Oral Pathology - ABGD Oral Board Review Flashcards
What is going on here?
Hereditary Hemorrhagic Telenglectasia
What should you examine a mucocele for?
- Examine carefully for presence of obstruction
- Foreign body
- Sialolith
What is going on here?
Melanoacanthosis
What is going on here?
Peutz-Jeghers Syndrome
What is going on here?
Dense Bone Island/Idiopathic Osteosclerosis
What is the suggested treatment for Minor Apthous Stomatitis?
- Option A
- No treatment
- Avoidance or irritating agents
- Option B
- Fluocinonide (Lidex), 0.05% gel
- Apply to affected areas 2-3 times per day
- Fluocinonide (Lidex), 0.05% gel
- CAUTION: Oral candidiasis
What is the suggested treatment for Erythema Multiforme?
- Patients often admitted
- Systemic steroids
- Prednisone, tapering dose
- IV immunoglobulins
- IV fluids
What are the 5 most common Odontogenic Tumors?
- Ameloblastoma
- Adenomatoid Odontogenic Tumor
- Ameloblastic Fibroma
- Ameloblastic Fibro-Odontoma
- Odontoma
What is going on here?
Fibrous Dysplasia
Describe a Peripheral Giant Cell Granuloma…
- Usually red/purple, bleed
- Associations: hyperparathyroidism (if intraosseous component)
- Histology: multinucleated giant cells
What is this an image of?
T1 of a Medulloblastoma
“Highlights differences in soft tissue densities”
What usually always favored the lower lip?
Mucocele
What is going on here?
Mucocele
What is going on here?
Fibroma, Giant Cell Type
What is going on here?
37 yo M with known Garner Syndrome, multiple osteomas
What are 3 terms to describe images in CT imaging?
- Hyperdense
- Hypoedense
- Mixed intensity/heterogeneous
What other diagnostic tests may be indicated in cases such as these (mixed red white lesions)?
- Incisional biopsy, with either routine histology (10% formalin) or immunofluorescence (Michel solution)
- Diagnostic devices that use cytology, reflectance, fluorescence or saliva analysis may be highly sensitive (they will
indicate disease when present) but less specific (many false positives); the evidence indicates these tests are less
specific than visual exam with magnification and illumination
What is a good rule of thumb regarding Salivary Gland Tumors and location?
80 - 50 - 20 rule
80% parotid benign, 50% submandibular/minor benign, 20% sublingual benign
What is going on here?
Lateral Periodontal Cyst (and/or botryoid variant)
What is going on here?
Dentinogenesis Imperfecta with Opalescent Dentin
What is going on here?
Leukemic Infiltrate
What is going on here?
Ameloblastic Fibro-Odontoma 14 yo
Image is seen with Odontoma Component
What is going on here?
Mucoepidermoid Carcinoma
What is going on here?
Fibrous Dysplasia
What is going on here?
Periapical Cemento-Osseous Dysplasia
What view is this?
Coronal
What is going on here?
Ameloblastoma (crossing the midline)
- Most common odontogenic tumor
What is going on here?
Buccal Birfurcation Cyst
Inflammatory Cyst
What is going on here?
- Geographic Tongue
- Erythema Migrans or Migratory Glossitis
What is going on here?
17 yo, multiple central giant cell granulomas - cherubism
What kind of process is going on in regards to antral pseudocyst and what should you do about it?
- Inflammatory
- Secondary to sinus inflammatory process (sinusitis)
- Secondary to dental inflammatory process (periapical pathosis)
- “Relative Radiopacity” in sinus
- Consider vitality testing of the teeth in the quadrant
- Consider periodontal evaluation ofthe teeth in the quadrant
What do you know about Pemphigus?
- Autoimmune process (against epithelial cell-cell attchments)
- Look for ragged/irregular ulcers elsewhere (buccal, palatal)
- You are likely to elicit a Nikolski (blister formation)
- Histology: “suprabasilar acantholytic process”
What is going on here?
Stafne Defect
- Lingual mandibular salivary gland defect
What is going on here?
