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Oral Pathology Flashcards

1
Q

Where are squamous cell carcinomas of the tongue most common?

A

On the lateral border of the tongue and the floor of the mouth.

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2
Q

What are squamous cell carcinomas of the tongue associated with?

A

They are aggressive tumours associated with other co-morbidity

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3
Q

What is a cyst?

A

A pathological cavity filled with fluid (gaseous or semi-fluid but not created by pus accumulation) and is lined by epithelium

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4
Q

What are the clinical features of a cyst?

A

Noticeable swelling Discharge into the mouth Pain due to secondary infection

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5
Q

How are cysts diagosed?

A

Combination of adequate history, clinical examination, and selected investigation (radiographs)

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6
Q

How are cysts classified?

A

They are either epithelial or non-epithelial.

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7
Q

What are non-epithelial cysts also known as?

A

Pseudocysts (eg. solitay bone cyst and aneurysmal)

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8
Q

What are the types of epithelial cysts?

A

Odontogenic Non-odontogenic

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9
Q

What are the types of non-Odontogenic cysts? What causes non-odontogenic cysts?

A

Nasopalatine duct cysts Nasolabial There are related to developmental defects

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10
Q

What are the the types of odontogenic cysts?

A

Inflammatory Developmental

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11
Q

What is another name for inflammatory odontogenic cysts?

A

Radicular cysts (Can be apical, lateral, or residual) Paradental cysts

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12
Q

Where do radicular inflammatory cysts appear?

A

Close to apex of root of the tooth (apical) Side of the root of the tooth (Lateral) When tooth is extracted the lesion is residual. (residual)

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13
Q

What are paradental cysts?

A

A group of inflammatory odontogenic epithelial cysts.

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14
Q

What are the subtypes of developmental cysts?

A

Dentigerous Odontogenic keratocyst Lateral periodontal Gingival - infants Gingival - adults Eruption cyst (cyst that interrupts eruption of the tooth)

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15
Q

What is a potential consequence of odontogenic keratocysts?

A

Can cause large amount of destruction to mandible or maxillary bone.

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16
Q

What percentage of all jaw cysts are radicular cysts?

A

60 - 75% (Most common)

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17
Q

What ages are radicular cysts most commonly seen in?

A

Peak in 4th adn 5th decades of life.

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18
Q

What are radicular cysts commonly seen in?

A

It is associated with non-vital tooth (Dead teeth where hard tissue is alive but soft tissue has died often due to necrotic bulb within tooth) Most common tooth it is seen in is upper lateral incisor.

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19
Q

What teeth are radicular cysts rare in?

A

It is rare in deciduous teeth.

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20
Q

What do the progression of symptoms look like in radicular cysts?

A

Asymptomatic or expansion -> springy -> egg-shell crackling -> fluctuation Usually these cysts are asymptomatic until they are infected.

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21
Q

Types of radicular cysts:

A

Apical where the cyst is located at the root of the tooth.

Lateral where the cyst is directly lateral to the root of the tooth

Residual where the cyst is located in the socket of the tooth that has been pulled out.

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22
Q

What radiological methods can be implemented for diagnosis of radicular cyst?

A

X-ray

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23
Q

How are radicular cysts treated?

A

They must be removed. They can be destructive to teeth if not fixed.

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24
Q

How are radicular cysts diagnosed?

