White Patch Flashcards
What is dysplasia?
Abnormal change in structure, differentiation and cellular appearance of epithelium
What is atypia?
Cellular changes that occur due to dysplasia
Differential diffuse white patch buccal mucosa?
Leukoplakia
Lichen planus
Frictional-keratosis
Leukoedema
What might see in dysplasia?
Epithelium invading connective tissue
If suspect hyperkeratosis how manage?
Identify cause of trauma
Remove
If lesion regress = diagnosis confirmed
What does non-homogenous mean?
Not only diff colour e.g red and white but also variation in thickness?
What is a drop shaped rete peg?
Tear dropped shape - narrow stalk wider as extend into CT
What histological changes may see in dysplasia?
APHID Behind U
Infiltration of neutrophil Area ulceration Nuclear cellular pleomorphism Basal compartment orientation lost Disordered epithelium Abnormal cell division Hyperchromatism
What is nuclear cellular pleomorphism?
Variation of shape and size of cells
What see is abnormal cell division?
Increased number of cells undergoing mitosis
What is hyperchromatism?
Cells stain darks due to genetically abnormal increase DNA
What expect to see in severe dysplasia?
Epithelium fully abnormal from basement membrane to surface
Issue w/ severe dysplastic lesions?
High risk of progression to malignancy
Pt management of dysplasia?
Excision
Reduce RFs: smoking/alcohol
Monitor
What are chronic inflammatory cells?
Lymphocytes and plasma cells
How identify neutrophil?
Multi-lobed nuclei
What additional test would do if suspect candida?
PAS stain - periodic acid Schiff stain
Why are neutrophils present CHC?
Candida is irritant
How does PAS identify candida?
Stain polysaccharide in cells walls of candida magenta
What expect CHC lesion look like clinically?
Reasonably well-defined white patch at commissure of mouth
Non-homogenous - mixed white and red lesion
Non uniform in appearance - appear thicker
What see is histology of CHC?
Branching hyphae candida within keratinised tissue
Hyperplastic epithelium
Where see candida in epithelium?
Keratin layer
What other stain can be used to identify candida?
Silver stain
What is significant of diagnosis of CHC?
Potentially malignant
Want to check for dysplasia
Management of CHC?
Remove cause - candidia
Topical antifungal
Systemic antifurncal - fluconazole
What interacts w/ fluconazole?
Warfarin
What other tests may be useful if diagnose CHC?
Full blood count
Random blood glucose - can be first sign diabetes
What features may see in SCC clinically?
High risk site: lateral border tongue, floor mouth, retromolar region
Raised, rolled borders
Non-homogenous
Ulcerated/ erosive lesion
What cytological changes see histologically in SCC?
Invasion - islands epithelium into CT Nuclear and cellular pleomorphism Hyperchromatisis Abnormal division - mitotic figures Disorganisation
Management of pt w/ SCC?
Excision
MRI scan - size tumour and check metastasis
Reconstruction if necessary
Possible causes for enlarged lymph node in neck?
Infection - dental, URTI
Malignancy
What features of enlarged lymph node would help w/ diagnosis?
Tender? - if so likely infected
Mobility
Texture
How expect lymph node appear in malignancy?
Painless, firm, hard, lack of mobility
