Pathology Flashcards
What are the clinical features of acute periradicular periodontitis? (4)
- history of pain
- grossly carious
- previous trauma
- nothing on radiograph
What are the treatment options for acute periradicular periodontitis? (2)
- extraction
- endodontic treatment
What is the histopathology of an acute periapical abscess?
In the centre is pus, then there is neutrophils around and then there is a surrounding membrane of capillaries and fibroblasts
What are the clinical features of chronic periradicular periodontitis? (3)
- non vital tooth
- minimal symptoms
- apical radiolucent lesion
What can a periapical granuloma transform to? (2)
- abscess
- radicular cyst
What is the histopathology of a periapical granuloma? (4)
- inflamed granulation tissue
- proliferation of cell rests of malassez
- haemosiderin and cholesterol deposits
- resorption of adjacent bone +/- tooth
What are the layers of the enamel organ? (4)
- inner enamel epithelium
- outer enamel epithelium
- stellate reticulum
- stratum intermedium
What are the types of inflammatory odontogenic cysts? (2)
- radicular cyst
- inflammatory collateral cysts (paradental cyst and mandibular buccal bifurcation cyst)
What progresses into a radicular cyst?
Epithelial proliferation of the cell rests of malassez within some periapical granulomas progress into a radicular cyst
What is a lateral radicular cyst?
A radicular cyst arising from a lateral root canal branch of a non vital tooth
What are the clinical features of a mandibular buccal bifurcation cyst? (2)
- often painless swelling
- associated tooth usually tilted buccal with deep perio pocket
What do odontogenic keratocysts arise from?
Remnants of the dental lamina
Name 8 developmental odontogenic cysts
- odontogenic keratocyst
- dentigerous cyst
- eruption cyst
- lateral periodontal cyst
- glandular odontogenic cyst
- gingival cyst
- calcifying odontogenic cyst
- orthokeratinised cyst
Where does a glandular odontogenic cyst occur?
Anterior mandible
What is the appearance of gingival cysts in adults? (2)
- painless dome shaped swelling in gingiva
- may be superficial erosion of underlying alveolar bone
Name 5 soft tissue cysts
- salivary mucocele
- epidermoid cyst
- dermoid cyst
- lymphoepithelial cyst
- thyroglossal cyst
Name 5 localised soft tissue hyperplasias
- epulides
- pyogenic granuloma
- fibroepithelial polyp
- denture irritation hyperplasia
- papillary hyperplasia of the palate
What is the name for a pedunculate or sessile firm mass on gingiva often between two teeth? It is pink in colour
Fibrous epulis
What is the name for a soft purplish gingival swelling which is mostly on gum of teeth anterior to molars?
Giant cell epulis
What is the name for a variant of a fibroepithelial polyp which is often seen on the gingivae?
Giant cell fibroma
Name 5 types of soft tissue neoplasms
- tumours of fibrose tissue
- tumours of adipose tissue
- tumours of vascular tissue
- tumours of peripheral nerves
- tumours of muscle
Name 4 tumours of vascular tissue
- haemangioma
- lymphangioma
- kaposis sarcoma
- angiosarcoma
What are the 4 variants of kaposis sarcoma?
- classic
- endemic
- AIDS associated
- iatrogenic
Name 4 tumours of peripheral nerves
- neurofibroma
- neurilmmona
- traumatic neuroma
- malignant peripheral nerve sheath tumours
What is the name for a benign peripheral nerve sheath tumour that arises from a mixture of cell types? It affects the tongue, gingivae, salivary glands or rarely intraosseous
Neurofibroma
What is the name for a reactive lesion after nerve damage, not a tumour? It is a smooth nodule
Traumatic neuroma
What is the name for a pink polypoid mass on the alveolus of new borns?
