Random exam mix Flashcards
What is the basic investigative process in oral pathology?
- Presentation of chief concers
- Information collection - medical history, patietn history, clinical examiantion and special tests
- Information collation
- Development of a differential diagnosis - list most likely diagnoses and do specific test to eliminate potential diagnoses
- Arrive to definitive diagnosis and commence treatment
What are the types of differential diagnosis?
- Clinical differential diagnosis
- Radiographic differential diagnosis
- Provisional/working/tentative diagnosis
- Histological differential diagnosis
- Definitive diagnosis
What is the step by step process to understand the arisal of a certain oral lesion?
Use this scheme
- Developmental origin
- Inflammatory origin
- Hyperplastic origin
- Degenerative origin
- Hormonal origin
- Neoplastic origin
- Idiopathic origin
DIHDHNI
How do we take history about a lesion?
- Duration when the patient first started seeing the lesion
- Variations in site and character of the lesion
- Symptoms - related to the lesion and any systemic symptoms
- Onset - any associated hsitorical events related to the lesion
What is the systematic way to examine a lesion?
- Site - using anatomical terminology
- Size - measure with a probe
- Morphology - elevated, flat or depressed
- Colour - compare to adjacent normal tissue
- Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
What are some of the terminology in a lesion with elevated morpholoy?
Blisters - Fuild filled masses:
- Vesicle - upto 0.5cm
- Bulla - more than 0.5cm
- Pustule - pus of any size
Non-blisters - not fluid filled elevations
- Papule - upto 0.5cm
- Nodule - from 0.5cm to 2 cm
- Tumour - more than 2 cm
- Plaque - more than 0.5cm but it is only clightly raised
What are some of the terminology of a lesion with depressed or flat morphology?
Depressed:
1. Ulcer (epithelium lost) - if it is yellow tissue more likely to be an ulcer
- Erosion (epithelium lost)/atrophy - if it is redness tissue more likely to be an erosion/atrophy
Flat:
1. Macule - discoloration (freckel)
- Patch - big discolouration
What kind of structure is this?
A brown macule - a flat discoloration
Site - RHS lower vermilion shifted around 10 mm from the midline of the lips
Size - measure with peiro probe - around 5-10mm
Morphology - flat, round, heart shapped
Colour - brown
Consistency - NOPE IT IS A PHOTO - Texture - maybe rough, defiantly different from the normal lip
What kind of structure is this?
It is a white polyp
Site - RHS buccal mucosa adjacanet to the buccal surface of 45
Size - measure with perio probe - around 10-15mm
Morphology - elevated, rounded, sphere like
Colour - white, opaque, with small amounts of pink
Consistency - NOPE IT IS A PHOTO - Texture - rubbery
What investigation do we have in oral pathology?
- Biopsy (taking the whole or some of the tissue) - histopathology (investigative process) and exfoliative cytology
- Adjunct diagnostic techniques - light-based and vital stains
- Other techniques - microbiology, biochemistry, serology
What are some of the types of biopsy?
- Scalpel biopsy - incisional or exitional - most common procedure
- Fine needle aspiration
- Core biopsy
- Exfoliative cytology - taking the gunk and spreading it over a film
What are the consideration during biopsy?
- The lesion in question
- Surrounding anatomy
What should you do with some of the lesions that you may encounter to understant if they are vascular?
Use a small, transparent plate and apply pressure - if the lesion stars to blanch, it is most likely to be vascular
What are some of the features of pathology that can be observed by a light based system such as Velscope?
In some instances, the pathological tissue may take up the light thus resulting in a shadowing of the structures.
Good adjunct but please do not use this as a basis of diagnosis.
What are some common stains in oral pathology?
- Haematoxylin and eosin
- Periodic Acid-Shiff - used for fungal infection
What is exfoliative cytology?
It is the examination of cells scraped from the surface of the lesion - great for fungal infection - it is quick and easy but may not be used to more complex lesions with pathology below the surface
What is fine needle aspiratin used for?
It is mostly used for intraosseous pathology and fluctuant soft tissue pathology and neck masses
What is core biopsy used for?
It is used to remove the core of some tissues - it is similar to scalpel biopsy but it has more complication than fine needle biopsy.
Mostly used in biopsy in the abdomen but also can be used on a lymph node
What is a smere vs a swab?
