral potentially malignant disorder
42
what is an example of an OMPD?
lichen planus
43
what is the frequency of malignant change in lichen planus?
0.1-10%
44
what are the clinical features of oral hairy leukoplakia?
white, shaggy appearance on lateral tongue asymptomatic
45
what virus causes oral hairy leukoplakia?
EBV and HIV
46
what is the histopathology of hairy leukoplakia?
thickened, hyperparakeratotic epithelium band of 'ballooned' pale cells in upper prickle cell layer
47
what is a leukoplakia?
white plaques of questionable risk, once other specific conditions and other OPMDs have been ruled out
48
how can leukoplakias be described?
homogenous white plaque nodular / verrucous
49
what type of cancer can proliferative verrucous leukoplakia degenerate into?
verrucous carcinoma squamous cell carcinoma
50
what kinds of red patches are idiopathic?
geographic tongue erythroplakia
51
what kinds of red patched are neoplastic?
dysplastic lesions squamous cell carcinoma
52
what does median rhomboid glossitis look like?
red patch on midline of posterior aspect of anterior 2/3 of dorsal tongue
53
what is the histopathology of median rhomboid glossitis?
loss of lingual papillae parakeratosis and acanthosis of squamous epithelium candidal hyphae in parakeratin and neutrophils chronic inflammatory infiltrate in connective tissue
54
how do you treat median rhomboid glossitis?
antifungal medication
55
what is the appearance of erythroplakia?
red velvety appearance, smooth or nodular
56
where is erythroplakia most common?
soft palate, floor of mouth, buccal mucosa
57
what is erythroleukoplakia?
speckled leukoplakia - leuko and erythroplakia
58
are erythroplakias prone to malignant transformation?
high likelihood - 50%
59
what are the exogenous causes of oral pigmentation?
superficial staining (food, drink, tobacco) black hairy tongue foreign bodies (amalgam tattoo) heavy metal poisoning drugs - NSAIDs, antimalarials, chlorhexidine
60
what is the histopathology of amalgam tattoo?
pigment dispersed in connective tissue as fine brown/black granules associated with collagen and elastic fibres and basement membranes
61
What is a melanotic macule?
well-defined small flat brown/black lesion
62
what causes a melanotic macule?
increased activity of melanocytes
63
where are melanotic macules most commonly found?
buccal mucosa, palate and gingiva
64
Why are melanotic macules frequently excised?
to confirm diagnosis and exclude melanoma
65
what is the histopathology of melanotic macules?
increased melanin pigment in basal keratinocytes
66
what is the histopathology of mucosal melanoma?
highly pleomorphic neoplasms, cells appear epithelioid or spindle-shaped
67
what is the treatment for mucosal melanoma?
surgical resection adjuvant radiotherapy
68
what is an ulcer?
localised surface defect with loss of epithelium exposing underlying inflamed connective tissue
69
what are causes of infective ulceration?
bacterial, fungal, viral (HSV, VZV, CMV, coxsackie)
70
What are causes of traumatic lesions?
mechanical chemical thermal factitious injury radiation
71
what drugs can cause ulceration?
nicorandil (angina) NSAIDs
72
name an idiopathic cause of ulceration?
recurrent aphthous stomatitis
73
what systemic disease can have associated ulcer?
haematological GI disease HIV
74
what dermatological disease has associated ulcers?
lichen planus discoid lupus erythematous immunobullous disease
75
what are neoplastic causes of ulceration?
oral SCC salivary neoplasms metastases
76
what is the histopathology of ulcers?
loss of surface epithelium, inflamed fibrinoid exudate and inflamed granulation tissue
77
what are the 2 histological classifications of vesicles/bullae?
1. intraepithelial 2. subepithelial
78
what are 2 types of intraepithelial vesicles?
non-acantholytic (viral infections eg HSV) acantholytic (desmosomal breakdown)
79
how are non-acantholytic vesicles formed?
