Pathology Mental Dental] Flashcards
Benign but Aggressive
Classic DDx for multilocular RL in post mand is _______, KCOT, CGCG, COF
Tx: wide excision or resection, high reccurence if too conservative
Ameloblastoma
RL with driven snow calcification (white flecks)
Amorphous pink amyloid with concentric calcifications termed Liesegang rings
Tx: excision, good prog
CEOT: Pinborg tumor
Contains epithelia duct-like spaces and enameloid material
Mostly in anterior max and over impacted canine
Tx: surg excision, good prog
AOT
Myxomatous connective tissue= slimy stroma
Messy RL with unclear borders and honeycomb pattern
Tx: surgical excision, moderate recurrence
Odontogenic Myxoma
Dense collagen strands of epithelium
Central: bone, well defined multilocular RL
Mostly in post mand
Central odontogenic fibroma
Well-circumscribed RO mass
Ball of cementum and cementoblasts replacing tooth root
Tx: surg excision and TE
Cementoblastoma
Occurs in children and teens
Mostly seen in post mand
Myxomatous connective tissue
Called different name is odontoma is also present
Tx: surg excision
Ameloblastic fibroma
RO lesion composted of dental hard tissues
Can block eruption
Compound: mostly anterior and toothicles
Complex: posterior, conglomerate mass
Garder syndrome: multiple odontomas and intestinal polyps
Odontoma
COmposed of fibroblastic stroma in which goci of mineralized products are formed
Central: bone, well-circumscribed RL
Juvenile= aggressive variant, rapid growth, younger population
Similar in appearance and behavior to cementifying fibroma
Tx: surg excision
Central ossifying fibroma
Ground glass appearance
Usually stops growing after puberty
McCune-Albright Syndrome; polyostotic fibrous dysplasia, cutaneous cafe au lait spots, endocrine abnormalilites like precocious puberty
Fibrous dysplasia
Reactive process of unknown orgin
Most common at apices of mand anterior teeth
Most common in middle aged black femals
Teeth are vital
Lucent to opaque
No tx
Periapical cemento-osseous dysplasia
Circumscribed opaque mass of bone and osteoblasts
Tx: surg excision
Osteoblastoma
Composed of firbroblasts and multinucleated giant cells
Anterior mand favored
Central= bone RL with thin wispy septations
Tx Excisiton
Central giant cell granuloma
Pseudocyst composed of blood filled spaces
ML RL
Expansile
Post mand favored
Tx Excision: Apsiration biopsy
Aneurysmal bone cyst
Causes multiple bone lesions resulting from excessive levels of PTH
Brown tumor= due to excess osteoclast activity
Elevated alkaline phosphatase due to too much breakdonw of bone
Von Recklinghhausen’s disease of bone= the result of this condition
Hyperparathyroidism
Austomsomal dominant
Symmetical bilateral swelling, expansile bilateral multilocular RLs
Stops growing after puberty
Giant cell lesion
Cheubism
Rare type of cancer
Langerhan cells are normally found in the skin as antigen presenting cells, but can cause damage if they buildup in certain parts of the body
Discrete punched out ice cream scoop RLs that lead to floating teeth
Tx: excision, radiation, chemo
Langerhans cell ds
Progressive metabolic distrubance of many bones causing symmetrical enlargement
Usually adults over 50
Elevated alkaline phosphatase due to breakdown of bone
Cotton wool appearance
Dentures and hats become too tight
Tx: bisphosphonates and calcitonin
Paget’s ds
Approx 1 in 1000 birth
Unilateral (80%) or bilateral (20%)
Lack of fusion between medial nasal process and max process
Cleft lip
Approx 1 in 2000 births
Lack of fusion of palatal shelves
Cleft palate
Invaginations at commissures or near midline
Van der Woude Syndrome= clefts and pits
Lip pits
Ectopic sebaceous glands
Fordyce Granules
White or whitish-gray edematous lesion of buccal mucosa
Dissipates when cheek is stretched
Leukoedema
Thryoid tissue mass at midline base of tongue
Located along embryonic path of thyroid descent
