Oral Pathology Flashcards

Question

Name 2 white lesions that are of idiopathic causes.

Answer 1

1. Leukoplakia 2. Proliferative verrucous leukoplakia

Answer 2

1. Dysplasia 2. Oral squamous cell carcinoma

Answer 3

- Autosomal dominant - May be apparent in infants or not until adolescents - Ill-defined white patches with "shaggy" surface. - Often bilateral - Any part of oral mucosa esp buccal mucosa - Can also effect nose, oesophagus, anogenital region, - Mutations in keratin 4 + 13

Answer 4

- hyperparakeratosis and acanthosis of epithelium - Marked intracellular oedema of prickle and parakeratinized cells - "basket weave" appearance. - No cellular atypia/dysplasia - No inflammatory changes in lamina propria.

Answer 5

Traumatic lesion where roughened white patch at site of chronic trauma.

Answer 6

- hyperkeratosis - prominent scarring fibrosis with submucosa.

Answer 7

- Common chronic inflammatory disease of skin and mucous membranes - Oral lesions in approx 50% of pt with skin lesions, but prevalence of skin lesions in pts primarily seen for oral LP is lower. - Mainly affects middle aged and over. - Females > Males - Aetiology unknown

Answer 8

T cell mediated immunological damage to the basal cells of epithelium

Answer 9

- Characteristic skin lesion is a violaceous, itchy papule which may have distinctive white streaks on the surface - Flexor surface of the wrist is the most common site - skin lesions develop slowly and 85% resolve within 18 months. - In contrast oral LP runs a more chronic course, sometimes several years. Oral lesions are usually bilateral and often symmetrical - Buccal mucosa is the most common site, though tongue lips, and gingivae may be affected. FOM and palate rarely affected.

Answer 10

Reticular Papular Atrophic Erosive Bullous Plaque-like

Answer 11

- Hyperparakeratosis of the epithelium which may be acanthotic or atrophic - Saw tooth rete ridges - Dense, band like lymphocytic infiltrate (mostly T cell mediated) - Degenerative cells appear as hyaline/condensed bodies known as "Civatte" bodies. These represent cells in the basal cell layer undergoing apoptosis.

Answer 12

-Lichenoid reaction - Lupus erythematosus - Graft-versus-host disease - Lichenoid inflammation associated with dysplasia.

Answer 13

0.1% over 10 years.

Answer 14

- White shaggy appearance on lateral tongue. - Asymptomatic - Can affect other sites. - Due to EBV infection - Strongly associated with HIV in many cases - Also seen in immunosuppressed individuals and in some apparently healthy patients.

Answer 15

- Thickened hyperparakeratotic epithelium - Band of "ballooned" pale cells in upper prickle cell layer - Often superadded candidal infection but without normal inflammatory response. - Presence of EBV confirmed by in situ hybridization

Answer 16

- Older patients, F>M - Gingival, buccal mucosa, tongue - Persistent, recurrent and becomes multifactorial - Difficult to completely excise - Histology shown hyperplastic lesion, hyperparakeratosis, often minimal dysplasia - Begins as simple hyperkeratosis that in time becomes exophytic and wart like - High risk that it may degenerate into oral cancer (verrucous carcinoma or squamous cell carcinoma).

Answer 17

1. Periodontal disease 2. Median rhomboid glossitis 3. HIV gingivitis

Answer 18

1. Erosive lichen planus 2. Discoid Lupus erythematosus

Answer 19

1. Geographic tongue 2. Erythroplakia

Answer 20

1. Dysplastic lesions 2. Squamous cell carcinoma.

Answer 21

Rhomboid red patch on midline of posterior aspect of anterior 2/3rd of dorsal tongue Asymptomatic Aetiology uncertain but associated with candidal infection.

Answer 22

-Loss of lingual papillae - Parakeratosis and acanthosis of the squamous epithelium - Candidal hyphae in parakeratin and associated neutrophils - Chronic inflammatory infiltrate in connective tissue

Answer 23

An oral potentially malignant disorder ‘A clinical term used to describe a red patch of questionable risk, once other specific conditions and other OPMDs have been ruled out’. WHO 2017 Red ‘velvety’ appearance, smooth or nodular Most common on soft palate, floor of mouth and buccal mucosa Erythroleukoplakia (speckled leukoplakia) = leuko and erythroplakia Erythroplakia and speckled leukoplakias have high likelihood of malignant transformation (50%) On biopsy, often severe dysplasia or early invasive SCC

Answer 24

1. Superficial staining of mucosa - foods, drinks, tobacco 2. Black hairy tongue - papillary hyperplasia, overgrowth of pigment containing bacteria 3. Foreign bodies e.g amalgam tattoo 4. Heavy metal poisoning 5. Some drugs e.g NSAIDS, antimalarials, chlorohexidine

Answer 25

- Pigment is present as widely dispersed, fine brown/black granules or as solid fragments of varying in size - Associated with collagen and elastic fibres and basement membranes - OR may be intracellularly within fibroblasts, endothelial cells, macrophages, and occasional foreign-body giant cells

Answer 26

- normal variation in pigmentation similar to that seen in skin - melanotic macule - pigmented naevi (developmental lesions with proliferation of melanocytes). - Peutz Jeghers syndrome (multiple pigmented lesion on skin/mucosa, lips, tongue, palate, buccal mucosa, intestinal polyps - Smokers melanosis - HIV infection - May be a manifestation of systemic disease (Addisons disease), malignancy - Melanotic neuroectodermal tumour of infancy - Mucosal melanoma

Answer 27

Well defined small flat brown/black lesions Due to increased activity of melanocytes Buccal mucosa, palate and gingivae most common sites Benign Frequently excised to confirm diagnosis and exclude melanoma

Answer 28

- Increased melanin pigment in basal keratinocytes - not increase number of melanocytes - Melanin pigmentary incontinence in underlying connective tissue

Answer 29

- Malignant neoplasm of melanocytes - Primary intraoral mucosal melanoma is rare but can occur - 40-60 years - Hard palate and maxillary gingivae most common sites - Dark brown or black or, if non-pigmented, red - Typically asymptomatic at first, may remain unnoticed until pain, ulcerated, bleeding or neck mass - Regional lymph node and blood-borne metastases are common - Typically very advanced at presentation - Very invasive, ,metastasis early - Prognosis is poor - Aetiology is unknown - Biology of mucosal melanoma is different from skin melanoma

Answer 30

-Melanomas are highly pleomorphic neoplasms, cells appear epithelioid or spindle-shaped - The amount of melanin pigment is variable and in some may be absent - Immunohistochemistry using specific markers for malignant melanocytes can be useful in such cases

Answer 31

- Resection is mainstay treatment - Adjuvant radiotherapy - ? Role of immunotherapy

Answer 32

Localised surface defect with loss of epithelium exposing underlying inflammed connective tissue

Answer 33

- Nicorandil - NSAID's

Answer 34

- Haematological disorders - GI disorders such as Crohn disease - HIV

Answer 35

1. Lichen Planus 2. Discoid Lupus Erythematosus 3. Immunobullous diseases

Answer 36

- neoplastic - infective - traumatic - idiopathic

Answer 37

- A large proportion of ulcers will show non-specific features ulceration with loss of surface epithelium, inflammed fibrinoid exudate and inflammed granulation tissue. - Obvious exceptions are neoplasms.