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
80
what is a cause of acantholytic lesions?
pemphigus - autoimmune disease
81
what causes pemphigus vulgaris?
autoantibodies to desmosomal protein (desmoglein 1 or 3) produced bullae form in skin and mucous membranes then rupture to leave ulcers
82
what is the tx for pemphigus
steroids
83
describe the histopathology of pemphigus
characteristic intraepithelial bullae produced by acantholysis Tzanck cells found lying free within the bullae fluid Tombstone-like basal cells remain attached to basement membrane
84
how is pemphigus vulgaris diagnosed?
direct immunofluorescence (DIF) studies used in conjuction with routine histopathology to confirm diagnosis
85
what are examples of subepithelial vescicles/bullae?
pemphigoid erythema multiforme dermatitis herpetiformis epidermolysis bullosa acquisita
86
what is pemphigoid
group of autoimmune diseases: - bullous pemphigoid - mucous membrane pemphigoif - linear IgA disease - drug induced pemphigoid
87
how do gingival mucous membrane pemphigoid lesions present?
desquamative gingivitis
88
what causes mucous membrane pemphigoid lesions?
autoantibodies to basement membrane components (usually BP180, less often integrins, laminin and type VII collagen)
89
what is the histopathology of mucous membrane pemphigoid?
separation of full thickness epithelium from connective tissue producing subepithelial bullae with a thick roof infiltration of neutrophils and eosinophils around and within bulla
90
what is epidermolysis bullosa acquisita?
acquired autoimmune blistering dermatosis with subepithelial bullae
91
what is epidermolysis bullosa?
formation of skin bullae which heal with scarring
92
what are the 3 variants of epidermolysis bullosa?
simplex (intraepithelial) junctional (subepithelial) dystrophic (subepithelial)
93
what is oral submucous fibrosis?
chronic, progressive, oral potentially malignant condition
94
what is oral submucous fibrosis associated with?
betel quid/areca nut
95
how does oral submucous fibrosis present?
clinically pale coloured mucosa, firm to palpate increasing submucosal fibrosis leading to very marked trismus
96
what is the histopathology of oral submucous fibrosis?
submucosal deposition of dense collagenous tissue decreased vascularity marked epithelial atrophy variable rates of dysplasia
97
what is chronic candidiasis/chronic hyperplastic candidosis?
persistent white patch on oral mucosa that cannot be removed by scraping
98
what is the most common site for chronic candidiasis/chronic hyperplastic candidosis?
buccal mucosa adjacent to commissure of lips
99
what is the histopathology of chronic candidiasis/chronic hyperplastic candidosis?
hyperparakeratosis prominent, irregular acanthosis numerous neutrophils in parakeratin, forming microabscessed candidal hyphae in parakeratin marked inflammation in parakeratin and prickle cell layers
100
what is epithelial dysplasia?
atypical epithelial alterations limited to the surface squamous epitelium
101
what are the histological features epithelial dysplasia?
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
102
how is epithelial dysplasia graded?
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
103
what is the histopathological difference between dysplasia and OSCC
in dysplasia the atypical cells are confined to the surface
104
what is the management of epithelial dysplasia?
modify risk factors high risk sites antifungal tx excision close clinical review rebiopsy
105
what are the risk factors of oral cancer?
tobacco alcohol betel quid/pan/areca nut previous oral cancer exposure to UV light poor diet immune suppression
106
what are the high risk sites for oral cancer?
lateral/ventral tongue FOM retromolar trigone
107
what are low risk sites for oral cancer?
hard palate dorsum of tongue
108
what additional detection tests can be used for oral cancer?
toludine blue autofluorescence chemiluminescence vizlite plus
109
how is SCC diagnosed?
incisional biopsy
110
what is the histopathology of SCC?
cytologically malignant squamous epithelium, invasion and destruction of local tissues
111
how is SCC graded?
degree of differentiation: well-differentatied - tumour cells very obvious moderately poorly - may be difficult to identify tumour cells as epithelial
112
what is the tx for SCC?
surgery adjuvant therapy monoclonal antibodies
113
What does TNM stand for when staging cancer?