Lingual thyroid
Midline neck swelling
Located along embryonic path of thyroid descent
Thyroglossal duct cyst
White annular (ringed) lesions surrounding central red islands that migrate over time
Occasionally hurt and burn
Tx: none
Geographic tongue
Folds and furrows of tongue dorsum
Melkersson-Rosenthal Syndrome= fissured tongue + granulomatous chelitis + facial paralysis
Fissured tongue
Tumors of blood vessels or lymph vessels
Angioma
Congential focal proliferation of capillaries
Most undergo involution but persistent lesions are excised
Hemangioma
Congential focal proliferation of lymph vessels
Oral are very rare purple spots on tongue
Called cystic hygroma when occurs in the neck
Sturge Weber syndrome: angiomas of leptomeninges (arachnoid and pia mater) + skin along th distribution of the trigeminal nerve
Lymphangioma
Mass in midline floor of mouth if about mylohyoid
Mass in upper neck if below mylohyoid
Contains adnexal structures like hair and sebaceous glands
Doughy consistency
Dermoid cyst
Lateral neck swelling
Epithelial cyst within lymph node of neck
Branchial cyst
Epithelial cyst within lymphoid tissue of oral mucosa
Palatine and lingual tonsils are common regions
ORal lymphoepithelial cyst
RL in post mand below mand canal
Due ot lingual concavity of jaw
Stafne defect
Heart shaped RL in nasopalatine canal
Caused by cystification of canal remnants
Tx: excision
Nasopalatine duct cyst
Large RL scalloped around roots
No epithelial lining in mand of teens
Tx: aspiriate to Dx just monitor
Traumatic bone cyst
White line in buccal mucosa
Type of focal hyperkeratosis due to chronic friction on mucosa
LInea alba
Red dots are inflamed salivary duct openings
ONly premalignant if related to reverse smling
Nicotine stomatitis
Traumatic implantation of amalgam particles into mucosa
Tiny RO particles in xray
Amalgam tattoo
Benign hyperpigmenation in mucous membranes
Basicallly a freckle of mucosa
Peutz-Jehgers: freckles and intestinal polyps
Melanotic macule
Elongated FILIFORM papilllae
Hairy tongue
Related to surfactant ingredient SLS
Dentrifice Assc sloughing
Primary: pan oral self limiting and childhood
Latent in Trigemial gang
Recurrent: keratinized mucosa only
Labilalis and recurrent intraoral
Whitlow: fingers
Gladiatorum: head
Acyclovir in prodromal period
HSV
Primary: chihckenpox, slef-limiting and childhood
Latent in trigemianl
Recurrent: shingles
Ramsay Hunt Syn: herp zoster in geniculate gang affecting CN 7 and 8 resuling in facial paralysis, vertico , deafness
Tx: acyclovir
Varicella zoster virus
Hand foot and mouth disease
Herpangina: posterior oral cavity
Coxsackie virus
Koplik’s spots (buccal mucosa dot ulcers) precede skin rash
Primary: self limiting and childhood
Measles (rubeola)
Caused by several strains of HPV
Benign epithelial pedunculated or sessile proliferation on skin or mucosa
Papilloma (wart)
Caused by several strains of HPV
Common skin wart
Verruca vulgaris
Caused by HPV 6 and 11
Genital wart or from oral sex with somone with genital warts
Tx: excision with high recurrence
Condyloma acuminatum
Caused by EBV
White patch on lateral tongue that does not wipe off
Opportunistic infection associated with HIV
Associate with Burkitt’s lymphoma
Oral hairy leukoplakia
Caused by contact with Treponema pallidum
Primary: chancre
Secondary: oral mucous patch, conyloma latum, maculopapular rash
Tertiary: gumma, CNS involvement, CV involvement
Congenital: Hutchinson’s triad (notched incisors and. mulberry molars, deafnenss, ocular keratitis
Syphillis
Cuased by Mycobacterium tuberculosis
Oral nonhealing chronic ulcers follow lung infection
Primary: Ghon complex( inhaled bacteria surrounded in a granuloma that undergoes caseating necrosis and infected hilar lymph node draining the first lesion)
Secondary: more widespread lung infection with cavitation