Answer 38

A small blister

Answer 39

Blister >10mm

Answer 40

A subset of lesions, these are autoimmune diseases in which auto-antibodies against components of skin and mucosa produce blisters

Answer 41

1. Intra-epithelial 2. Sub-epithelial

Answer 42

1. Non-acantholytic 2. Acantholytic

Answer 43

Herpes simplex virus in primary herpetic stomatitis and herpes labialis. 1. Virus targets and replicates within epithelial cells 2. Leads to cell lysis 3. Groups of infected cells breakdown to form vesicles within the epithelium 4. Infected cells infect nearby normal cells and an ulcer forms when the full thickness of the epithelium is involved and destroyed.

Answer 44

Pemphigus vulgaris.

Answer 45

- Most frequently affect females, 40-60 years - Autoantibodies to desmosomal protein (desmoglein 1 and 3 produced). - Bullae form in skin and mucous membranes then rupture to leave ulcers. Treatment : steroids

Answer 46

- Characteristic intra-epithelial bullae produced by acantholysis (breakdown of desmosomes) - Bullae typically just above basal cells and these form the base of the lesion (tombstones) - Acantholytic cells (Tzank cells) found lying free within the bullae fluid - Tzank cells are small, round and enlarged hyperchromatic nuclei unlike normal polyhedral spinous cells - Little inflammation until the lesion ruptures

Answer 47

DIF in addition to normal histochemical staining. Fresh specimen mandatory for DIF.

Answer 48

1. Pemphigoid 2. Erythema multiforme 3. Dermatitis herpetiformis 4. Epidermolysis bullosa acquisita

Answer 49

- Mostly in females 50-80 years - Oral mucosa almost always involved and usually first affected site. Gingivae, tongue, buccal mucosa, and palate - Gingival lesions present as "desquamative gingivitis"clinical description, - Eyes, nose, larynx, pharynx, oesophagus and genitalia may be involved -Bullae tend to be relatively tough as the ‘lid’ is full thickness epithelium. When they rupture tend to heal slowly with scarring. Ocular lesions can lead to blindness

Answer 50

- Separation of full thickness of epithelium from connective tissue producing subepithelial bulla with a thick roof - Infiltration of neutrophils and eosinphils around within bulla. - Base of bulla is inflammed connective tissue.

Answer 51

- Uncommon - Acquired autoimmune blistering dermatosis with subepithelial bullae - Oral lesions in approx 50% cases - Early stage may mimic pemphigoid and later resembles epidermolysis bullosa - Separation occurs in or beneath lamina densa in basement membrane zone.

Answer 52

- Group of rare genetic conditions - Formation of skin bullae which heal with scarring. Variable involvement of oral mucosa.

Answer 53

3 variants: Simplex- intraepithelial, mutations in keratins 5/14 Junctional- subepithelial, separation in lamina lucida, laminin mutations Dystrophic- subepithelial, separation beneath basal lamina, mutation in type VII collagen gene

Answer 54

Spontaneous blood-filled bullae, burst to form ulcers and heal uneventfully Most common on soft palate Older adults Subepithelial cleft ? Trauma Not due to systemic or haematological disease

Answer 55

Chronic, progressive, oral potentially malignant condition Associated with betel quid/areca nut Clinically pale coloured mucosa, firm to palpate Increasing submucosal fibrosis leading to very marked trismus Typically fibrous bands which affect buccal mucosa, soft palate and labial mucosa

Answer 56

Submucosal deposition of dense collagenous tissue Decreased vascularity Marked epithelial atrophy Variable rates of dysplasia High risk of malignant transformation

Answer 57

Persistent white patch on oral mucosa, cannot be removed by scraping Buccal mucosa adjacent to commissure of lips most common site Triangular, often bilateral, white plaque tapering posteriorly Palate or tongue can be involved Often associated with angular cheilitis Degree of risk of malignancy controversial?? Likely low

Answer 58

Hyperparakeratosis Prominent, irregular acanthosis Numerous neutrophils in parakeratin, forming microabscesses Candidal hyphae in parakeratin Acute and chronic inflammation in prickle cell layer Mixed chronic inflammatory infiltrate in lamina propria Varying degrees of cellular atypia

Answer 59

Atypical epithelial alterations limited to the surface squamous epithelium Architectural changes- maturation and differentiation Cytological changes- changes in cells Indicates a risk of developing carcinoma

Answer 60

1. Nuclear and cellular pleomorphism 2. Alteration in nuclear/cytoplasmic ratio (invariably an increase) 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 ie wider at their deepest part 9.Irregular epithelial stratification or disturbed maturation 10. Abnormal keratinization ‘Dyskeratosis’- cell starts to keratinize before the surface is reached) 11. Loss/ reduction of intercellular adhesion

Answer 61

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

Answer 62

All the features of dysplasia may be seen in oral squamous cell carcinoma, however in dysplasia the atypical cells are confined to the surface. In squamous cell carcinoma, the atypical cells invade into the underlying connective tissue.

Answer 63

Modify risk factors High risk sites - lateral border of tongue and FOM managed less conservatively Antifungal treatment? Excision/CO2 laser ? Topical agents Close clinical review Biopsy

Answer 64

Tobacco Alcohol Betel quid/pan/areca nut Previous oral cancer Exposure to UV light (lip) Poor diet Immune suppression Genetics?? Social deprivation ?? HPV- Oropharyngeal cancer

Answer 65

Lateral/ventral tongue FOM retromolar trigone (tonsils/soft palate/oropharyngeal).

Answer 66

Lumps and bumps Ulcers White patches Red patches Speckled patches Non-healing socket Tooth mobility not associated with periodontal disease Induration/fixation of mucosa Dysphagia Pain/paraesthesia Bleeding

Answer 67

Scottish Referral Guidelines for Suspected Cancer and NICE guidelines e.g: Persistent unexplained head and neck lumps for >3 weeks Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >3 weeks All unexplained red or mixed red and white patches of the oral mucosa persisting for >3 weeks Persistent (not intermittent) hoarseness lasting for >3 weeks. If other symptoms are present to suggest suspicion of lung cancer, refer via lung cancer guideline Persistent pain in the throat or pain on swallowing lasting for >3 week

Answer 68

Incisinal biopsy: Usually straightforward diagnosis on H & E stained slides Further investigations usually not required Very poorly differentiated tumours may require immunohistochemistry to confirm diagnosis (Immunohistochemistry p16 and HPV in situ hybridization used for all Oropharyngeal SCCs)

Answer 69

Considerable variation in appearances, however cytologically malignant squamous epithelium and ALL show invasion and destruction of local tissues

Answer 70

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

Answer 71

- maximum diameter of tumour - maximum depth of invasion - Type of carcinoma - Degree of differentiation - Distance of carcinoma from surgical margins - Any bone/vascular/nerve invasion

Answer 72

- increase no of nodes - size of nodes involved - whether or not there is extranodal extension

Answer 73

Because you cant tell from a bipsy/resection if there are any metastases elsewhere in the body.

Answer 74

- History of pain - Grossly carious or heavily restored tooth - Previous trauma - Typically little to see radiographically unless acute exacerbation of chronic lesion

Answer 75

- Acute inflammatory changes - Vascular dilation - Neutrophils - Oedema

Answer 76

- Extraction or endodontic treatment

Answer 77

Pain and swelling/sinus

Answer 78

- Central collection of pus (comprises neutrophils, bacteria and cellular debris) - Adjacent zone of preserved neutrophils - Surrounding membranes of sprouting capillaries and vascular dilation and occasional fibroblasts (granulation tissue).

