Pathology - mouth to eso Flashcards
list the benign salivary tumours
pleomorphic adenoma
warthin tumour
where do salivary tumours most often present?
parotid gland
female with painless, mobile mass on jaw
pleomorphic adenom
histo of pleomorphic adenoma please
chondromyxoid stroma and epithelium
when will a pleomorphic adenoma reoccur?
if ruptures or not completely excised in surgery
chrondomyxoid stroma and epithelium
pleomorphic adenoma more common in women benig painless mass parotid gland
what is the most common malignant salivary gland tumor?
mucoepidermoid carcinoma
painless, slow growing mass
usually in minor salivary glands
mucoepidermoid carcinoma
histo of a mucoepidermoid carcinoma please
mucinous and squamous components.
mucinous and squamous components on a salivary gland biopsy
malignant
mucoepidermoid carcinoma
presents as painless, slow growing mas. doesn’t mention anything about mobility (pleomorphic adenoma is mobile)
what is a warthin tumor?
benign cystic tumour with germinal centres
kaka a papillary cystadenoma lymphomatosum
who is more like to get a benign cystic tumor with germinal centres
warthin tumour
males
what causes achalasia?
failure of relaxation of the LES due to loss of myenteric/auerback plexus
describe the manometer reading in achalasia
high LES resting pressure
uncoordinated peristalsis
barium swallow with dilated distal esophagus with area of distal stenosis
bird beak
achalasia
what does achalasia increase the risk of?
esophageal squamous cell carcinoma
what infection can cause achalasia
T cruzi
Chagas disease
or a paraneoplastic syndrome.
nocturnal regurgitation of undigested food dysphagia of solids and liquids chest pain and heart burn frequent hiccups nocturnal cough from aspiration difficultly belching
achalasia
describe the s and sxs of esophageal disorders please
heart burn (most common in GERD) dysphagia of solids only - due to obstruction ie cancer, web, stricture dysphage of solids and liquids - due to problems with motility ie dermamyositis, myasthenia gravis, stroke, systemic sclerosis, CREST syndrome and achalsia
CREST syndrome
calcinosis, anticentromere abs Raynaud phenomenon esophageal dysphagia - s and l sclerodactyly telangiectasia
pneumomediastinum
boerhaave syndrome
transmural teat of the esophagus
boerhaave syndrome
what causes boerhaave syndrome
violent retching
tis a transmural tear at the distal esophagus -> surgical emergency
which is a surgical emergency, Mallory Weiss or boerhaave?
boerhaave
atopy in a patient dysphagia heart burn strictures no response to GERD theraphy
eosinophilic esophagitis
what causes eosinophilic esophagitis
esophageal infiltration into the esophagus due to atopy to food allergen
presentation of eosinohpilic esophagitis
dysphagia
heart burn
strictures
what causes esophageal stricutures?
lye ingestion
alkali chemical ingestion
acid reflux
who cares about esophageal strictures
stricture – perforation – squamous cell carcinoma
what are esophageal varices
dilated submucosal veins in lower 1/3 of esophagus
what causes esophageal varices
portal hypertension, common in OH (cirrhosis)
may be source of upper git bleed
esophagitis causes in non immunocompromised
acid reflux
chemical ingestion
esophagitis in immunocompromised/AIDs
candida - pseudomembrane white, yeast with pseudohyphase
HSV-1: punched out ulcers, intranuclear inclusions
CMV: linear ulcers with intranuclear eosinophilic inclusions
heart burn
regurgitation on supine
GERD
heart burn indigestion nocturnal cough nocturnal asthma acid damage to enamel early satiety and full abdomen bloating and belching
GERD
adult onset asthma
GERD
describe the manometry in GERD
decreased LES tone < 10 mmHg
risk factors for GERD please
smoking OH caffeine fatty food chocolate pregnancy obesity hiatal hernia
what dose GERD progress to?
barrets - adeoncarcinoma
hematemesis in a bulumic
Mallory Weiss tear
also in OHics
what is a Mallory Weiss tear
mucosal lacerations at gastroesophageal junction due to severe vomiting.
intermittent dysphagia to solids
microcytic anaemia
esophageal web
possible glossitis
plummer vinson syndrome
DIE: dysphagia, iron deficiency, esophageal web
what does plummer vinson syndrome increase the risk of?
squamous cell carcinoma of esophagus (Strictures, achalasia so far)
describe how the esophagus is affected in scleroderma
esophageal smooth muscle atrophy – decreased LES pressure and dysmotility – acid reflux and dysphagia – stricture, barrets, aspiration
what are consequences of atrophy of the esophageal smooth muscle in scleroderma
decreased LES pressure and dysmotlilty
acid reflux – stricture, barrets, aspiration
what is barrett esophagus?
glandular metaplasia - replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium ie nonciliated columnar with goblet cells in the distal esophagus
what causes barrett esophagus?
chronic acid reflux/GERD
what pathologies is barrett esophagus associated with?
esophagitis
esophageal ulcers
increased risk of esophageal adenocarcinoma
supraclavicular node
adenocarcinoma of stomach
esophageal cancer
cervical cancer
pancreatic cancer
progressive dysphagia for solids then liquids
weight loss
esophageal cancer
what is most common type of esophageal cancer world wide
squamous cell carcinoma
what is most common type of esophageal cancer in the USA?
adenocarcinoma
where does squamous cell carcinoma of esophagous occur
upper 2/3
where does adenocarcinoma of esophagus occur?
lower 1/3
risk factor for both adenocarcinoma and squamous cell carcinoma of esophagus
cigarette smoking
risk factors for squamous cell carcinoma please
achalasia alcohol cigarettes zenker diverticula esophageal web familial hot liquids
risk factors fo squamouc cell carcinoma please
bareets cigarettes fat GERD familial
RF for esophageal cancer: achalasia
squamous
RF for esophageal cancer: alcohol
squamous
RF for esophageal cancer: barretts
adenocarcinoma
RF for esophageal cancer: cigarettes
squamous
adenocarcinoma
RF for esophageal cancer: zenker diverticula
squamous
RF for esophageal cancer: esophageal web/scleroderma/CREST
squamous
RF for esophageal cancer: familial
squamous
adenocarcinoma
RF for esophageal cancer: obesity
adenocarcinoma
RF for esophageal cancer: GERD
adenocarcinoma
RF for esophageal cancer: hot liquides
squamous
list all the risk factors for esophageal cancer
achalasia alcohol barrets cigarettes esophageal web fat familial GERD hot liquids