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Tim's Cards > Orathon3: Adventures in Pathology > Flashcards

Orathon3: Adventures in Pathology Flashcards

1
Q

A white patch or plaque that Won’t rub off and which can’t be diagnosed as any specific condition. A Clinically descriptive term.

A

Leukoplakia

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2
Q

2 etiologies of Leukoplakia:

A

Frictional Keratosis (physical)

Tobacco (most)

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3
Q

80% of Leukoplakia is _____, _____, and ______

17% is ______

3% is _____

A

Hyperparakeratosis, Hyperorthokeratosis, Acanthosis (increased thickness)

Epithelial dysplasia/carcinoma in situ (pre-malignant)

Superficially invasive squamous cell carcinoma

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4
Q

Superficially Invasive Squamous Cell Carcinoma makes up ____% of __________,

A

3%, Leukoplakia

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5
Q

Superficialy invasive squamous cell carcinoma (3% of Leukoplakia), a single incisional biopsy will underdiagnose ___%, and surgical excision will display carcinoma ___%

Multiple biopsies will underdiagnose ____%, carcinoma __%

A

30%, 12%

12%, 2.4%

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6
Q

3 most common anatomic sites for Leukoplakia:

% of time Dysplastic/Invasive for each

A

Floor mouth/ventral tongue (50%)

Lateral Tongue (25%)

Lower lip (35%)

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7
Q

There is homogenous Leukoplakia and Non-homogenous leukoplakia, which makes up ____ % of dysplastic/invasive

A

50-80%

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8
Q

3 types of Non-homogenous Leukoplakia:

A

Erythroleukoplakia (Erosive)

Nodular leukoplakia (Speckled)

Verrucous leukoplakia

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9
Q

The Rare form of progressive leukoplakia that is characterized by progression, multifocality, verrucous morphology, recurrence after excision, progression to SCC and death

A

Proliferative Verrucous Leukoplakia

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10
Q

Leukoplakia Malignant trasfromation _____ overall:

____% if dysplastic

____% if NOT dysplastic

A

4-6%

15%

1-3.5%

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11
Q

A red patch which can’t be diagnosed as a specific condition

clinically descriptive term considerable less common than leukoplakia

A

Erythroplakia

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12
Q

T/F

Erythroplakia has a tendency for high risk sites and may produce symptoms

A

True

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13
Q

Histology of Erythroplakia

A

Dysplasia

Carcinomainsitu/carcinoma

*almost 100%

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14
Q

Tx of Erythroplakia depends on presence/absence of what?

A

dysplasia

*severity

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15
Q

% if Erythroplakia resolves with Smoked tobacco cessation:

spit/topical tobacco cessation:

A

50%

95%

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16
Q

4 Premalignant conditions of Erythroplakia:

A

Sideropenic dysphagia

Submucous fibrosis

Lichen planus (controversial)

Immunosuppression

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17
Q

Oral Cancer: (known as what 2 things)

A

Squamous Cell Carcinoma

Epidermoid Carcinoma

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18
Q

SCC represents greater than ___% of all oral cancer

A

90%

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19
Q

90% of Oral Cancer is SCC. 10% is made up of what 3 types?

A

carcinoma/adenocarcinoma (salivary, metastatic)

Sarcoma

Leukemia/Lymphoma

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20
Q

How many new cases of SCC diagnosed/year?

How many will die?

A

30,000

9,000

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21
Q

Average 5 yr survival rate for oral SCC is less than

A

50%

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22
Q

Oropharyngeal cancer survival is (represents 1/3):

Oral cavity cancer survival is (represents 2/3):

*these 2 are computed together = 63%

A

90%

49.5%

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23
Q

Oral cavity cancer (SCC) has the __th lowest survival rate of any cancer

A

6th

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24
Q

T/F
Survival rates of oral cancer aren’t improving

Represent 4th most common cancer in black males

6th most common cancer in white males

A

True

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25
Q

T/F

oral cavity cancer has a higher death rate than Melanoma, Cervical Cancer, Breast Cancer

A

True

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26
Q

Peak age of incidence of Oral Cancer:

Increasing incidence:

A

50-70

under 40

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27
Q

male:female ratio for Oral Cancer

A

males 2:1

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28
Q

Risk Factors of Oral Cancer:

A 
radiation (lip only)
tobacco
alcohol
immune
genetic
environmental
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29
Q

In __% of cases, Oral Cancer pt is/was a Smoker

A

75%

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30
Q

T/F

The risk for cigars/pipe smoking = risk for cigarettes for intraoral SCC

A

True

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31
Q

T/F

Smokeless tobacco has the same incidence of oral SCC as smoked

A

False

*smokeless much lower

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32
Q

T/F

Typically, oral SCC SMOKELESS pts have been exposed to tobacco for 20-30 years

A

True

*site of quid, cancer develops

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33
Q

Statistically, what is a greater risk factor for Oral SCC than tobacco?