A

Soft tissue biopsy

X-ray

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25
What would a biopsy of radicular cysts show?
Cholesterol crystals Serum proteins Water and electrolytes Breakdown of cell products
26
What tissue lines a radicular cyst?
Non-keratinised stratified squamous epithelium (diagnostic feature) Foam cells, lymphocytes, plasma cells, cholesterol clefts, and surrounding fibrosis. Lining becomes thinner and less inflamed.
27
What are odontogenic keratocysts known as now? Why?
Odontogenic keratocystic tumours because they are very aggressive and they are associated with genetic mutations.
28
What percentage of jaw cysts are odontogenic keratocysts?
5 - 10% of all jaw cysts
29
Where on the jaw do odontogenic keratocysts most commonly present?
70 - 80% on mandible 50% on the angle/ramus
30
What are the symptoms of odontogenic keratocysts?
Often asymptomatic (unless there is a concurrent infection) Swelling Discharge Pain Pathological fracture Tooth displacement Rarely buccal expansion
31
True or False; Odontogenic keratocysts have a high recurrance rate.
True
32
What does a odontogenic keratocyst look like radiologically?
Well demarcated radiolucency Pseudolocular or multilocular often with scalloped periphery Root or tooth displacement
33
What are the contents of the odontogenic keratocyst?
Stratified squamous epithelium (para-keratinised or keratinised) Basal cells are unique, uniform and palisaded
34
How are tumours different structurally to cysts?
Tumours typically have irregular margins and cysts have well defined margins. This is why odontogenic keratocysts were originally named cysts.
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How do Odontogenic keratocysts enlarge?
Anteroposteriorly without causing bucco-lingual expansion. (this is why it can cause lots of damage before being discovered)
37
What is the recurrence rate of odontogenic keratocysts?
Up to 60%
38
How do odontogenic keratocysts commonly recur?
Remnants can multiply and can form another cysts They can also form satellite cysts
39
What do odontogenic keratocysts look like?
Thin, friable capsule Can be associated with a genetic symptom called Gorlin-Goltz of multiple basal cell naevus syndrome.
40
What does Gorlin-Goltz syndrome result in?
Production of many odontogenic keratocysts as well as basal cell carcinomas
41
Where do odontogenic tumours most commonly form?
In posterior mandible
42
What is the difference between orthokeratinised and parakeratinised odontogenic keratocysts?
With orthokeratinised cysts there is a complete keratinisation With parakeratinisation there are visible nucleus remnants near the surface of the cyst.
43
Where are odontogenic tumours most commonly found?
In posterior mandible
44
What are the classes of benign odontogenic tumours?
Odontogenic epithelium without odontogenic ectomesenchyme Odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation Odontogenic ectomesenchyme with or without included odontogenic epithelium
45
Where do tooth develop from originally and what structures of teeth arise from these locations?
Tooth develops from tooth germs (epithelial layer and mesenchymal layer) Both layers produce hard tissues. Enamel is produced from epithelial component. Dentin is produced by ectomesenchyme tissue (dental papilla). (Mutation in all of these cells can produce a neoplasm.)
46
What are the types of tumours with odontogenic epithelium without odontogenic mesenchyme?
Ameloblastima Squamous odontogenic tumour Calcifying epithelial odontogenic tumour (Pindborg Tumour)
47
What are the types of tumours with odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue?
Ameloblastic fibroma Ameloblastic fibro-dentinoma Ameloblastic fibro-odontome Adenomatoid odontogenic tumour Calcifying odontogenic cyst Complex odontome Compound odontome
48
What we need to know regarding neoplasms of the oral cavity:
Tumours can be epithelial, mesenchymal or both
49
What are some examples of odontogenic ectomesenchyme with or wothout included odontogenic epithelium?
Odontogenic fibroma Myxoma Benign cementoblastoma
50
What are the types of malignant odontogenic tumours?
Clear cell odontogenic carcinoma Malignant ameloblastoma Primary intra-osseous carcinoma Malignant variants of other odontogenic epithelial tumours Malignant changes in odontogenic cysts
51
What is the most common type of odontogenic malignant tumour?
Ameloblastoma (cancer of the cells that are responsible for producing enamel)
52
Who most commonly gets ameloblastomas?
Males \>40 years old Black people
53
Are ameloblastomas fast or slow growing?
