Pathology Flashcards
Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue; classically seen in adolescent males
Presents with profuse epistaxis
Angiofibroma
Protrusion of edematous, inflamed nasal mucosa.
Usually secondary to repeated bouts of rhinitis; also occurs in cystic fibrosis and aspirin-intolerant asthma
NASAL POLYP
Aspirin-intolerant asthma is characterized by the triad of asthma, aspirin-induced bronchospasms, and nasal polyps; seen in 10% of asthmatic adults
Inflammation of the nasal mucosa;
Presents with sneezing, congestion, and runny nose (common cold).
Rhinovirus is the most common cause.
RHINITIS
Allergic rhinitis is a subtype of rhinitis due to a type I hypersensitivity reaction (e.g., to pollen), and is characterized by an inflammatory infiltrate
Malignant tumor of nasopharyngeal epithelium
Associated with EBV; classically seen in African children and Chinese adults.
Biopsy usually reveals pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a background of lymphocytes.
NASOPHARYNGEAL CARCINOMA
Often presents with involvement of cervical lymph nodes
Inflammation of the epiglottis; H influenzae type b is the most common cause, especially in non immunized children.
Presents with high fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor; risk of airway obstruction
ACUTE EPIGLOTTITIS
Inflammation of the upper airway; parainfluenza virus is the most common cause.
Presents with a hoarse, “barking” cough and inspiratory stridor
LARYNGOTRACHEOBRONCHITIS (CROUP)
Due to excessive use of vocal cords; usually bilateral.
Composed of degenerative (myxoid) connective tissue.
Presents with hoarseness; resolves with resting of voice.
VOCAL CORD NODULE (SINGER’S NODULE)
Nodule that arises on the true vocal cord
Benign papillary tumor of the vocal cord
Due to HPV 6 and 11; papillomas are usually single in adults and multiple in children.
Presents with hoarseness
LARYNGEAL PAPILLOMA
Full-thickness defect of lip or palate, due to failure of facial prominences to fuse.
During early pregnancy, facial prominences (one from superior, two from the sides, and two from inferior) grow and fuse together to form the face.
CLEFT LIP AND PALATE
C. Cleft lip and palate usually occur together; isolated cleft lip or palate is less common.
Painful, superficial ulceration of the oral mucosa that arises in relation to stress and resolves spontaneously, but often recurs.
Characterized by a grayish base surrounded by erythema
APHTHOUS ULCER
Recurrent aphthous ulcer is called Behcet syndrome
Recurrent aphthous ulcers, genital ulcers, and uveitis
Due to immune complex vasculitis involving small vessels. Can be seen after viral infection, but etiology is unknown
BEHCET SYNDROME
Vesicles involving oral mucosa that rupture, resulting in shallow, painful, red ulcers.
Primary infection occurs in childhood; lesions heal, but virus remains dormant in ganglia of the ______ nerve.
Stress and sunlight cause reactivation of the virus, leading to vesicles that often arise on the lips.
ORAL HERPES (Usually due to HSV-1)
trigeminal nerve
Malignant neoplasm of squamous cells lining the oral mucosa.
Tobacco and alcohol are major risk factors.
Floor of mouth is the most common location.
Oral leukoplakia and erythroplakia are precursor lesions.
SQUAMOUS CELL CARCINOMA
Erythroplakia and leukoplakia are often biopsied to rule out carcinoma.
_______ is a white plaque that cannot be scraped away; often represents squamous cell dysplasia.
Leukoplakia
It is distinct from oral candidiasis (thrush) and hairy leukoplakia.
_________ is a white, rough (‘hairy’) patch that arises on the lateral tongue. It is usually seen in immunocompromised individuals (e.g., AIDS) and is due to EBV-induced squamous cell hyperplasia; not pre-malignant
Hairy leukoplakia
________ is a white deposit on the tongue, which is easily scraped away; usually seen in immunocompromised states and is caused by fungi
Oral candidiasis
______ represents vascularized leukoplakia and is highly
suggestive of squamous cell dysplasia.
Erythroplakia (red plaque)
Infection resulting in bilateral inflamed parotid glands. Orchitis, pancreatitis, and aseptic meningitis may also be present.
- Serum amylase is increased due to salivary gland or pancreatic involvement.