Answer 79

- Drainage and XLA - Endo

Answer 80

May follow acute periodontitis or be chronic from onset - Non-vital tooth, may be previous RCT - Often minimal symptoms - Apical radiolucent lesion may be evident on radiograph

Answer 81

Chronic inflammatory changes - lymphocytes -plasma cells - macrophages - granulation tissue - resorption of bone - minimal if any tooth resorption

Answer 82

- XLA - Endo - Endro retreatment if applicable - peri-radicular surgery Chronic periradicular periodontitis will not resolve spontaneously.

Answer 83

A mass of inflammed granulation tissue at the apex of non-vital tooth. Not a true granuloma. Can transform to abscess. Some may undergo cystic changes e.g to form a radicular cyst.

Answer 84

The same as chronic periradicular periodontitis however apical radiolucent lesion typically evident on radiograph

Answer 85

- Inflammed granulation tissue- inflammatory component typically lymphocytes, plasma cells, macrophages and neutrophils - Proliferation of cell rests of Malassez, often in long strands and arcades (may ultimately lead in inflammatory cyst formation) - Haemosiderin and cholesterol deposits from RBC/inflammatory cell breakdown, and associated multinucleate foreign giant body cells - Resorption of adjacent tooth/bone.

Answer 86

- Extraction - Endodontic treatment - Endodontic re-treatment - Periradicular surgery

Answer 87

Inflammation of soft tissues around partially erupted tooth, frequently lower 8's. Often exacerbated by trauma from opposing tooth. - Pain - swelling/tenderness of operculum - Bad taste - Trismus

Answer 88

Acute and chronic inflammatory changes including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue Paradental cyst may arise in chronic pericoronitis.

Answer 89

- Irrigation - Consider extraction of opposing tooth - Antibiotics (only if systemically unwell)

Answer 90

A pathological cavity with fluid or semi-fluid contents. Lined wholly or in part by epithelium. Not due to accumulation of pus as this is an abscess.

Answer 91

1. Inflammatory 2. Developmental

Answer 92

1. Initiation 2. Bud stage 3. Bell stage 4. Cap stage 5. Maturation stage

Answer 93

Tissues such as primitive oral epithelium and ectomesechymal cells that are derived from neural crest cells. These tissue form a dental lamina, from here the dental lamina proliferates to form a bud.

Answer 94

A tooth bud is formed which is attached to the oral epithelium by the dental lamina. Differential proliferation of cells (cells inside the bud grow at a different rate) cause the formation of a cap shape.

Answer 95

Here the cap forms an enamel organ which has different types of epithelial cells. The enamel organ has 4 layers such as the inner and outer enamel epithelium, the stellate reticulum and the stratum intermediate.

Answer 96

The cap changes shape to form an invagination of the inner and outer epithelium which forms the dental papillae. A sac forms around the tooth germ which forms the dental follicle.

Answer 97

Ameloblasts - create enamel Odontoblasts - create dentine

Answer 98

The dental lamina (connecting the tooth germ to the oral epithelium) disintegrates. However sometimes remnants of the dental lamina can remain forming issues in the future (such as supernumerary, cysts or odontoma)

Answer 99

Hertwigs epithelial root sheath

Answer 100

Histodifferentiation into osteooblasts and fibroblasts which form form and the PDL.

Answer 101

1. Radicular cysts 2. Inflammatory collateral cysts

Answer 102

1. Buccal bifurcation cysts 2. Paradental cysts.

Answer 103

- Most common type of cyst in jaw (55% of jaw cysts) - Arise from epithelial proliferation and cyst formation within some periapical granulomas - Anterior maxilla most frequent location - Wide age range - Slow growing swelling - Often no symptoms unless very large - Must be associated with an non-vital tooth - Radiographically appears as well-circumscribed, unilocular radiolucent lesion seen at apex

Answer 104

Arises from proliferation of epithelium (cell rests of Malassez) in response to inflammation - Cysts enlarges due to osmotic pressure - Local bone resorption

Answer 105

- Chronically inflammed fibrous capsule - Wholly-partly lined non-keratinized stratified squamous epithelium of variable thickness - Hyperplasia of epithelium common, often in arcades - Mucous metaplasia and ciliated cells may be seen - Hyaline/Rushton bodies - Cholesterol clefts and haemosiderin

Answer 106

- Small cysts may resolve after RCT/Extraction/Periradicular surgery - Enucleation - Marsupialisation

Answer 107

A lateral root canal branch of a non vital tooth.

Answer 108

Persists after extraction of the associated non-vital tooth.

Answer 109

Lower 3rd molars

Answer 110

Lower 1st-2nd molars.

Answer 111

- Long standing peri-coronitis - Associated with vital tooth - Well-demarcated radiolucency.

Answer 112

- Often painless swelling - Associated tooth is tilted buccally with a deep perio pocket - Well-demarcated buccal radiolucency.

Answer 113

- Essentially the same as a radicular cyst.

Answer 114

Enucleation.

Answer 115

1. Odontogenic keratocyst 2. Dentigerous cyst 3. Eruption cyst 4. Lateral periodontal cyst and Botryoid odontogenic cyst 5. Glandular odontogenic cysts 6. Gingival cysts 7. Calcifying odontogenic cyst 8. Orthokeratinized odontogenic cyst.

Answer 116

- 3rd most common cyst of the jaws - Occurs over a wide age range. Peaks in 2nd-3rd then 6th-8th decade - Slight male predilection - Majority (80%) arise in mandible esp posteriorly - Often symptom free unless infected or have bony expansion - Well defined uni or multilocular lesion.

Answer 117

- Arise from remnants of the dental lamina - Associated with mutation or inactivation of PTCH 1 gene, chromosome 9, activates SHH pathway resulting in aberrant cell proliferation of epithelium.

Answer 118

- Multiple odontogenic keratocysts - Occur at a younger age than sporadic cases - Basal cell naevi, multiple, recurring odontogenic keratocysts, skeletal abnormalities, multiple basal cell carcinomas. - AD inheritance - PTCH1 gene mutation

Answer 119

- cystic lesion - keratinized stratified squamous epithelial lining, 5-10 cells thick. - Corrugated appearance of surface parakeratin layer - Well-defined, palisaded basal cell layer - Keratin debris in the lumen - Thin fibrous cyst wall with no inflammation, unless secondary infection - May be daughter/satellite cysts in wall.

Answer 120

- Histopathological features are lost therefore cannot distinguish between other inflammatory cysts.

Answer 121

- High recurrence rate (25%) if incompletely removed - has thin capsule and daughter cysts.

Answer 122

-Marsupialization -Enucleation -Marsupialization + Enucleation -Enucleation + Carnoy’s solution (modified Carnoy’s) -Enucleation + Cryotherapy - Resection *no evidence to support best treatment*

Answer 123

-2nd most common odontogenic cyst -Encloses all or part of crown of unerupted tooth -Attached to Amelocemental junction -Impacted teeth or late to erupt; 3, 5, 8 s -Mandible > Maxilla, 20-50yrs -Symptom-free until significant swelling or if infected -Ballooning expansion -Well-circumscribed unilocular radiolucency associated with crown of unerupted tooth

Answer 124

Thin non-keratinized stratified squamous epithelial lining, 2-5 cells thick Mucous metaplasia common feature Fibrous capsule- No inflammation, unless secondary infection May be odontogenic epithelium remnants, calcification, Rushton Bodies

Answer 125

- Enucleation - Exposure/transplantation/extraction of associated tooth.

