Robbins Flashcards
is caused by focal demineralization of tooth structure (enamel and dentin) by acidic products of bacterial sugar fermentation
dental carries
inflammation of the oral mucosa surrounding the teeth, caused by accumulation of dental plaque and calculus
gingivitis
is an inflammatory process that affects the supporting structures of the teeth (ligaments), alveolar bone, and cementum
Periodontitis
a submucosal nodular mass of fibrous connective tissue stroma that occurs primarily on the buccal mucosa along the bite line or the gingiva
irritation fibroma
typically found on the gingiva of children, young adults, and pregnant women. This exophytic inflammatory lesion is red to purple in color and frequently ulcerated. Histologically, they are a highly vascularized proliferation of organizing granulation tissue.
pyogenic granulomas
red, ulcerated, nodular lesions of the gingiva that arise from a long-standing pyogenic granuloma, while others develop de novo from cells of the periodontal ligament, complete surgical excision down to the periosteum is required
Peripheral ossifying fibroma
oral cavity lesion that contains aggregates of multinucleate, foreign body–like giant cells separated by a fibroangiomatous stroma
Peripheral giant cell granuloma
The pseudomembranous form of oral candidiasis is called
thrush
a distinctive oral lesion on the lateral border of the tongue caused by EBV
Hairy Leukoplakia
T/F until proven otherwise by histologic evaluation, all leukoplakias must be considered precancerous
true
a possibly precancerous lesion which is red, velvety, possibly eroded area within the oral cavity that usually remains level with or may be slightly depressed relative to the surrounding mucosa
erythroplakia
Approximately 95% of cancers of the head and neck are _____, with the remainder largely consisting of ____
SCCs, adenocarcinomas of salivary origin
primary cause of SCC of the oropharynx
HPV infection
oropharyngeal carcinoma
prognosis is better in
hpv related scc or “classic” scc?
hpv related
postulates that multiple individual primary tumors develop independently in the upper aerodigestive tract as a result of years of mucosal exposure to carcinogens
field cancerization
T/F second primary tumors in the oropharyngeal classic scca have the highest rate among all malignancies and commonly have good prognosis
False, they are usually fatal
mutations in these 3 genes are drivers of cancer development
TP53, CDKN2A, PIK3CA
hpv oncoproteins and the proteins they inactivate
E6 - p53
E7 - RB
classic hpv neg scca vs hpv-assoc scca:
favored locations are the ventral surface of the tongue, floor of the mouth, lower lip, soft palate, and gingiva
classic
classic hpv neg scca vs hpv-assoc scca:
tend to develop without a readily identified premalignant (i.e., dysplastic) component
hpv-assoc
oropharyngeal:
classic hpv neg scca vs hpv-assoc scca:
appear as raised, firm, pearly plaques or irregular, roughened, or verrucous areas of mucosal thickening
classic
oropharyngeal carcinoma
classic hpv neg scca vs hpv-assoc scca:
are most often nonkeratinizing neoplasms arising in the reticulated epithelium of the tonsillar crypts within the lingual tonsils, base of tongue, soft palate, and pharynx
hpv-assoc
oropharyngeal carcinoma
classic hpv neg scca vs hpv-assoc scca:
typically preceded by premalignant lesions, such as leukoplakia and erythroplakia
classic
oropharyngeal cancer
classic hpv neg scca vs hpv-assoc scca:
present as small primary tumors that lack obvious surface mucosal lesions but are accompanied by significant cervical lymphadenopathy
hpv assoc
The histology of this invasive oropharyngeal tumor is characterized by the proliferation of nests and lobules of nonkeratinizing and basaloid cells
HPV-associated SCC
Immunohistochemical detection of strong ____ protein expression can serve as a marker for HPV-associated SCC
p16
originates around the crown of an unerupted tooth as a result of fluid accumulation between the developing tooth and the dental follicle. Histologically, they are lined by a thin layer of stratified squamous epithelium, and there is frequently a dense chronic inflammatory cell infiltrate in surrounding connective tissue
dentigerous cyst
well-defined unilocular or multilocular radiolucencies with a lining consisting of a thin layer of keratinized stratified squamous epithelium with a prominent basal cell layer and a corrugated epithelial surface. it is locally aggressive
keratocystic odontogenic tumor
keratocystic odontogenic tumor is usually solitary so multiple cysts should be evaluated for this syndrome
nevoid basal cell carcinoma (Gorlin syndrome)
mutations associated with nevoid basal cell carcinoma syndrome (Gorlin syndrome)
PTCH (Patched), chromosome 9q22
common inflammatory lesion found at the tooth apex. The cysts develop as a result of long- standing inflammation of the tooth (pulpitis), often secondary to advanced carious lesions or local trauma. Over time, granulation tissue may develop, with subsequent epithelialization that results in a cyst
radicular cyst
two most common and clinically significant odontogenic tumors
odontoma and ameloblastoma
most common odontogenic tumor, arises from epithelium and is associated with extensive enamel and dentin deposition. These lesions probably represent hamartomas rather than true neoplasms and are cured by local excision.