How would you treat this?
- Diagnosis: (ulcerated) fibroma
- Differential Diagnosis:
- Fibroma
- Pyogenic Granuloma
- Soft Tissue Tumor (Neuroma, Neurofibroma, Neuroma)
- Biopsy to exclude other soft tissue lesionsd (ex. pyogenic granuloma, neuroma, neurofibroma, lipoma)
What does MRI stand for?
What must you caution for?
- Magnetic Resonance Imaging
- No harmful radiation (uses a magnetic field)
- Caution:
- cardiac pacemakers
- certain metallic implants
What is going on here?
Primary Herpetic Gingivostomatis
What does a Cobweb Trabeculation apperance go with?
Odontogenic Myxoma
What are some contraindications to CT?
- Allergy to contrast agent
- Compromised renal function
What is CT imaging best used for?
Better hard tissue contrast
What is the suggested treatment for Major Apthous Stomatitis?
- Option A
- No treatment
- Avoidance of irritating agents
- Option B
- Fluocinonide (Lidex), 0.05% gel
- Apply to affected areas 2-3x per day
- Fluocinonide (Lidex), 0.05% gel
- Option C
- Clobetasol (Temovate), 0.05% gel
- Apply to affected areas 2-3 times per day
- Clobetasol (Temovate), 0.05% gel
- Caution: Oral Candidiasis
Observe this helpful image…
What is going on here?
Pemphigoid
What does Beaten Copper/Beaten Metal appearance go with?
Crouzon and Apert Syndromes
Hypophosphatasia
What is going on here?
Herpes Labialis and Whitlow
What is going on here?
Squamous Papilloma (human papilloma virus)
What is going on here?
Pyostomatitis Vegetan (ulcerative colitis)
What is going on here?
Lipoma
What % of all cases of idiopathic osteosclerosis are associated with root resorption?
9-12%
What is going on here?
What can cause this?
- Gingival Overgrowth (medication induced)
- Anti-seizure medications
- Dilantin
- Chemotherapeutics
- Cyclosporine
- Calcium Channel Blockers
- Enalapril
What is going on here?
Hyperparathyroidism
39 yo M, parathyroid disease, elevated PTH; biopsy; central giant cell granuloma
What is going on here?
Hemangioma
What is going on here?
Multiple Myeloma
67 yo F, history of myeloma; prior pathologic fractures of L mandible
Describe a Peripheral Odontogenic Fibroma…
- Pink to red
- Associations: none specific
- Histology: epithelial odontogenic rests
What is going on here?
Squamous Cell Carcinoma (Stage IV; lymph node metastases arrows)
What is going on here?
Pemphigoid
What is this imaging dipicting?
PET scan of primary/nodal disease
What are some common bacteria in Oral Ulcers and Lymphadenopathies?
- Streptococcal and Staphylococcal species
- Treponema
- Bartonella
- Actinomycetes
What is going on here?
Squamous Cell Carcinoma
- Differential Diagnoses:
- Exclusion of malignancy in an otherwise unexplainable red/white lesion
What is going on here?
- Differential Diagnoses:
- Pyogenic Granuloma
- Peripheral Ossifying Fibroma, Odontogenic Fibroma, Giant Cell Granuloma
- Langerhans Cell Histiocytosis
What are some common Non-Odontogenic Tumors?
- Traumatic Bone Cyst
- Central Giant Cell Granuloma
- Aneurysmal Bone Cyst
- Langerhans Cell Histiocytosis
How can the dental team manage nutritional deficiencies, and should they?
- Nutritional counseling can be performed by a dentist if an appropriate food diary is developed by the patient
- Nutritional supplementation, however, should be managed by a physician, nutritionist/dietician or other health care
professional trained in these areas; a thorough analysis including bloodwork may be required, and GI or other metabolic
diseases may need to be excluded
What is going on here?
Where can they be found?
- Lymphoepithelial Cyst
- Can be found
- Adenoids
- Palatine Tonsil
- Lingual Tonsil
- Foliate Papillae
What is going on here?
