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Gastroenterology > Pathology of Mouth and Esophagus > Flashcards

Pathology of Mouth and Esophagus Flashcards

1
Q

What infectious organisms typically infect the mouth and the esophagus?

A

HSV 1 and 2 CMV Fungal: Candida, Aspergillus, Mucor

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2
Q

What Lesion is this? Describe what you see on this lesion.

A

Herpetic vesicle

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3
Q

What Lesion is this? Describe what you see on this lesion.

A

herpetic ulcer

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4
Q

What Lesion is this? Describe what you see on this lesion.

A

Diagnosis of HSV infection. Multinucleate, intra-nuclear smudgy/steel gray inclusions

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5
Q

What type of cells does HSV infect?

A

epithelial cells

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6
Q

What Lesion is this? Describe what you see on this lesion.

A

Intra-nuclear and cytoplasmic inclusions “owl eye”

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7
Q

What type of cells does HSV infect?

A

Endothelial and mesenchymal cells

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8
Q

What Lesion is this? Describe what you see on this lesion.

A

Oral thrush

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9
Q

What is candida?

A

Budding yeast and pseudohyphae Most common –> C. albicans

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10
Q

What lesion or organism is this? Give a description.

A

Aspergillus: - hyphal forms only - septate hyphae with parallel walls - branching at acute angles of 45 degrees - also angioinvasive

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11
Q

What are the common pathogenic species of Aspergillus?

A

A. niger, A. fumigatus, A. flavus

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12
Q

What are the other species of infectious candida?

A

C. tropicalis, C. krusei, C. parapsilosis, C. guillermondii

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13
Q

What is this lesion? Describe what you see.

A

Mucormycosis: - hyphal forms only - bold, bulbous, non-septate hyphae - Right Angle branching - Also angioinvasive - Mucor, Rhizopus, Absidia

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14
Q

Key terms for HSV infections:

A

epithelial cells, multinucleation, nuclear inclusions, tzanck test

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15
Q

key terms for CMV infections:

A

endothelial and mesenchymal cells, nuclear (owl) and cytoplasmic inclusions

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16
Q

key terms for candida:

A

budding yeast, pseudohyphae

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17
Q

key terms for aspergillus:

A

hyphae, 45 degree branching

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18
Q

key terms for mucormycosis:

A

hyphae, 90 degree branching

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19
Q

what lesion is this?

A

Pyogenic granuloma - a type of oral cavity lesion

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20
Q

What Lesion is this? Describe what you see on this lesion.

A

Pyogenic granuloma: - Lobular capillary hemangioma with surface ulceration - Inflammation is secondary

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21
Q

What Lesion is this? Describe what you see on this lesion.

A

Hair leukoplakia: EBV associated lesion - benign

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22
Q

Which patients do you usually see hairy leukoplakia?

A

immunocompromised patients; HIV 80% organ transplant patients on radiation and chemotherapy

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23
Q

What Lesion is this? Describe what you see on this lesion.

A

hyperkeratosis, acanthosis and balloon cells

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24
Q

What Lesion is this? Describe what you see on this lesion.

A

Oral leukoplakia; 5-25% are pre-malignant; range from hyperplasia and hyperkeratosis to high grade dysplasia

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25
Q

What Lesion is this? Describe what you see on this lesion.

A

Erythroplakia

26
Q

What is the significance of erythroplakia lesion?

A

More ominous lesion –> pre-malignant Atypical epithelium Higher risk of progression

27
Q

What Lesion is this? Describe what you see on this lesion.

A

Squamous cell carcinoma

28
Q

Characteristics of Squamous cell carcinoma?

A

95% oral cancer, 50% mortality, associated with smoking, alcohol and HPV

29
Q

What is the progression of squamous cell carcinoma?

A

Normal –> hyperplasia/hyperkeratosis –> mild/moderate dysplasia –> severe dysplasia/CIS –> SCC

30
Q

What are the common locations of squamous cell carcinoma?

A

soft palate, anterior pillar, retromolar trigon, papilla

31
Q

Salivary gland neoplasms

A

Parotid - 30% of tumors are malignant Submandibular - 40% are malignant Sublingual - 80% of tumors are malignant

32
Q

How do you classify salivary gland tumors?

A

benign: - pleomorphic adenoma (50%) - warthin tumor (5-10%) - oncocytoma - others malignant: - mucoepidermoid carcinoma (15%) - acinic cell carcinoma - adenoid cystic carcinoma - malignant mixed tumors - Others

33
Q

Describe the normal histology of the salivary gland.