Swab - microbial analysis - need to send to a lab for something like PCR
Smere - do a cell analysis - straight under the microscope - think exfoliative cytology
What are the two basic types of mucosa present in the mouth?
- Attached, orthokeratinised mucosa
- Non-attached, non-keratinised mucosa
What are the four layer of the epithelium?
- stratum basale (D)
- stratum spinosum (C)
- stratum granulosum (B)
- stratum corneum (A)
E and F and the papillary and reticular layer accordingly
What are some the benign lesion of epithelial layer with idiopathic or developmental origin?
- Leukoedema
- White Sponge Nevus
- Epidermolysis Bullosa
What is a leukoedema?
It is a common developmental lesion of the oral mucosa. It is a variation of normal mucosa and it is more common in individuals with dark skin. Mainly in buccal mucosa
It can be implicated by the use of tobacco or alcohol.
They are asymptomatic, bilateral, poorly defined and it disappears when the mucosa is stretched or whipped with a gauze. Please consider not to stretched the attached gingiva!
What is the histology of leukoedema?
It appears in the supperficial half of the epithelium.
There are large vacuolated cells present with some Pyknotic nuclei.
Epithelial hyperplasia present as well as long elongated rete pegs
What is the management of leukoedema?
Unless there are any other worrying signs - no management is needed just monitoring
What is the White Sponge Naevus?
It is a rare inherited condition. It is autosomal dominants trait and it is early onset. Majority of cases present with oral lesion, other mucosal surface may be affected.
It is asymptomatic, diffuse, with white thickening and if irregular thickening
What is the histology of White Sponge Naevus?
It appears in the superficial layer of the epithelium.
Large vacuolated cells.
Pyknotic nuclei and thickened parakeratin layer
No dysplasia present
What is benign migratory glossitis?
It is also known as geographic tongue - it is quite common and the aetiology is well known
It is a result of loss (atrophy) of filiform papillae. Sometimes it can be sore but again not much can be done - if concerning please refer for biopsy
What can be commonly seen int eh benign migratory glossitis histologically?
Numerous microabscesses in the surface of epithelium filled with neutrophils and lymphocytes
What is hairy tongue (aka coated tongue)?
It is a condition with poorly understood aetiology and a result of increased length of filliform papilla.
May be initiated by heavy smoking, atiobiotics and other.
Usually asymptomatic.
Increased number of chromogenic microorganisms thus a change in colour to usually darker one
What do we do in the instance of hariy tongue, migratory glossitis or other benign developmental deviation?
- Ensure the patient that this is not something pathological
- Take a smear if needed
What is haemangioma?
It is a localised vascular proliferation that may be congenital or arise later in life.
Could be single or multiple and results in soft tissue lesions usually
What is the hsitological appearance of haemangioma?
- Layer of epileium
- Perforations of endothelial blood vessels and cells - forming capillaries
What type of haemangioma is this?
This is capillary haemangioma due to the small capillary vessels presence
What type of haemgioma is this?
This is cavernous haemangioma due to larger blood vessels present
What is lymphangioma?
It is a type of lesion that is present in tongue swelling. The epithelium lining is very thin with a large, lymph filled vascular spaces
What kind of condition is this?
This a lymphagioma of the tongue - due to the pink limp liquid being observed in the hghlighted areas
What conditions is this?
This is a caliber persistent labial artery.
It occurs when the inferior alveolar artery maintains it’s size after leaving the mental forament and becomes superficial in the lower lip.
It can present as a nodule. PLEASE PULPATE IT BECAUSE IT WILL PULSE
What is this condition?
Oral melanotic macule or focal melanosis or an intraoral freckle
It is a well demarcated, uniform in colour, asymptomatic and has the same consitency as the surrounding mucosa macule.
Histologically it is related to increase melanin deposition.
Sometimes can arise due to medication use specifically oral medications.
Remeber macules DO NOT CHANGE OVER TIME
What is this condition?
This iss a mucosal menocytic naevus.
It is a rare oral cavity lesion or patch.
It is bening proliferation of neaevus cells.
The lesion is not neoplastic but is a hamartomatous lesion
What is a hamartoma?
It is a tumour-like lesion.
Non-neoplastic proliferation of tissue.
It grows at the same rate as the surrounding tissue
What type of naevus is this?
