Oral Pathology Chapter 10 Flashcards by Marc Jolley

Human Papilloma Virus types 6 and 11 result in what sort of benign oral manifestation?

Squamous Papilloma

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What term describes the ability of a virus to break down the human defenses and cause disease in an individual?

Virulence

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What term describes the ability of a virus to horizontally transfer from individual to individual?

Infectivity

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What is the name given to a wart on the tongue?

Verruca Vulgaris

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What types of HPV cause warts on the tongue?

2, 4, 6, and 40

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If there is a single papule or nodule that has a “cobblestone” appearance, what is the first thing you should think it might be?

Verruca Vulgaris

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What is the scientific name for venereal wart?

Condyloma Acuminatum

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What eight forms of HPV can cause venereal warts?

2, 6, 11, 16, 18, 31, 53, and 54

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What three forms of HPV that cause venereal warts are considered “high risk”?

16, 18 and 31

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Which two forms of HPV risk forming into squamous cell carcinoma?

16 and 18 in genitourinal area

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Should a whole score of cobblestone growths appear in the mouth, what is the most likely culprit?

Multifocal Epithelial Hyperplasia (Heck’s disease)

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What is it called when a growth occurs in the nose?

Sinonasal Papilloma

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What are the three forms of sinonasal papillomas that exist?

Fungiform, 2. Inverted and 3. Cylindrical cell

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What form of sinonasal papilloma is the most dangerous (has the greatest odds of malignancy)?

Inverted

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What is the name of painless, skin-colored lesions that are typically seen in children, are sessile papules with smooth surfaces?

Molluscum Contagiosum

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What type of virus causes Molluscum Contagiosum?

DNA poxvirus

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What histological feature is present in Molluscum Contagiosum?

Henderson-Paterson bodies

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Is Molluscum Contagiosum ever malignant?

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What disease appears as painless, sessile lesions with roughened surfaces with lipid-laden histiocytes in the epithelium?

Verruciform Xanthoma

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What is the skin condition that causes moles to appear all over the skin?

Seborrheic Keratosis

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What is the name of the skin condition that Morgan Freeman has?

Dermatosis papulosa nigra

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Should a sudden onset of Seborrheic keratoses occur, what is the primary concern?

That the patient has developed Leser-Trelat sign (sign of internal malignant cancer)

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What is it called when the sebaceous cells in the face grow out of control?

Sebaceous Hyperplasia

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What is the primary concern with sebaceous hyperplasis?

That it’s not a more serious facial tumor

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What is the distinct form of sebaceous hyperplasia?

Umbilicated appearance

What is the scientific name for freckles?

Ephelis

What are the brown age spots on the hands of old people called?

Actinic lentigo

Should a group of benign cutaneous melanocytes cluster together in a child to form a mass, what is that called?

Lentigo Simplex

What is the name of the acquired, hormonally-driven hyperpigmentation of the skin of the face?

Melasma

What is the best treatment for Melasma?

Avoiding the sun/sunscreen

What is the oral counterpart to the freckle?

Oral melanotic macule

A freckle that is large and on the lips/vermilion border is known as what?

Labial Melanotic macule

Should a freckle on the lip be biopsied?

Probably - they look a lot like melanomas

What is the name of the brown bruising that occurs on the inner cheeks of African-American women and that can be caused by birth control?

Oral melanoacanthoma

What is the scientific name of the common mole?

Acquired melanocytic nevus

What are superficial, round aggregates of nevi called?

Theques

What is the name of the huge, ugly moles that sometimes cover portions of newborns?

Congenital Melanocytic Nevus

What is a common companion symptom to Congenital Melanocytic nevi?

Hypertrichosis (excess hair)

What should be done with Congenital melanocytic nevi?

They should be removed if at all possible (15% cancerous)

Should a mole be surrounded by a white ring, what is that called?

Halo nevus

What is a red mole called?

Spitz Nevus

What is a blue mole called?

Blue nevus

Where are the blue moles in the mouth found?

Almost always on the palate

What causes the blue pigmentation?

Tyndall effect

What are we worried about if we see white on the borders of the tongue?

Leukoplakia

What is a leukoplakia?

An intraoral white plaque that does not rub off and cannot be identified as any other well-known entity

What is the 2nd most common melanocytic nevus encountered in the oral cavity?

Blue nevi

What are five white lesions that CAN be scraped off?

1. Materia alba, 2. White-coated tongue (plaque), 3. Burn, 4. Pseudomembranous candidiasis and 5. Sloughing from toothpaste

What percentage of precancer is comprised by a leukoplakia?

85%

What is SCCA also known as?

Squamous cell carcinoma

What is the lesion called from smokeless tobacco?

Tobacco pouch keratosis

What is the name of the herbal extract found in toothpastes and mouth rinses that can cause leukoplakia?

Sanguinaria

Which two microorganisms can cause leukoplakia?

1. Treponema pallidum and 2. Candida albicans

Which virus two strains have been identified in some leukoplakias?

HPV 16 and 18

What three areas are most concerning to find a leukoplakia?

1. Vermilion border, 2. Lateral/ventral tongue and 3. Floor of the mouth

What is the name of patches of red in leukoplakia where epithelial cells are so immature that they can no longer produce keratin?

Erythroplakia

What is it termed when leukoplakia are white and red?

