Pathology of Mouth and Esophagus Flashcards
What infectious organisms typically infect the mouth and the esophagus?
HSV 1 and 2 CMV Fungal: Candida, Aspergillus, Mucor
What Lesion is this? Describe what you see on this lesion.
Herpetic vesicle
What Lesion is this? Describe what you see on this lesion.
herpetic ulcer
What Lesion is this? Describe what you see on this lesion.
Diagnosis of HSV infection. Multinucleate, intra-nuclear smudgy/steel gray inclusions
What type of cells does HSV infect?
epithelial cells
What Lesion is this? Describe what you see on this lesion.
Intra-nuclear and cytoplasmic inclusions “owl eye”
What type of cells does HSV infect?
Endothelial and mesenchymal cells
What Lesion is this? Describe what you see on this lesion.
Oral thrush
What is candida?
Budding yeast and pseudohyphae Most common –> C. albicans
What lesion or organism is this? Give a description.
Aspergillus: - hyphal forms only - septate hyphae with parallel walls - branching at acute angles of 45 degrees - also angioinvasive
What are the common pathogenic species of Aspergillus?
A. niger, A. fumigatus, A. flavus
What are the other species of infectious candida?
C. tropicalis, C. krusei, C. parapsilosis, C. guillermondii
What is this lesion? Describe what you see.
Mucormycosis: - hyphal forms only - bold, bulbous, non-septate hyphae - Right Angle branching - Also angioinvasive - Mucor, Rhizopus, Absidia
Key terms for HSV infections:
epithelial cells, multinucleation, nuclear inclusions, tzanck test
key terms for CMV infections:
endothelial and mesenchymal cells, nuclear (owl) and cytoplasmic inclusions
key terms for candida:
budding yeast, pseudohyphae
key terms for aspergillus:
hyphae, 45 degree branching
key terms for mucormycosis:
hyphae, 90 degree branching
what lesion is this?
Pyogenic granuloma - a type of oral cavity lesion
What Lesion is this? Describe what you see on this lesion.
Pyogenic granuloma: - Lobular capillary hemangioma with surface ulceration - Inflammation is secondary
What Lesion is this? Describe what you see on this lesion.
Hair leukoplakia: EBV associated lesion - benign
Which patients do you usually see hairy leukoplakia?
immunocompromised patients; HIV 80% organ transplant patients on radiation and chemotherapy
What Lesion is this? Describe what you see on this lesion.
hyperkeratosis, acanthosis and balloon cells
What Lesion is this? Describe what you see on this lesion.
Oral leukoplakia; 5-25% are pre-malignant; range from hyperplasia and hyperkeratosis to high grade dysplasia
What Lesion is this? Describe what you see on this lesion.
Erythroplakia
What is the significance of erythroplakia lesion?
More ominous lesion –> pre-malignant Atypical epithelium Higher risk of progression
What Lesion is this? Describe what you see on this lesion.
Squamous cell carcinoma
Characteristics of Squamous cell carcinoma?
95% oral cancer, 50% mortality, associated with smoking, alcohol and HPV
What is the progression of squamous cell carcinoma?
Normal –> hyperplasia/hyperkeratosis –> mild/moderate dysplasia –> severe dysplasia/CIS –> SCC
What are the common locations of squamous cell carcinoma?
soft palate, anterior pillar, retromolar trigon, papilla
Salivary gland neoplasms
Parotid - 30% of tumors are malignant Submandibular - 40% are malignant Sublingual - 80% of tumors are malignant
How do you classify salivary gland tumors?
benign: - pleomorphic adenoma (50%) - warthin tumor (5-10%) - oncocytoma - others malignant: - mucoepidermoid carcinoma (15%) - acinic cell carcinoma - adenoid cystic carcinoma - malignant mixed tumors - Others
Describe the normal histology of the salivary gland.
Duct
Mucinous glands
Serous glands
Parotid is mostly serous and Salivary are mucinous
What Lesion is this? Describe what you see on this lesion.
Pleomorphic adenoma (mixed tumor)
- Well circumscribed. See some Heamorrhagic areas
- Biphasic tumor: ductal (epithelial) & myoepithelial
–> So you can sheets of epithelial cells, the proliferation from the duct; mesenchymal region proliferation; spindle elongated nuceli = interspered epithelial cells
–> On the second set, you see epithelial cell region, myoepithelial cells and mixoid region
Characteristics of pleomorphic adenoma
Biphasic tumors: ductal (epithelial) and myoepithelial More common in parotid than submandibular or sublingual 60% of parotid tumors are mixed tumors Low but definite risk of malignant transformation (carcinoma ex pleomorphic adenoma 2% at 5yrs and 10% at 10yrs)
What type of lesion is this and list characteristics of this lesion.