Answer 126

Typically seen in children Deciduous and permanent molars Presents as bluish swelling

Answer 127

*Same as dentigerous cyst*: Thin non-keratinized stratified squamous epithelial lining, 2-5 cells thick Mucous metaplasia common feature Fibrous capsule- No inflammation, unless secondary infection May be odontogenic epithelium remnants, calcification, Rushton Bodies

Answer 128

None- exposure of erupting tooth.

Answer 129

-Uncommon -Arise adjacent to vital tooth -Canine and premolar region of mandible -Wide age range -Usually symptom-free, incidental finding -Well-circumscribed radiolucency in PDL

Answer 130

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

Answer 131

Excision- recurrence is rare.

Answer 132

Very rare multicystic variant of lateral periodontal cyst Botryoid= ‘Bunch of grapes’- polycystic appearance Typically multilocular radiolucency Mandibular premolar =canine region Adult Can recur

Answer 133

Very rare Anterior mandible Wide age range Multilocular radiolucency Strong tendency to recur

Answer 134

Cystic lumen lined by epithelium of various thickness with mucous cells and glandular structures (crypts/ cyst-like spaces) Focal epithelial plaques/thickenings Must be differentiated from central mucoepidermoid carcinoma

Answer 135

Enucleation/55%

Answer 136

Seen as Bohn’s nodules, superficial keratin-filled cysts in the gingivae of newborns ??Due to proliferation of dental lamina remnants (Glands of Serres) Present as white nodules in gingivae

Answer 137

None - usually go away within weeks.

Answer 138

Very rare Middle-aged adults Painless dome-shaped swelling in gingiva Majority in Mandibular canine-premolar region May be superficial erosion of underlying alveolar bone ???Derived from dental lamina remnants

Answer 139

Cyst just below oral epithelium Uninflamed fibrous wall Lined by thin epithelium, cuboidal to squamous

Answer 140

Simple excision

Answer 141

Rare Wide age range, average 30 yrs Painless swelling of jaw Well-defined radiolucency Tooth displacement and resorption common Either jaw, often anterior Minority can be in soft tissues

Answer 142

Unicystic Lined by epithelium which is ameloblastoma-like Palisaded basal layer with overlying stellate reticulum-like layer Focal ‘Ghost cells’, which may calcify

Answer 143

Enucleation- recurrence is rare.

Answer 144

Actual prevalence uncertain, rare Wide age range, peak 3rd-4th decade Male predilection 90% mandible Typical presentation is painless swelling of jaw Well-defined unilocular radiolucency

Answer 145

Uninflamed fibrous wall Lined by stratified squamous epithelium Prominent granular cell layer and orthokeratinized No basal palisading, no corrugated parakeratin

Answer 146

1. Nasopalatine cyst 2. Nasolabial cyst 3. Surgical ciliated cyst.

Answer 147

-Uncommon -Originate from epithelium of nasopalatine duct in incisive canal -Occur anywhere in the nasopalatine canal but most frequently at the palatal end. - Any age but frequently 5th and 6th decades. - Slow growing - Swelling in midline of anterior hard palate - May complain of salty taste - Rounded or heart shaped radiolucency in midline of anterior hard palate

Answer 148

- Epithelial lining can either be stratified squamous, respiratory, columnar or cuboidal - Fibrous connective tissue capsule - Neurovascular bundles may be seen in capsule - Mucous glands may be seen in capsule - Often chronically inflammed

Answer 149

Enucleation- recurrence is unlikely

Answer 150

- Rare - F = M - Peak incidence in 5th and 6th decades - Most common in posterior maxilla - rare in mandible - May be asymptomatic or present with pain and swelling - Develop after sinus/nasal mucosa implanted in the jaw following surgery

Answer 151

- Cyst lined by respiratory epithelium (ie pseudostratified columnar epithelium) - Fibrous connective tissue capsule may be inflammed

Answer 152

Enucleation - recurrence is rare.

Answer 153

- Very rare - F>M - Peak incidence in 4th-5th decades - Arise in upper lip below nose, lateral to midline - Slow growing, distorts nostril - Painless unless infected - 10% bilateral - Now considered to likely derive from remnants of the embryonic nasolacrimal duct or the lower anterior portion of the mature duct.

Answer 154

Cystic lesion with fibrous capsule Usually pseuodocolumnar epithelial lining.

Answer 155

1. Salivary mucoceale 2. Epidermoid cyst 3. Dermoid cyst 4. Lymphoepithelial cysts 5. Thyroglossal cysts

Answer 156

- More common on the skin - Painless swelling - Often following trauma or surgery

Answer 157

- Cystic lesion with thin cyst wall - Lined by keratinizing stratified squamous epithelium - Abundant keratin debris in the lumen - No skin appendages in cyst wall

Answer 158

Local excision

Answer 159

- Development lesion - Arise at various locations of the head and neck - Most common site is FOM - Presents as painless swelling in the midline

Answer 160

- As epidermoid cyst with keratinizing stratified squamous lining - Keratin debris within cyst lumen - MUST have skin appendages e.g sebbaceous glands, hair follicle in cyst wall.

Answer 161

- Development lesions - Uncommon but do occur in the oral cavity - FOM most common intra-oral site - Typically present as painless small swelling which may be yellowish in colour

Answer 162

- Thin keratinized stratified squamous epithelium lining - Keratin debris in lumen - Lymphoid tissue in cyst wall

Answer 163

- Development cyst derived from embryonic thyroglossal duct - Intraoral lesions are very rare - Most arise near hyoid bone - Present as midline swelling, wide age range - Usually painless - Symptoms if infected, or very large - May have functioning thyroid tissue

Answer 164

- Cystic lesion lined by stratified squamous epithelium/ciliated columnar epithelium/noncilated columnar epithelium - Fibrous wall which typically contains thyroid tissue - Can find incidental thyroid carcinoma

Answer 165

Excision- "Sistrunk procedure" which involves removing middle third of hyoid bone along with lesion which reduces the chance of recurrence.

Answer 166

1. Simple/Solitary lesion 2. Aneurysmal bone cyst *Almost exclusively mandible*

Answer 167

- Peak incidence is 2nd decade - Typically seen in premolar/molar region of mandible - May be incidental finding or present as asymptomatic swelling. - Large radiolucency on radiographs - Not true cysts (cavities that are empty) - Cause is unknown

Answer 168

- Bony cavity with no epithelial lining - May be thin fibrovascular tissue lining with haemosiderin, RBC's or giant cells covering bony walls - Usually no cystic contents

Answer 169

No treatment - usually resolves spontaneously. If not may resolve after opening investigation of lesion

Answer 170

- Very rare in jaws - Usually mandible - Young people more commonly - Painless swelling - Radiolucent lesion on radiograph - unknown cause

Answer 171

- Blood filled spaces separated by cellular fibrous tissue - No lining of spaces - Multinucleate giant cells in fibrous band

Answer 172

- Curettage - May recur

Answer 173

NOT a true lesion Developmental anomaly Due to part of submandibular gland indenting lingual mandible Appears cyst like on radiograph and be mistaken for a cyst

Answer 174

1. Ameloblastic carcinoma 2. Primary intraosseous squamous cell carcinoma 3. Sclerosing odontogenic carcinoma 4. Clear cell odontogenic carcinoma 5. Ghost cell odontogenic carcinoma

Answer 175

1. Ameloblastic sarcoma 2. Ameloblastic fibrodentinosarcoma 3. Ameloblastic fibrodontosarcoma

Answer 176

1. Ameloblastoma 2. Squamous odontogenic tumour 3. Calcifying epithelial odontogenic tumour 4. Adenomatoid odontogenic tumour