Erythroleukoplakia

What type of leukoplakia has the greatest risk for cancer?

Proliferative verrucous leukoplakia

Name and place the four types of leukoplakia in order of cancer risk and association from least worrisome to most worrisome:

1. Leukoplakia, 2. Erythroleukoplakia, 3. Erythroplakia and 4. Proliferous leukoplakia

What is it called when cellular alterations are limited to the lower 1/3?

Mild dysplasia

What is it called when alternations are limited to the lower 1/2?

Moderate dysplasia

What is it called when you have alterations above the lower 1/2?

Severe dysplasia

What is it called when you have alterations throughout the entire epithelium?

Carcinoma in situ

At what level should a leukoplakia be completely removed?

Moderate epithelial dysplasia or worse

What is the name of a red patch that cannot be diagnosed as any other condition?

Erythroplakia

When is a lesion most likely to occur in smokeless tobacco use?

When heavy use begins

Betel quid or paan cause what disease?

Oral Submucous Fibrosis

What is a common first time complaint from using Betel quid or paan?

Trismus and mucosal pain (association with spicy food)

What oral change can occur due to smoking (largely from the heat)?

Nicotine Stomatitis

What is the name of a common cutaneous premalignant lesion caused by UV radiation with scaly, irregular plaques?

Actinic keratosis

What is it called when sun damage causes "farmer's lip" in older individuals?

Actinic cheilosis

What is the name of a redish mole with a scabby appearance on top?

Keratoacanthoma

What disease predisposes individuals to keratoacanthomas?

Muir-Torre syndrome

What is the recommended treatment for keratoacanthomas?

Surgical excision

What cancer is the most dangerous in the oral cavity?

Squamous cell carcinoma

What four behavioral traits can lead to increased risk for SCC?

1. Alcohol, 2. tobacco, 3. Phenolic agent exposure and 4. Radiation

What two nutritional deficiencies can increase risk for SCC?

1. Iron deficiency and 2. Vitamin A deficiency

What three diseases increase risk for SCC?

1. Syphilis, 2. Oncogenic viruses and 3. Immunosuppression

What two genetic factors predispose an individual for SCC?

Oncogenes and Tumor suppressor gene mutations

What five physical forms can a SCC take?

1. Exophytic, 2. Endophytic, 3. Leukoplakia, 4. Erythroplakia and 5. Erythroleukoplakia

What are the first thru fourth most common locations for SCC?

1. Tongue, 2. Floor of the mouth, 3. Soft palate and 4. Gingiva

Where are floor of the mouth SCCs most likely to be located?

Near the frenum, near the midline

Should an SCC develop on the soft palate or tonsillar area, what does this likely mean for the patient?

That the disease has metastisized from a different location

Where does SCC spread most commonly?

Ipsilateral cervical lymph nodes

What is the system that determines a patient's prognosis for SCC?

TNM system

What does the T stand for in TNM?

Tumor (size)

What does the M stand for in TNM?

Distant metastasis

What does the N stand for in TNM?

Nodes (local lymph nodes)

Should a value of x be given to one of the letters in TNM, what does that indicate?

That there was no available information about that specific thing

Tis signifies what in the TNM system?

That the carcinoma is in situ

What sizes do T1, T2 and T3 correspond to?

T1 = 2cm or less, T2 = 2-4 cm and T3 = more 4 cm

What does T4a mean?

Tumor is resectable and does not involve major anatomy

What does T4b mean?

Tumor is unresectable

What does N1 mean?

Single ipsilateral node, 3cm or less

What does N2 mean?

Ipsilateral or contralateral node or nodes; 6 cm or less

What does N3 mean?

Any metastasis in a nod more than 6 cm

What does M0 mean?

No metastasis

What does M1 mean?

Metastasis

What does a stage I TNM classification respond to?

T1, N0, M0

What does a stage II TNM classification respond to?

T2, N0, M0

What does a stage III TNM classification respond to?

T3, N0, M0 or an T, N1, M0

What does a stage IV TNM classification represent?

Any M; any T4; any N3

What does the staging of histological features indicate in SCC?

How similar the tumor is to its parent cells - lower grades are better.

Which is better for diagnosing prognosis; histological features or clinical features?

Clinical

What is it called when you have two separate occurrences of the same disease?

Synchronous

What is it called when you get the same disease that you already had years down the road?

Metachronous

Once you've had SCC, you have a tendency to develop multiple mucosal cancers. What is this known as?

Field Cancerization

What cancer are smokeless tobacco users at particular risk for developing?

Verrucous carcinoma

What cancer is particularly common in Chinese men and can cause a lump in the lateral neck?

Nasopharyngeal Carcinoma

What is the most common of all cancers?

Basal cell carcinoma

What term refers to superficial capillaries sometimes seen in Basal cell carcinomas?

Telangiectatic

What disease is described as a malignant neoplasm of melanocytic origin?

Melanoma

What is it called when Melanoma spreads horizontally?

Radical growth

What is it called when Melanoma spreads deeper?

Vertical growth

What do the ABCDEs of Melanoma stand for?

A = Asymmetry, B = Border irregularity, C = Color variation, D = Diameter greater than 6 mm and E = Evolving

What is the acronym for the worst areas to have melanoma and what does it stand for?

BANS = Back, Arms, Neck and Scalp