Miliary: systemic spread
HIV pts are at high risk of getting progressive ds
Tx: multidrug
TB
Caused by Neisseria gonorrhoeae
Oral pharyngitis rarely seen
Gonorrhea
Caused by actinomyces israelii (not fungal)
Opportunistic infection chronic and granulomatous
PA: jaw infections
Cervicofacial: head and neck infectoins
Sulfur granules in purulent exudate
Tx Long term high dose penicillin
Actinomycosis
Caused by strep group A (strep pyogenes
This when strep throat becomes a systemic infection
Strawberry tongue: white coated tongue with red inflamed FUNGIFORM papillae
Tx Pen
Scarlet fever
Pseudomembranous: white plaque that rubs off
Atrophic: red
Median rhomboid glossitis: loss of lingual papillae
Angular chelitis: corner of mouth
Tx: antifungal
Candidiasis
Canker sore
Nonkeratinized
Minor: heal without scarring
Major heal with scarring
Sutton ds: another name for major form
Behcet’s syndrome: multisystem vasculitis that causes apthous-type ulcers of oral and gential and inflammation of ete
Tx: corticosteroids for Behcet’s
Aphthous ulcer
Often on lips but can occur anywhere on skin and mucosa
Minor: herpes simplex hypersensitivity
Major: drug sensitivity
Stevens-Johnson Syndrome: another name for major form
Erythema Multiforme
Allergic reaction to drug or food contact
Diffuse swelling of lips neck or face
Mediated by mast cell release of IgE and histamines
Tx: antihistamines
Angioedema
Allergic reaction to inhaled antigen
Strawberry gingivitis
Tx: corticosteroids and cyclophosphamide
Wegner’s granulomatosis
T lymphocytes target and destroy basal keratinocytes
Basal zone vacuolizatoin and sawtooth rete pegs secondary to this destruction is observed histologically
Reticular: wickham striae, more common
Erosive: wickham striae with red ulceration
Tx: corticosteroids
Lichen planus
Discoid chronic type
Disc like lesions on facial skin
Oral lesions mimic erosive lichen planus
Systemic acute type
Multiple organ involvement
Butterfly rash over bridge of nose
Austoantibodies (ANA test)
Tx: corticosteroids
Lupus Erythematosus
Hardening of skin and connective tissue
Restricted opening and uniform widening of PDL space
Scleroderma
Suprabasilar
Autoantibodies against desmosomes
Multiple painful ulcers preceded by bullae
Postivie Nikolsky’s sign
Tx: corticosteroids
Pemphigus vulgaris
Subasilar
Autoantibodies agaisnt basement membrane (hemidesmosomes)
POstivie Nikolsky’s sign
MMP
Clinical description not a Dx
White patch that does not rub off
Tx: biopsy mandatory
Leukoplakia
Recrrent and warty
May be assc with HPV 16 and 18
High risk of malignant transformation to SCC or verucous carcinoma
Proliferative Verrucous Leukoplakia
Clincial description not Dx
Red patch
Higher risk than leukoplakia
Tx: Biopsy mandatory
Erythroplakia
Tobacco and HPV 16 and 18 are causes
Slow-growing malignancy
Tx: excision
Verrucous carcinoma
Caused by oncogenes or inactivation of tumor suppressor genes
Increased incidence of oropharyngeal SCC assc with HPV 16 and 18
5-survival is about 50%
Plummer-Vinson Syndrome: mucosal atrophy, dysphagia, iron deficiency anemia, increased risk of oral cancer
Tx: excision or radiation
SCC
Sue to sun damaged
Very rarely metastasizes
Tx: surg
Basal cell carcinoma
Malignancy of melanocytes
High risk sites are palate and gingiva
5-year survival for skin lesions is greater than 65% but less than 20% for oral lesions
Oral melanoma
Calcium channel blockers
Dilantin
Cyclosporine
Tx: gingivectomy and discontinue drug is possible
Gingival hyperplasia
Entangled submucosal mass of neural tissue
Caused by injury to nerve
MOst common at mental foramen
Multiple Endocrine Neoplasia (MEN 2B)+ multiple neuromas and medullary thyroid cancer and pheochromocytoma of the adrenal gland
Traumatic neuroma
Hyperplasia of capillaries: red
Caused by chronic trauma or irritation
Common in gingiva
Pyogenic granuloma
Neoplasm of fibroblasts