A

Alcohol

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34
Q

Risk for use of Alcohol developing oral SCC is greater than 2 pack/day smokers

A

True

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35
Q

Alcohol has what 3 effects that contribute to SCC

A

drying agent

solvent

contaminant

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36
Q

Alcoholics have nutritional deficiencies and liver disease (increase of carcinogens) that lead to oral SCC

A

True

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37
Q

Abuse of Alcohol is considered to be ___ alcohol equivalents/day

A

6

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38
Q

Risk min smoking/drinking:

heavy smoking/minimum drinking:

heavy drinking/ minimum smoking

heavy smoking/drinking:

A

1

8

23

100

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39
Q

Aging, chronic nutritional deficiency, disease states, and therapeutic interventions can all affect the Immune System and are risk factors for Oral SCC

A

True

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40
Q

4 types of Chronic Nutritional Deficiencies

*risk factors for Oral SCC

A

Iron deficiency (Plummer-Vinson)

Vitamin A deficiency (protective/preventive)

Vitamin C deficiency

Vitamin E deficiency (antioxidant)

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41
Q

Chronic candidal infection can lead to what 2 conditions (increasing risk factor for Oral SCC)

A

Epithelial hyperplasia

Persistent/continuous inflammatory cell response

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42
Q

Several types of HPV are oncogenic and produce ____ of cell cycle regulation that compromise immune system _____

A

inhibition

surveillance

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43
Q

T/F

Significant increase of Oral SCC due to HPV

A

True

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44
Q

30 years ago HPV cause ___% of throat cancer

today it is ___%

A

15%

80%

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45
Q

2 types of Herpes associated with Oral SCC

A

EBV (HHV 4)

KSAV (HHV 8)

*both inhibit immune surveillance

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46
Q

Chronic conditions stimulate the immune system can accumulate what?

A

Genetic defects of affected cells

*diabetes, perio, lichen planus - leads to Oral SCC

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47
Q

3 Types of Therapeutic interventions that can increase risk for Oral SCC

A

Chemo

Radiation

Routine meds (anti-rejection)

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48
Q

Genetic defects associated with what 2 Syndromes increase risk for genetic defects:

*but, not particularly Oral SCC

A

Basal Cell Nevus Syndrome

Gardner’s Syndrome

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49
Q

Though basal cell nevus syndrome and Gardner’s syndrome are associated with Genetic Defects, specific syndromes are NOT reported associated with Oral SCC

A

True

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50
Q

Family Hx of Oral SCC is a risk factor

A

True

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51
Q

3 Environmental factors increase risk for Oral SCC:

A

Carcinogenic chemicals

Foods/additives

Heat

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52
Q

Only ____% of US adults can correctly identify early signs of Oral Cancer

Only ___% of US adults know risk of alcohol

Only ___% of US adults have had an Oral Cancer exam

A

25%

13%

14%

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53
Q

In ___% of new Oral SCC cases, the Pts have absolutely no evident risk factors

A

25%

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54
Q

Warning Signs for Oral SCC (H/N)

A 
C hange in sensation
A sore will not heal
U nexplained hoarseness/difficulty swallowing
T hickening/lump
I nability to pronounce
O bvious change in mole, wart, etc
N agging cough
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55
Q

4 things Oral SCC can look like:

A

Leukoplakia (white plaque)

Erythroplakia (red plaque)

Ulcer

Exophytic Mass

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56
Q

T/F

Earliest lesions do NOT show characteristic features that increase index of suspicion for Oral SCC

A

True

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57
Q

Advances lesions for Oral SCC have 5 characteristics:

A

firm/hard (indurated)

non-moveable

Irregular, exophytic growth

Non-healing ulcer (rolled borders very ominous)

Pain

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58
Q

T/F
An oral cavity site of Origin for Oral SCC is decreasing

it can, however, occur anywhere

A

True

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59
Q

2 areas rarely affected by Oral SCC

3 high risk sites:

A

Dorsum tongue, Anterior hard palate

lower lip, posterior lateral tongue, floor mouth

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60
Q

T/F

Males are 2:1 Oral SCC, though females are increasing

A

True

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61
Q

Increasing incidence of Oral SCC in Females is in what 2 areas?