Answer 177

- unicystic - peripheral - metastazing

Answer 178

2nd most common type of odontogenic tumour 30-60 years Usually posterior mandible Swelling Radiolucent lesion on imaging Slow growing, locally aggressive

Answer 179

2 types of tumour cells: 1.well-organized peripheral single layer of tall, columnar, pre-ameloblast-like cells, which have nuclei at the opposite pole to the basement membrane (reversed polarity) 2. core of loosely arranged cells resembling stellate reticulum 2 patterns : -follicular (islands of epithelial cells) -plexiform (long strands of epithelial cells) tumour regardless of pattern is set in fibrous stroma

Answer 180

- complete excision with a margin of uninvolved tissue. - If excision incomplete then it will recur - Follow up required

Answer 181

-Most in 2nd decade, 90% before 30yrs -Females>males -Maxilla>mandible -Majority in canine region -Often associated with unerupted permanent tooth -Unilocular radiolucency, may mimic dentigerous cyst -Most are asymptomatic

Answer 182

-Odontogenic epithelium arranged in solid nodules or rosette-like structures -Duct-like structures -Eosinophilic amorphous material -Minimal fibrous stroma

Answer 183

Local excision Recurrence is rare

Answer 184

1. Ameloblastic fibroma 2. Primordial odontogenic tumour 3. Odontoma 4. Dentinogenic ghost tumour

Answer 185

Developmental malformations (hamartomas) of dental tissues Once fully calcified do not develop further Young patients Painless slow growing lesions Contain enamel, dentine and sometimes cementum

Answer 186

Most common odontogenic tumour Esp anterior maxilla Lots of tooth like structures on imaging Fibrous capsule "Bag of teeth"

Answer 187

Commonly posterior mandible Radiopaque mass on imaging Consist of an irregular mass of hard and soft dental tissues, haphazard arrangement with no resemblance to a tooth and often forming a cauliflower-like mass Cementum is often very scant

Answer 188

Enucleation Mature lesions completely enucleated do not recur Incompletely enucleated developing lesions may recur

Answer 189

1. Cementoblastoma 2. Odontogenic fibroma 3. Cemento-ossifying fibroma 4. Odontogemic myxoma

Answer 190

Formation of cementum-like tissue in connection with root of tooth 10- 40 yrs Mandible> maxilla, esp associated with 6s Painful swelling Tooth remains vital Well-defined radiopaque or mixed-density lesion

Answer 191

Dense masses of acellular cementum-like material Fibrous, sometimes vascular stroma Tumour blends with root of tooth- helps distinguish lesion from bone tumours

Answer 192

Complete excision and removal of tooth Commonly recur if incompletely excised

Answer 193

1. Chondrosarcoma 2. Mesenchymal chrondrosarcoma 3. Osteosarcoma

Answer 194

Chondroma Osteoma Melanotic neuroectodermal tumour of infancy Chondroblastoma Chondromyxoid fibroma Osteoid osteoma Osteoblastoma Desmoplastic fibroma

Answer 195

- Benign slow-growing tumour consisting of well-differentiated mature bone - Occur mostly in adults, M>F - Mandible>Maxilla - Usually solitary lesions, although multiple lesions can occur as a feature of Gardner Syndrome

Answer 196

Rare Autosomal dominant disorder, features include multiple osteomas, polyposis coli (which shows a marked tendency to undergo malignant change), and multiple fibrous tumours and epidermal/sebaceous cysts of skin.

Answer 197

Compact type- mass of dense lamellar bone with few marrow spaces Cancellous type- interconneting trabeculae enclosing fatty or fibrous tissue.

Answer 198

- Lesions is removed if asymptomatic or causing problems with fit of denture. - Recurrence is rare.

Answer 199

Very rare tumour (most are benign) Most < 1 yr old M>F Locally aggressive, rapidly growing pigmented mass Most frequently anterior maxillary alveolus

Answer 200

Tumour comprises 2 cell population - neuroblastic cells and pigmented epithelial cells.

Answer 201

- Complete local excision of treatment of choice - Most are benign but small number do metastasize. - Can recur

Answer 202

1. Cemento-osseous dysplasia 2. Osteochrondroma 3. Fibrous dysplasia 4. Familial gigantiform cementoma 5. Ossifying fibroma

Answer 203

1. Solitary bone cyst 2. Aneurysmal bone cyst 3. Cherubism 4. Peripheral giant cell granuloma 5. Central giant cell granuloma

Answer 204

- Solitary plasmacytoma of bone - Localized proliferation of monoclonal plasma cells involving bone -Mandible>Maxilla - No other bony lesions, no clinical features of plasma cell myeloma.

Answer 205

All histologically characterised by replacement of normal bone by cellular fibrous tissue within which islands and trabeculae of metaplastic bone develop Cannot be diagnosed by histology alone, need clinical/radiographic features

Answer 206

Slow, painless expansion of bone- jaws and craniofacial skeleton Peak incidence 3rd- 4th decades F>M Different variants- cemento-ossifying fibroma occurs exclusively in the tooth-bearing regions of the jaws Mandible > maxilla

Answer 207

Well-demarcated or rarely encapsulated benign lesion Fibrous tissue containing varying amounts of metaplastic bone and mineralised masses resembling cementum *Demarcated nature is an important feature distinguishing it from fibrous dysplasia*

Answer 208

Complete excision Ossifying Fibroma continues to enlarge if left untreated Must be distinguished from fibrous dysplasia

Answer 209

Rare form of fibro-osseous lesion of jaws Early onset of fast growing multifocal/multiquadrant expansive lesions May be massive with ++ facial deformity Inheritance in some not all cases

Answer 210

Surgery- difficult!

Answer 211

Fibro-osseous lesion of growing bones May involve one (monostotic) or several bones (polyostotic) Sporadic condition GNAS1 mutations identified

Answer 212

Gives rise to painless bony swelling, facial asymmetry Usually starts in childhood and arrests in adulthood M=F Jaws most frequent head + neck site Radiographically -orange-peel/ground glass effect Maxilla>mandible Maxillary lesions often involve adjacent bones- Craniofacial fibrous dysplasia

Answer 213

Rare F>M Affects several bones Skin pigmentation and endocrine abnormalities also associated Albright’s syndrome comprises polyostotic fibrous dysplasia, skin pigmentation and sexual precocity Head + neck involved in ~50% of cases

Answer 214

Irregularly shaped slender trabeculae of woven (immature) bone lying in a very cellular fibrous tissue Fuses directly with normal bone at edges of lesion

Answer 215

Aesthetic surgery Rarely, malignant change, typically osteosarcoma, can occur in FD Lesions stabilise as skeleton matures.