Easy to eradicate and rarely recurs
Tx surgical excision
Nodular fasciitis
Neoplasm of fibroblasts
Difficult to eradicate and often recurs
Fibromatosis
Neoplasm of Schwann cells
Named such because these tumor cells have a granular cytoplasm
Pseudoepitheliomatous hyperplasia (PEH) in this tumor mimics SCC
Most common on dorsal tongue
Variant on gingiva is congenital epulis of new born
Granular cell tumor
Neoplasm of schwann cells
Acellular verocay bodies in Antoni A tissue
Schwannonma (Neurilemmoma)
Neoplasm of schwann cells and fibroblasts
Neurofibromatosis type 1/ Non Recklinghausen’s ds: multiple neurofibromas and multiple skin freckles and axillary freckles: neurofibromas can neurofibrosarcomas here
Neurofibroma
Malingnat proliferation of fibroblasts
Fibrosarcoma
Malignant proliferation of schwann cells
Neurofibrosarcoma
Malignant proliferation of endothelial cells
Caused by HHV8 and most commonly seen as complication of AIDS
Purple lesion
Kaposi’s sarcoma
Caused by by trauma to salivary duct
Mucocele: common in lower lip
Ranula when occurs on the floor of the mouth
Tx: excision
Mucous extravasation phenomenon
Histologically a true cyst lined by epithelium
Caused by blockage of salivary duct by sialolith
Mucous retention cyst
Rapidly expanding ulcerative lesion
Usually due to ischemic necrosis of minor salivary glands in response to trauma or local anesthesia
Tx: heals on its own in 6-10 wks
Necrotizing sialometaplasia
Caused by blockae of glands in sinus mucosa
Sinus retention cyst
Hyperimmune: granulomas
May. be triggered by mycobacteria
Primarily pulomonary ds, but also affects salivary glands mucosa
Xerostomia
Lofgren’s syndrome: erythema nodosum and bilateral hilar lymphadenopathy and arthritis
Heerfordt syndrome: anterior uveitis and parotid gland enlargement and facial nerve palsy and fever:
Tx: corticosteroids
Sarcoidosis
Autoimmune- lymphocyte mediated
Affects salivary and tear glands
Primary: keratoconjunctivitis sicca and xerostomia
Secondary= above plus another autoimmune ds usually RA
Tx: symptomatic
Sjogren’s syndrome
Composed of mixture of cell types (mixed tumor)
Most common benign salivary gland tumor
Firm rubbery swelling
Most common site is palate for minor salivary gland or ear for parotid gland
Pleomorphic adenoma
Composed of single cell type
Includes basal cell adenoma, canalicular adenoma, myoepithelioma, and oncocytic tumor
Tx: surgical excision
Monomorphic Adenoma
Composed of oncocytes and lymphoid cells
Oncocyte: epithelial cell with excessive number of mitochondria
Usually found in the parotid of older men
Warthin’s tumor
Most common salivary gland malignancy
Mucoepidermoid carcinoma
Second most common salivary gland malignancy for minor glands
Polymorphous Low-grade Adenocarcinoma (PLGA)
Cribriform or swiss cheese microscopic pattern
5-year survival is 70%, 15 year survival is 10%
Adenoid cystic carcinoma
Reed-sternberg cells = malignant b cells
Very rare in the oral cavity
Tx: chemo/radio
Hodgkin’s lymphoma
Neoplasm of B or T cells
Burkitt’s lymphoma= type of B cell NHL with bone marrow invovlement, swelling, pain, tooth mobility, lip paresthesia, and halts root development
Tx: chemo/radio
Non-Hodgkin’s lymphoma (NHL)
Involves neoplasm of antibody-secreting B cells aka Plasma cells
Multiple punched out RL usually in skull
Amyloidosis due to accumulation of complex amyloid proteins that develop from antibody light chains
Tx: chemo, poor prognosis
Multiple myeloma
Neoplasm of bone marrow cells
Classification based on cell lineage and where disease is acute of chronic
ALL, CML, AML, ALL
Three clinical signs are bleeding, fatigue, and infection
Leukemia
MOst common odontogenic cyst
RL at apex
Always assc with nonvital tooth
Necrotic pulp causes PA inflamm
Acute: abscess
Chronic: granuloma