This has minimal association with what?

A

tonsillar pillars/soft palate margins

HPV

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62
Q

T/F

Oropharynx cancers are decreasing in frequency

A

False

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63
Q

What 2 areas comprise the vase majority of Oropharynx Cancers?

A

Base of tongue

Tonsillar regions

64
Q

Oropharynx cancers are highly associated with what?

65
Q

The risk factors for Oropharynx Cancers are different than Oral Cavity - 4 Factors:

A

non-smokers

non alcohol abusers

early sex

multiple sex partners!!!

66
Q

T/F
Majority of Oral Cancers diagnosed after they have metastasized to neck nodes

*directly related to survival

67
Q

Squamous Cell Carcinoma in Young Adults defined as before what age?

*alarming increase in incidence

68
Q

What area is SCC of Young Adults most associated with?

A

Lateral border tongue

69
Q

T/F

There is conflicting data if SCC under 40 is more aggressive and higher recurrence

70
Q

3 subsets of young tongue cancer cohort

Natl Cancer Data Base Report

A

less than 35% = female, few risk factors, aggressive, bad prognosis

less than 40% = male, tobacco/alcohol, prognosis depends on stage

less than 40% = slight male, tobacco, differentiated, Tx response good

71
Q

2 Staging Systems:

72
Q

TNM:

A

Tumor Size

Nodal Metastasis

Metastatic Spread

73
Q

STNMP:

A

Site of primary tumor

Tumor size

Nodal metastasis

Metastatic spread

Pathologic Grade of Tumor

74
Q

TNM: T1 - T4:

A

T1: < 2 cm

T2: between 2 and 4 cm

T3: > 4 cm

T4: >4 and in Antrum, Skin, Pterygoids, Base of Tongue

75
Q

TNM: N0 - N3:

A

N0: no lymph node

N1: only node, same side, < 3cm

N2: one node, same side, 3-6 cm (multiple nodes, same side, < 6cm)

N3: Contralateral/bilateral OR same side > 6 cm

76
Q

TNM: M:

A

M0: no distant metastasis

M1: Distant metastasis

77
Q

Stage 1 TNM:

A

T1, N0, M0

78
Q

Stage 2 TNM:

A

T2, N0, M0

79
Q

Stage 3 TNM:

A

T3, N0, MO

T1, N1, M0

T2, N1, M0

T3, N1, M0

80
Q

Stage 4 TNM:

A

Any T4

Any N2 or N3

Any M1

81
Q

Stage 1 survival (5 year):

Stage 2

Stage 3

Stage 4

A

77-85%

66-76%

41-44%

9-20%

82
Q

Document abnormalities (draw it out), include color size, surface characteristics, feel

83
Q

Eliminate possible causes (noxious habits), smooth rough teeth (restore)

84
Q

If you think a Pt has an abnormality _________

A

Schedule Appointment

85
Q

Tx of SCC dependent on what 2 things?

A

Stage

Location

86
Q

Chemo is curative

87
Q

Drooling, speech impairment, facial deformity, all are potential complications of Surgical Tx

88
Q

4 potential complications of Chemo:

*also Nausea, Neurotoxicity

A

Mucositis/ulceration

Xerostomia

Infection

Bleeding

89
Q

5 potential complications of Radiation:

A

Dermatitis

Mucositis/ulceration

decreased salivation

taste alteration

Infection

90
Q

4 Long term complications of Tx for SCC

A

Xerostomia

Osteoradionecrosis

Trismus/figrosis

Alopecia

91
Q

80% of all skin cancer

A

Basal Cell Carcinoma

92
Q

Basal Cell Carcinoma (80% skin cancer) cases/yr?

90% sun exposure, proportion of US people will develop?

A

1 million

1/5 (1/3 Texans)

93
Q

Etiology for Basal Cell Carcinoma

describe:

A

UV

low grade, slow growing, almost never metastasize

94
Q

Most common clinical form of Basal Cell Carcinoma:

A

noduloulcerative

95
Q

Basal Cell Carcinoma is usually noduloulcerative, with the center _____ with ______ borders and _____ vessels

A

cratered ulceration

rolled

telangiectatic (dilated)

96
Q

Histologically, what is Basal Cell Carcinoma?