odontoma
arises from odontogenic epithelium and does not display ectomesenchymal differentiation. It is cystic, slow growing, and locally invasive with a typically indolent course. Treatment requires wide surgical resection to prevent recurrence.
ameloblastoma
T/F most people with nasal polyps are atopic
false, only 0.5% of atopic people have nasal polyps
a benign, highly vascular tumor that arises within the fibrovascular stroma of the posterolateral wall of the roof of the nasal cavity and occurs almost exclusively in adolescent males who are often fair-skinned and red headed
nasopharyngeal angiofibroma
mutation present in the majority of nasopharyngeal angiofibromas
CTNNB1 (beta-catenin)
Sinonasal papilloma occurs in 3 forms: in descending order of frequency
exophytic
endophytic (inverted)
oncocytic
Most endophytic sinonasal papillomas have mutations in _____ the remaining harbor _____
EGFR, HPV DNA, 6 and 11
Sinonasal papilloma is a benign neoplasm arising from the
respiratory or Schneiderian mucosa lining the nasal cavity and paranasal sinuses
arise from neuroectodermal olfactory cells within the mucosa, particularly in the superior aspect of the nasal cavity are small, blue, round cell neoplasms typically composed of well-circumscribed nests and lobules of cells separated by fibrovascular stroma
Olfactory Neuroblastoma (Esthesioneuroblastoma)
carcinoma uniformly associated with translocations that fuse genes encoding chimeric proteins composed of a chromatin regulator, and a portion of a “chromatin reader” protein, usually BRD4.
NUT midline carcinoma
T/F nasopharyngeal carcinoma is characterized by a distinctive geographic distribution, a close anatomic relationship to lymphoid tissue, and an association with EBV infection
T
3 patterns of nasopharyngeal carcinoma
keratinizing
non-keratinizing
basaloid
three principal factors that influence development of nasopharyngeal carcinomas are
heredity
age
EBV infection
refers to laryngotracheobronchitis in children that produces a characteristic inspiratory stridor due to airway narrowing
croup
develop in the vocal cords often in smokers/ those who strain their voice often, covered by squamous epithelium that may become keratotic, hyperplastic, or even slightly dysplastic overlying a loose myxoid connective tissue core. The latter may be variably fibrotic, fibrinous, or highly vascularized
Reactive Nodules (bilateral)
Polyps (unilateral)
mutiple laryngeal lesions in children which are caused by HPV types 6 and 11 acquired via the maternal birth canal
juvenile laryngeal papillomatosis
T/F Nondysplastic hyperplasias in the larynx have almost no potential for malignant transformation
True
most common risk factor for laryngeal carcinoma
tobacco smoke
these ear cysts are typically 1 to 4 cm in diameter, lined by keratinizing squamous or metaplastic mucus-secreting epithelium, and filled with amorphous, keratinous debris
cholesteatoma
refers to abnormal bone deposition in the middle ear about the rim of the oval window into which the footplate of the stapes fits
Otosclerosis
benign lesions usually appear on the upper lateral aspect of the neck along the sternocleidomastoid muscle, lined by stratified squamous or pseudostratified columnar epithelium. The fibrous cyst walls typically contain lymphoid tissue with prominent germinal centers. Cyst contents may be clear and watery or mucinous and may also contain desquamated cells and granular cellular debris
branchial cysts
lined by stratified squamous epithelium when located near the base of the tongue or by pseudostratified columnar epithelium in lower locations The fibrous cyst wall often includes lymphoid aggregates or thyroid remnants.