Slow growing but radioresistant extend anteriorly-posteriorly
54
How are ameloblastomas treated?
It required excision of the entire area of the mandible.
55
What does histologic evaluation of ameloblastoma looke like?
Reverse polarity (nucleus on the opposite side) is the main characteristic feature of ameloblastoma.
56
What are Oral Potentially Malignant Disorders (OPMDs)?
They are conditions that are characterized with an increased risk of malignant transformation.
57
58
What do OPMDs look like?
white, red, and ulcerated lesions (leukoplakia and erythroplakia)
59
What is leukoplakia?
White ulcerated lesion that is an OPMD with 0 - 34% chance of malignant transformation.
60
What is erythroplakia?
Very rare red OPMD lesion which has a 90% change of becoming cancer.
61
Who is more prone to cancer progression from OPMDs?
Females
62
What percentage of people develop OPMDs?
4 - 5%
63
What are the risk factors of OPMDs?
Tobacco (both smoked and chewed) 10x Alcohol 4 - 5x Tobacco and alcohol use simultaneously increase the risk to 17x HPV type 16 and 18 infection (95% of pharyngeal carcinomas) Unbalanced diet
64
Why does eryhtroplakia appear red?
Apoptosis of tissue overlying blood vessels causes redness to form
65
What does dysplasia tell us?
Dysplasia is the gold standard to assess risk of malignant transformation. (Dysplasia refers to an alteration in the size shape and organisation of the cellular components of a tissue)
66
What kind of architecture changes are observed for chances of OPMD conversion into malignancy?
Irregular epithelial stratification Loss of polarity of basal cells Drop-shaped rete ridges Increased number of mitotic figures Abnormally superficial mitoses Premature keratinisation in single cells Keratine pearls within rete ridges
67
What kind of cytology changes are observed for chances of OPMD conversion into malignancy?
Abnormal variation in nuclear size and shape Abnormal variation in cell size and shape Increase Nuclear-cytoplasmic ratio Increase in nuclear size Atypical mitoses Increase number and size of nucleoli Hyperchromatism
68
What does histology tell us about the severity of basal cell carcinoma?
Lower third is considered mild Lower 2/3rds is considered moderate If it extends to full thickness it is called full carcinoma
69
Why do leukoplakias form?
The thickness of the tissue above the blood vessels blocks the redness from the blood vessels from showing.
70
What layer is thicker in leukoplakia?
The keratin layer and the cells that produce keratin
71
What does severe dysplasia/carcinoma in situ look like?
Mitotic divisions everywhere with random cell sizes as well as drop shaped rete ridges. The reason it is called carcinoma in situ is because there is no ridge for the basement membrane so it can grow very quickly.
72
How common are oral cancers?
Oral cancer ranks 12th among all cancers in prevalence worldwide. When combined with pharyngeal cancer it ranks 6th in the world.
73
What is the prognosis of oral cancer?
It is associated with low prognosis rate (nearly 50% for 5 years) This can be diagnosed very easily but it has delayed diagnosis and it is unknown when neoplasms can undergo malignant transformations.
74
Which country is most commonly associated with oral cancer and why?
Chewing Betel nut in India makes it the most common country to have oral cancers
75
How common is oral cancer in Australia?
4500 every year (900 - 1000 in WA every year)
76
What are the risk factors for oral cancers?
HPV Betel nuts Sun exposure (decrease in number of the lip but increase in tongue and soft palate)
77
What are the signs/symptoms of oral squamous cell carcinoma?
A long standing white patch A small exophytic growth (possibly with no ulceration) A long standing red patch These lesions are generally painless Features that should be viewed with suspicion: Ulceration, induration (fixed lumps), fixation to underlying structures, bone destruction
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How are oral cancers treated?
Surgery Radiotherapy Chemotherapy Anti-monoclonal antibodies
80
What is the 5 year survival rate of oral cancer?
Stage I: \>80% Stage II: ~60% Stage III: ~35% Stage IV: \<15%
81
How are oral cancers staged?
TNM classification: Extent of the Tumour (T) The spread to nearby lymph Nodes (N) The spread to distant sites (Metastasis) (M)
82
How can oral cancer be prevented?
Late diagnosis contributes to advanced stage disease and poor prognosis Smoking and alcohol cessation Early detection is so important in improving the survival rate Oral cancer screening

IMED3001 (46 decks)

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