A

Duct

Mucinous glands

Serous glands

Parotid is mostly serous and Salivary are mucinous

34
Q

What Lesion is this? Describe what you see on this lesion.

A

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

35
Q

Characteristics of pleomorphic adenoma

A

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)

36
Q

What type of lesion is this and list characteristics of this lesion.

A

Warthin tumor; Cystic; Motor oil secretions

Characteristics:

10% bilateral; associated with smoking

Has two components:

  1. Epithelial component - dense, eosinophilic, granular cytoplasm (mitochondria)
  2. Lymphoid component –> reactive. Not really part of the tumor process.
37
Q

What is this lesion shown and describe the histology.

A

Warthin Tumor.

First picture shows a follicle with plenty of inflammatory cells.

Second picture shows 2 layer epithelial layer. Proliferated.

38
Q

Outline the structures you see in this electron micrograph.

A

Nucleus

Nucleolus

Chromatin

Mitochondria

39
Q

What is the most common malignant tumor of salivary glands?

A

Mucoepidermoid carcinoma

40
Q

What are the two components of the mucoepidermoid carcinoma? How does predominance of the components affect prognosis?

A
  1. Mucus-secreting cells and,
  2. 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

41
Q

What lesion do you see? Describe the characteristics shown in this H&E section.

A

Mucoepidermoid carcinoma

  • not well circumscribed
  • Squamoid areas and cystic mucus areas
42
Q

What lesion do you see and describe the two features seen.

A

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
43
Q

Describe the lesion and the characteristics seen.

A

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

44
Q

What are the characteristics of an adenoid cystic carcinoma?

A

slow growing

high recurrence - about 30%

only 30% survival at 10 years

low longterm survival

45
Q

What is this lesion?

A

Mallory Weiss Tear

  • laceration at GEJ
  • present with forceful vomiting
46
Q

What is this lesion?

A

Boerhave syndrome

  • Esophageal rupture

Catastrophic event

47
Q

What are these lesions?

A

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
48
Q

What is this lesion?

A
  • Reflex Esophagitis
  • Intraepithelial eosinophils
  • DIagnose by: hyperplastic basal layers AND Eosinophils in the epithelial layers
49
Q

What are the two types of esophageal carcinoma?

A
  1. Squamous cell carcinoma –> caused by alcohol, tobacco, fungus-derived carcinogens and nitrocamines, responsible for 90% esophageal cancer worlwide
  2. Adenocarcinoma –> incidence is rapidly increasing; vast majority of cases in barrett esophagus; 50% of esophageal cancer in the US
50
Q

How does the presentation of esophageal squamous cells carcinoma vary?

A

Esophageal squamous cell carcinoma

  • mid esophagus = circumscribed ulcerated or constricted, circumscribed and ulcerated
51
Q

What lesion is this? Describe the is diagnostic.

A

Squamous cell carcinoma

LEFT - SCC pearls; well differentiated with keratonization

RIGHT - poorly differentiated and less keritinization

52
Q

What is the current criteria for BE?

A
  • Affects distal esophagus
  1. Endoscopic evidence of columnar epithelium in distal esophagus
  2. Intestinal metaplasia (i.e. goblet cells) on a mucosal biopsy from this segment
  3. long segment is greater than 3cm, short segment less than 3cm
53
Q

What lesion do you see? Describe the features.

A

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
54
Q

What lesion is this?

A
  1. Barrett esophagus
  2. See presene of goblet sells defines the disease
  3. Pink/Red due to vessels

Similar to large intestine mucosa

55
Q

How is dysplasia (low or high greade) in BE managed?

A

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

56
Q

What is this lesion?

A

Low grade dysplasia in BE

  • elongated and stratified epithelial layer - center
57
Q

What is this lesion?

A
  1. High grade dysplasia in BE
  2. Prominent nucleus in cells
  3. Glands pushed down
  4. Cribiform appearance
58
Q

What is this lesion?

A

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
59
Q

How are focal epithelial lesions in the esophagus treated?

A

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

60
Q

How does the distribution of malignant esophageal tumors cary between populations?

A

Squamous cell carcinoma:

  1. More common in mid-esophagus –> 30%
  2. More common in african-americans
  3. more common worldwide

Adenocarcinoma

  1. Most arise in BE
  2. Most arise in lower third of esophagus (distal)
  3. Surveillance for dysplasia and early diagnosis of cancer is critical for management –> better prognosis

Gastroenterology (11 decks)

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