Answer 216

-Fibro-osseous lesion occurring in tooth-bearing areas of jaws -Most common fibro-osseous lesion of jaws -Often asymptomatic -Involved teeth remain vital -Characterized by replacement of normal bone by fibrous tissue and metaplastic bone -Predilection for middle-aged African/ African-American females

Answer 217

1. Peri-apical cemento-osseous dysplasia 2. Focal cemento-osseous dysplasia 3. Florid cemento-osseous dysplasia

Answer 218

Periapical cemento-osseous dysplasia--->Involves apical incisor region of mandible, several adjacent teeth involved Focal cemento-osseous dysplasia-->Associated with a single tooth Florid cemento-osseous dysplasia -->Multifocal/multiquadrant

Answer 219

Surgery only if symptomatic

Answer 220

-Bony projection with a cap of cartilage -Continuous with underlying bone -Rare in maxillofacial bones (occurs at sites of endochondral ossification) -Symptoms depend on site of lesion

Answer 221

Complete excision

Answer 222

Localized benign (but can be aggressive) lesion Most < 30 years Mandible > Maxilla F > M Often asymptomatic If cortical plate perforates lesion can present as a peripheral giant-cell granuloma

Answer 223

Large numbers of multi-nucleate, osteoclast-like giant cells Set in a vascular fibrous stroma Areas of haemorrhage and haemosiderin

Answer 224

Rare inherited, AD, causing distension of jaws M>F Mandible often more extensively involved Normal at birth but painless swelling, usually bilateral, symmetrical, of jaws appear between 2-4 yrs Enlarge until ~7yrs May regress by adulthood Lesions cause fullness of cheeks and in severe cases maxillary swellings cause eyes to look upward giving ‘Cherub-like” appearance May be dental anomalies

Answer 225

-Lesions consist mainly of cellular and vascular fibrous tissue containing varying numbers of multinucleate giant cells -As activity decreases lesions become progressively more fibrous and numbers of giant cells decreases

Answer 226

- central giant cell granuloma - brown tumour of hyperparathyroidism - giant-cell tumour - aneurysmal bone cyst

Answer 227

1. Osteogenesis Imperfecta 2. Osteopetrosis (marble bone disease) 3. Cleidocranial Dysplasia 4. Achondroplasia

Answer 228

-Hereditary disease, AD and AR and sporadic -Heterogeneous group of related disorders characterized by impairment of collagen maturation -Collagen is component of bone, ligaments, sclerae, dentine, skin -Several different types of OI, type I most common and mild Variety of clinical features: Easily fractured, osteoporotic bone Affected teeth appear as in dentinogenesis imperfecta Malocclusion may be a problem

Answer 229

-Group of rare genetic diseases in which there is marked increase in bone density- infantile and adult forms -Due to failure of normal osteoclast activity and absence of normal modelling resorption -Cortices are thickened and sclerosis of cancellous bone -Anaemia is common due to marrow space deficiency -Osteomyelitis is a recognized complication and prevention of dental infections important

Answer 230

Rare genetic disorder, AD and sporadic Characterized by abnormalities of many bones but most notably there is defective formation of the clavicles, delayed closure of fontanelles and sometimes retrusion of the maxilla Partial or complete absence of clavicles allows patient to bring shoulders together in front of the chest Dental anomalies are common, particularly delayed eruption of permanent dentition and supernumerary teeth (often numerous) Narrow, high-arched palate

Answer 231

May be AD inheritance or spontaneous Associated with an abnormality in endochondral ossification Head and trunk of normal size but limbs are excessively short Defective growth at base of skull leads to a retrusive maxilla, often resulting in severe malocclusion

Answer 232

1. Osteoporosis 2. Hyperparathyroidism 3. Rickets/osteomalacia 4. Acromegaly

Answer 233

Results when bone loss is excessive or when apposition of bone is reduced Most common in postmenopausal women Also accentuated in other diseases including Cushing syndrome, thyrotoxicosis and primary hyperparathyroidism Osteoporotic bone is of normal composition but is reduced in quantity There is increased radiolucency of bone, cortex is thinned, and there are more marrow spaces in the cancellous bone associated with thin trabeculae Both jaws may be affected Nb Bisphosphonates

Answer 234

-Overproduction of parathormone, PTH -Mobilises calcium and raises the plasma calcium level -Primary hyperparathyroidism usually due to hyperplasia or adenoma of the parathyroids -Most patients are female and postmenopausal -Secondary hyperparathyroidism develops when PTH produced in response to chronic low calcium levels, often seen in chronic renal disease

Answer 235

-Patients present with ‘stones, bones and abdominal groans’ -Stones- renal calculi and other calcifications -Bones- various bone lesions including ‘brown tumour’ of hyperparathyroidism -Abdominal groans- tendency to develop duodenal ulcers -May present in dental patients as a cyst-like swelling of the jaw which displays the histological features of a giant-cell lesion

Answer 236

Rickets and its adult counterpart osteomalacia are due to deficiency of, or resistance to the action of, vitamin D Failure of mineralization of osteoid and cartilage Dental defects rarely seen except in very severe cases when hypocalcification of dentine and enamel hypoplasia may occur May also be a delay in tooth eruption Dental defects also seen in hypophosphataemia (Vitamin-D resistant rickets)

Answer 237

Caused by prolonged and excessive secretion of growth hormone Usually due to anterior pituitary tumour developing after epiphyses have closed There is renewed growth of the bones of the jaws, hands and feet with soft tissue overgrowth also Activation of condylar growth centre of mandible causes jaw to become enlarged and protrusive with increased spacing between teeth Thickening of facial soft tissues

Answer 238

1. Alveolar osteitis 2. Osteomyelitis 3. Radiation injury and osteoradionecrosis 4. MRONJ 5. Pagets disease of bone

Answer 239

Unpredictable complication of extractions, particularly lower molars Due to failure of blood clot to form or dislodgment or breakdown of clot. Bone of socket becomes infected and necrotic and very painful! Inflammatory reaction in adjacent marrow localises the infection to the walls of the socket, otherwise osteomyelitis would ensue Dead bone is separated by osteoclasts and small sequestra form and are shed

Answer 240

Spectrum of inflammatory and reactive changes in bone and periosteum Typically in mandible of adults Reflects a balance between the nature and severity of the irritant, the host defences, and local and systemic predisposing factors Acute and chronic suppurative and non-suppurative and sclerotic forms

Answer 241

Radiation affects the vascularity of bone by causing proliferation of the intima of the blood vessels (endarteritis obliterans) Potentially serious in mandible with its end artery supply ID artery or its branches may become thrombosed The non-vital bone which results is sterile and asymptomatic but very susceptible to infection and trauma Infection can spread rapidly through irradiated bone, resulting in extensive osteomyelitis and painful necrosis of bone Can be very difficult to treat

Answer 242

MRONJ defined as’ exposed bone, or bone that can be probed through an intraoral or extraoral fistula, in the maxillofacial region that has persisted for more than eight weeks in patients with a history of treatment with anti-resorptive or anti-angiogenic drugs, and where there has been no history of radiation therapy to the jaw or no obvious metastatic disease to the jaws’

Answer 243

IV bisphosphonates Patients taking anti-resorptive medications for cancer.

Answer 244

Form of osteodystrophy characterised by disorganised formation and remodelling of bone unrelated to functional requirements Aetiology unknown ?? Paramyxovirus ??Genetic Factors ? endocrine Relatively common Often subclinical 40yrs ?M>F Geographic variation in incidence Chronic slowly progressing condition

Answer 245

-Single or multiple bones can be affected -Sacrum, spine, skull, femora and pelvis most common sites -Can be asymptomatic or be painful -Maxilla more often affected than mandible -Patients show varying degrees of bony deformation and distortion of weight-bearing portions of skeleton -Affected bones are thickened but weaker and pathological fractures occur -Progressive enlargement of skull and facial bones- hats don’t fit, dentures don’t fit - Narrowing of foramina can cause cranial nerve deficits -In dentate, derangement of occlusion and spacing of the teeth can occur -Also may be hypercementosis and ankylosis of teeth leading to extraction difficulties -Development of osteosarcoma is a recognised, rare complication of Paget’s disease of bone -Giant cell tumours may also arise in bones affected by Paget’s -Characteristic radiographic ‘cotton-wool’ appearance

Answer 246

1. Initial predominantly osteolytic phase 2. Active stage of mixed osteolysis and osteogenesis 3. Predominantly osteoblastic or sclerotic phase

Answer 247

-varies with phase -Main features are irregular pattern of reversal lines, many osteoblasts and osteoclasts, fibrosis of marrow spaces and increased vascularity -Destruction and new bone formation may alternate rapidly, marked histologically by haemotoxylin-staining reversal lines Their irregular pattern produces a ‘Mosaic’ appearance in the bone -Early phase there is typically more resorption than osteoblastic activity -Late stage bones are thick, cortex and medulla are obliterated and the whole bone is spongy in texture

Answer 248

Serum calcium and phosphorus levels are usually normal but alkaline phosphatase level is very high

Answer 249

Calcitonin Bisphosphonates (nb MRONJ!)