thyroglossal duct cyst
also called carotid body tumors
paraganglioma
occur frequently in both hereditary and spontaneous paragangliomas
loss-of-function mutations in genes encoding succinate dehydrogenase (SDH) subunits
Nests (zellballen) of round to oval chief cells with abundant, clear or granular, eosinophilic cytoplasm and uniform, round to ovoid, sometimes vesicular, nuclei are surrounded by delicate vascular septae
paraganglioma
The supporting network of spindle-shaped stromal cells in paragangliomas, collectively called ________, are positive for S-100 protein
sustentacular cells
paragangliomas that occur with the adrenal (pheochromocytomas) are associated with the familial _____
MEN2
paragangliomas that occur in association with hereditary paraganglioma syndromes (PGL1-4, SDH deficient), usually involve the _____
head and neck
T/F Paragangliomas with succinate dehydrogenase A (SDHA) mutations are associated with the highest rates of metastasis (30% to 50%)
False, succinate dehydrogenase B (SDHB)
Hereditary head and neck paragangliomas are associated with____ mutations, occur at younger ages, are often multiple, and can be malignant
succinate dehydrogenase gene mutations
are these glands mostly serous, mucinous, or mixed?
parotid
submandibular
sublingual
parotid - serous
submandibular - mixed, mostly serous
sublingual - mixed, mostly mucous
most prevalent form of sialadenitis
mucocele
most common viral cause of sialadenitis
mumps
most often found on the lower lip as the result of trauma, occur at all ages, and present as fluctuant lower lip swellings with a blue translucent hue. They are pseudocysts lined by inflammatory granulation tissue or fibrous connective tissue and filled with mucin and inflammatory cells, particularly macrophages
mucocele
____ are epithelial-lined cysts that arise when the duct of the sublingual gland has been damaged
ranula
T/F the malignant potential of salivary gland tumors is inversely proportional to gland size, with smaller glands harboring greater numbers of cancers
True
the most common salivary gland neoplasm
Pleomorphic adenoma (PA)
PA are most commonly seen in the _____ gland
parotid
Many cases of PA are associated with chromosomal rearrangements that induce overexpression of
PLAG1
In PA cases that lack PLAG overexpression mutations of ____ are usually present
HMGA2
The dominant histologic feature of this salivary tumor is morphologic heterogeneity. The epithelial elements resembling ductal cells or myoepithelial cells are arranged as ducts, acini, irregular tubules, strands, or sheets of cells. and are typically dispersed within a background of loose myxoid and hyaline tissue containing islands of cartilage and, rarely, foci of bone
pleomorphic adenoma
second most common salivary gland neoplasm that arises almost exclusively in the parotid gland
warthin tumor
risk for development of a warthin tumor are increased by 8 fold in
smokers
round to oval encapsulated mass with a lining that is composed of a double layer of oncocytic cells; the innermost layer is columnar, while cuboidal cells occupy the outer layer, usually in a lymphoid stroma
warthin tumor
most common primary malignant tumor of salivary glands
Mucoepidermoid carcinoma
fusion protein that is believed to play a key role in the genesis of mucoepidermoid carcinoma
CRTC1-MAML2
this salivary tumor demonstrates cords, sheets, or cystic configurations of squamous, mucous, or intermediate cells that have squamous features and small to large mucus-filled vacuoles
mucoepidermoid carcinoma
small, poorly encapsulated, infiltrative, gray-pink lesions composed of small cells with dark, compact nuclei and scant cytoplasm.The tumor cells are organized in a cribriform growth pattern that resembles swiss cheese.The spaces between the tumor cells are often filled with hyaline material thought to represent excess basement membrane
adenoid cystic carcinoma
gene rearrangement present in a subset of adenoid cystic carcinomas
MYB-NFIB
T/F Adenoid cystic carcinomas arising in the parotid tend to have a poorer prognosis than those arising in the minor salivary glands
False, poorer prognosis if in minor salivary glands
The cytoplasm of cells of acinic cell carcinomas contain purple granules called
zymogen granules
Eosinophilic, granular to vacuolated cytoplasm with no zymogen granules.
Tubular, papillary and cystic growth.
Sometimes has distinctive eosinophilic secretions in lumina.
secretory carcinoma
fusion gene associated with secretory carcinoma
ETV6-NTRK3
Solid, trabecular, or tubular growth
Perpendicular basal cells on outside of nests
Epithelial cells on inside of nests
pleomorphic adenoma without the stroma
basal cell adenoma / monomorphic adenoma
translocations common in acinic cell carcinomas
NR4A3 translocations