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
describe a T4a lip tumour?
invades through cortical bone, inferior alveolar nerve, FOM or skin
115
describe a T4a oral cavity tumour
invades through cortical bone of the mandible or maxillary sinus, or invades skin of face
116
describe a T4a lip and oral cavity tumour
invades masticator space, pterygoid plates, skull base, encases internal carotid artery
117
what are the clinical features of acute periradicular periodontitis?
history of pain grossly carious/heavily restored tooth previous trauma
118
what is the histopathology of acute periradicular periodontitis?
acute inflammatory changes; - vascular dilation - neutrophils - oedema
119
what are the tx options for acute periradicular periodontitis?
XLA or RCT
120
what are the clinical features of acute periapical absces?
pain swelling/sinus
121
what is the histopathology of acute periapical abscess?
central collection of pus adjacent zone of preserved neutrophils surrounding membrane of sprouting capillaries and vascular dilation and occasional fibroblasts
122
what are the tx options for acute periapical abcesses?
drainage XLA RCT
123
what are the clinical features of chronic periradicular periodontitis?
non-vital tooth, maybe previous RCT often minimal symptoms apical radiolucent lesion
124
what is the histopathology of chronic periradicular periodontitis?
chromic inflammatory changes - lymphocytes - plasma cells - macrophages - granulation tissue progressing to fibrosis - resorption of bone
125
what are the tx options for chronic periradicular periodontitis?
XLA RCT RCT retreatment Periradicular surgery
126
what is periapical granuloma?
a mass of inflamed granulation tissue at the apex of a non-vital tooth
127
what can happen to a periapical granuloma?
undergo cystic change - become radicular cyst
128
what is the histopathology of periapical granuloma?
inflamed granulation tissue multinucleated giant cell proliferation of cell rests of Malassez haemosiderin and cholestrol deposits resorption of adjacent bone/tooth
129
what are the tx options for periapical granuloma?
XLA RCT RCT retx periradicular surgery
130
what is the histopathology of pericoronitis?
acute and chronic inflammatory changed including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue
131
what is the tx option for pericoronitis?
irrigation XLA opposing tooth antibiotics if systemically unwell
132
what is a cyst?
a pathological cavity having fluid or semi-fluid content lined wholly or in part by epithelium not due to accumulation of pus
133
what ate odontogenic cysts?
derived from epithelial residues of tooth-forming organ
134
what are non-odontogenic cysts?
derived from sources other than tooth forming organ
135
what do teeth develop from?
odontogenic epithelium and neural crest derived ectomesenchyme
136
what odontogenic remnants are there after development?
dental lamina - glands of Serres root sheath - cell rests of Malassez
137
what are the 2 types of odontogenic cysts?
developmental inflammatory
138
what are the 2 types of inflammatory odontogenic cysts?
1. radicular cyst (apical, lateral, residual) 2. inflammatory collateral cyst (paradental, mandibular buccal bifurcation cyst)
139
what are radicular cysts?
most common jaw cyst arise from epithelial proliferation and cyst formation within some periapical granulomas must be associated with a non-vital tooth
140
describe the radiograohic appearance of a radicular cyst
well-circumscribed unilocular radiolucent lesion seen at apex
141
what is the pathogenesis of radicular cysts?
proliferation of epithelium (cell rests of malassez) in response to inflammation cyst enlarges due to osmotic pressure local bone resorption
142
what is the histopathology of radicular cysts?
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
what is the tx for radicular cysts?
small cysts may resolve after RCT/XLA/periradicular surgery enucleation marsupialisation for very large lesions
144
what is a lateral radicular cyst?
radicular cyst arising from a lateral root canal branch of a non-vital tooth
145
what is a residual cyst?
radicular cyst that persists after XLA of the associated non-vital tooth
146
what are the 2 types of inflammatory collateral cysts?
Paradental - lower 8's Mandibular buccal bifurcation cyst - lower 6/7's
147
what condition may cause paradental cysts to arise?
long-standing pericoronitis
148
what are the clinical features of mandibular buccal bifurcation cysts?
painless swelling associated tooth tilted buccally with deep perio pocket well-demarcated buccal radiolucency
149
what are some developmental odontogenic cysts?
odontogenic keratocyst dentigerous cyst eruption cyst
150
what direction do odontogenic keratocysts expand?
anterior-posterior direction
151
How do odontogenic keratocysts appear radiographically?
Well-defined radio lucent uni or multilocular lesion
152
What is the aetiology of odontogenic keratocysts?