Amelogenesis Imperfecta (Hypoplastic)
What is this?
What would you consider doing about it?
- Peripheral Giant Cell Granuloma
- Consider
- Periodontal Probing
- Periapical Radiographs
- Vitality Testing
What is going on here?
Cat Scratch Disease (Bartonella)
If you are uncertain about what is going on when you observe Desquamative Gingivitis, what would you consider doing?
- Consider (direct) immunofluorescence (IF)
- Submit fresh tissue directly to the lab if you have capability
- Submit in Michel’s solution if you have to send the specimen
- Split specimens (half formalin, half MIchel’s)
What is going on here?
Pemphigus
What is going on here?
Dense Bone Island/Idiopathic Osteosclerosis
What does a Sunburst/Sunray Opacification apperance suggest?
Osteosarcoma
Condrosarcoma
Hemangioma
What is going on here?
Multiple Odontogenic Keratocysts; consider nevoid basal cell carcinoma syndrome
What exactly is a Ranula?
Ranula = mucocele in the floor of the mouth
What is going on here?
Dentinogenesis Imperfecta with Opalescent Dentin
What is going on here?
Pyostomatitis Vegetans (ulcerative colitis)
What is going on here?
Pemphigus
What is going on here?
Central Giant Cell Granuloma
- May consider:
- Calcitonin
- Corticosteroids
- a-interferon
What is going on here?
Fibrous Dysplasia
What is going on here?
Dentinogenesis Imperfecta with Opalescent Dentin
What is going on here?
12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome
What is going on here?
Granular Cell Tumor
What is going on here?
Pemphigus
What is going on here?
Herpes Zoster
What does a Punched Out Lesion appearance suggest?
Myeloma (in adults)
Lngerhands Cell Histiocytosis (in children)
What is going on here?
Multiple Myeloma
What is Dentinogenesis Imperfecta/opalescent dentin associted with?
- Pulpal defects
- Defects in or absence of root morphology
- Osteogenesis imperfecta
- Overlaps with dentin dysplasia
What is going on here?
What do you think is the etiology?
- Mucosal Slough
- Consider
- Mouthwash
- Dentifrice
- Dietary
What is this?
What would you consider doing about it?
- Pyogenic Granuloma
- Consider
- Periodontal Probing
- Periapical Radiographs
- Vitality Testing
What is going on here?
Lymphoma (non healing periradicular lesion following NSRCT)
If you see desquamative gingivitis, what are your 3 top differentials?
- Erosive Lichen Planus
- Pemphigoid
- Pemphigus
What is going on here?
Melanoma
What are 4 Soft Tissue Masses that are Neoplastic?
- Neuroma
- Neurofibroma
- Lipoma
- Granular Cell Tumor
What is going on here?
Dentinogenesis Imperfecta with Opalescent Dentin
What is going on here
Acinic Cell Adenocarcinoma
This would also be a common site for mixed tumor and Warthin Tumor
What is going on here?
Syphilis (Treponema)
- Primary
- Chancre
- Secondary
- Mucus patch
- “Split papule”
- Condyloma lata
- Tertiary
- Gumma
- Congenital
- Dental deformities
- Developmental delay
What is going on here?
Mucocele (superficial)
What is going on here?
Taurodontism
What is going on here?
Morsicatio (frictional keratosis)
What % of formalin do you put biopsies in?
10% buffered formalin for routine histology
What is this?
What would you consider doing about it?
- Peripheral Odontoma
- Consider
- Periodontal Probing
- Periapical Radiographs
- Vitality Testing
What is going on here?
Apthous Ulcer (apthous stomatitis)
What is going on here?
What duct is near this location?
Sialolith
(painful hard nodule, Stensel’s duct)
What are some treatment complications for Antivirals?
Little or none in our context
Describe the clinical history of Necrotizing Sialometaplasia?
- Pain
- Rapid Onset
- Rapid Ulceration (“part of palate fell out”)
What usually favors the upper lip?
