Pathology of oesophagus and mouth Flashcards
what is reflux oesophagitis?
inflammation of oesophagus due to refluxed low pH content
what might cause reflux oesophagitis?
defective sphincter motility +/- hiatus hernia
abnormal esophageal motility
increased intra-abdominal pressure (pregnancy)
what will be seen microscopically in oesophagitis?
bazal zone epithelial expansion
intraepithelial neutrophils, lymphocytes and eosinophils
what will be seen histologically in oesophagitis?
basal zone expansion
lengthening of papillae
what can cause a tissue to change?
continuous stress
list 3 complications of reflux
ulceration (discontinuity in epithelial surface)
stricture (due to healing/scarring of ulcer causing dysphagia etc)
Barrets Oesophagus
what is Barrets oesophagus?
replacement of stratified squamous epthelium by columnar epithelium due to persistant reflux of acid or bile
what does barrets oesophagus do to the epithelium of the oesophagus?
red velvety mucosa replaces squamous
squamous mucosa replaced by columnar mucosa which is genetically unstable
what is another name for allergic oesophagitis?
eosinophilic oesophagitits
when is allergic oesophagitis more common?
family history of allergy
asthma
young
males more than females
what are the findings in allergic oesophagitis?
pH probe negative for reflux
increased eosinophils in blood and intraepithelium
corrugated (feline) or spotty oesophagus (oesophagus looks like trachea)
how is allergic oesophagitis treated?
steroids
chromoglycate
monteleukast
what is the most common benign oesophageal tumour?
squamous papilloma
list 4 other benign oesophageal tumours
leiomyomas
lipomas
fibrovascular polyps
granular cell tumours
what are the 2 types of oesophageal tumours?
squamous cell carcinoma
adenocarcinoma
who is squamous cell carcinoma more common in?
males smokers drinkers Vit A/zinc deficiency HPV
what is the pathogenesis of squamous cell carcinoma?
normal > GORD > severe dyspasia
what physical problems can oesophageal squamous cell carcinomas cause?
dysphagia
eventually cant swallow solid foods
what does squamous cell carcinoma look like histologically?
keratinised pearls
who is adenocarcinoma more common in?
Caucasian males
obese
the West
People with Barrets oesophagus
where is an adenocarcinoma most likely to arise?
lower 1/3rd of oesophagus
describe the pathogenesis of adenocarcinoma
genetic factor, reflux disease etc > chronic reflux > Barrets oesophagus > low grade dysplasia > high grade dysplasia > adenocarcinoma
name 3 mechanisms of metasteses in carcinoma of the oesophagus
direct invasion
lymphatic permeation
vascular invasion
where can an oesophageal carcinoma directly invade?
trachea (produces fistula)
causes aspiration pneumonia, sepsis, death etc
Heart
Anything nearby
the oesophagus is enriched in lymph nodes, true or false?
true
this is why carcinoma can spread via lymph nodes
how might a carcinoma of the oesophagus present?
dysphagia (due to obstruction)
General malignancy symptoms (anaemia, weight loss, lethargy etc)
what type are 90% of oral cancers?
squamous cell carcinoma
as smoking etc damages eithelium
how might an oral SCC present?
white, red, speckled, ulcer, lump
what can cause an oral SCC?
tobacco alcohol betel quid (rare) HPV other rare causes
how are SCCs graded?
by degree of differentiation
- well differentiated tumour cells, obviously squamous with prickles and keratinization
- moderately differentiated
- moderately differentiated, difficult to identify as epithelial
what histopathological features can affect the prognosis of SCC?
tumour diameter
depth of invasion
pattern of invasion (cohesive or non-cohesive)
Lymphovascular invasion
what is TNM system?
staging of tumours
T = diameter of tumour, structures invaded
N = lymph node status
M = metasteses
what types of treatment are there for SCC?
surgery
+/- adjuvant therapy
what is the 5 year survival from SCC and why?
40-50%
due to late detection
Barrets oesophagus causes increased risk of dysplasia and carcinoma, true or false?
true
is barrets oesophagus kept under surveillance?
yes