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
What is Gorlin syndrome?
Naevoid basal cell carcinoma syndrome
154
What happens in Gorlin syndrome?
Multiple odontogenic keratocysts Basal cell naevi Skeletal abnormalities Multiple basal cell carcinomas
155
What is the histopathology of odontogenic keratocyst?
Keratinised stratified squamous epithelial lining Corrugated appearance of surface parakeratin layer Well-defined, palisaded basal cell layer Keratin debris in lumen
156
What are the tx options for odontogenic keratocysts?
Marsupialization Enucleation Marsupialization and enucleation Enucleation and Carnoy’s solution Enucleation and cryotherapy Resection
157
What are the clinical features of a dentigerous cyst?
Encloses all or part of crown of unerupted teeth Attached to amelocemental junction Well-circumscribed unilocular radiolucency associated with crown of unerupted tooth
158
What is the histopathology of a dentigerous cyst?
Thin, non-keratinised squamous cell epithelial lining Mucous metaplasia Fibrous capsule
159
What are the tx options for dentigerous cyst?
Enucleation Exposure/transplantation/extraction of associated tooth
160
What are the clinical features of an eruption cyst?
Dentigerous cyst arising in extra-alveolar location Typically in children Deciduous and permanent molars Presents as bluish swelling
161
What are the clinical features of lateral periodontal cysts?
Arise adjacent to vital teeth Canine and premolar region of mandible Usually symptom free Well-circumscribed radiolucency in PDL
162
What is the histopathology of lateral periodontal cysts?
Thin, non-keratinised squamous or cuboidal epithelium Focal thickenings/plaques Uninflamed fibrous wall
163
What is the tx for lateral periodontal cysts?
Enucleation
164
What is a botryoid odontogenic cyst?
Very rare multi cystic variant of lateral periodontal cyst
165
Where would you typically find a glandular odontogenic cyst?
Anterior mandible
166
What is the radiographic appearance do glandular odontogenic cysts have?
Multilocular radiolucency
167
What is the histopathology of glandular odontogenic cysts?
Cystic lumen lined by epithelium of various thickness with mucous cells and glandular structures
168
What is the histopathology of calcifying odontogenic cysts?
Unicystic Lined by epithelium which is ameloblastoma-like Palisaded basal layer with overlying stellate reticulum-like layer
169
What are the clinical features of orthokeratinised odontogenic cysts?
Wide age range, peak 30-40 Male predilection 90% mandible Painless swelling of jaw Well-defined unilocular radiolucency
170
What is the histopathology of orthokeratinised odontogenic cysts?
Uninflamed fibrous wall Lined by stratified squamous epithelium Prominent granular cell layer and orthokeratinised
171
Where are non-odontogenic cysts derived from?
Sources other than tooth-forming organ
172
Name 3 non-odontogenic cysts
Nasopalatine duct cyst Surgical ciliated cyst Nasolabial cyst
173
What are the clinical features of a nasopalatine duct cyst?
Uncommon Originates from epithelium of nasopalatine duct in incisive canal Occur anywhere in nasopalatine canal, mostly palatal end Usually 50-60s
174
What are the symptoms of nasal palatine duct cysts?
Swelling in midline of anterior palate Salty taste
175
How do nasopalatine duct cysts present radiographically?
Rounded or heart-shaped radiolucency in midline of anterior hard palate
176
What is the histopathology of nasopalatine duct cysts?
Epithelial lining either stratified squamous, respiratory, cuboidal or columnar Fibrous connective tissue capsule Neurovascular bundles and mucous glands may be seen in capsule
177
What is the treatment for nasapalatine duct cysts?
Enucleation Recurrence unlikely
178
What are the clinical features of surgical ciliated cysts?
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
What is the histopathology of surgical ciliated cysts?
Cyst lined by respiratory epithelium (pseudostratified columnar epithelium) Fibrous connective tissue capsule which may be inflamed
180
What are the clinical features of nasolabial cysts?
Very rare Mainly 40s-50s Arise in upper lip below nose, lateral to midline Slow growing, distorts nostril Painless unless infected
181
Where do nasolabial cysts develop from?
