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GI 2 > Pathology of GI Tract Ch 16 Robbins > Flashcards

Pathology of GI Tract Ch 16 Robbins Flashcards

1
Q

What are dental carries and what causes them?

A
  • Tooth decay caused by focal demineralization of enamel and dentin by acidic metabolites of fermenting sugars produced by bacteria
  • one of most commmon diseases worldwide
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2
Q

What is Gingivits?

A
  • Inflammation of oral mucosa surrounding the teeth as a result of poor oral hygiene leading to the accumulation of plaque and calculus
  • Reversible
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3
Q

What is a dental plaque? Who is it most prevalent in?

A
  • sticky colorless biofilm that collects between and on the surface of the teeth
    • contains mix of bacteria, saliva, and desquamated epithelial cells
  • Adolescence
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4
Q

What is Periodontitis?

A
  • Inflammatory process affecting the supporting structures of the teeth, alveolar bone, and cementum
  • Results in eventual loss of teeth
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5
Q

What type of bacteria colonizes periodontitis?

A
  • facultative gram positive colonize healthy gingival sites while plaques contain anaerobic and microaerophiolic gram negative floura
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6
Q

What are the systemic diseases that periodontal disease can be a component of?

A
  • AIDS
  • Leukemia
  • Chron dz
  • DM
  • Down syndrome
  • Syndromes with Neutrophil defects
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7
Q

Periodontal infections can be the origin of important systemic diseases such as ___, ___ , and ____.

A
  • Infective endocarditis
  • Pulmonary abscess
  • Brain abscess
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8
Q

What is an Apthous ulcer?

A

Canker sore

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9
Q

Describe an apthous ulcer.

A
  • Common in first two decades of life
  • Common recurrent very painful superficial oral mucosal ulcerations
  • Unknown etiology
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10
Q

What immunologic disorders are Apthous ulcers assoc. with?

A
  • Celiac
  • IBD
  • Behcet
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11
Q

How do Apthous ulcers look?

A
  • Single or multiple shallow hyperemic ulcerations covered by a thin exudate rimmed with narrow zone of erythema
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12
Q

Describe the underlying inflammatory inflitrate in a canker sore?

A
  • Initially largely mononuclear
  • Secondary bacterial infections result in neutrophilic invasion
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13
Q

Describe an irritation fibroma grossly, cause of it, and treatment?

A

Aka Traumatic fibroma and focal fibrous hyperplasia

  • Submucosal noduoalr mass of fibrous connect tissue stroma that occurs primarily on buccal mucosa along bite line
  • Believed to be reactive proliferation caused by repetitive trauma
  • Surgical excision
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14
Q

What is a pyogenic granuloma:

  • Who is it found in commonly
  • Gross appearance
  • Cause
  • Prognosis
A
  • Inflammatory lesion found of gingive of children, young adults, and pregnant women
  • Ulcerated ret to purple lesion with alarmingly rapid growth
  • Histologically they have high vascular proliferation with organizing granulation tissue
  • Regress, mature into dense fibrous mass, or devellop into peripheral ossifying fibroma
  • Complete surgical resection
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15
Q

What is a peripheral ossifying fibroma? How does it arise, and gross appearance?

A
  • Common fingival growth most likely reactive in nature rather than neoplastic
    • may arise from chronic pyogenic granuloma OR
    • denovo from cells of periodontal ligament
  • Red ulcerated and nodular lesions onf gingiva
  • Young kids and females
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16
Q

Periphreal ossifying fibroma treatment?

A

High recurrence so excision down to periosteum is tx

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17
Q

What ype of herpes causes orofacial heerpetic infections? What age does it typically occur?

A

HSV 1 ages 2-4

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18
Q

What symptoms accompany acute herpetic gingivostomatitis?

A
  • Lymphadenoathy
  • fever
  • anorexia
  • irritabiltiy
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19
Q

In adults, reactivation of HSV 1 is associated with what factors?

A
  • Trauma
  • Allergies
  • UV exposure
  • URI
  • Pregnancy
  • Menstruation
  • Immunosuppression
  • Temp extremes
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20
Q

How do herpetic labial lesions appear

A

small groups of vesicles on lips nasal orifices buccal mucosa gingiva and hard palate resolving in 7-10 days

  • immunocompromised persist and may need systemic antivirals
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21
Q

What is the most common fungal infection of the oral cavity?