Epithelial Rest of Malassex from hertwigs epithelial root sheath within pocket of inflamm encapsulate the lesion resulting in formation of a cyst
Radicular cyst
RL attached to CEJ of impacted tooth
Most common with canines and 3rd molars
Accumulaton of fluid between crown and reduced enamel epithelium
Tx: excision but may be source of future odontogenic tumor
Dentigerous cyst
Most common in mand pm region
Always assc with vital tooth
Tx: excision
Lateral periodontal cyst
Soft tissue conterpart to LPC
Gingival cyst
Bohn’s nodules= lateral palate
Epsteins pearls: midline palate
Rests of dental lamina epithelialize the small lesions
Gingival cyst of newborn
Cyst that develops where a tooth would have formed
Most common at mand 3rd molar region
Tx: complete removal
Primordial cyst
Aggressive and recurrent
Most common in post ascending ramus
Thin corrugated parakeratized epithelium
Gorlin syndrome: multiple KCOTs, multiple BCCs, calcified flax cerebri, fatal,
Tx: aggressive enucleation
Keratocystic odontogenic tumor
Rare and unpredicable
Ghost cells: empty space where nucleus was and keratin fills it, can undergo calcification and little RLs detected radiographically
calcifying odontogenic cyst
Most common initiating causes are odontogenic infection and trauma
Infection and inflammation usually begins in medullary space involving the cancellous bone and spreads to cortical bone periosteum and soft tissues
Symptoms
-Deep and intense pain
-High or intermittent fever
-Paresthesia or anesthesia of IAN
-Tooth is NOT loose, this caused by periodontitis
Tx: Abx and drainage
Acute osteomyelitis
Diffuse mottled RL
Sequestra= piece of dead bone
Garre’s osteomyelitis: chronic osteomyelitis with proliferative periosteitis
Tx: Abx and debridement
Chronic osteomyelitis
Sarcoma of jaws where new bone is produced by tumor cells
Sunburst pattern
5 year survival is 25-40%
Tx: resection and chemo
Osteosarcoma
Saroma of jaws where new cartilage is produced by tumor cells
Same presentation and tx as previous
More common involving condyle due to cartilaginous origin
Chondrosarcoma
Sarcoma of long bones involving “round cells”
Seldom affects the jaws
Affects children
Involves swelling
Ewing’s Sarcoma
Pain swelling and especially paresthesia
Ill-defined changes are noted
Breast, lung, kidney, colon, prostate
Metastatic carcinoma
Autosomal dominant
Asymptomatic spongy white buccal mucosa
White sponge nevus
Autosomal dominant
Olser-Weber-Rendu Syndrome: another name for this disorder
Telangiectasia: red macule or papule dilated or broken capillary
Abnormal capillary formation on skin, mucosa, and viscera
Assc with iron-deficiency anemia
Epistaxis is a frequent presenting sign
Hereditary Hemorrhagic Telangiectasia
Autosomal dominant
Missing clavicles
Supernumerary teeth
Cleidocranial dysplasia
X-linked recessive
Missing teeth
Hypoplastic hair and nails
Ectodermal dysplasia
AD or AR
Albergs-Schonberg ds and marble bone ds
Lack of bone remodeling and resorption leads to stone bone
Osteopetrosis
AD, AR, x-linked
Intrinsic alteration of enamel
All teeth from both dentitions are affected
Thin to no enamel, but dentin and pulp are normal
Tx: Full coverage
Amelogenesis Imperfecta
AD
Intrinsic alteration of dentin
All teeth from both dentitions are affected
Shorts roots, bell-shaped crowns, and obliterated pulps
Bulbous crowns in radiographs due to constricted DEJ
Blue sclera
Tx: fulll coverage crowns
Dentinogenesis imperfecta
AD
Intrinsic alteration of dentin
All teeth from both dentitions are affected
Chevron pulps and short roots
Teeth are not good candidates for restoration
Dentin dysplasia
Quadrant of teeth exhibit short roots, open apices, and enlarged pulp chambers
Ghost teeth
Tx: extracted affected teeth
Regional odontodysplasia
Two buds merge into one tooth
Tooth count is one less tooth than normal
Fusion
One root bud into 2 crowns
Tooth count is normal
Gemination