The remnants of the embryonic nasolacrimal ducts or the lower anterior portion of the mature duct
182
What is the histopathology of nasolabial cysts?
Cystic lesion with fibrous capsule Usually pseudostratified columnar epithelium lining
183
What is the treatment for nasolabial cysts?
Excision
184
What are the soft tissue cysts?
Salivary mucocoele Epidermis cyst Dermoid cyst Lymphoepithelial cyst Thyroglossal cyst
185
What are the clinical features of an epidermoid cyst?
Painless swelling Often follow trauma or surgery More common on skin
186
What is the histopathology of an epidermoid cyst?
Cystic lesion with thin cyst wall Keratinising stratified squamous epithelium lining Abundant keratin debris in lumen No skin appendages in cyst wall
187
What are the clinical features of a dermoid cyst?
Developmental lesion Various locations in head and neck Floor of mouth is most common oral site Present as painless swelling in midline
188
what is the histopathology of dermoid cysts?
same as epidermoid cyst with keratinized stratified squamous lining keratin debrin within cyst lumen must alos have skin appendages in cyst wall
189
what are the clinical features of a lymphoepithelial cyst?
developmental lesion uncommon but do occur in oral cavity FOM most common painless small swelling yellowish colour
190
What is the histopathology of a lymphoepithelial cyst?
thin keratinized stratified squamous epithelium keratin debris in cyst lumen lymphoid tissue in cyst wall
191
what are the clinical features of a thyroglossal duct cyst?
derived from embryonic thyroglossal duct most arise near hyoid bone midline swelling painless
192
what is the histopathology of a thyroglossal duct cyst?
cystic lesion lined by stratified squamous epithelium/ciliated columnar epithelium/nonciliated columnar epithelium
193
what is the tx for thryoglassal duct cysts?
excision - sistrunk procedure removal of mid third of hyoid bone
194
what are the clinical features of ameloblastoma?
30-60 years posterior mandible swelling slow growing, locally aggressive
195
what is the histopathology of ameloblastoma?
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
what is the tx for ameloblastoma?
complete excision with margin of uninvolved tissue longterm follow-up
197
why are maxillary ameloblastomas more dangerous?
readily spread through base of skull difficult to excise potentially lethal
198
what are the clinical features of adenomatoid odontogenic tumours?
majority in canine region associated with unerupted permanent teeth unilocular radiolucency, may mimic dentigerous cyst
199
what is the histopathology of adenomatoid odontogenic tumours?
odontogenic epithelium arranged in solid nodules or rosette-like structures duct-like structures eosinophilic amorphous material minimal fibrous stroma
200
what is an odontoma?
developmental malformations of dental tissues once fully calcified do not develop further usually in young pts
201
what does a compound type odontoma look like?
fibrous capsule enclosing many separate, tooth-like structures (denticles/odontoids)
202
what is a complex type odontoma?
irregular mass of hard and soft dental tissues, haphazzard arrangement with no resemblance to a tooth and often forming a cauliflower-like mass
203
what is the tx for odontomas?
enucleation
204
what are the clinical features of cementoblastoma?
formation of cementum-like tissue in connection with root of tooth mandible > maxilla painful swelling tooth remains vital
205
how does cementoblastoma present radiographically?
well-defined radiopaque or mixed-density lesion
206
what is the histopathology of cementoblastoma?
dense masses of acellular cementum-like material fibrous, sometimes vascular stroma tumour blends with root of tooth - helps distinguish lesion from bone tumours
207
what is an osteoma?
benign slow-growing tumour consisting of well-differentiated mature bone
208
how does an osteoma present?
usually solitary lesions, multiple can occur as a feature of Gardner syndrome
209
what is Gardner syndrome?
a rare AD disorder
210
what is the histopathology of a compact type osteoma?
mass of dense lamellar bone with few marrow spaces
211
what is the histopathology of cancellous type osteoma?
interconnecting traberculae enclosing fatty or fibrous marrow
212
what are haematolymphoid tumours?
solitary plasmacytoma of bone localised proliferation of monoclonal plasma cells involving bone
213
what are haematolymphoid tumours?