- Orchitis carries risk of sterility, especially in teenagers.
MUMPS
Inflammation of the salivary gland. Most commonly due to an obstructing stone (sialolithiasis) leading to Staphylococcus aureus infection; usually unilateral
SIALADENITIS
Benign tumor composed of stromal (e.g., cartilage) and epithelial tissue; most common tumor of the salivary gland. Usually arises in parotid; presents as a mobile, painless, circumscribed mass at the angle of the jaw.
This tumor has high rate of recurrence; extension of small islands of tumor through tumor capsule often leads to incomplete resection.
PLEOMORPHIC ADENOMA
Rarely may transform into carcinoma, which presents with signs of facial nerve damage (facial nerve runs through parotid gland)
Benign cystic tumor with abundant lymphocytes and germinal centers (lymph node-like stroma); 2nd most common tumor of the salivary gland.
This tumor almost always arises in the parotid
WARTHIN TUMOR
Malignant tumor composed of mucinous and squamous cells; most common malignant tumor of the salivary gland.
Usually arises in the parotid; commonly involves the facial nerve.
MUCOEPIDERMOID CARCINOMA
A 6-year-old boy presents with painful sores on his upper
lip. He was seen for a fl u 1 week ago. The lesion appears as 0.2- to 0.4-cm vesicles with focal ulceration. Which of the following is the most likely histologic feature of this skin lesion?
(A) Acute arteritis
(B) Caseating granulomas
(C) Fungal hyphae
(D) Multinucleated epithelial cells
(E) Noncaseating granulomas
The answer is D: Multinucleated epithelial cells. Herpes labialis (cold sores, fever blisters) and herpetic stomatitis are caused by herpes virus type 1. Microscopically, the herpetic vesicle forms as a result of “ballooning degeneration” of the epithelial cells. Some epithelial cells show intranuclear inclusion bodies. At the edge of the ulcer are large, multinucleated, epithelial cells with “ground glass” homogenized nuclei, often exhibiting nuclear molding. The ulcers heal spontaneously without scar formation.
A 40-year-old woman is hospitalized because of a massive neck infection that developed over a period of 3 days after extraction of an impacted wisdom tooth. She has a high fever, and her lower jaw and entire neck are swollen, red, and painful. Throat culture reveals a mixed bacterial fl ora, containing both aerobic and anaerobic microorganisms. Which of the following is the most likely diagnosis?
(A) Actinomycosis
(B) Acute necrotizing ulcerative gingivitis
(C) Ludwig angina
(D) Pyogenic granuloma
(E) Scarlet fever
Ludwig angina is a rapidly spreading cellulitis, or phlegmon, which originates in the submaxillary or sublingual space but extends locally to involve both. The bacteria responsible for this infection originate from the oral flora. After extraction of a tooth, hairline fractures may occur in the lingual cortex of the mandible, providing microorganisms ready access to the submaxillary space. By following the fascial planes, the infection may dissect into the parapharyngeal space and, from there, into the carotid sheath. Actinomycosis (choice A) features branched, filamentous bacteria. Acute necrotizing ulcerative gingivitis (Vincent angina, choice B) does not extend to the neck. Pyogenic granuloma (choice D) is a focal, reactive vascular lesion.
A 16-year-old girl presents with a sore throat of 4 months in duration. She describes feeling a lump in her throat. Physical examination reveals a 1-cm cystic lesion at the base of the tongue. This developmental lesion most likely arises as a remnant of which of the following anatomic structures? (A) Auditory tube (B) Branchial arches (C) Facial fusion lines (D) Rudimentary thymus (E) Thyroglossal duct
The answer is E: Thyroglossal duct. During its normal development, the thyroid gland descends from the base of the tongue to its final position in the neck. Heterotopic functioning thyroid tissue or a developmental cyst (thyroglossal duct cyst) may occur anywhere along the path of descent. The most common location is at the foramen cecum of the tongue. Symptoms such as dysphonia, sore throat, and awareness of a mass in the throat often become evident during adolescence and pregnancy. The other choices do not present in this anatomic location. In particular, branched cleft cysts that originate from remnants of the branchial arches (choice B) occur in the lateral anterior aspect of the neck or in the parotid gland.