Answer 250

Exostoses are localised bony protuberances Non-neoplastic lesion that may be developmental in origin or may be a response to a stimulus such as chronic trauma A torus is an exostosis which occurs at a characteristic site, either in the midline of the palate (torus palatinus) or on the lingual surface of the mandible, usually premolar region above the mylohyoid line (torus mandibularis) Mandibular tori often bilateral Typically seen in adults Their aetiology is unknown

Answer 251

breast, bronchus, prostate, thyroid, kidney

Answer 252

the gingiva or alveolar mucosa, followed by the tongue

Answer 253

Soft tissue hyperplastic lesion located on the ginigvae

Answer 254

- Fibrous epulis - Pyogenic granuloma/Pregnancy epulis - Giant-cell epulis - Fibroepithelial polyp - Denture irritation hyperplasia - Papillary hyperplasia of the palate

Answer 255

Pedunculated or sessile firm mass on gingiva, often between 2 teeth Pink in colour Wide age range

Answer 256

Nodular lesion Hyperplastic surface epithelium Cellular fibroblastic granulation tissue + collagen bundles Variable inflammation Calcification or metaplastic bone formation can be seen (‘Mineralising’ or ‘Ossifying Fibrous Epulis’)

Answer 257

- Excision - Remove source of infection

Answer 258

Soft red/purple swelling Often ulcerated Wide age range Pregnancy epulis is pyogenic granuloma in specific patient group

Answer 259

Nodular lesion Surface epithelium often ulcerated Underlying vascular proliferation- either solid sheets of endothelial cells or small and large vascular spaces Oedematous fibrous stroma Variable inflammation- often acute and chronic

Answer 260

Local excision Good OH and periodontal treatment and lesions typically regress post-partum.

Answer 261

Soft purplish gingival swelling Mostly on gum of teeth anterior to molars F>M Wide age range, esp 30-40 yrs

Answer 262

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

Answer 263

- Excision of lesion - Curettage of underlying bone to reduce chance of recurrence

Answer 264

-Pink smooth mucosal polyp -Very common -Wide age range -Buccal mucosa, lip, tongue -FEP under denture = leaf fibroma

Answer 265

Polypoid lesion with core of dense scar-like fibrous tissue Overlying stratified squamous epithelium may be hyperplastic Typically little inflammation

Answer 266

- Excision Nb. Giant Cell Fibroma is a variant of fibroepithelial polyp, often seen on the gingivae and tongue

Answer 267

- Broad based, leaf-like folds of tissue related to periphery of badly fitting dentures. - Typically pale, fibrous swelling - May be ulcerated

Answer 268

- hyperplastic fibrous connective tissue - Hyperplasia of the overlying epithelium - May show focal ulceration - Variable inflammation

Answer 269

Excision and new dentures

Answer 270

- Numerous, small tightly packed nodular lesions - Involves all or part of denture bearing area of palate - Typically older patients, ill-fitting dentures - Can be seen in non-denture wearers - May be superadded candidal infection (not causative)

Answer 271

Papillary/nodular projections Underlying hyperplastic, chronically-inflamed vascular fibrous tissue Hyperplastic overlying epithelium Fungal organisms with acute inflammation may be seen

Answer 272

- Good denture hygiene - Antifungals if needed - Rarely surgery

Answer 273

Fibrosarcoma - Rare in the oral cavity - Neoplastic fibroblasts with variable amount of collagen - Radical excision - Can recur, rarely metastasise

Answer 274

1. Lipoma (benign) 2. Liposarcoma (malignant)

Answer 275

Soft smooth swelling Pedunculated or sessile Asymptomatic Can be yellowish or pink Buccal mucosa most common intraoral site Patients typically adults 40+ yrs

Answer 276

Histopathology: Well-circumscribed lesion Thin capsule Lobules of mature fat cells Bands (septa) of fibrous tissue Treatment: Excision

Answer 277

1. Haemangioma 2. Lymphangioma 3. Karposi's sarcoma 4. Angiosarcoma

Answer 278

Vascular hamartomatous lesion/ developmental lesions/benign neoplasm Wide age range, common in children esp Females Dark red/purple swelling Blanch on pressure Usually solitary though can be part of angiomatous syndrome- Sturge-Weber Syndrome

Answer 279

Juvenile haemangioma very cellular endothelial proliferation Capillary and Cavernous depending on size of vascular spaces Spaces are endothelium lined and contain red blood cells Capillary-lots of small blood vessels Cavernous- large blood-filled spaces Oral haemangiomas may also involve muscle, bone and salivary glands

Answer 280

Rare Pale swelling Often present in childhood Malformation of lymphatic vessels May be bleeding into lesion Can be localised or diffuse lesion May present in neck (cystic hygroma)

Answer 281

Subepithelial collection of dilated lymphatic channels Vessels contain lymph

Answer 282

Locally aggressive (intermediate grade) tumour of endothelial cells

Answer 283

Classic Endemic AIDS-associated Iatrogenic (Immunosuppression associated)

Answer 284

Palate and gingivae most common intraoral sites Purplish/red lesion Becomes increasingly nodular Lesions frequently bleed

Answer 285

Antiretroviral therapy/chemotherapy

Answer 286

Malignant tumour of vascular endothelium Very rare in the oral cavity Forehead and Scalp of older male patients Excision +/- radiotherapy Prognosis poor

Answer 287

1. Neurofibroma 2. Neurilemmoma 3. "Traumatic neuroma 4. Malignant peripheral nerve sheath tumours (MPNST)

Answer 288

-Benign peripheral nerve sheath tumour -Arises from mixture of cell types -Rare in the mouth -Smooth painless swelling -Affects tongue, gingivae, salivary glands or rarely intraosseous -Solitary or multiple, associated with Neurofibromatosis-1 -NF-1 type significant risk of malignant transformation

Answer 289

Mixed cellular components including Schwann cells and intraneural fibroblasts Spindle cells with wavy, dark-staining nuclei and scanty cytoplasm Background of collagen fibres, myxoid stroma and occasional mast cells

Answer 290

- Benign peripheral nerve sheath tumour - Schwann cell origin - Slow growing painless swelling - Tongue most common site

Answer 291

- Encapsulated tumour - Spindle cells with palisaed nuclei (Antoni A areas) - Loose, cellular connective tissue (Antoni B areas)

Answer 292

- Reactive lesion after nerve damage, not a tumour! - Smooth nodule - Tongue, lower lip, saliva gland most common sites - History of trauma/surgery - Uncommon - May be painful

Answer 293

- proliferation of nerve bundles - Random arrangement

Answer 294

Accounts for 2-4% Head and Neck Sarcomas May be associated with NF-1 Adults, young adults in NF-1 Painful quickly growing mass Mandible, lips, buccal mucosa Radical Excision +/- adjuvant therapy Prognosis poor, esp in NF-1

Answer 295

1. Leiomyoma (benign) 2. Leiomyosarcome (malignant)

Answer 296

- Rare in the oral cavity - Most arise from vascular smooth muscle - Slow growing nodule - Sometimes painful - Lips, tongue, palate, buccal mucosa most common sites

Answer 297

- Well circumscribed proliferation of smooth muscles cells - May be multiple vessels with thickened walls in angioleiomyoma).

