Path slide set 1 Flashcards
1
Q
Classic SCC is preceded by?
A
precancerous lesion
2
Q
What salivary tumor occurs much more often in males an perhaps reflects the higher prevalence of smoking amoung men
A
Warthin tumor
3
Q
What causes caries
A
focal demineralization of tooth structure by acidic metabolites of fermenting sugars that are produced by bacteria
4
Q
How does herpetic stomatitis differ from acute herpetic gingivostomatitis?
A
it occurs at the site of primary inoculation or in adjacent mucosa associated with the same ganglion
5
Q
Salivary glands secrete this for digestion?
Lubrication?
Protection?
A
- ptalin/salivary amylase
- mucus
- IgA, Lactoferrin, lysozyme
6
Q
histologically; spectrum of epithelial changes ranging from hyperkeratosis overlying a thickened acanthotic but orderly mucosal epithelium to lesions with markedly dysplastic changes sometimes merging into carcinoma in situ
A
Leukoplakia
7
Q
intermediate form having characteristics of both leukoplakia and erythroplakia
A
speckled leukoerythroplakia
8
Q
Major cause of tooth loss before age 35
A
Caries
9
Q
Theory that multiple independent primary tumors develop as result of years of chronic exposure of the mucosa to carcinogens
A
“field cancerization”
10
Q
The granular appearance of the cytoplasm of the upper layer of cells in a warthin tumor is due to presence of numerous what?
A
mitochondria . . “oncocytic”
11
Q
50% found in minor salivary glands. . particularly palatine glands
A
Adenoid cystic carcinoma
12
Q
MECT1-MAML2 fusion gene
A
mucoepidermoid carcinoma
13
Q
Periodontitis can be associated with what systemic diseases?
A
- AIDS
- Leukemia
- Crohn disease
- Diabetes
- Down syndrome
- Sarcoidosis
- Syndromes associated with neutrophil defect
14
Q
location for periapical cyst
A
apex of teeth
15
Q
Are Caries painful
A
yes to extent it affects daily life
16
Q
Complications of Xerostomia
A
- increased rates of dental caries
- candidiasis
- difficulty swallowing and speaking
17
Q
Survival with a mucoepidermoid carcinoma depends on what?
A
Grade dependent
18
Q
Most neoplasms of salivary glands arise where
A
parotids
19
Q
treatment for irritation fibroma
A
complete surgical excision
20
Q
Size of salivary tumor when first diagnosed
A
4 to 6 cm
21
Q
second primary tumors in oral cavity
A
rate of development higher compared to other malignancies
22
Q
Candidiasis remains superficial unless what? then it invades
A
immunosuppression
23
Q
Distant metastases of SCC
A
- mediastinal nodes
- lungs
- liver
- Bones
24
Q
on microscopic exam, there is intracellular and intercellular edema (acantholysis)
A
HSV
25
When Sjogren syndrome produces dry eyes
keratoconjunctivitis sicca
26
treatment for keratocystic odontogenic tumor
complete removal
27
can be scraped off
Candida albicans
28
describe the inflammatory infiltrate of an aphthous ulcer
at first largely mononuclear but secondary bacterial infection may result in a neutrophilic infiltrate
29
submucosal nodular mass of fibrous connective tissue stroma that occurs primarily on the buccal mucosa along the BITE LINE or the gingiva
- irritation fibroma
- Traumatic fibroma
- focal fibrous hyperplasia
All of these are different names for the same thing
30
Derived from remnants of odontogenic epithelium present within the jaw
Odontogenic cysts and tumors
31
histolgically, Dentigerous cysts are lined by what?
What else is found?
a thin layer of stratified squamous epithelium
often there is a dense chronic inflammatory cell infiltrate in connective tissue stroma
32
What can Sialadenitis be induced by?
- trauma
- Viral (mumps)
- Bacterial
- autoimmune disease
33
3 major clinical forms of oral candidiasis
- pseudomembranous
- erythematous
- hyperplastic
34
San Joaquin Valley fever complex
Cocci
35
White patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease
Leukoplakia
36
5 year survival if Tobacco related and late stage SCC
20%
37
Periapical cyst is ______ in origin?
inflammatory
38
What are the 2 malignant neoplasms of salivary glands
- mucoepidermoid carcinoma
| - Adenoid cystic carcinoma
39
Painless, slow-growing, mobile discrete mass within the parotid or submandibular areas or in the buccal cavity
Pleomorphic adenoma
40
offenders for nonspecific bacterial sialadenitis
Staph and strep viridans
41
- small, poorly encapsulated, infiltrative, gray-pink lesions
histology: small cells having dark, compact nuclei and scant cystoplasm. spaces bt tumor cells are often filled with hyaline material . . excess basement membrane
Adenoid cystic carcinoma
42
epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged
Ranula
43
number of aphthous ulcers
single or multiple
44
Most common primary malignancy of salivary glands
mucoepidermoid carcinoma
45
Periodontitis can be the origin of what systemic diseases
- infective endocarditis
| - pulmonary and brain abscesses
46
plaque within areas of active periodontitis contains what bacterial?
