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%
Typically how big are pheripheral giant cell granulomas?
less than 2 cm, some are bigger.
What is a peripheral ossifying fibroma?
Reactive growth found exclusively on gingiva.
Describe a peripheral ossifying fibroma.
Pedunculated/sessile nodular mass, Red-pink in color ulcerated from trauma.
What is a common issue with a peripheral ossifying fibroma?
Can become large and interfere with eating or speaking.
What is a pyogenic granuloma?
proliferation by local irritation.
Describe a pyogenic granuloma?
Smooth/lobulated mass that bleeds easily and is vascular.
Where is a pyogenic granuloma typically found?
Common on gingiva in children and young adults.
What is are common causes of a pyogenic granuloma?
Poor oral hygiene, or hormones it can be called a “pregnancy tumor”.
What is the proper treatment of a pyogenic granuloma?
May resolve without treatment but reccurence is common.
What are common types of physical injuries of the oral tissues?
Nicotine Stomatitis
Mucocele
Amalgam tattoo
What is nicotine stomatitis?
Long-term cigar & pipe smoking, palatal mucosa diffusely gray or white.
Descibe the typical patient that may present with Nicotine stomatitis.
Male, 45+, smoker.
How is nicotine stomatitis developed?
Develops in response to HEAT not chemicals in tobacco smoke.
Describe what nicotine stomatitis looks like in the oral cavity.
Numerous slightly elevated papules with pinpoint red centers, inflamed and altered minor salivary gland ducts.
Is nicotine stomatitis reversible?
Yes, if there is discontinued use of the source that causes it.
What is a mucocele (mucous retention cyst)?
Dilation of minor salvary glands secondary to duct obstruction or trauma. Mucus secretion accumulates, and eventually ruptures.
What does a mucocele look like?
Mobile, smooth soft.
Where is the most common place a mucocele presents in the mouth?
Lower lip is the most common area.
What is a mucocele in the floor of the mouth called?
Ranula
Describe a ranula.
Blue, dome-shaped, fluctuat swelling that is typically unilateral.
What is an amalgam tattoo?
Silver particles of amalgam accidentally embedded into tissue during restoration.
How does an amalgam tattoo present on a x-ray?
Radiopaque
What is Tobacco Pouch Keratosis?
Site at which pt holds snuff typically in the vestibule, gingiva, labial & buccal mucosa.
Describe what a snuff pouch (tobacco pouch keratosis) looks like.
Velvety pouch or thin gray white translucent plaque may appear wrinkled in appearance.
What does a tobacco pouch keratosis cause?
painless gingival recession.
How do the chances of getting cancer change for a person who uses snuff?
Chances are 4 times greater for a patient who uses snuff.
How long does a snuff pouch need to be there before it is biopsied?
1 month
What is cellulitis?
Acute inflammation of the periapical infection, particularly an abscess, surrounding soft tissues of the jaws.
How do you treat cellulitis?
Antibiotics
What is actinomycosis?
Abscess has no where to drain and causes a bacterial infection.
What is a severe swelling of the tongue?
Ludwig’s angina
What can cause ludwig’s angina?
A dental abscess that spreads along facial planes causing a parapharyngeal abscess resulting in constriction of airway.
What is the proper treatment of a dental abscess?
Antibiotics, extraction, endo tx.
Where is an operculum found?
Over partially erupted 3rd molars.
What is pericoronitis?
Acute inflammation of mucosa around crown of a partially soft-tissue and/or osseous impacted tooth.
What causes pericoronitis?
Normal flora composed of many types of bacteria proliferate in pocket between soft tissue & crown.
What is the proper treatment for pericoronitis?
Mechanical debridement
Oral irrigation
Antibiotic therapy
What is the etiology of syphilis?
Treponema pallidum (spirochete)
What is congenital syphilis?
Syphilis passed from mother to child during fetal development or at birth.
What clinical implication is associated with congenital syphilis?
Hutchinson’s incisors
What are the 3 stages of syphilis?