This is a junctional naevus because is confined to the basal layer of the epithelium
What type of naevus is this?
This is intraomucosal naevus - because is is not in the epeithelium
What condition is this?
This is an amalgam tattoo - it is associated with some of the amalgam being incorporate into the adjcent soft tissue over time. PLEASE LOOK AT AMALGAM NEAR BY.
This lesion can grow but usually at a none alarming rate.
What does ectopic mean?
It is a tissues that are in an abnormal sire of position
What are Fordyce spots?
They are ectopic sebaceous glands that usually occur on the buccal mucosa - their instance increases with age.
They are slightly elevated yellowish nodules.
It arises due to the arisal of the tissue from the ectoderm during the embrio development
What are the histological features of the Fordyce spots?
They are very similar to sebaceous glands
What condition is this?
These are lingual tonsils.
This is part of the lymphoid tissue (Welder’s ring) that is used to fight infection.
The lymphoid tissue underneath the folliate papilla goes through lymphoid hyperplasia (growth) and result in an elevation on the postra-lateral tongue surface.
What type of nodules are theses?
This is lymphoid hyperplasia
What type of tissue is this?
This is lingual thyroid tissue
What are the Tori and exostoses?
They are bony protuberances.
Non-neoplastic.
Possibly inherited
Exotoses - multiple or single nodules at the buccal aspect of the alveolar bone
What type of cyst is this?
This is a nasopalatine cyst.
It is the most common non-odontogenic oral cyst.
It s asymptomatic unless secondarily inflamed.
What type of conditon is this and why?
These are fordyce spots
They are sebatious glands in the oral mucosa.
Do not biopsy and reassure the patient that this is normal.
Pathogenesis: ectoderm refrences
What are the two basic morphological potentials of a lesion?
- Senssile lesion - broad based lesion
- Pedunculatedlesion - on a stalk - use a perioprobe to see if a lesion has a neck
What are some of the other adjectives that can be used to describe a lesion?
- Papillary - any small growth projectin into a cavity
- Verrucous - warty surface appearance (small hyperkeratinised projections)
- Epulis - lump on the gum non-neoplastic
What is fibroepithelial hyperplasia?
It is a growth of fibrous connective tissue underneath an epithelium
WHat are the clinical features of fibroepithelial hyperplasia?
It is a exophytic lesion.
Site is a site of trauma
Size is around 1-2mm upto 1cm
Moprphology could be sessile or pedunculated
Colour is similar to normal mucosa but could look inflamed
Consistency could be soft to hard depending on the age of the fibrous tissue
What is papillary hyperplasiaof the palate?
It is a nodular overgowth that is associated with dentures and S.Candida infection.
Associated with nodular hyperplasia in histological samples
What is the common histological presentation of the S.Candida infection
It is a presented as a nodule appearance with chronic inflammatory cell infiltrate
What condition is this?
This is fibroepithelial polyp. It is a localised fibroepithelial hyperplasia. Can occur anywhere but commonly sites prone to trauma.
It is similar to the colour of the surroinding tissue but may appear a bit more inflammaed.
What is the histopathology of fibroepithelial polyp?
It is an overlying epithelium - hyperplastic or atopic or normal. Bulk lesion is made up of densely collagenous fibrous connective tissue.
MAY OCCUR WITH OSSIFICATION
What condition is this?
This is pyogenic granuloma.
It is a localised soft tissue lesion that is common in people who are pregnant due to the hormone imbalance.
Site: Anywhere but classically arises from the interdental papilla
What are the clinical features of pyognic granuloma?
Usually sensile
Sudden onset and rapid growth
Bright red and haemorrhagic, ulcerated surface.
Tissue may mature thus becomes fibrosed
What is the hsitopathology of Pyogenic granuloma?
Many lesions are made up of exuberant granulation tissue. It is a very vascular lesion with large numbers of thin walled dilated blood vessels lined by endothelial cells
What is peripheral giant cell granuloma?
It is a similar lesion to the pyogenic granuloma but it also involves bone tissue
What is the histopathology of the peripheral giant cell granuloma?
It is a well vascularised cellular tissue with mononuclear cells.
If you see multinucleadted diant cells - probs a peripheral giant cell granuloma
What is the imortant aspect of the peripheral giant cell granuloma?