Specific examples
anaerobic and microaerophilic gram-negative
- Aggregatibacter (Actinobacillus) Actinomycetemcomitans
- porphyromonas gingivalis
- prevotella intermedia
47
- well demarcated
- encapsulated but capsule not fully developed
- cut surface is gray-white with myxoid and blue translucent areas of condroid
- epithelial elements dispersed within mesenchyme-like background of loose myxoid tissue
pleomorphic adenoma
48
do aphthous ulcers run in families
Yes
49
What do patients with mucocele report
history of changes in size of the lesion, especially in association with meals
50
HSV viral reactivation is called what?
Herpetic stomatitis
51
cough, choriza, conjunctivitis in a child
measles
52
organism for Scarlet fever
Group A beta hemolytic strep
53
What are the two benign neoplasms of salivary glands
- Pleomorphic adenoma
| - Warthin tumor (Papillary Cystadenoma Lymphomatosum)
54
results from either blockage or rupture of a salivary gland duct, with consequent leakage of saliva into the surrounding connective tissue stroma
Mucocele
55
Acute Herpetic gingivostomatitis is accompanied by what other symptoms?
- lymphadenopathy
- fever
- anorexia
- irritability
56
lack well defined capsules and often infiltrative at margins
histo: cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells
mucoepidermoid carcinoma
57
age for leukoplakia/erythroplakia
males 2:1
58
Bony, hard protrusion on roof of mouth. Can also be on mandible
Torus Palatinus
59
Most common fungal infection of the oral cavity
Candida Albicans
60
Is gingivitis reversible
yes
61
HSV treks along regional nerves and eventually becomes dormant in what ganglion
trigeminal
62
anatomic sites of origin for HPV associated SCCs of oropharnx
- tonsillar crypts
- base of tongue
- oropharynx
63
Age for gingivitis
any age but most prevalent and severe in adolescence
64
chromosomal rearrangement of PLAG1
Pleomorphic Adenoma
65
psuedocysts with cyst-like spaces lined by inflammatory granulation tissue or by fibrous connective tissue. cystic spaces filled with mucin and inflammatory cells, particulcarly macrophages
Mucocele
66
Must be differentiated from other odontogenic cysts because of its aggressive behavior
odontogenic keratocyst (OKC) also called keratocystic odontogenic tumor
67
If a dental plaque is not removed, what happens?
it becomes mineralized to form calculus (tartar)
68
11:19 transolcation
mucoepidermoid carcinoma
69
inflammation of salivary glands is called
Sialadenitis
70
Molcular biology of HPV related SCC
- p16 overexpression encoded by CDKN2A
- p53
- RB
- E6 and E7
71
Primary HSV infections typically occur in children b/t what ages?
2 and 4
72
Decreases salivary secretions caused by dehydration may lead to the development of bacterial suppurative parotitis in who?
elderly patients with a recent history of major thoracic or abdominal surgery
73
What virus is associated with erythro/leukoplakias
HPV
74
distinctive oral lesion on lateral border of the tongue that is usually seen in immunocompromised patients
Hairy Leukoplakia
75
what is required for therapy of mucocele
complete excision and its accompanying minor salivary gland
76
what predisposed to oral candidiasis
immunosuppression
77
dirty white, fibrinosuppurative, tough inflammatory membrane over the tonsils and retropharynx
Diptheria
78
shallow, hyperemic ulcerations covered by a thin exudate rummed by a narrow zone of erythema
aphthous ulcers
79
in the oropharynx, as many as 70% of SCCs, particularly thoses involving the tonsils, the base of the tongue, and the pharynx, harbor oncogenic variants of what?
HPV-16
80
Until proven otherwise by means of histologic evalulation, all leukoplakias must be considered what?
precancerous
81
Severe oral infections in the form of gingivitis, pharyngitis, tonsillitis; may extend to produce cellulitis of the neck (Ludwid angina)
Pancytopenia (agranulocytosis, aplastic anemia)
82
Age and gender and location for keratocystic odontogenic tumor
between 10 and 40 and most common in males within posterior mandible
83
mucoceles most often found where and are result of what
lower lip and trauma
84
Can Hairy leukoplakia be scraped off
no
85
Sticky, colorless, biofilm that collects b/t and on the surface of teeth
Dental plaque
86
predisposing influence for SCC of lower lip
Actinic radiation (sunlight) and particularly pipe smoking
87
Raspberry or strawberry tongue
Scarlet fever
88
appear as solitary or multiple white patches or plaques, often with sharply demarcated borders
leukoplakias
89
Xerostomia is a major feature of what autoimmune disorder and is usually accompanied by what other symptome
Sjogren syndrome
Dry eyes
90
epithelial elements dispersed throughout the matrix along with varying degrees of myxoid, hyaline, chondroid (cartilaginous), and even osseous tissue
Pleomorphic Adenoma
91
Salivary gland tumors are mobile on palpation except in what case
neglected malignant tumors
92
superficial gray to white inflammatory membrane
thrush
93
What leads to accumulation of what?
