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omopor > white lesions part 1 (developmental and reactive) > Flashcards

white lesions part 1 (developmental and reactive) Flashcards

1
Q

clinical presentation of fordyce granules

A
  • ectopic sebaceous glands on oral mucosa
  • multiple
  • small (1-2mm)
  • white or yellow white papules
  • asymptomatic
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2
Q

2 types of developmental white lesions

A

1) fordyce granules
2) leukoedema

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3
Q

3 locations of fordyce granules

A

1) buccal mucosa
2) lateral portion of vermillion border of lip
3) retromolar areas

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4
Q

fordyce granules resemble ___ found in skin but lack ____ (histopatho)

there are ___ lobules seen beneath ____ surface, communicating with the surface via _____

A

1) sebaceous glands
2) hair follicles
3) acinar
4) epithelial
5) central duct

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5
Q

sebaceous cells in lobules of fordyce granules are what shape and what features?

A

polygonal shape
centrally located nuclei, abundant foamy cytoplasm

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6
Q

clinical presentation of leukoedema

A
  • oral condition, of unknown cause
  • folded surface -> wrinkles and streaks
  • diffuse, greyish white, milky, opalescent
  • does not rub off, but disappears on stretching of mucosa
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7
Q

location of leukoedema

A
  • bilateral buccal mucosa
  • floor of mouth (rare)
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8
Q

histopatho findings of leukoedema

A

1) acanthosis
2) intracellular oedema of spinous layer (keratinocyte oedema)
3) large vacuolated cells with pyknotic nuclei

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9
Q

what is acanthosis

A

the increase in thickness of epithelium and elongation of rete ridges

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10
Q

DDX of leukoedema , how to distinguish?

A

1) leukoplakia
2) oral lichen planus (OLP)
3) oral candidiasis
4) submucous fibrosis

dfferentiate because this will disappear when stretched

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11
Q

6 types of reactive white lesions

A

1) BARK benign alveolar ridge keratosis
2) fricitional hyperkeratosis – linea alba
3) frictional hyperkeratosis – morsicato buccarum (chronic mucosal chewing)
4) nicotinic stomatitis
5) coated tongue/ hairy/ black hairy tongue
6) smokeless tobacco lesions

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12
Q

aetiology of BARK

A

benign alveolar ridge keratosis
occurs due to chronic mehanical irritation, due to opposing dentition or reaction to trauma of impacted food on mucosa

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13
Q

clinical presentation of BARK

A

poorly demarcated white plaque

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14
Q

location of BARK

A
  • keratinised mucosa of alveolar ridge
  • retromolar pad
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15
Q

linea alba is more common in females or males

A

female

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16
Q

aetiology of linea alba

A

due to frictional irritation from repetitive interdigitation of teeth

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17
Q

clinical presentation of linea alba

A
  • usually bilateral
  • uniform, adherent horizontal white line
  • rough and frayed surface
  • may be scalloped
  • more prominent adjacent to posterior teeth
18
Q

location of linea alba

A
  • buccal mucosa, along occlusal plane
  • more prominent adjacent to posterior teeth
19
Q

etiology of morsicato buccarum

A

unintentional habit of cheek biting

20
Q

clinical presentation of morsicato buccarum

A

-usually bilateral
- shredded, white area
- irregular ragged surface with tags of epithelium that peel off
- may have erytehma, erosion or ulceration

21
Q

location of morsicato buccarum

A
  • buccal mucosa ( more common at anterior)
  • lateral border of tongue
  • labial mucosa (rare or upper lip mucosa)
22
Q

histopatho of BARK, linea alba and morsicato buccarum

A
  • hyperkeratosis and acanthosis
  • keratinocyte oedema
  • no/mild inflammatory infiltrate
  • no dysplasia
23
Q

what is the difference between hyperkeratosis and acanthosis

A

hyperkeratosis is thickened keratin layer of surface epithelium

acanthosis is thickened spinous layer of surface epithelium

24
Q

nicotinic stomatitis usually in male or female

A

male >45 yo

25
Q

etiology of nicotinic stomatitis

A
  • due to cigar and pipe smoking, develops in response to heat from smoke (rather than the chemicals)
  • also seen in long term consumption of very hot beverages
26
Q