Congenital epulis
What are the causes of sialadenitis? (5)
- bacterial
- viral
- trauma
- irradiation
- allergic reactions
What are the treatment options for chronic bacterial sialadenitis? (3)
- stimulate saliva flow
- sialogogues
- removal of the stone, gland or duct
What are the causes of salivary calculi formation? (4)
- xerostomia
- stasis of saliva
- mucous plug
- duct stricture
What is necrotising sialometaplasia?
An inflammatory condition causing a tumour like lesion
What are the causes of sialadenosis? (6)
- malnutrition
- anorexia
- bulimia
- alcoholism
- liver cirrhosis
- hormonal disturbances
What are the tumours of the salivary glands? (4)
- malignant tumours
- benign tumours
- non neoplastic epithelial lesions
- haematolymphoid tumours
What are the types of white patches? (8)
- developmental
- normal variation
- hereditary
- traumatic
- dermatological
- infective
- idiopathic
- neoplastic
Name an idiopathic white patch
Leukoplakia
What can lichen planus be confused with? (4)
- lichenoid reaction to drugs/restorative material
- lupus erythematous
- graft versus host disease
- lichenoid inflammation associated with dysplasia
What are the types of red patches? (4)
- infective
- associated with dermatological disorders
- idiopathic
- neoplastic
Where is median rhomboid glossitis found?
Median rhomboid glossitis is a rhomboid red patch on midline of posterior aspect of anterior 2/3 of dorsal tongue
What is oral submucosa fibrosis associated with?
Betel quid/areca nut
What are the clinical features of oral sub mucous fibrosis? (3)
- clinically pale coloured mucosa, firm to palpate
- trismus
- fibrous bands which affect buccal mucosa, soft palate and labial mucosa
What types of exogenous oral pigmentation can you get> (5)
- superficial staining of mucosa e.g tobacco
- black hairy tongue
- foreign bodies e.g amalgam tattoo
- heavy metal poisoning
- drugs, NSAIDs, antimalarials, chlorohexidine
What is an amalgam tattoo associated with?
Collagen and elastic fibres and basement membranes
What types of endogenous oral pigmentation can you get? (4)
- racial pigmentation
- melanotic macule
- peutz jeghers syndrome
- smokers melanosis
What are the features of ulcers? (3)
- ulceration with loss of surface epithelium
- inflamed fibrinoid exudate
- inflamed granulation tissue
What happens in pemphigus?
Autoantibodies to desmosomal protein are produced
What is the location of mucous membrane pemphigoid?(7)
- oral mucosa
- eyes
- nose
- larynx
- pharynx
- oesophagus
- genitalia
What is epidermolysis bullosa?
Formation of skin bullae which heal with scarring
What are the inherited forms of epidermolysis bullosa? (3)
- simplex
- junctional
- dystrophic
What is epidermolysis bullosa acquits?
An acquired blistering dermatosis with sub epithelial bullae
What are the histological features of epithelial dysplasia? (3)
- nuclear and cellular pleomorphism
- alteration in nuclear/cytoplasmic ratio
- prominent nucleoli
How do you manage epithelial dysplasia? (3)
- modify risk factors
- anti fungal treatment
- biopsy to assess dysplasia
What are the oral cancer detection test? (4)
- toludene blue
- autofluorescence
- chemiluminescence
- vizilite plus
What are the core data items included in the pathology report? (4)
- maximum diameter of tumour
- maximum depth of invasion
- degree of differentiation
- pattern of invasion
What is verrucous carcinoma?
An uncommon distinctive low grade variant of SCC
Name a odontogenic carcinoma
Ameloblastic carcinoma
Name a odontogenic sarcoma
Ameloblastic fibrosarcoma
What are the clinical features of an ameloblastoma? (3)
- swelling
- radiolucent lesion on imaging
- slow growing, locally aggressive
What are the clinical features of an adenomatoid odontogenic tumour? (3)
- associated with unerupted permanent teeth
- unilocular radiolucency may mimic dentigerous cyst
- most are asymptomatic
What is a odontoma?
Painless slow growing lesion that are developmental malformations of dental tissues
What is an odontoma complex type?
