Oral Pathology Flashcards
A 60 year old female patient has a bony enlargement on the middle of her palate that has been present for all her adult life which has not changed. She will be getting a complete denture, her dentist states the boy enlargement on her mid-palate must first be removed before fabrication of the new denture. What is the most likely diagnosis?
A. Pyogenic granuloma
B. Osteosarcoma
C. Palatal torus
D. Osteoma
Palatal torus
What is a lesion?
Pathological change in tissues or organs resulting from injury or disease.
What tissues can develop a lesion?
Epithelium
Connective tissue
Where does a lesion present in epithelial tissue?
Surface Mucosa
Under Surface: Salivary or Odontogenic
Where does a lesion present in connective tissue?
Bone or cartilage (Hard)
Vessels or cells (blood)
Fibrous, nerve, fatty (other)
What lesions can present from diseases or syndromes?
Systemic
Neoplastic
A 3yr old boy has multiple purple and reddish-colored vascular lesions present on his head and also intraoral, which blanch when compressed. His mother states they developed and rapidly enlarged right after birth. Which is the best diagnosis?
A. Hemangioma
B. Kaposi’s sarcoma
C. Hematoma
D. Neurofibroma
A. Hemangioma
What is a pyogenic granuloma?
Relatively common skin growths that are small, round, and usually bloody-red in color. They tend to bleed because they contain a very large number of blood vessels. They’re also known as lobular capillary hemangioma, or granuloma telangiectaticum.
What is an osteosarcoma?
A malignant tumor of bone in which there is a proliferation of osteoblasts.
What are palatal torus?
A bony protrusion on the palate.
What is an osteoma?
An osteoma (plural: “osteomata”) is a new piece of bone usually growing on another piece of bone, typically the SKULL. It is a BENIGN tumor. When the bone tumor grows on other bone it is known as “homoplastic osteoma”; when it grows on other tissue it is called “heteroplastic osteoma”.
What immunological disease is associated with Kaposi’s sarcoma?
Aids
What is kaposi’s sarcoma?
A form of cancer involving multiple tumors of the lymph nodes or skin, occurring chiefly in people with depressed immune systems, e.g., as a result of AIDS.
What is a hematoma?
A solid swelling of clotted blood within the tissues. Occurs outside of the blood vessels.
What is a neurofibroma?
A peripheral nerve neoplasm. A tumor formed on a nerve cell sheath, frequently symptom-less but occasionally malignant.
How are lesions classifed?
Benign
Pre-malignant
Malignant
What does benign mean?
Encapsulated; abnormal cell growth, usually slow growing, the cells are confined to original tissue, localized.
What does pre-malignant mean?
Abnormal cell growth, the cells have the POTENTIAL to metastasize. AKA “carcinoma in situ”
What does malignant mean?
Abnormal cell growth, cells have metastasized (moved) from original tissue, usually fast growing, invade and destroy…AKA “cancer”
What are the two types of clinical lesions seen?
Blisterform lesions
Non-blisterform lesions
Describe a blisterform lesion.
Contains fluid, translucent appearance, soft consistency. Usually seen in the mucosa.
What are some examples of blisterform lesions?
Vesicle, pustule, bulla.
Describe a non-blisterform lesion.
Solid, contains no fluid, firm consistency.
What are the two types of non-blisterform lesions?
Pedunculated
Sessile
Describe and give an example of a peduculated non-blisterform lesion.
Attached by stem-like or stalk-like base.
i.e. papilloma (wart or fibroma)
Describe and give an example of a sessile non-blisterform lesion.
Attached by broad base.
i.e. papule, nodule, tumor, plaque
What does it mean if a lesion is described as elevated?
Above the plane of mucosa i.e. nodule.
What does it mean if a lesion is described as depressed?
Below the level of mucosa, flat or raised border, superficial or deep.
i.e. ulcer
What does it mean if a lesion is described as flat?
On the same level as mucosa, regular or irregular shape.
i.e. macule
How should you measure a clinical lesion?
Probe at least two dimensions (width & length) - height appropriate for elevated lesions.
10mm = 1cm
What are common colors of a lesion?
Red, pink, salmon, white, blue-black
When a lesion is described like erythema what does that mean?
Abnormal redness of mucosa or gingiva.
When a lesion is described as pallor?
Paleness of skin or mucosa.
When the color of a lesion is described as having melanin pigmentation?
Brown color, more prominent in dark skinned races.
A 68 year-old male patient resents with a 35-40 pack/year history of smoking. He drinks alcohol occasionally. Intraoral exam reveals 12mmX8mm indurated non-healing ulceration on the right posterior lateral border of the tongue which has been present for 6 months and is enlarging. Which is the best diagnosis.
A. Lichen planus
B. Papilloma
C. Squamos cell carcinoma
D. Pemphigus vulgaris
C. Squamos cell carcinoma
What is the most common of all malignancies?
Squamos cell carcinoma
What location is the worst possible diagnosis?
Floor of the mouth.
Where is the most common place that squamous cell carcinoma occurs?
Posterior lateral border of the tongue.
What is a squamous cell carcinoma?
Abnormal growth of squamous cell carcinoma. “CANCER”
What is a pemphigus vulgaris?
A rare autoimmune disease that causes painful blistering on the skin and mucous membranes. If you have an autoimmune disease, your immune system mistakenly attacks your healthy tissues. Pemphigus vulgaris is the most common type of a group of autoimmune disorders called pemphigus.
A lesion which is separate and distinct would be considered:
A. Verrucous
B. Linear
C. Indurated
D. Discrete
D. Discrete
What are the different ways to describe the surface texture of a lesion?