dental plaque and calculus
94
Radiographically, unilocular lesion, most often associated with impacted third molar (wisdom) teeth
Dentigerous cyst
95
Adenoid cystic carcinomas have a tendency to invade what?
perineural spaces . . so pain is a common symptome
96
white, confluent pathenes of fluffy, hyperkeratotic thickenings
hairy leukoplakia
97
location of warthin tumor (papillary cystadenoma lymphomatosum)
almost exclusively in the parotid
98
age for mucocele
all ages but most common in toddlers, young adults, and elderly who are prone to falling
99
Age for benign salivary gland tumors?
Malignant?
5th to 7th decades
Later
100
time frame for HSV vesicle
spontaneously clear within 3 to 4 weeks
101
What are the most common type of inflammatory salivary gland lesion?
Mucocele
102
most common type of odontogenic tumor that arises from epithelium but shows extensive depositions of enamel and dentin
Odontoma
103
Favored location for classic SCC
- ventral tongue
- floor of mouth
- lower lip
- soft palate
- Gingiva (look under dentures)
104
Develops as a result of long standing inflammation of the tooth (pulpitis), which may be caused by advanced carious lesions or by trauma to the tooth in question
periapical cyst
105
vesicles are first filled with a clear, serous fluid, but rapidly rupture to yield painful, red-remmed, shallow ulcerations
HSV
106
red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed.
erythroplakia
107
Mucicarmine stains this reddish pink
mucoepidermoid carcinoma
108
What clinical form of oral candidiasis is most common and what is it also called
pseudomembranous . . also known as thrush
109
95% of head and neck cancers are what histological type?
squamous cell carcinomas (SCC)
110
inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum
periodontitis
111
When multiple keratocystic odontogenic tumors are found, patients should be evaluated for what?
nevoid basal cell carcinoma syndrome (Gorlin syndrome)
112
Epidermal cells sometimes develop esosinophilic INTRANUCLEAR VIRAL INCLUSIONS, or several cells may fuse to produce MULTINUCLEATED POLYKARYONS
HSV
113
broad based budding yeast
Blasto
114
composed of variable mixtures of squamous cells, mucus-secreting cells, and intermediate cells
Mucoepidermoid carcinoma
115
`Location of mucoepidermoid carcinoma
Mainly parotids but also account for large fraction of salivary gland neoplasms in other glands, particularly the minor salivary glands
116
compare long term survival of HPV-positive SCC to HPV negative
greater
117
Reactivation of latent HSV is associated with what?
- trauma
- allergies
- UV light exposure
- URI
- pregnancy
- menstruation
- immunosuppression
- exposure to temperature extremes
118
histologically, cyst lined with a thin layer of keratinized stratified squamous epithelium with a prominent basal cell layer and a corrugated epithelial surface
keratocystic odontogenic tumor
119
inflammation of oral mucosa surrounding teeth
gingivitis
120
Arises from odontogenic epithelium and show NO ectomesenchymal differentiation
Ameloblastoma
121
The likelihood of a salivary gland tumor being malignant is inversely proportional to what?
size of the gland
122
Gingivitis is result of what?
poor oral hygiene
123
What glands are affected by mumps
major ones particularly parotids
124
Bats, birds, caves
histo
125
2 subtypes of odontogenic cysts
inflammatory or developmental
126
if a ranula becomes so large that it has dissected through the connective tissue stroma connecting the two bellies of the mylohyoid muscle
plunging ranula
127
Why is it thought that HPV related cancers of oropharynx will surpass HPV related cervical cancer?
they are not readily accessible or amenable to cytologic screening for premalignant lesions
128
inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women
pyogenic granuloma (pregnancy tumor)
129
Decreased secretory function may also predispose to secondary bacterial invasion, as sometimes occurs in patients receiving what?
