Pathology of Mouth and Oesophagus

Question 1

inflammatory disorders or oesophagus

Answer 1

acute oesophagitis - rare

chronic oesophagitis - common

Question 2

describe causes of acute oesophagitis

Answer 2

corrosive - chemical ingestion

infection -immunocompromised patients (e.g. candidates, herpes, CMV)

Question 3

describe chronic oesophagitis

Answer 3

reflux disease (reflux oesophagitis)
Crohn's disease - rare

Question 4

what is reflux oesophagitis

Answer 4

inflammation of oesophagus due to refluxed low pH gastric content

Question 5

causes of reflux oesophagitis

Answer 5

defective sphincter mechanisms +/- hiatus hernia
abnormal oesophageal motility
increase intra-abdominal pressure (pregnancy)

Question 6

microscopic changes in reflux oesophagitis

Answer 6

basal zone epithelial expansion
lengthening of papillae
intraepithelial neutrophils, lymphocytes and eosinophils

Question 7

complications of reflux oesophagitis

Answer 7

ulceration (bleeding)
stricture
Barrett’s oesophagus

Question 8

what is Barrett’s oesophagus

Answer 8

metaplasia - replacement of stratified squamous epithelium by columnar epithelium

Question 9

causes of Barrett’s oesophagus

Answer 9

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

Question 10

macroscopic changes in Barrett’s oesophagus

Answer 10

red velvety mucosa in lower oesophagus

Question 11

microscopic changes in Barrett’s oesophagus

Answer 11

columnar lined mucosa with intestinal metaplasia

Question 12

complications of Barrett’s oesophagus

Answer 12

unstable mucosa (continuing damage) - requiring surveillance 
increased risk of developing dysplasia and carcinoma of oesophagus

Question 13

what is allergic oesophagitis

Answer 13

eosinophilic oesophagitis

Question 14

who is most likely to get allergic oesophagitis

Answer 14

asthmatics
younger patients
males > females
history of allergies

Question 15

presentation of allergic oesophagitis

Answer 15

corrugated (feline) or spotted oesophagus
pH probe negative for reflux
increased eosinophils in blood

Question 16

treatment for allergic oesophagitis

Answer 16

steroids
chromoglycate
montelukast

Question 17

benign tumours of oesophagus

Answer 17

squamous papilloma

Question 18

describe squamous papilloma

Answer 18

rare
papillary
asymptomatic
HPV related

Question 19

very rare benign tumours of oesophagus

Answer 19

leiomyomas
lipomas
fibrovascular polyps
granular cell tumours

Question 20

malignant tumours of oesophagus

Answer 20

squamous cell carcinoma

adenocarcinoma

Question 21

who is more likely to get squamous cell carcinoma

Answer 21

males > females

Question 22

causes of squamous cell carcinoma

Answer 22

vitamin A, Zinc deficiency 
tannic acid/strong tea
smoking
alcohol 
HPV
oesophagitis 
genetic

Question 23

who is more likely to get adenocarcinoma

Answer 23

common in caucasians
males > females
obesity

Question 24

pathophysiology of adenocarcinoma

Answer 24

commonest in lower 1/3 oesophagus

Question 25

mechanisms of metastases of carcinoma of the oesophagus

Answer 25

direct invasion lymphatic permeation vascular invasion

Question 26

symptoms of carcinoma of oesophagus

Answer 26

``` dysphagia general symptoms of malignancy; anaemia weight loss fatigue ```

Question 27

presentation of oral squamous cell carcinoma

Answer 27

``` variable; white red speckled ulcer lump ```

Question 28

where are oral squamous cell carcinomas located - high risk sites

Answer 28

floor of mouth lateral border of and ventral tongue soft palate retromolar pad/tonsillar pillars

Question 29

where are oral squamous cell carcinomas located - rare sites

Answer 29

hard palate | dorsum of tongue

Question 30

cause of oral squamous cell carcinomas

Answer 30

``` 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 ```

Question 31

microscopic oral squamous cell carcinoma

Answer 31

malignant squamous epithelium - invasion and destruction of local tissues

Question 32

how are squamous cell carcinomas graded

Answer 32

by degree of differentiation

Question 33

TNM system

Answer 33

staging tumours; T - diameter of tumour, structures invaded N - lymph node status M - metastasis

Question 34

treatment of oral squamous cell carcinomas

Answer 34

surgery +/- adjuvant therapy (late detection of tumour)