Verrucous Fissured Corrugated Crusted Discrete Coalescing Circumscribed Unilocular/Multiocular Indurated Fluctant
What does verrucous mean?
Wart-like or caulifolower-like appearance/growth.
What does fissured mean?
Cracked surface.
What does corrugated mean?
Wrinkled appearance.
What does crusted mean?
Dry or scab-like
What does discrete mean?
Separate & distinct not attached to others
What does coalescing mean?
Numerous, proximity to one another. The margins may emerge to form one mass.
What does circumscribed mean?
“fluid filled” To encircle, encompass, or to limit or confine, distinctly outlined (homogenous)
What does Unilocular/Multiocular mean?
Radiographic term referring to an image of a lesion that has single or multiple chambers.
What does indurated mean?
To become hard, hardened.
i.e. nodule, tumor
What does fluctuant mean?
Wave-like motion detected when a structure containing fluid is palpated.
i.e. Bulla greater than 5mm
What are warning signs and signals to watch for in the IEOE exam?
- hoarseness, raspy voice
- persistent cough, or feeling of “lump in throat”
- Dysphagia (difficulty swallowing)
- Sore that does not heal or bleeds
- Asymmetry, firmness, fixed to tissues
- Enlargement, metastasizing
- Paresthesia, facial paralysis
- Drainage from lacrimal system
- Protrusion of eyes, color changes in sclera of eyes
- any lesion present over 2-3 weeks (biopsies)
- Pain typically found in later stages of cancer
What is the best way to distinguish between leukoedema and other similar lesions of the oral cavity?
A. biopsy
B. compression
C. stretching cheek
D. Watching it
C. Stretching cheek
Leukodema disappears when stretched, while other lesions do not.
Which of the following microorganisms is associated with Median rhomboid glossitis?
a. Candida
b. Mycobacteria
c. Treponema
d. Epstein-Barr
a. Candida
Median rhomboid glossitis is associated with fungal infections.
What is mycobacteria associated with?
Tuberculosis
What is treponema associated with?
Syphillis
What is Epstein-Barr associated with?
Mononucleousas
What are common variations from normal and physical injuries?
- Leukoedema
- Median rhomboid glossitis
- Geographic tongue
- Hairy tongue
- Tori/torus
- Bony exostosis
- Fordyce granules
- Ankyloglossia
- Lingual variocosities
- Lingual thyroid nodule
- Linea alba
- Melanin pigmentation
What are reactive lesions?
Result from reaction in the environment, causing damage/injury to tissues.
What are the common causes of reactive lesions?
- physical or mechanical trauma
- Nutritional deficiencies, medications
- chemical, heat
- microorganisms
How do you treat reactive lesions?
Identify the key factor, take causative agent away otherwise recurrence is likely. Tissue may regenerate and repair.
A healthy 24yr old female has developed a focal enlargement in her mandibular anterior gingiva. It has slowly growing within the last year in an area with significant amounts of calculus. Which of the following is LEAST likely to be the diagnosis?
a. peripheral giant cell granuloma
b. medication-induced gingival enlargement
c. fibroma
d. pyogenic granuloma
b. medication-induced gingival enlargement.
In the seventh month of her pregnancy, your 25 year-old patient develops a red spongy, vascular lesion on the marginal gingiva of #14. What is the best diagnosis?
a. Pyogenic granuloma
b. Neurofibroma
c. Granular cell tumor
d. Mucosal neuroma
a. pyogenic granuloma
Pyogenic granuloma is a response to local irritation or trauma.
Which reactive growth develops under an ill-fitting denture and clinically resents with multiple small pebbly nodules?
a. hemangioma
b. peripheral giant cell granuloma
c. epulis fissuraum
d. inflammatory papillary hyperplasia
d. inflammatory papillary hyperplasia
What are the common reactive lesions?
- Fibroma
- Epulis Fissuratum
- Inflammatory papillary hyperplasia
- Peripheral Giant Cell Granuloma
- Peripheral Ossifying Fibroma
- Pyogenic Granuloma
What is a fibroma?
(irritation/traumatic fibroma) not a true neoplasm - a reactive hyperplasia in response to local irritation.
Where is the most common location of a fibroma?
Buccal mucosa on the bite line
What does a fibroma look like?
Smooth surfaced pink nodule.
What is the proper treatment of a fibroma?
Conservative surgical excision.
What is an epulis fissuratum (inflammatory fibrous hyperplasia)?
Tumor-like hyperplasia in association with flange of an ill-fitting denture.
Where is epulis fissuratum look like?
Hyperplastic tissue in the vestibule.
When your patient presents with epulis fissuratum how does their denture usually fit?
The flange of denture fits into the fissure.
What is the proper treatment for epulis fissuratum?
Surgical removal of hyperplastic tissue and correction of the denture.
What is inflammatory papillary hyperplasia?
“denture sore mouth” associated with candida, presents as mucosa red with pebbly/papillary surface.
What typically causes inflammatory papillary hyperplasia?
- ill-fitting denture
- poor denture hygiene
- wearing denture 24hrs a day
Where does inflammatory papillary hyperplasia typically occur?
Hard palate beneath a denture.
What is the proper treatment for inflammatory papillary hyperplasia?
Excise lesion before fabricating a new denture.
What is a peripheral giant cell granuloma?
Reactive growth on interdental gingiva or edentulous ridge.
Describe a peripheral giant cell granuloma.
Red or reddish-blue nodular mass, that can be sessile or peducaulated.
What causes proliferation of a peripheral giant cell granuloma?
Proliferation arises from irritation or trauma.
What percentage of peripheral giant cell granulomas are ulcerated?
50%