solitary plasmacytoma of bone localised proliferation of monoclonal plasma cells involving bone
214
what are the clinical features of ossifying fibroma?
slow, painless expansion of bone 30-40s F>M
215
what is the histopathology of ossifying fibroma?
well-demarcated or rarely encapsulated benign lesion fibrous tissue containing varying amounts of metaplastic bone and mineralised masses resembling cementum
216
what is the tx for ossifying fibroma?
complete excision continues to enlarge if left untreated
217
what is a familial gigantiform cementoma?
rare form of fibro-osseous lesion of jaws early onset of fast frowing multifocal/multiquadrant expasive lesions
218
what is fibrous dysplasia of bone?
fibro-osseous lesion of growing bones may involve one or several bones (monostotic or polystotic)
219
what is monostotic fibrous dysplasia?
painless bony swelling, facial asymmetry radiographically - orange-peel/ground glass effect
220
what is the histopathology of fibrous dysplasia?
irregularly shaped slender trabeculae of woven bone lying in a very cellular fibrous tissue
221
what is cemento-osseous dysplasia?
fibro-osseous lesion occurring in tooth-bearing areas of jaws replacement of normal bone by fibrous tissue and metaplastic bone
222
what are the 3 forms of cemento-osseous dysplasia?
periapical - apical incisor region of mandible focal - associated with a single tooth florid - multifocal/multiquadrant
223
what is osteochondroma?
bony projection with a cap of cartilage
224
what are the features of central giant cell granuloma?
localised benign lesion aggressive <30 years F>M asymptomatic
225
what is the histopathology of central giant cell granuloma?
large numbers of multi-nucleate, osteoclast-like giant cells in vascular fibrous stroma
226
what is cherubism?
rare inherited AD, causing distension of jaws
227
what is the histopathology of cherubism?
lesions consist of mainly cellular and vascular fibrous tissue containing varying numbers of multinucleate giant cells
228
what are the clinical features of osteogenesis imperfecta?
easily fractures, osteoporotic bone affected teeth appear as in DI malocclusion may be a problem
229
what is osteopetrosis?
marble bone disease increase in bone density
230
what is cleidocranial dysplasia?
defective formation of clavicles delayed closure of fontanelles delayed eruption supernumerary teeth
231
what causes acromegaly?
prolonged and excessive secretion of growth hormone
232
how does radiation affect bone?
affects vascularity by causing proliferation of the intima of the blood vessels
233
what are the 3 phases of Paget's disease
1. initial predominately osteolytic phase 2. active stage of mixed osteolysis and osteogenesis 3. predominately osteoblastic or sclerotic phase
234
what is the histopathology of Paget's disease?
irregular pattern of reversal lines many osteoblasts and osteoclasts fibrosis of marrow spaces and increased vascularity
235
what are the clinical features of fibrous epulis?
pedunculated or sessile firm mass on gingiva, often between 2 teeth pink in colour wide age range
236
what is the histopathology of fibrous epulis?
nodular lesion hyperplastic surface epithelium cellular fibroblastic granulation tissue and collagen bundles
237
what are the clinical features of pyogenic granuloma/pregnancy epulis?
soft red/purple swelling often ulcerated wide age range
238
what is the histopathology of pyogenic granuloma?
nodular surface epithelium ulcerated underlying vascular proliferation oedematous fibrous stroma
239
what is the tx for pregnancy epulis?
good OH and perio tx, lesion regress post-partum
240
what are the clinical features of giant-cell epulis/peripheral giant-cell granuloma
soft purple gingival swelling gum of teeth anterior to molars
241
what is the histopathology of giant-cell epulis/peripheral giant-cell granuloma?