A

Islands of Basaloid Epithelial cells showing invasive growth

97
Q

Tx Basal Cell Carcinoma:

A

Excision, curettage w/ electrodessication

Radiation

98
Q

Prognosis BCC:

A

90-95% 5 year survival

99
Q

Syndrome associated with Nasopharyngeal Carcinoma?

A

Trotter’s syndrome

100
Q

Trotter’s Syndrome (nasopharyngeal carcinoma) has pain referred where?

includes what nerve exiting the Foramen Ovale?

A

tongue/jaw (secondary to invasion of carcinoma)

trigeminal

101
Q

Bulky or Fleshy mass under the surface skin or mucosa

This comprises 1% H/N malignancies and affect what age?

A

Mesenchymal Sarcoma

broad age range

102
Q

3 types of Mesenchymal Sarcoma:

A

CT

Muscle

Nerve

103
Q

4 kinds of CT Mesenchymal Sarcoma:

A

Fibrosarcoma

Liposarcoma

Angiosarcoma

Kaposi’s Sarcoma

104
Q

Malignancy of the vascular endothelium

*more in H/N, scalp and forehead

A

Angiosarcoma

105
Q

Malignancy of Vascular Endothelium

A

Kaposi’s Sarcoma

106
Q

Kaposi’s Sarcoma associated with what Herpes?

Lesiona reddish/purple, patch or mass, ______

50% HIV+KS has ____ lesions

More prevalent in what 2 areas?

A

HHV 8

macula

oral

gingiva, palate

107
Q

Histology of KS, variable but most include ____ cell proliferation with slit like vascular spaces and prominent _____ extravasation

A

spindle

RBC

108
Q

Tx KS (4 options)

A

Radiation

Chemo

Excise

Intralesion Vinblastine (vinblastine sulfate)

109
Q

2 types of Muscle (mesenchymal sarcoma):

A

Leiomyosarcoma

Rhabdomyosarcoma

110
Q

What is the most common soft tissue malignancy in children?

2 areas increased prevalence?

Graplike clusters called…

A

Rhabdomyosarcoma

H/N, urogenital tract

sarcoma botryoides

111
Q

Malignant peripheral nerve sheath tumor, aka…

may arise from what?

Mass lesion w/ pain and ____ deficit

A

Neurogenic Sarcoma

neurofibromatosis

nerve

112
Q

Tx Sarcomas (mesenchymal - that’s CT, muscle, nerve):

Prognosis:

A

Surgery +- radiation +- chemo

variable

113
Q

What is the most common malignancy in bone of Oral Cavity?

Mx?

Mn?

Mx/Mn represent 2/3, other 1/3 found where?

A

Metastatic Disease

20%

80%

soft tissue/gingiva

114
Q

Primary site of Metastatic Disease found in Oral Cavity for Males includes:

Females:

A

lung, kidney, liver, prostate

breast, genitals, kidney, colorectal

115
Q

What % of Metastatic Disease found in the Oral Cavity Precede the Primary Diagnosis?

116
Q

4 Clinical Signs of Metastases to the Oral Cavity:

although may be asymptomatic

A

pain

paresthesia

swelling

loosening of teeth

117
Q

How does Metastases to the Oral Cavity look Radiographically?

A

destructive, invasive, POORLY MARGINATED Lucency

*rarely stimulated production of bone/osteosclerosis

118
Q

Osteosclerosis/production of bone is indicative of what Metastatic Disease?

119
Q

Histology of Mestastases to the Oral cavity, is usually what form of cancer?

Tx:

A

carcinoma

palliation (often)

120
Q

Malignancies of the immune system, mostly lymphocytes

121
Q

Lymphoma is divided into what 2 categories?

A

Hodgkins

Non-Hodgkins

122
Q

Lymphomas tend to have lymphadenopathy where nodes are firm, rubbery, painless, moveable or fixed

and Multifocal

123
Q

Hodgkins cases/yr:

malignant Cell:

80% of malignant cells have what marker?

Classic presentation:

Spread:

Oral involvement?

A

8000

Reid-Sternberg

B-cell

lymphadenopathy

predictable/contiguous

rare

124
Q

___% of Hodgkin’s disease is cervical or supraclavicular

125
Q

Clinical staging of Hodgkin’s Lymphoma determine the Anatomic Sites Involved

By what means?