Primary: Chancre
Secondary: Mucous patch
Tertiary: Gumma
When does a chancre typically appear?
2-3 weeks after infection, the sore heals within 6 weeks.
When does the secondary presentation of syphillis occur?
4-6 weeks after the primary presentation “chancre”.
What does a tertiary presentation of syphilis look like?
The tertiary presentation called a gumma looks like a granuloma.
What is the proper treatment of syphilis?
Penicillin at all stages.
What are characteristics of a malignant neoplasm?
- Result of abnormal cell division, mitotic activity
- Reproduce abnormally in disorderly fashion
- Good blood supply (oxygen & nutrients)
- Invasive, change in size & shape of cells
- Carcinogens cause neoplasm and alter DNA of cell
What are different types of carcinogens?
Chemical Bacterial toxins Virus Physical Radioactivity Actinic radiation
What are chemical carcinogens?
Hydrocarbons from tobacco, colvents, cosmetic sprays, etc.
What is dysplasia?
Mutations that lead to cell proliferation. Abnormal changes in formation of tissue.
How does dysplasia begin?
Can begin as harmless looking lesion but often visible as a change in color to white, red, or mixture.
Is it possible for a dysplasia lesion to revert back to normal?
Yes, if the stimulus is removed (smoking).
What is low grade dysplasia?
Transformation of low grade dysplasia to cancer is low.
What is high grade dysplasia?
Some risk of transformation to cancer.
What is epithelial dysplasia?
Pre-malignant condition.
What is leukoplakia?
“White patch” or plaque that can’t be SCRAPED off and characterized clinically or pathologically as any other disease - WHO
What is the percentage of oral cancer that starts as a white lesion?
80-90%
Where are the common sites leukoplakia can be found?
Lateral and ventral tongue, and floor of the mouth.
What percentage of Leukoplakia is pre-malignant?
10-20%
What is erythroplakia?
Clinical term for chronic red macule/plaque which cannot be rubbed off.
Which prognosis is worse, erythroplakia or leukoplakia?
Erythroplakia
What is erythroplakia NOT attributed to?
Inflammation
Candidiasis
Vascular lesions
What can contribute to erythroplakia?
Alcohol & tobacco use
Who typically gets erythroplakia?
Common in older men
Where is erythroplakia typically found?
Floor of the mouth, tongue, soft palate
What percentage of severe dysplasia is carcinoma in situ or squamous cell carcinoma?
90%
What is the most common epithelial malignancy of the oral cavity?
Squamous Cell Carcinoma
What other malignancies can occur in the mouth?
Salivary gland, blood cells, bone, and melanocytic
What does squamous cell carcinoma develop from?
Dysplasia
What are risk factors for squamous cell carcinoma?
Tobacco Heavy alcohol use Sun exposure Products containing betel nut HPV
What are clinical features of squamous cell carcinoma?
Exophytic Endophytic Leukoplakic Erythroplakic Erythrolukoplakic
What does exophytic mean?
Mass-forming
What does endophytic mean?
Ulcerating
What does leukoplakic mean?
White patch
What does Erthropakic mean?
Red patch
What does Erythroleukoplakic mean?
Speckled
Where are common locations squamous cell carcinoma can be found?
Ventral-lateral posterior tongue Floor of the mouth Soft palate Tonsillar pillars Retromolar area
What is the MOST common location squamous cell carcinoma is found?
Ventral-lateral posterior tongue
What location of squamous cell carcinoma is the worst prognosis?
Floor of the mouth.
Why is the floor of the mouth the worst prognosis for squamous cell carcinoma?
In this area the squamous cell carcinoma is most likely to metastasize.
What is the proper treatment and prognosis for squamous cell carcinoma?
Excision Radiation Chemotherapy Neck dissection (if metastasized) TNM Clinical staging (higher stage = worse prognosis)
What are the best indicators for the prognosis of squamous cell carcinoma?
Tumor size & extent of metastatic spread.
