White & Red Patches Flashcards
What layers does mucosa consist of?
- Epithelium
- Lamina propria
- Musclaris mucosa
What are the THREE types of gross mucosa?
- Lining
- Masticatory
- Gustatory
What are the two types of keratinised epithelium?
- ORTHOkeratinised = anucelar keratin layer
- PARAkeratosis = some nuceli
What are the epithelial strata?
- Stratum corneum
- Stratum granulosum
- Stratum spinosum
- Stratum basale
What are the SIX reactions (of epithelium) in the oral mucosa?
- Atrophy (reduction in viable layers)
- Erosion (PARTIAL thickness loss)
- Ulceration (FULL thickness loss)
- Oedema
- Blister (vesicle/ bulla)
- Dysplasia (not seen clinically; disordered growth pattern in cells & tissue as whole)
What factors contribute to atrophy of oral mucosa?
- Age (progressive)
- Nutritional deficiencies - iron, vit b12, folate
List the aetiologies for inflammation
- Trauma (physical/ chemical)
- Infection (viral, bacterial, fungal)
- Immunological
Define ‘leukoplakia’ (WHO)
- Clinical description
- White patch that cannot be scraped off and attributed to any other cause
- Diagnosis of exclusion, must be biopsied if unexplained
Define ‘erythroplakia’
- Red patch that cannot be rubbed off and attributed to any other cause
- Atrophic end of spectrum
- Must be biopsied if unexplained
What are some known causes for white patched in the mouth?
- Hereditary =
- -> WHITE SPONGY NAEVUS
- -> FORDYCE SPOTS
- Smoking/ frictional =
- -> SMOKER’S KERATOSIS
- -> FRICTIONAL KERATOSIS
- Lichen planus
- -> LICHEN PLANUS
- -> LICHENOID REACTION
- Lupus Erythematous
- -> DISCOID LE
- Candidal infection
- Carcinoma
What causes white spongy naevus?
- Autosomal dominant condiditon
- Gene responsible for keratin production and desquamation is mutated
What are Fordyce’s spots?
- Sebaceous glands (inactive) found inside mouth (not usually found there)
What are the characteristics of smoker’s keratosis?
- Pink spots on hard palate (minor salivary glands blocked –> inflamed)
- Seen in pipe smokers
- Hyperkeratosis
- Histology = low chance malignancy, variable dysplasia, minimal infiltrate
What is the similarity and difference between ‘lichen planus’ and ‘lichenoid reaction’?
- SIMILARITY = histologically same
- DIFFERENCE = LP- autoimmune, unknown cause, LR- hypersensitivity reaction, known cause
What is lupus erythematous?
- Connective tissue disease
- Characterised by skin rash, esp face
- Red/ white striae on mucosa, esp palate
What are the types of lupus erythematous?
- Discoid = face and oral cavity ONLY
- Systemic = any organ
Why must you not depend entirely on biopsy results for suspected lupus erythematous?
Histologically similar to lichen planus!
Give a list of differential diagnoses for white patches of the oral cavity seen in smokers
- Smoker’s keratosis
- Hyperplastic candidosis
- Leukoplakia
What are the LOCALISED causes for brown/ black lesions found in the oral cavity?
- Amalgam tattoo
- Malignant melanoma (pre-malignant lentigo)
- Macule/ naevus (freckle/mole)
- Pigmentary incontinence (normal pigm leak into gingivae)
- Kaposi’s sarcoma
- Peutz-Jehger’s Syndrome
What are the GERNERALISED causes for brown/ black lesions found in the oral cavity?
- Racial/ familial
- Drugs
- Addison’s disease (hyperfunctioning adrenal gland –> ACTH same precursor for melanosis –> pigmentation oral cavity)
- Smoking
What is a hamartoma?
Benign, localised malformation resembling a neoplasm in tissue of its origin
What is a haemangioma?
- Hamartoma
- characterised by rapid growth during first few weeks of life which then usually regresses over the next 10 years
What are vascular malformations?
- Congenital vascular abnormalities
- includes lymph nodes, veins and arteries (single entities or combination)
What are the types of vascular malformations?
- Capillary
- Cavernous
- Sturge-Weber Syndrome
What are lymphangionmas?
- Hamartoma
- benign tumour composed of lymph vessels (dilated & newly formed)
- Most are cavernous
List lesions commonly seen on the tongue
- Geographic tongue (depapillation of filiform papillae)
- Black hairy tongue (extended filiform papillae)
- Fissured tongue
- Glossitis = dry tongue, nutritional deficiency