A 2-year-old girl was withdrawn from a day care center for excessive irritability. On physical examination, she has multiple, small superfi cial ulcers of the oral mucosa. The ulcerations heal spontaneously over the next 5 days. Which of the following is the most likely diagnosis? (A) Aphthous stomatitis (B) Candidiasis (C) Gingivitis (D) Ludwig angina (E) Pyogenic granuloma
Aphthous stomatitis describes a common disease that is characterized by painful, recurrent, solitary or multiple, small ulcers of the oral mucosa. The causative agent is unknown. Microscopically, the lesion consists of a shallow ulcer covered by a fibrinopurulent exudate. Candidiasis (choice B) features white plaques.
A 6-year-old boy presents with a painful sore in his mouth. Physical examination reveals a small, elevated, and focally ulcerated red-purple gingival lesion. A soft red mass measuring 1 cm in diameter is surgically removed. Histologic examination discloses highly vascular granulation tissue, with marked acute and chronic inflammation. What is the most likely diagnosis? (A) Acute necrotizing gingivitis (B) Aphthous stomatitis (C) Herpes labialis (D) Pyogenic granuloma (E) Tuberculosis
Pyogenic granuloma is a reactive vascular lesion that commonly occurs in the oral cavity. Usually some minor trauma to the tissues permits invasion of nonspecific microorganisms. In the oral cavity, pyogenic granulomas, ranging from a few millimeters to a centimeter, are most frequent on the gingiva. The lesion is seen as an elevated, red or purple, soft mass, with a smooth, lobulated, ulcerated surface. Microscopically, the nodule consists of highly vascular granulation tissue that shows varying degrees of acute and chronic inflammation. With time, pyogenic granuloma becomes less vascular and comes to resemble a fibroma. Choices A, B, and C are ulcerating lesions. Tuberculosis (choice E) features granulomatous inflammation.
A 60-year-old man, who is a chronic alcoholic, is referred
by a homeless shelter for facial ulcers. On physical examination, there are large ulcerations in the mouth and facial tissues with focal exposure of bone. A culture grows Borrelia vincentii. Which of the following is the most likely diagnosis?
(A) Acute necrotizing ulcerative gingivitis
(B) Apical granuloma
(C) Ludwig angina
(D) Periodontitis
(E) Pyogenic granuloma
Acute necrotizing ulcerative gingivitis (Vincent angina) represents an infection by two symbiotic organisms; one is a fusiform bacillus, and the other is a spirochete (B. vincentii). The fact that these organisms are found in the mouths of many healthy persons suggests that predisposing factors are important in the development of acute necrotizing ulcerative gingivitis. The most important element appears to be decreased resistance to infection as a result of inadequate nutrition, immunodefi ciency, or poor oral hygiene. Vincent infection is characterized by punched-out erosions of the interdental papillae. The ulceration tends to spread and eventually to involve all gingival margins, which become covered by a necrotic pseudomembrane.
A 4-year-old boy from Uganda presents for pre-school physical examination. His parents indicate that hearing loss in his right ear developed 3 years ago following an acute illness. If this child’s hearing loss was caused by a viral infection, which of the following was the most likely etiology? (A) Chickenpox (B) Epstein-Barr virus (C) Mumps (D) Rubella (E) Yellow fever
Mumps is the most common cause of deafness among the postnatal viral infections. The infection can cause rapid hearing loss, which is unilateral in 80% of cases. By contrast, prenatal infection of the labyrinth with rubella (choice D) is usually bilateral, with permanent loss of cochlear and vestibular function.
A 64-year-old man presents with sores on the gums. Oral
examination shows multiple, gingival abscesses adjacent to the teeth and excessive mobility of several teeth. Which of the following is the most likely diagnosis?
(A) Dental caries
(B) Hyperparathyroidism
(C) Osteitis deformans
(D) Periapical granuloma
(E) Periodontal disease
Periodontal disease refers to acute and chronic disorders of the soft tissues surrounding the teeth, which eventually lead to the loss of supporting bone. Chronic periodontal disease typically occurs in adults, particularly in persons with poor oral hygiene. However, many persons with apparently impeccable habits, but a strong family history of periodontal disease, manifest the disorder.