What is the most common skin cancer, malignant tumour, that does not occur intraorally?
Basal cell carcinoma
What is believed to be the origin of basal cell carcinoma?
Hair shaft in origin.
What is basal cell carcinoma associated with?
Sun exposure
What are characteristics of basal cell carcinoma?
Non-healing skin ulcer with rolled boarders
Cratered center
Occasionally bleeds
What is the proper treatment of basal cell carcinoma?
Surgical and/or radiation therapy
What is the prognosis of basal cell carcinoma?
Good, but may have recurrences or other sun-related malignancies.
What is a melanoma?
Malingant tumor of melanocytes.
Where can melanomas be found?
Skin (acute sun damage)
Oral cavity
Eye
Nasal cavity
What neumonic is used to evaluate a melanoma?
A: asymmetry B: irregular borders C: color variation D: diameter larger than a pencil eraser E: evolving
What is the prognosis of a melanoma?
Poor prognosis, 5-20% have a 5 year survival rate.
What is common treatment for a melanoma?
Radical surgery, often hemimaxillectomy.
What viral infections affect the oral cavity?
HPV Hairy Leukoplakia Epstein Barr Virus Herpes Simplex HIV
What is HPV?
Verruca Vulgaris, benign squamous papilloma.
What causes HPV?
Paipillomavirus
How does HPV spread?
Contagious spreads by autoinoculation.
How does HPV affect skin cells?
Causes skin cells to proliferate forming a wart.
Where is HPV commonly found intraorally?
Labial mucosa, and anterior tongue.
What is the recommended treatment for HPV?
Excision
What is oral hairy leukoplakia?
Faint white vertical to thickened & furrowed areas of leukoplakia.
What is the etiology of oral hairy leukoplakia?
Epstein Barr Virus
Where does hairy leukoplakia occur?
Lateral of the tongue
What patients typically present with oral hairy leukoplakia?
Immuno-compromised patients
HIV
Smoking more than 1pk/day
Ulcerative colitis
What is epstein barr virus?
The cause of infectious mononucleosis.
How is Epstein Barr virus transmitted?
Saliva
What are clinical symptoms of Epstein Barr virus?
Fatigue, fever, enlarged spleen
What are clinical oral signs of Epstein Barr virus?
Palatal petechiae
How is Epstein Barr virus diagnosed?
Blood work
What is the treatment for Epstein Barr virus?
Rest, or steroids if severe.
What are the two types of herpes simplex virus?
Type 1: Oral
Type 2: Genital
Where does herpes simplex virus lie dormant?
HSV is dormant in the trigeminal ganglion and travels back and forth via sensory axons on the peripheral skin or mucosa.
What is primary acute herpes gingivostomatitis?
First exposure to herpes simplex virus usually seen in young children ages 6months - 6 years
What are characteristics of acute herpes gingivostomatitis?
Numerous mucous membrane lesions
Acute gingivitis and eruption of vesicles that rupture leaving ulcers
Heals in 10-14 days
What is the proper treatment of acute herpes gingivostomatitis?
Palliative
What are secondary herpes simplex infections?
Secondary lesions called fever blisters or cold sores.
What triggers the recurrence of secondary herpes simplex infections?
UV light
Trauma
What are prodromal symptoms?
When the patient can feel the secondary herpes simplex infection coming on…
How early is the onset of prodromal symptoms of a secondary herpes simplex infection?
6-24 hours before the lesion appears the patient can feel pain and itching.
Where are secondary herpes simplex infections typically found?
Usually located extra orally
How do secondary herpes simplex infections appear?
They appear as vesicles that rupture to form ulcers.
How do secondary herpes simplex infections present intraorally?
Intraoral lesions are in form of ulcers & located on the bound to bone mucosa. Found on keratinized mucosa and follow certain stimuli.
What does AIDS stand for?
Acquired immunodeficiency syndrome
What is the etiology of aids?
Human immunodefiency virus (HIV)
How is aids transmitted?
Sexual contact
Blood or blood products