Favors Monomorphic (canalicular) adenoma
Favors pleomorphic adenoma
What are some abnormalities that have Enamel Defects?
- Consider spectrum of tricho-dento-osseous syndrome
- Consider spectrum of ectodermal dysplasias
What is going on here?
Paraneoplatic Pemphigus
What is going on here?
Paraneoplastic Pemphigus
What is going on here?
9 yo F, nelarged tongue, multiple cafe au lait macules
Multiple Endocrine Neoplasia
In the world of Herpesviruses, what are HHV-1 through HHV-4 associated with?
- HHV-1 (HSV-1): Oral and mucosal herpetic lesions
- HHV-2 (HSV-2): Oral and mucosal herpetic lesions
- HHV-3 (VZV): Chicken pox, Herpes zoster
- HHV-4 (EBV): Infectious Mononucleosis, Oral Hairy Leukoplakia, Malignancies (Hodgkin’s, Nasopharynx)
How would a lymphom and an HPV-related oropharyngeal carcinoma be treated (differently)?
- Setting aside causes of HPV-related disease (early sexual activity, multiple partners, non-vaccinated) vs lymphoma
(multiple including genetics, cancer causing agents, some infectious diseases such as EBV-related Hodgkin lymphoma’
and Helicobaacter pylori association with GI mucosal related lymphomas), each may require chemoradiotherapy in
addition to any surgical intervention; the chemotherapy agents will differ, and outcomes may differ [HPV related oral
and oropharynx cancers are noted to have higher survival rates vs non-HPV related oral cancers; lymphomas are highly
variable in therapeutic response, depending on the specific diagnosis and genetic alterations]
Does Lichen Planus require treatment?
- Asymptomatic: not required, though biopsy may be indicated to exclude other diseases
- Symptomatic: consider topical steroid
- Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one)
Clobetasol Fluocinonide 0.05% gel, DISP 30 gram tube, SIG apply to affected area twice per day, REFILLS = 1 (one)
What is going on here?
Hyperparathyroidism
Describe the transition of Cemento - Osseous Dysplasia
Usually begin radiolucemt and may opacity over time
What is going on here?
Lichenoid Mucositis
(with associated lichenoid dermatitis)
What is going on here?
Mucoepidermoid Carcinoma
If you see Central Giant Cell Granulomas…consider…
Cherubism
Parathyroid/renal disease
What is going on here?
Amelogenesis Imperfecta (Hypoplastic)
What is going on here?
Syphilis (Treponema)
- Primary
- Chancre
- Secondary
- Mucus patch
- “Split papule”
- Condyloma lata
- Tertiary
- Gumma
- Congenital
- Dental deformities
- Developmental delay
What is going on here?
Morsicatio (frictional keratosis)
What is going on here?
- Diagnosis: Mixed Tumor (pleomorphic adenoma)
- Differential Diagnoses:
- Salivary Gland Tumor
- Salivary PAthology (mucocele, necrotizing sialometaplasia)
- Other tumors (e.g. lymphoma)
What is going on here?
Mild to Moderate Epithelial Dysplasia
Where is Periapical, Focal, and Florid Cemento - Osseous Dysplasia typically found?
- Periapical: Usually limited to man anterior
- Focal: Usually limited to man or max posterior
- Florid: Multiple Sites
What is going on here?
Erythema Multiforme
What are 4 etiologies of Infectious Ulcerative Disorders?
- Viral: HHV, HPV, enteroviruses
- Bacterial: Mycobacterium, Treponema, Actinomycetes
- Fungal: Histoplasmosis
- Parasitic: Myasis (fly larvae)
What is going on here?
Alveolar Ridge Keratosis (frictional keratosis)
What is going on here?
Leukoedema
How do you determine the diagnosis via histology or immunofluorescence?