An irregular mass of hard and soft dental tissues, haphazard arrangement with no resemblance to a tooth and often forming a cauliflower like mass
Name a benign mesenchymal odontogenic tumour
Cementoblastoma
What are the clinical features of a cementoblastoma? (3)
- painful swelling
- tooth remains vital
- well defined radiopaque or mixed density lesion
Name a malignant maxillofacial bone and cartilage tumour
Chrondrosarcoma
Name a benign maxillofacial bone and cartilage tumour
Chondroma
Name a giant cell lesion and bone cyst
Aneurysmal bone cyst
Name a haematolymphoid tumour
Solitary plasmacytoma of bone
What is an osteoma?
A benign slow growing tumour consisting of well differentiated mature bone
What is gardeners syndrome?
Rare AD disorder and features include multiple osteomas, polyposis coli and multiple fibrous tumours and epidermal/sebaceous cysts of the skin
What are cancellous type osteomas?
Interconnecting trabecular enclosing fatty or fibrous marrow
What is a melanotic neuroectodermal tumour of infancy?
A locally aggressive rapidly growing pigmented mass which is most frequently in the anterior maxillary alveolus
What cell populations does a neuroectodermal tumour of infancy have? (2)
- neuroblastic cells
- pigmented epithelial cells
What are fibro osseous lesions histologically characterised by?
Replacement of normal bone by cellular fibrous tissue within which islands and trabecular of metaplastic bone develop
What is an ossifying fibroma?
Slow, painless expansion of bone, jaws and craniofacial skeleton
Where does a cemento ossifying fibroma occur?
Exclusively in the tooth bearing regions of the jaws
What is fibrous dysplasia of bone? What is it due to?
Fibre osseous lesion of growing bones. Due to GNAS1 mutations
What does monostotic fibrous dysplasia give rise to?
Painless bony swelling and facial asymmetry
What are the features of polyostotic fibrous dysplasia? (2)
- affects several bones
- skin pigmentation and endocrine abnormalities
What is albright syndrome?
Polyostotic fibrous dysplasia, skin pigmentation and sexual precocity
What is an osteochondroma?
Bony projection with a cap of cartilage
What is the histopathology of a central giant cell granuloma? (3)
- large numbers of mudltinucleate, osteoclast like giant cells
- set in a vascular fibrous stroma
- areas of haemorrhage and haemosiderin
What is osteogenesis imperfecta?
Hereditary disease characterised by impairment of collagen maturation
What are the clinical features of osteogenesis imperfecta? (3)
- easily fractured, osteoporotic bone
- affected teeth appear as in dentinogenesis imperfecta
- malocclusion may be a problem
What is osteopetrosis?
A group of rare genetic diseases in which there is a marked increase in bone density
What is osteopetrosis due to?
Failure of normal osteoclast activity and absence of normal modelling resorption
What is the result of osteopetrosis? (2)
- cortices are thickened and sclerosis of cancellous bone
- anaemia is common due to marrow space deficiency
What is a recognised complication of osteopetrosis?
Osteomyelitis
What is cleidocranial dysplasia characterised by?
Defective formation of the clavicles, delayed closure of the fontanelles and retrusion of the maxilla
What is achondroplasia?
An abnormality of endochondrial ossification. The head and neck is of normal size but limbs are excessively short
What is osteoporosis?
Bone is of normal composition but is reduced in quantity
What are the dental defects of rickets and osteomalacia? (2)
- hypo calcification of dentine and enamel hypoplasia
- delay in tooth eruption
What is the dental presentation of acromegaly? (2)
- jaw is enlarged and protrusive with increased spacing between teeth
- thickening of facial soft tissues
What are the clinical features of pagets disease? (2)
- affected bones are thickened but weaker and pathological fractures can occur
- narrowing of foramina can cause cranial nerve defects
What is the treatment of pagets disease? (2)
- calcitonin
- bisphosphonates