Warthin tumor; Cystic; Motor oil secretions
Characteristics:
10% bilateral; associated with smoking
Has two components:
- Epithelial component - dense, eosinophilic, granular cytoplasm (mitochondria)
- Lymphoid component –> reactive. Not really part of the tumor process.
What is this lesion shown and describe the histology.
Warthin Tumor.
First picture shows a follicle with plenty of inflammatory cells.
Second picture shows 2 layer epithelial layer. Proliferated.
Outline the structures you see in this electron micrograph.
Nucleus
Nucleolus
Chromatin
Mitochondria
What is the most common malignant tumor of salivary glands?
Mucoepidermoid carcinoma
What are the two components of the mucoepidermoid carcinoma? How does predominance of the components affect prognosis?
- Mucus-secreting cells and,
- Squamous cells
Low grade mucous cells predominate - 15% recurrence, 90% 5year survival
High grade squamous cells predominate, greater atypia - 25% recurrence and 50% 5year survival
What lesion do you see? Describe the characteristics shown in this H&E section.
Mucoepidermoid carcinoma
- not well circumscribed
- Squamoid areas and cystic mucus areas
What lesion do you see and describe the two features seen.
Squamous and Mucinous parts of a mucoepidermoid carcinoma.
- You can see the mucin in the cells on the left H&E stain
- You see the red stained mucin in the mucicarmine stain on the right
Describe the lesion and the characteristics seen.
Adenoid cystic carcinoma
- hyaline, basement membrane material; perineural invasion
- Not mucin on the left, its Basement membrane material
On the right you see a paraneural invasion with tumor clusters surronding the nerve
What are the characteristics of an adenoid cystic carcinoma?
slow growing
high recurrence - about 30%
only 30% survival at 10 years
low longterm survival
What is this lesion?
Mallory Weiss Tear
- laceration at GEJ
- present with forceful vomiting
What is this lesion?
Boerhave syndrome
- Esophageal rupture
Catastrophic event
What are these lesions?
Esophageal varices
- Develop in 90% of cirrhotic patients
- Consequence of portal hypertension
- Major cause for bleeding in these patients
- See engorged vessels
- Treat by banding
What is this lesion?
- Reflex Esophagitis
- Intraepithelial eosinophils
- DIagnose by: hyperplastic basal layers AND Eosinophils in the epithelial layers
What are the two types of esophageal carcinoma?
- Squamous cell carcinoma –> caused by alcohol, tobacco, fungus-derived carcinogens and nitrocamines, responsible for 90% esophageal cancer worlwide
- Adenocarcinoma –> incidence is rapidly increasing; vast majority of cases in barrett esophagus; 50% of esophageal cancer in the US
How does the presentation of esophageal squamous cells carcinoma vary?
Esophageal squamous cell carcinoma
- mid esophagus = circumscribed ulcerated or constricted, circumscribed and ulcerated
What lesion is this? Describe the is diagnostic.
Squamous cell carcinoma
LEFT - SCC pearls; well differentiated with keratonization
RIGHT - poorly differentiated and less keritinization
What is the current criteria for BE?
- Affects distal esophagus
- Endoscopic evidence of columnar epithelium in distal esophagus
- Intestinal metaplasia (i.e. goblet cells) on a mucosal biopsy from this segment
- long segment is greater than 3cm, short segment less than 3cm
What lesion do you see? Describe the features.
Barrett esophagus
- You can see the irregular margin between the pink columnar area and the squamous area which is more white
- the pink area is the barrett esophagus
What lesion is this?
- Barrett esophagus
- See presene of goblet sells defines the disease
- Pink/Red due to vessels
Similar to large intestine mucosa
How is dysplasia (low or high greade) in BE managed?
These patients undergo routine surveillance and biopsy
- aim to identify individuals at increased risk of progression of cancer
- morphological detection of dysplasia current gold standard
NB: regenerative atypia can mimic dysplasia
What is this lesion?
Low grade dysplasia in BE
- elongated and stratified epithelial layer - center
What is this lesion?
- High grade dysplasia in BE
- Prominent nucleus in cells
- Glands pushed down
- Cribiform appearance
What is this lesion?
Esophageal carcinoma
- Barrett circular areas on the left. Invasive adenocarcinoma on the left with crowded glands
- Invasion of the muscular mucosa
- HIgh mortality and mobidity once cancer arises in BE
How are focal epithelial lesions in the esophagus treated?
Endoscopic Mucosal resection (EMR)
- inject saline to left it up and pick it up
- You can study the specimen to check if it is invading the SM or not.
- HIgh rate of invading lymphoid tissues
Early cancer can be treated with limited resection
How does the distribution of malignant esophageal tumors cary between populations?
Squamous cell carcinoma:
- More common in mid-esophagus –> 30%
- More common in african-americans
- more common worldwide
Adenocarcinoma
- Most arise in BE
- Most arise in lower third of esophagus (distal)
- Surveillance for dysplasia and early diagnosis of cancer is critical for management –> better prognosis