It is important to determine that the lesion is not an intra-bony or central lesion which has perforated cortical bone
What is ulcerated fibrous epulis with ossification? what are the clinical features?
It is a relatively common oral lesion. Presents as localised lesion of gingiva like fibrous epulis and pyogenic granuloma.
Clinical features:
1. Painless
- Relatively rapid growth
- Size usually less than 1 cm
- Sometimes - surface ulceration
What is the histopathology of ulcerated epulis with ossification?
It is a very cellular lesion - well vascularised and collagenous. IT CONTAINS CALCIFICATIONS.
What are generalised gingival hyperplastic lesions?
They are lesion that occur due to underlying factors such as plaque or use of certain medications such as hypertension medication (calcium channel blockers) or anti-covulsants or immunosupresants.
Drug Induced Gingival Overgrowth is one of them
What is morsicatio buccarum?
It is cheek biting which causes chronic mechanical trauma.
Clinical presentation is a unilateral or bilateral white patch on the buccal mucosa, which is rough and whitenned. Usually symptomless
What is frictional keratosis?
It is similar to the cheek biting and linea alba but usually occurs on commonly traumatised sites such as the lips, lateral border of the tongue, buccal mucosa, edentulous alveolar ridge.
Appears as a poorly demarcated white lesion.
What happens histologically in frictional keratosis? What is the management?
Histological features:
1. Hyperkeratosis
- No dysplastic changes
Management:
- Identify and try and remove a cause - might be difficult with edentulous patients
- Always biopsy if in doubt :)
What is smoker’s keratosis?
It is a diffused, white, moderately thickened palate that can be sometimes roughened.
It usually involves the entire palate with characteristic, red, minor salivary gland dots.
Associated with tobacco smoking, especially reverse smoking.
What condition is this?
This chronic hyperplastic candidiasis.
It is usually a single, fixed, white or mix of white and red patch that syays when whipped.
May occur anywhere but common sites are the tongue and buccal mucosa.
What is the histopathological appearance of chronic hyperplastic candidiasis?
Thickening large bulbus epithelial with keratinisation
What are histopathological features of the giant cell fibroma? What are the clinical features?
The main difference between giant cell fibroma is the Giant Stellate Cells rather than the osteoclast like cells.
The clinical features are similar: small, raised, pedunculated lesion that is asymptomatic
What is traumatic neuroma? What are it’s clinical signs?
It is a lesion thatoccurs due to the damage of a nerve trunk following some sort of injury (like surgery or pressure on dentures).
Essenially - the repair of the axon does not go as planned and the lesion if fully comprised of the neural tissue.
Clinical features: small swelling or nodule on mucosa near mental foramen, alveolar ridge, lips or tongue. Pressure on the nodule cuases pain
What is histapathology and treatment of traumatic neuroma?
Histopathology: Presents as a mass of irregular bundle situated in variable amount of connective tissue stroma.
Treatment: surgical excision
What is this condition?
This is verruciform xanthoma, it is a rare lesion that mimic squamous cell carcinoma.
It is flat, velvety, pebbly.
What is the histopathological appearacnce of verruciform xanthoma?
It is usually associated with foamy, lipid filled marophages.
The lesion is bening
What is a traumatic eosinophilic ulcer?
It is a bening chronic ulcer usually presenting on the tongue.
It is crateriform in shape.
What is the histopathological significance of eosinophilic ulcer and why should it worry us?
Eosinophilic ulcers are usually associated with an abnormal presentation of eosinophils thus it is important to send a biopsy sample of the ulcer for histopathological investigation to ensure it is not malignant
What is this condition?
This is a minor aphthous ulcer - which one of the most common ulcer of infectious origin.
It usually occurs in non-keratinised mucosa, it is shallow and rounded.
It has erythematous margins and yellowish floor
What is this condition?
This is a major Aphthous Ulcer - an uncommon ulcer of infectious origin.
It is usually very large and can involve keratinised mucosa. This need to be reffer for biopsy because this could be a melignancy.
What is this condition?
This is Herpetiform aphthous ulvers - it is an uncommon and are very very small.
Named herpetiform due to the resemblance of the ulcers to those of herpetic stomatitis
What are the oral manifestations of Crohn’s disease?
- Diffuse lip swelling
- Coble stone thickening of the mucosa
- Ulcers