- Tissues may be submitted in (10% buffered) formalin for routine histology, or Michel solution for IF; the specimen should
be split, laid on a suture card or sterilization wrapper to minimize curling, and then sent to a lab that manages IF (the
Michel solution can often be obtained by Dermatology or directly from the supporting lab) - Lichen planus demonstrates a linear deposition of fibrinogen at the basement membrane
Pemphigus demonstrates a ‘chicken wire’ deposition of immunoglobulins and/or complement
Pemphigoid demonstrates a linear deposition of immunoglobulins and/or complement at the basement membrane - Lichen planus demonstrates a band like lymphocytic infiltrate at or into the the epithelial base
Pemphigus demonstrates acantholysis (the epithelial cells detached from each other and leave a ‘row of tombstones’)
Pemphigoid demonstrates a complete epithelial split from the connective tussue
When you diganose by radiography, what does radiolucent, mixed radiodensity, and radiopaque apperances indicate?
- Radiolucent: Implies minimal or no hard tissues
- Mixed Radiodensity: Implies hard tissue component
- Radiopaque: Implies predominantly hard tissue
What is going on here?
Dense Bone Island/Idiopathic Osteosclerosis
What is this?
What would you consider doing about it?
- Peripheral Ossifying Fibroma
- Consider
- Periodontal Probing
- Periapical Radiographs
- Vitality Testing
What is going on here?
Ameloblastoma (in the periapical position; multiple failed endodontic procedures)
- Most common odontogenic tumor
What is going on here?
Melanocytic Blue Nevus
What is going on here?
Simple hemorrhagic/idiopathic/traumatic/soliary bone cyst
Surgeon reports entering into an empty cavity…
What does a Floating in Air appearance go with?
Langerhans Cell Histiocytosis
What are Enteroviruses associated with?
Coxsackievirus & Echovirus
What is going on here?
Amelogenesis Imperfecta (Hypoplastic)
What does a Hair on End Pattern Suggest?
Sick Cell Anemia
Thalassemia
What is going on here?
Florid Cemento - Osseous Dysplasia
What is going on here?
Palatal Perforation Secondary to Cocaine Abuse
What is going on here?
Adenomatoid Odontogenic Tumor
- Often second decade; often mimics dentigerous cyst, may be associated with impaction/failure to erupt
What is going on here?
12 yo, multiple Odontogenic Keratocysts; Fam Hx of nevoid basal cell carcinoma syndrome
What are 2 less common Odontogenic Tumors?
- Calcifying Odontogenic Cyst (Gorlin Cyst); often included as tumor
- Calcifying Epithelial Odontogenic Tumor (Pindborg tumor)
What is going on here?
Focal Cemento-Osseous Dysplasia
Observe the flow of treatment…
What is going on here?
Antral Pseudocyst
(incidental radiographic finding)
What are the 3 pillars of oral cancer treatment?
- Surgery
- Radiation
- Chemotherapy
When you see central giant cell granulomas - one should consider what 2 pathologies?
- Hyperparathyroidism
- Renal Osteodystrophy
What is going on here?
Apthous Ulcer (apthous stomatitis)
What are some treatment complications for Steroids/immune suppressants?
- Fungal infections, burning sensation with some topical agents
- Immune/marrow suppression (opportunistic infections)
What is going on here?
Histoplasma
What is Lidex?
- This medication is used to treat a variety of skin conditions (e.g., eczema, dermatitis, allergies, rash).
- Fluocinonide reduces the swelling, itching, and redness that can occur in these types of conditions.
- This medication is a strong corticosteroid.
What are some signs of MEN IIB?
- Pheochromocytoma (a hormone secreting tumor that can occur in the adrenal glands)
- Throid medullary carcinoma
- Mucosal neuromas
What is going on here?
Gingival Overgrowth (necrotizing gingivitis)
What is going on here?
How would you treat this?
- Differential Diagnoses:
- (Primary) Herpetic Gingivostomatitis
- Apthous Stomatitis
- AMnifestation of Systemic Disease (Crohn’s Disease, inflammatory bowel disease, autoimmune)
What is going on here?
Ameloblastoma (in the dentigerous position)
- Most common odontogenic tumor
What are the most common Non-Odontogenic Cysts?
