Pathology of Mouth and Oesophagus Flashcards
inflammatory disorders or oesophagus
acute oesophagitis - rare
chronic oesophagitis - common
describe causes of acute oesophagitis
corrosive - chemical ingestion
infection -immunocompromised patients (e.g. candidates, herpes, CMV)
describe chronic oesophagitis
reflux disease (reflux oesophagitis) Crohn's disease - rare
what is reflux oesophagitis
inflammation of oesophagus due to refluxed low pH gastric content
causes of reflux oesophagitis
defective sphincter mechanisms +/- hiatus hernia
abnormal oesophageal motility
increase intra-abdominal pressure (pregnancy)
microscopic changes in reflux oesophagitis
basal zone epithelial expansion
lengthening of papillae
intraepithelial neutrophils, lymphocytes and eosinophils
complications of reflux oesophagitis
ulceration (bleeding)
stricture
Barrett’s oesophagus
what is Barrett’s oesophagus
metaplasia - replacement of stratified squamous epithelium by columnar epithelium
causes of Barrett’s oesophagus
persistent reflux of acid or bile - protective response, faster regeneration
expansion of columnar epithelium from gastric glands or from submucosal glands
differentiation from oesophageal stem cells
macroscopic changes in Barrett’s oesophagus
red velvety mucosa in lower oesophagus
microscopic changes in Barrett’s oesophagus
columnar lined mucosa with intestinal metaplasia
complications of Barrett’s oesophagus
unstable mucosa (continuing damage) - requiring surveillance increased risk of developing dysplasia and carcinoma of oesophagus
what is allergic oesophagitis
eosinophilic oesophagitis
who is most likely to get allergic oesophagitis
asthmatics
younger patients
males > females
history of allergies
presentation of allergic oesophagitis
corrugated (feline) or spotted oesophagus
pH probe negative for reflux
increased eosinophils in blood
treatment for allergic oesophagitis
steroids
chromoglycate
montelukast
benign tumours of oesophagus
squamous papilloma
describe squamous papilloma
rare
papillary
asymptomatic
HPV related
very rare benign tumours of oesophagus
leiomyomas
lipomas
fibrovascular polyps
granular cell tumours
malignant tumours of oesophagus
squamous cell carcinoma
adenocarcinoma
who is more likely to get squamous cell carcinoma
males > females
causes of squamous cell carcinoma
vitamin A, Zinc deficiency tannic acid/strong tea smoking alcohol HPV oesophagitis genetic
who is more likely to get adenocarcinoma
common in caucasians
males > females
obesity
pathophysiology of adenocarcinoma
commonest in lower 1/3 oesophagus
mechanisms of metastases of carcinoma of the oesophagus
direct invasion
lymphatic permeation
vascular invasion
symptoms of carcinoma of oesophagus
dysphagia general symptoms of malignancy; anaemia weight loss fatigue
presentation of oral squamous cell carcinoma
variable; white red speckled ulcer lump
where are oral squamous cell carcinomas located - high risk sites
floor of mouth
lateral border of and ventral tongue
soft palate
retromolar pad/tonsillar pillars
where are oral squamous cell carcinomas located - rare sites
hard palate
dorsum of tongue
cause of oral squamous cell carcinomas
smoking alcohol betel quid HPV chronic infections nutritional deficiencies genetics post transplant history of primary oral squamous cell carcinoma - increased risk of developing new second primary
microscopic oral squamous cell carcinoma
malignant squamous epithelium - invasion and destruction of local tissues
how are squamous cell carcinomas graded
by degree of differentiation
TNM system
staging tumours;
T - diameter of tumour, structures invaded
N - lymph node status
M - metastasis
treatment of oral squamous cell carcinomas
surgery
+/- adjuvant therapy
(late detection of tumour)