A

Candida

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22
Q

What are the three major forms of oral candidiasis?

A
  • Psuedomembranous
  • Erythematous
  • Hyperplastic
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23
Q

Gross appearance of thrush?

A
  • superficial gray to white inflammatory membrane
  • made of matted organisms in a fibrinosuppurative exudate
  • readily scraped off
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24
Q

Infections of candidia usually remain superficial except in the case of what?

A
  • Immunosuppression
  • bone marrow/organ transplant
  • neutropenia
  • chemo induced immunosuppression
  • AIDS
  • DM
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25
Scarlet fever oral lesion?
* Fiery red tongue with prominent papillae
26
Measels oral lesion?
Koplik spots
27
Mono oral changes?
* Acute pharyngitis and tonsillitis that may cause coating with grey white exudative membrane * Enlargement of lymph nodes in neck * Palatal petechiae
28
Diptheria oral changes?
* dirty white fibrinosuppurative tough inflammatory membrane over tonsilis
29
What is a distinctive oral lesion on the lateral border of the tongue typically seen in immunocmpromised patients? What causes this lesion?
Hairy Leukoplakia EBV
30
What does hairy leukiplakia look like
* white confluent patches of flufffy hyperkeratotic thickenings * Cannot be scraped off
31
What does the microscopic appearnce of hairy leukoplakia look liek?
* hyperparakeratosis and acanthosis with balloon cells in upper spinous layer
32
All leukoplakias must be considered \_\_\_\_.
Precancerous
33
Whath is erythroplakia?
* Uncommon, high risk malignant transformation * Red velvety eroded area within oral cavity that may be slightly depressed din relation to surrounding mucosa
34
What fungal infections have a predilection ofr oral cavity and head/neck region? In what kind of patient?
* histoplasmosis * Blastomycosis * Cocidiodomycosis * Cryptococcosis * Zygomycosis * Aspergillosis Immunocompromised patient
35
Histological changes in erythroplakia?
* rarely demonstarte orderly epidermal maturation * Most 90% have severe dysplasia * Carcinoma in situ * Minimally invasive carcinoma * Usually see intense supepithelial inflammatory reaction with vascular dilation * contributes to the reddness
36
Leukoplakia and erythroplakia are common in what ages and sex?
* 2:1 male to female * 40-70
37
What type of cancer is 95% of the neck and head cancers?
SCC with the remainder being adenocarcinomas of salivary gland
38
What type of HPV is assoc. with SCC? Why will HPV assoc.SCC of the oral cavity surpass cervical HPV cancer?
* HPV 16 * There are no screenings for SCC of mouth AND no precursor lesions
39
40
HPV assoc. SCC has mutations in what?
P16 overexpression E6 and E7 expresssion inactivating p53 and RB paths
41
What is a Dentigerous cyst?
* cyst that orioginates around crown of un erupted tooth and is result of fluid acucmulation btw developing tooth and dental follicle
42
What is an Odontogenic keratocyst aka Keratocystic odontogenic tumor? Who are they in and where
* MUST be differentitated from other odontogenic cysts bc it is **aggessive** * Diagnosed btw 10 and 40 * Occur in males more in posterior mandible
43
What do OKC's look like radiographically? Histologically?
* well defined unilocular or multilocular radiolucencies * cyst lining made of thin keratinized stratified squamous epithelium with prominent basal cell layer and corrugated epithelial surface
44
How do you treat OKC's?
Complete removal bc they are lcoally aggressive and recurrencec rates for inadquately removed OKC's are high
45
Multiple OKC's occur in 20% of patients. These patients should be evaluated for what syndrome?
Gorlin syndrome/nevoid BCC syndrome which is assoc. with PTCH mutations on 9q22
46
What is a branchial cyst?
* arises from remnants of second branchial arch * Seen in young adults btw 20-40 yo * Upper lateral aspect of neck along SCM muscle
47
Thyroglossal Duct cyst?
* Remnant of developmental tract for thyroid development. * lined by strat squam or psuedostrat column * locatd midline
48
Xerostomia?
dry mouth
49
What autoimmune syndrome has xerostomia associated with it?
Sjogren syndrome
50