clinical presentation of nicotinic stomatitis

A
  • diffuse grey/ white mucosa (reactive keratosis)
  • elevated papule with punctate red centres (inflamed minor salivary gland duct orifices)
  • painless
27
Q

location of nicotinic stomatits

A

hard palate

28
Q

histopatho findings of nicotinic stomatitis

  • ____ and acanthosis
  • ________ inflammation of subepithelial CT and _______
  • squamous metaplasia of ______
  • inflammatory exudate within _______
  • no/ got dysplasia ?
A
  • hyperkeratosis and acanthosis
  • mild, patchy chronic inflammation of subepithelial CT and mucous glands
  • squamous metaplasia of excretory ducts
  • inflammatory exudate within duct lamina
  • no dysplasia
29
Q

histopatho findings of nicotinic stomatitis

  • hyperkeratosis and ______
  • mild, patchy chronic inflammation of ______ and ________
  • ______- of excretory ducts
  • ___________ within duct lamina
  • no/ got dysplasia
A

hyperkeratosis and acanthosis
- mild, patchy chronic inflammation of subepithelial CT and mucous glands
- squamous metaplasia of excretory ducts
- inflammatory exudate within duct lamina
- no dysplasia

30
Q

management of nicotinic stomatisis

A
  • reversible with cessation of habit (1-2 weeks)
  • no malignant potential but any lesion that persist after 1 month of cessation, then we will suspect true leukoplakia and do biopsy
31
Q

etiology of coated/ hairy/ black hairy tongue and predisposing factors

A

accumulation of keratin on filiform papillae (usually due to decrease in normal keratin desquamation)

predisposing factors: smoking, AB, hyposalivation, dehydration, oral inactivity, poor OH

32
Q

difference in clinical presentation of coated and hairy tongue

A

coated tongue: thickened, matted appearance
hairy tongue: elongated, hair like filiform papille projections

33
Q

clinical presentation of hairy tongue

  • (colour) due to (reason)
  • asymptomatic/ symptomatic
  • px may complain of ___ sensation, and __-
A
  • brown/ yellow/ black due to chromogenic bacteria, food, tobacco
  • asympt
  • px complain of gagging sensation, bad breath and taste in mouth
34
Q

location of coated/ hairy tongue

A

dorsal tongue (usually midline anterior to circumvallate papillae)

35
Q

histopatho findings of hairy/coated tongue

  • ___ of filiform papillae
  • many bacterial colonies on ___
A
  • elongation and hyperkeratosis
  • epithelial surface
36
Q

management of hairy coated tongue

A
  • benign
  • eliminate predisposing factors
  • improve OH (scrape tongue) -> promote desquamation of hyperkeratotic papillae and surface debri
37
Q

etiology of smokeless tobacco lesions

A

due to use of topical tobacco on oral mucosa

38
Q

clinical presentation of early smokeless tobacco lesions

A
  • poorly demarcated white plaque
  • granular, wrinkled
  • mild peripheral erythema
  • soft and velvety
  • painless
39
Q

clinical presentation of late smokeless tobacco lesions

A
  • severe liao so got extensive white thickening
  • leathery/ nodular
40
Q

location of smokless tobacco lesions

A
  • buccal sulcus, vestibule areas
  • mucosa directly in contact with tobacco used
41
Q

histopatho findings of smokeless tobacco lesions

  • specifc/ non specific
  • hyperkeratosis & ___
  • may have intracellular ___ (oedema) of ____ superficial cells
  • no/ got dysplasia
A
  • not specific
  • acanthosis
  • intracellular vacuolisation of glycogen rich superficial cells
  • no or mild dysplasia
42
Q

management of smokeless tobacco lesions

A
  • reversible with cessation of habit ( 2 weeks)
  • any lesion that persists after 6 weeks of cessation, we suspect true leukoplakia and should do biopsy

omopor (11 decks)

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