long term phenothiazines
130
cyst that originates around the crown of an unerupted tooth and is thought to be the result of fluid accumulation between the developing tooth and the dental follicle
Dentigerous cyst
131
What during delivery predisposes infant to oral thrush
vaginal yeast infections
132
Therapy for gingivitis
aimed at reducing the accumulation of plaque and calculus via regular brushing, flossing, and dental visits
133
virus that causes hairy leukoplakia
EBV
134
Gland for pleomorphic adenoma
60% of the parotid tumors and less common in submandibular and rare in minor glands
135
Most common pathogenic factor for leuko/erythroplakias
tobacco . . alcohol also contributes
136
50% of adenoid cystic carcinomas disseminate where decades after primary tumor removal
bone, liver, brain
137
pale gray surface punctuated by narrow cystic or cleftlike spaces filled with mucinous or serous secretions.
on microscope: spaces lined by DOUBLE LAYER of neoplastic epithelial cells resting on dense lymphoid stroma with germinal centers
Warthin tumor
138
5 year survival for early stage and tobacco related SCC
80%
139
gene and chromosome for Gorlin syndrome?
PTCH on chromosome 9
140
Maculopapular, vesiculobullous eruption that sometimes follows an infection elsewhere, ingestion of drugs, development of cancer, or a collagen vascular disease; when it involves the lips and oral mucosa it's called stevens-johnson syndrome
Erythema multiforme . . . life threatening
141
What does a dental plaque contain?
mixture of bacteria, salivary proteins, and desquamated epithelial cells
142
time for herpetic stomatitis
7 to 10 days
143
Nonspecific bacterial sialadenitis is usually secondary to what?
Ductal obstruction produced by stones (Sialolithiasis)
144
Radiographically, well-defined unilocular or multiolcular radiolucencies
keratocystic odontogenic tumor
145
Acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane; enlargement of lymph nodes in neck; palatal petechiae
infectious mononucleosis
146
A lack of salivary secretions is a major complication of what therapy
Radiation
147
Classic pathogenesis for squamous cell carcinomas
tobacco and alcohol
148
What immunologic disorders may aphthous ulcers be associated with
- Celiac disease
- IBD
- Behcet disease
149
color for mucocele
blue translucent hue
150
smoking and Warthin tumors
8 times greater risk
151
Benign tumor that consist of a mixture of ductal (epithelial) and myoepithelial cells and therefore show both epithelial and mesenchymal differentiation
Pleomorphic adenoma
152
Local expansion of SCC
submandibular glands and cervical nodes
153
age for leukoplakia/erythroplakia
any age but usually 40 to 70
154
intercellular bridges and cytokeratin positive
SCC
155
common, often recurrent, exceedingly painful, superficial oral mucosal ulcerations of unknown etiology
Aphthous ulcers (canker sores)
156
Koplik spots
Measles
157
Painful enlargement and sometimes a purulent ductal discharge and UNILATERAL involvement of a single gland
Nonspecific sialadenitis
158
Erythroplakia compared to Leukoplakia
- risk of malignant transformation much higher
- less common
- more ominous
159
Resolution of an Aphthous ulcer
typically spontaneously in 7 to 10 days
160
Xerostomia
dry mouth
161
Rarely show orderly epidermal maturation. Virtually all show SEVERE dysplasia, carcinoma in situ, or minimally invasive carcinoma
Erythroplakia
162
if a carcinoma arises in a pleomorphic adenoma, it is reffered to as what?
carcinoma ex pleomorphic adenoma or a malignant mixed tumor . . . super agressive
163
describe growth and invasion of ameloblastoma
commonly cystic, slow growing, and locally invasive but has an indolent curse in most cases
164
What likely contributes to the reddish clinical appearance of erythroplakia
an intense subepithelial inflammatory reactions with vascular dilation
165
What cures a dentigerous cyst
complete removal
166
clinical presentation for HPV type SCC
- no preceding/precancerous lesion
| - Non specific symptoms such as sore throat, ear ache, pain on swallowing (odynophagia), weight loss
167
Leukoplakias may occur anywhere in oral cavity but favor what locations
- buccal mucosa
- floor of mouth
- ventral surface of tongue
- palate
- gingiva
168
Molecular biology of classic SCC
- TP53 on chromosome 7
- NOTCH
- p63 protein
169
What drug can cause striking fibrous enlargement of the gingivae?
phenytoin (dilantin) . . for siezures
170
Age and gender for salivary gland neoplasms
usually adults and slight female predominance
171
Age for aphthous ulcers
first 2 decades
172
Tzanck test
HSV
173
microscopically: hyperparakeratosis and acanthosis with "balloon cells" in upper spinous layers
Hairy leukoplakia
174
oral SCC in individuals younger than 40 with no known risk factors like smoking and alcohol?
HPV
175
Nonspecific bacterial sialadenitis most often involves what glands
major, particularly submandibular
176
What increases the risk of pleomorphic adenomas
Radiation
177
what drugs can eliminate or alter the normal bacterial flora of the mouth and can result in oral candidiasis
broad spectrum antibiotics or steroid inhalers