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
what is the tx for giant-cell epulis/peripheral giant-cell granuloma?
excision curettage of underlying bone to reduce chance of recurrence
243
what are the clinical features of a fibroepithelial polyp?
pink smooth mucosal polyp very common buccal mucosa, lip, tongue FEP under denture = leaf fibroma
244
what is the histopathology of fibroepithelial polyp?
polypoid lesion with core of dense scar-like fibrous tissue overlying stratified squamous epithelium may be hyperplastic little inflammation
245
what are the clinical features of denture irritation hyperplasia?
broad-based, leaf-like folds of tissue related to periphery of badly fitting denture typically pale, fibrous swelling may be ulcerated
246
what is the histopathology of denture irritation hyperplasia?
hyperplastic fibrous connective tissue hyperplasia of the overlying epithelium may show focal ulceration variable inflammation, often acute and chronic
247
what are the clinical features of papillary hyperplasia of the palate?
numerous, small, tightly packed, nodular lesions involves all or part of denture bearing area of palate
248
what is the histopathology of papillary hyperplasia of the palate?
papillary/nodular projections underlying hyperplastic, chronically inflamed vascular fibrous tissue
249
what is the tx for papillary hyperplasia of the palate?
good denture hygiene antifungals if indicated rarely surgery
250
what are 2 tumours of adipose tissue?
lipoma (benign) liposarcoma (malignant)
251
what are the clinical features of lipoma?
soft smooth swelling pedunculated or sessile asymptomatic yellowish or pink usually buccal mucosa
252
what is the histopathology of lipoma?
well-circumscribed lesion thin capsule lobules of mature fat cells bands (septa) of fibrous tissue
253
what are the clinical features of haemangioma?
vascular hamartomous lesion/developmental lesions/benign neoplasm wide age range, common in children dark red/purple swelling blanch on pressure
254
how are hamartomatous lesions removed?
cryosurgery
255
what are the 4 variations of Kaposi's sarcoma?
classic endemic AIDS-associated iatrogenic
256
what are the clinical features of Kaposi's sarcoma?
palate and gingivae most common purplish/red lesion becomes increasingly nodular lesions frequently bleed
257
what is the tx for kaposi's sarcoma?
antiretroviral therapy chemotherapy
258
what is an angiosarcoma?
malignant tumour of vascular endothelium
259
where is angiosarcoma commonly found?
forehead and scalp of older male patients
260
what are the clinical features of neurofibroma?
benign peripheral nerve sheath tumour smooth painless swelling rare in mouth affects tongue, gingivae, salivary glands
261
what is the histopathology of neurofibroma?
mixed cellular components incl schwann cells and intraneural fibroblasts spindle cells with wavy nuclei
262
what is neurilemmoma?
schwannoma benign peripheral nerve sheath tumour tongue most common site
263
what are the clinical features of traumatic neuroma?
reactive lesion after nerve damage, not a tumour smooth nodule tongue, lower lip, salivary gland history of trauma/surgery
264
what is the histopathology of traumatic neuroma?
proliferation of nerve bundles random arrangement
265
what are the 2 smooth muscle tumours?
leiomyoma (benign) leiomyosarcoma (malignant)
266
what are the 2 skeletal muscle tumours?
rhabdomyoma (benign) rhabdomyosarcoma (malignant)
267
where would you likely find a granular cell tumour?
tongue, buccal mucosa, FOM, palate
268
what is the histopathology of granular cell tumours?
large eosinophillic cells with granular cytoplasm in subepithelial tissue unencapsulated
269
what is mucoepidermoid carcinoma?
most common primary epithelial salivary gland malignant tumour most frequently affects parotids
270
what is the histopathology of mucoepidermoid carcinoma?
tumour unencapsulated and displays infiltrative pattern of growth 3 types of tumour cell: - mucous-secreting - epidermoid - intermediate
271
how does adenoid cystic carcinoma present?
slow growing, painful, ulceration of overlying mucosa/skin prognosis poor
272
what is the histopathology of adenoid cystic carcinoma?
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
where do acinic cell carcinomas usually arise?
as swelling in parotid
274
what is the histopathology of acinic cell carcinomas?
non-encapsulated and may have pushing or infiltrative pattern of growth almost uniform pattern of large tumour cells
275
what is pleomorphic adenoma?
benign most common salivary gland tumour painless, slow growing, 'rubbery' lump
276
what is the histopathology of pleomorphic adenoma?
well-circumscribed tumour incomplete fibrous capsule may be cystic
277
where are most canalicular adenomas found?
80% upper lip
278
what is the histopathology of canalicular adenoma?
well-circumscribed two rows of columnar epithelial cells which are alternately closely opposed and widely separated