Pathology of oesophagus and mouth

Question 1

what is reflux oesophagitis?

Answer 1

inflammation of oesophagus due to refluxed low pH content

Question 2

what might cause reflux oesophagitis?

Answer 2

defective sphincter motility +/- hiatus hernia
abnormal esophageal motility
increased intra-abdominal pressure (pregnancy)

Question 3

what will be seen microscopically in oesophagitis?

Answer 3

bazal zone epithelial expansion

intraepithelial neutrophils, lymphocytes and eosinophils

Question 4

what will be seen histologically in oesophagitis?

Answer 4

basal zone expansion

lengthening of papillae

Question 5

what can cause a tissue to change?

Answer 5

continuous stress

Question 6

list 3 complications of reflux

Answer 6

ulceration (discontinuity in epithelial surface)
stricture (due to healing/scarring of ulcer causing dysphagia etc)
Barrets Oesophagus

Question 7

what is Barrets oesophagus?

Answer 7

replacement of stratified squamous epthelium by columnar epithelium due to persistant reflux of acid or bile

Question 8

what does barrets oesophagus do to the epithelium of the oesophagus?

Answer 8

red velvety mucosa replaces squamous

squamous mucosa replaced by columnar mucosa which is genetically unstable

Question 9

what is another name for allergic oesophagitis?

Answer 9

eosinophilic oesophagitits

Question 10

when is allergic oesophagitis more common?

Answer 10

family history of allergy
asthma
young
males more than females

Question 11

what are the findings in allergic oesophagitis?

Answer 11

pH probe negative for reflux
increased eosinophils in blood and intraepithelium
corrugated (feline) or spotty oesophagus (oesophagus looks like trachea)

Question 12

how is allergic oesophagitis treated?

Answer 12

steroids
chromoglycate
monteleukast

Question 13

what is the most common benign oesophageal tumour?

Answer 13

squamous papilloma

Question 14

list 4 other benign oesophageal tumours

Answer 14

leiomyomas
lipomas
fibrovascular polyps
granular cell tumours

Question 15

what are the 2 types of oesophageal tumours?

Answer 15

squamous cell carcinoma

adenocarcinoma

Question 16

who is squamous cell carcinoma more common in?

Answer 16

males
smokers
drinkers
Vit A/zinc deficiency
HPV

Question 17

what is the pathogenesis of squamous cell carcinoma?

Answer 17

normal > GORD > severe dyspasia

Question 18

what physical problems can oesophageal squamous cell carcinomas cause?

Answer 18

dysphagia

eventually cant swallow solid foods

Question 19

what does squamous cell carcinoma look like histologically?

Answer 19

keratinised pearls

Question 20

who is adenocarcinoma more common in?

Answer 20

Caucasian males
obese
the West
People with Barrets oesophagus

Question 21

where is an adenocarcinoma most likely to arise?

Answer 21

lower 1/3rd of oesophagus

Question 22

describe the pathogenesis of adenocarcinoma

Answer 22

genetic factor, reflux disease etc > chronic reflux > Barrets oesophagus > low grade dysplasia > high grade dysplasia > adenocarcinoma

Question 23

name 3 mechanisms of metasteses in carcinoma of the oesophagus

Answer 23

direct invasion
lymphatic permeation
vascular invasion

Question 24

where can an oesophageal carcinoma directly invade?

Answer 24

trachea (produces fistula)
causes aspiration pneumonia, sepsis, death etc
Heart
Anything nearby

Question 25

the oesophagus is enriched in lymph nodes, true or false?

Answer 25

true | this is why carcinoma can spread via lymph nodes

Question 26

how might a carcinoma of the oesophagus present?

Answer 26

dysphagia (due to obstruction) | General malignancy symptoms (anaemia, weight loss, lethargy etc)

Question 27

what type are 90% of oral cancers?

Answer 27

squamous cell carcinoma | as smoking etc damages eithelium

Question 28

how might an oral SCC present?

Answer 28

white, red, speckled, ulcer, lump

Question 29

what can cause an oral SCC?

Answer 29

``` tobacco alcohol betel quid (rare) HPV other rare causes ```

Question 30

how are SCCs graded?

Answer 30

by degree of differentiation - well differentiated tumour cells, obviously squamous with prickles and keratinization - moderately differentiated - moderately differentiated, difficult to identify as epithelial

Question 31

what histopathological features can affect the prognosis of SCC?

Answer 31

tumour diameter depth of invasion pattern of invasion (cohesive or non-cohesive) Lymphovascular invasion

Question 32

what is TNM system?

Answer 32

staging of tumours T = diameter of tumour, structures invaded N = lymph node status M = metasteses

Question 33

what types of treatment are there for SCC?

Answer 33

surgery | +/- adjuvant therapy

Question 34

what is the 5 year survival from SCC and why?

Answer 34

40-50% | due to late detection

Question 35

Barrets oesophagus causes increased risk of dysplasia and carcinoma, true or false?

Answer 35

true

Question 36

is barrets oesophagus kept under surveillance?

Answer 36

yes