Answer 298

Very rare in the oral cavity Older patients when does arise Enlarging mass which may be painful Treatment: Radical excision +/- adjuvant therapy Variable behaviour May recur locally Can metastasise

Answer 299

1. Rhabdomyoma (benign) 2. Rhabdosarcoma (malignant)

Answer 300

- Foetal - Adult

Answer 301

-Young children (some adults) -Very rare -Male more common -Swelling face and ear region -Proliferation of immature muscle cells -Must distinguish from rhabdomyosarcoma - Treatment: Local excision

Answer 302

-Older male patients -Floor of mouth, tongue, soft palate most common sites -Often large slow growing mass -Histology shows lobules of closely packed more mature muscle cells -Can be multifocal -Local excision, can recur

Answer 303

-More frequent in young children -Often painless rapidly growing mass -Head and neck most common site -Various histological patterns including embryonal and alveolar -Prognosis varies between types -Specific genetic alterations identified - Treatment : Radical excision +/- adjuvant therapy

Answer 304

Benign tumour, ? Schwann cell origin Clinical Features: Tongue, buccal mucosa, floor of mouth, palate Wide age range, rare in children Females>males Submucosal, smooth, painless swelling

Answer 305

Large eosinophilic cells with granular cytoplasm in subepithelial tissue Unencapsulated Tend to merge with underlying skeletal muscle fibres Marked hyperplasia of overlying epithelium

Answer 306

-Uncommon -Pink polypoid mass on alveolus of newborns (very rarely on tongue- not epulis!) -Can be quite large -Anterior maxilla most frequent site -Females>>> males -Origin ?

Answer 307

Mass of large eosinophilic granular cells similar to those seen in granular cell tumour Hyperplasia of overlying epithelium not seen Immunohistochemistry different from granular cell tumour

Answer 308

Excision, esp if breathing or feeding difficulties Spontaneous regression in some cases Should not recur

Answer 309

Parotid - mainly serous acini Submandibular- Mixed serous (90%) and mucous acini (10%) Sublingual - mucous acini.

Answer 310

More common in major.

Answer 311

55% occur in the palate 20% occur in the upper lip lower lip is rare

Answer 312

Minor salivary glands

Answer 313

Clinical and radiographic findings are very important in terms of diagnosis. Biopsys are carried out to get a definite diagnosis such as: - Fine needle aspiration (FNA) - Core biopsy - Open biopsy - Excisional biopsy

Answer 314

Can be given limited sampling which can be non diagnostic. Salivary gland tumours are often heterogenous and frequently all of the tumour requires to be examined histologically to reach a definitive diagnosis.

Answer 315

1. Mucoepidermoid carcinoma 2. Acinic cell carcinoma 3. Adenoid cystic carcinoma

Answer 316

- It is the most common primary epithelial salivary gland malignant tumour - It most frequently affects the parotids but can occur in others including the minor salivary glands - Can be seen in children and young adults - More common in females than in males - It is locally invasive, it can recur and metastasise

Answer 317

- The tumour is unencapsulated and displays an infiltrative pattern of growth.

Answer 318

1. Mucous-secreting cells 2. Epidermoid (squamous) cells 3. Intermediate cells Tumours with high mucous cell numbers tend to be more cystic whereas mainly epidermoid lesions tend to be more solid and often aggressive

Answer 319

Complete excision of the tumour.

Answer 320

- Esp middle-aged or elderly patients - Found in parotid, submandibular and minor salivary glands - Found in 30% of minor salivary gland tumours esp palate - Slow growing, painful, tends to be ulceration of overlying skin/mucosa. - Tendency to infiltrate and spread along nerve sheaths - May also infiltrate along marrow spaces - Metastases usually appear late, prognosis is poor.

Answer 321

- Tumour consists of epithelial and myoepithelial cells in variable configurations in scanty connective tissue stroma - Characteristic feature is the presence of numerous microscopic cyst-like spaces within the epithelial islands, producing a cribiform, lace-like or "Swiss-cheese" pattern. - Less frequently tubular or solid patterns are seen - Perineural invasion frequently observed.

Answer 322

- Most arise as swelling (sometimes cystic) in parotid - F>M - Wide age range including children - Unpredictable behaviour - can be invasive and can metastasise.

Answer 323

Non-encapsulated and may have pushing or infiltrative pattern of growth Almost uniform pattern of large tumour cells, similar to serous cells, with granular cytoplasm, often in acinar arrangement Can show other patterns with other non-acinar cells Less well-differentiated lesions show obvious features of malignancy

Answer 324

1. Pleomorphic adenoma 2. Warthin tumour 3. Canalicular adenoma

Answer 325

- Most common type of salivary gland tumours - Accounts for approximately 60% of all parotid tumours - Slightly more common in females than in males - Occur at any age, peak incidence 5th and 6th decades. - Benign, painless, slow growing "rubbery" lump - Usually solitary although recurrences may be multifocal -Most are associated with gene rearrangements in PLAG1 or HMGA2

Answer 326

- Well-circumscribed tumour - Incomplete fibrous capsule (tumour nodules can extend through capsule). - May be cystic - Variety of histological appearances with a complex intermingling of epithelial and myoepithlial components. Tumour epithelial cells differentiate to connective tissue type and can form connective tissue e.g cartilage and bone

Answer 327

- Complete excision - If incompletely excised pleomorphic adenoma has a high recurrence rate - Malignant transformation can occur in pleomorphic adenoma, usually in long standing lesions. - Transformed tumours, called ex pleomorphic adenoma, are typically high grade malignancies with poor prognosis.

Answer 328

- Almost exclusively in the parotid - Bilateral lesions in 5-10% of cases - M>F - >50years - Painless swelling - Strong link with cigarette smoking - Radiation - Increased frequency in pts with autoimmune disorder?

Answer 329

- Well circumscribed with thin capsule - Tumour tissue comprised of epithelial and lymphoid elements - Papillary (finger-like) processes of tumour tissue project into irregular cystic spaces containing mucoid material - Double layer of epithelial cells covers projections (basal cuboidal cells below columnar cells) - Stroma contains a variable amount of lymphoid tissue, often with germinal centres evident

Answer 330

- Almost exclusively (80%) in the upper lip - Can be multifocal - Typically painless slow growing nodule - >50years - F>M

Answer 331

-Well-circumscribed -Two rows of columnar epithelial cells which are alternately closely opposed and widely separated -Minimal vascular stroma -May be cystic -Can sometimes resemble adenoid cystic carcinoma but no evidence of invasion

Answer 332

- sclerosing polycystic adenosis - Nodular oncocytic hyperplasia - Lymphoepithelial sialadenitis - Intercalated duct hyperplasia

Answer 333

Haemangioma Lipoma/sialolipoma Nodular fasciitis

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Oral Pathology Flashcards

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