- Nasopalatine Duct Cyst, medial palatal cyst
- Nasoalveolar Cyst, lacrimal duct cyst
- Nasolabial Cyst
- Stafne Defect/Lingual Mandibular Salivary Gland Defect
Regarding an MRI weighting and enhancements, what does a T1 image help with?
- “Fat Image”
- Differentiate water from fat
- Highlights differences in soft tissue densities
What is the importance of understanding HPV-related oropharyngeal cancer?
- Overlaps other malignancies in location (tonsils… lymphoma)
- Higher stage on diagnosis (often detected first as metastatic disease to lymph nodes of head and neck)
- Often requires additional diagnostic tests (PET/CT or ENT endoscopy to locate unknown head/neck primary)
- Higher 5-year survival rates
- Vaccinations are available for HPV-related disease; long term preventive and therapeutic benefits are well
documented in HPV-related cervical cancer and pathophysiology of HPV-related disease in other sites such as anal
cancers, oropharyngeal and nasopharyngeal cancers may herald similar results [long term studies are ongoing] - HPV salivary testing is available; it’s highly specific and sensitive but there is little to no evidence base for
predictive value (just because HPV is detected in saliva, there’s no known correlation with disease) - There are social, moral, ethical and religious implications and as such we must be sensitive to our patients and their
beliefs
What is going on here?
Herpes Zoster
What is going on here?
Metastatic Adenocarcinma
56 yo M being treated for “cancer” with extensive caries; periapical tissues #31 submitted for histologic evaluation
What is going on here?
Lichenoid Mucositis
What is going on here?
Herpes Zoster
What are some Autoinflammatory Ulcerative Disorders?
- Apthous Stomatitis
- Bachet’s Disease
- Lichenoid Mucositis
What are the most common sites for Malignancy regarding Salivary Gland Tumors?
- Sublingual Gland: 70-90% (usually malignant)
- Minor Glands: 46-82% (50/50)
- Submandibular: 37-45% (50/50)
- Parotid: 15-32% (usually benign)
What is going on here?
What can asymmeric tonsils suggest?
- Tonsillolith
- Tonsilloliths
- HPV-related carcinoma
- Lymphoma
What is going on here?
Dentin Dysplasia
How do Viral Diseases commonly present in the oral cavity?
- Single or multiple coalescing ulcers
- Usually (but not always) on ‘attached/keratinized mucosa’
- Gingiva
- Tongue
- Palate
- Primary forms may occur anywhere in the oral cavity
What are 3 Dentin Defects?
- Consider Dentinogenesis Imperfecta
- Consider Dentin Dysplasia
- Consider Osteogenesis Imperfecta
What is going on here?
Osteo (chemo) necrosis
72 yo M, non-healing extraction site, history of myeloma and IV zolendronic acid exposure (bisphosphonate)
Describe a Peripheral Ossifying Fibroma…
- Usually pink to red
- Associations: none specific
- Histology: bone or dystrophic calcifications (make a radiograph)
What is going on here?
Necrotizing Sialometaplasia
(47 yo M, palatal mass)
What is going on here?
Multiple Myeloma
67 yo F, history of myeloma; prior fractures of L mandible
Regarding MRI weight and enhancements, what does a T2 image help with?
- “Water Image”
- Differentiate water from fat
- Highlights edema
- Highlights CSF
What oral pathology is this picture related to?
Pemphigoid
What is going on here?
Recurrent Herpes Labialis
What is the most common site of Salivary Gland Tumors?
- Parotid: 64-80%
- Minor glands: 9-23%
- Submandibular: 8-11%
- Sublingual: 0.3-1%
What is a Nikolsky sign?
Is dislodgment of intact superficial epidermis by a shearing force, indicating a plane of cleavage in the skin at the dermal-epidermal junction. The histological picture involves thinner, weaker attachments of the skin lesion itself to the normal skin, resulting in easier dislodgement
What is HHV-1 (HSV-1) associated with?
Human Herpes Simplex Virus, Type 1