A

PE, chest film, CT, MRI, lymphangiography, laparotomy

126
Q

Histologic classification of 4 subtypes of Hodgkin’s Lymphoma:

A

Ann Arbor System

127
Q

Ann Arbor System (Hodgkin’s Lymphoma) 4 Stages:

*Histologic

A

I single lymph node (I), single estralymphatic (IE)

II 2 or more nodes, same side diaphragm (II), extralymphatic site (IIE)

III nodes both sides diaphragm (III), extralymphatic (IIIE), spleen (IIIS)

IV Diffuse/disseminated extralymphatic organs (with or without associated node involvement)

128
Q

Ann Arbor (Hodgkins) A =

B =

A

absence of systemic signs

fever, night sweats, 10% body weight loss 6 months prior to diagnosis

129
Q

Tx of Hodgkins via Ann Arbor System:

A

Stage I/II = radiation therapy

Stage III/IV = chemo +/- radiation

130
Q

Most pts survive Hodgkins Lymphoma, Stage I/II survival is…

131
Q

Non-Hodgkins Lymphoma are a diverse group of ______ malignancies

Usually what cell in origin?

A

immune system

B-cell (some T cell)

132
Q

Non-Hodgkins lymphoma represent ____ cases/yr

affect lymphoid tissues, compared to Hodgkins, spread…

lymphadenopathy/mass lesion orally, commonly affects _____ (can affect bone)

A

80,000

unpredictably (often to non-lymphoid)

palate

133
Q

3 subtypes, Non-Hodgkin’s Lymphoma:

A

low, intermediate, high grades

134
Q

1 specific type of Non-Hodgkin’s Lymphoma:

A

Burkitt’s lymphoma

135
Q

Burkitt’s lymphoma is a _______ lymphoma

aka…

A

non-Hodgkins B-cell

African jaw lymphoma (affects jaws of childres)

136
Q

90% Burkitt’s lymphoma associated with ______

80% show translocation of protooncogene from _______to ______

Very rapidly growing destructive ______

American Burkitt’s has less _____ involvement and is in older pts (increase CNS/abdominal involvement)

A

EBV

C8 to C14

lucency

jaw

137
Q

Starry Sky

A

Burkitt’s lymphoma

*phagocytic cells in sea of malignant lymphoid cells

138
Q

Tx Burkitt’s Lymphoma:

*what drug?

A

aggressive chemo

*cyclophosphamide

139
Q

Tx and Prognosis Burkitt’s lymphoma is Radiation +/- chemo, and prognosis is highly variable

140
Q

Group of monoclonal malignant proliferative diseases affecting Plasma Cells where cells remain functional and produce whole antibody molecule or part of it

A

Plasma cell dyscrasias

141
Q

Bence Jones proteinuria:

A

Plasma Cell Dyscrasias

*light chain of antibody of functional but malignant plasma cell

142
Q

Light chain of Ab of functional but malignant plasma cell:

A

Bence Jones proteinuria

*plasma cell dyscrasia

143
Q

2 types of Plasma Cell Dyscrasia:

A

Multiple Myeloma

Extramedullary plasmacytoma

144
Q

The most common malignancy of the bone:

cases/yr?

A

Multiple Myeloma

30,000

*plasma cell dyscrasia

145
Q

Multiple Myeloma 2 risk factors:

146
Q

Multiple Myeloma affect bones with _______

includes vertebrae, ribs, skull, pelvis, and ___% in the jaw

A

active marrow

10%

147
Q

Bone pain, anemia, infection renal insufficiency, fatigue

A

Multiple myeloma

148
Q

IgA, IgG, IgM, IgE, IgD in the serum

A

Multiple myeloma

  • monoclonal gammopathy
  • may or may not have light chains (Kappa/Lambda)
149
Q

Multiple Myeloma will present how orally?

Skull?

A

destructive lucencies

punched out lucencies

150
Q

Tx Multiple myeloma

Prognosis

survival at 5 yrs:

A

chemo, immunomodulating agents, stem cell/marrow transplant

poor

33%

151
Q

Single lesion of myeloma in the bone

*many progress to multiple

A

Solitary myeloma

152
Q

Soft tissue lesions

*isolated or with multiple myeloma

A

Extramedullary plasmacytoma

153
Q

Malignancies of bone marrow stem cells

154
Q

3 types of Leukemia:

aside from acute/chronic

A

myelocytic

lymphocytic

monocytic

155
Q

Primary oral manifestation of Leukemia:

Secondary (3):

A

gingival enlargement

anemia, thrombocytopenia (bleeding), immunosuppression

Tim's Cards (140 decks)

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