What is xerostomia frequently a side effect from?
* major complication of radiaiton therapy * anticholinergics * Antidepressants/psychotics * diuretic * antihypertensive * sedative * mm relaxer * analgesic * antihistamine
51
How will xerostomia present grossly?
* Atrophy of papilla * Dry mouth * Fissuring and ulcerations of tongue * Increased dental caries and difficulty swallowing and speaking and candidias
52
Sialadentitis?
* induced by trauma, viral, bacterial , or autoimmune diseases
53
What is a mucocele?
* common lesion of salivary gland resulting from blockage or rupture of saliva into surrounding CT stroma * common on lower lip and from trauma * all ages * Blue translucent hue
54
Rannula?
* epithelial lined cyssts that arise hewn duct of sublingual gland has been damaged * Can be so large it develops a plunging ranula * goes through CT stroma connecting mylohyoid muscle
55
Nonspecific bacterial sialadentitis cause? What are the bacteria?
* Involves major salivary glands particularly submandibular, secondary to ductal obstruction by stones * S. aureus or S. viridans * **unilateral involvement single gland** * **​painful enlargement**
56
In general salivary gland tumors occur in who?
* Adults with slight female predominance
57
Warthin tumors occcur in who when? Risks?
* Males more than females * Higher prevelance of smoking * 50-70 yo
58
What is a pleomorphic adenoma made up of, what is the risk, where are they typically found?
* Benign salivary tumor made of mix of ductal and myoepithelial cells * mesenchymal and epithelial differentiation * 60% of parotid tumors * Radiation exposure increases risk
59
What is the mutation in pleomorphic adenomas?
PLAG1 overexpression
60
Pleomorphic adenoma gross appearance and histology?
* Rounded well demarcated mass rarely bigger than 6 cm * Grey to white with myxoid and blue translucent areas of chrondroid * Histologic feature is Heterogeneity of the tumor * epitlelial elements resemble ductal cells or myoepithelial cells arranged in duct formation * dispersed within mesenchyme backround of loose myxoid tissue with islands of cartilage
61
How do benign salivary tumors present?
* Slow growing * Painless * mobile * discrete mass
62
What tumor arises exclusively in the parotid gland? When/ who is it common in?
Warthin's Tumor a*ka Papillary Cystadenoma Lymphomatosum* More common in men btw 50 and 70 years old
63
Warthin tumor gross appearance and histologic?
* round to oval encapsulated masses, 2-5cm * Superficial parotid gland, transection shows pale gray surface with narrow cleft like spaces wih mucinous/serous secretions * Spances lined bdy double layer of neoplastic epithelial cells resting on dense lymphoid stroma looking like germinal center * Palisading columnar cells abundant finely granular eosinophilic cytoplams
64
What are mucoepidermoid carcinomas composed of?
* squamous cells * mucus ssecreting cells * intermediate cells * 15% of all salivary gland tumors occuring mainly in parotids
65
What is the mutation in mucoepidermoid carcinomas?
* balanced (11;19) (q21;p13) transcocation creating fusion gene made of **MECT1** and **MAML2**
66
What is the most common form of primary malignant tumor of the salivary glands?
mucoepidermoid carcinomas
67
Gross appearance of mucoepidermoid carcinomas
* 8 cm * circumscribed but lack well defined capsules and are infiltrative at margins * Pale and grey-white on tarnsection * contain small mucin containng cysts
68
Histologic appearance of mucoepidermoid carcinomas
* hybrid cell types have squamous features with small to large mucus filled vacuoles * mucin stain * highly anaplastic cells
69
Occurence of adenoid cystic carcinioma? Prognosis?
* Relatively uncommon usually found in the minor salivary glands (palatine) * Slow growing but can invade perineural spaces and are very recurrent * 50% disseminate
70
Adenoid cystic carcinoma gross appearance?
* generally small poorly encapsulated infiltrative gray pink lesions
71
Histologic appearance of adenoid cystic carcinoma?
* small cells with dark compack nuclei and scant cytoplasm * tubular solid or cribiform patterns * Spaces btw cells have hyaline material

GI 2 (19 decks)

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