Wk1 Oral cavity Esophageal pathology Flashcards
common, shallow, superficial mucosal ulcerations
usually painful and often recurrent
Etiology is uncertain
may be associated with celiac disease or inflammatory bowel disease
Typically spontaneously regress within several weeks
Aphthous ulcer (Canker sore)
reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue
typically secondary to chronic irritation
Mucosal fibroma
polypoid RED lesion
lobular reactive proliferation of capillaries (eruptive hemangioma)
gingiva in children, young adults, pregnant women.
Pyogenic granuloma
inflammation of the tongue
also used to describe the beefy-red appearance of the tongue encountered in certain deficiency states, such as vitamin B12 deficiency
Red appearance is secondary to atrophy of the papillae of the tongue and thinning of the mucosa.
Glossitis
Combination of iron-deficiency anemia, glossitis, and esophageal dysphagia associated with esophageal webs
Plummer-Vinson syndrome
migratory “map like” appearance of the tongue
due to focal loss of the papillae with formation of smooth red patches
Microscopically, intraepithelial neutrophilic inflammation is present
usually asymptomatic
may experience a mild burning sensation
Etiology is unknown; may be a genetic component.
Geographic tongue
White, confluent patches of “fluffy” hyperkeratosis
lateral sides of the tongue
cannot be scraped off
immunocompromised individuals; secondary to EBV infection.
May be the first presenting sign of HIV infection.
Hairy leukoplakia
Exophytic papillary proliferation of squamous mucosa
fibrovascular core
Some are associated with HPV infection; others may represent reaction to trauma/irritation.
Some can undergo malignant transformation to in-situ and invasive squamous cell carcinoma.
Squamous papilloma
red, velvety patch in the oral cavity
may be flat or slightly eroded.
higher incidence of pre-cancerous dysplasia than leukoplakia
Erythroplakia
Leukoplakic lesion of the lower lip
loss of the distinct demarcation between the lower lip vermilion border and the skin of the lip
connective tissue solar changes
actinic cheilitis
Risk factors for oral, esophageal, pharyngeal SCC:
alcohol
tobacco
HPV
Risk factors for nasopharyngeal SCC:
EBV
Africa/China
Most common site of metastases for oral and pharyngeal SCC:
cervical neck lymphnodes
dry mouth due to decrease in the production of saliva
Causes include Sjogren’s syndrome, previous radiation therapy, and side effect of prescribed medications.
Xerostomia
inflammation of the salivary glands
trauma, bacterial or viral infections (e.g. mumps), and autoimmune disease (e.g. Sjogren’s syndrome)
Sialadentis
stone in the salivary duct
can lead to obstruction and secondary bacterial infection (often Staphylococcus aureus or Streptococcus viridans
Sialolithiasis
blockage (retention mucocele) or traumatic injury (extravasation mucocele) to a minor salivary gland
leakage of contents into the surrounding connective tissue stroma.
Presents as a fluid filled mucosal nodule with varying degrees of inflammation.
Mucocele
mucocele that arises when the sublingual duct is damaged.
can become quite large and dissect into the neck (plunging).
Ranula
Autoimmune disease involving the salivary glands.
(50%) represent salivary gland manifestations of Sjogren’s syndrome
polyclonal lymphoid inflammation of the salivary gland
gland enlargement and characteristic lymphoepithelial lesion
**need to be distinguished from primary lymphoma of the salivary gland, many of which have the morphology of B-cell MALT lymphoma (although other types of lymphoma can occur).
LESA (lymphoepithelial sialidentis)
aka: Michlicz disease
Most common salivary gland tumor
found in the parotid gland
Benign tumor consisting of a mix of proliferating epithelial (ductal and myoepithelial) cells, associated with a mesenchymal matrix of myxoid, hayline, and chondroid (cartilaginous-like) tissue. It may be that all neoplastic tissue elements in this tumor may be of ductal or myoepithelial origin, hence the name.
painless, discrete masses
seemingly well circumscribed, they have small extensions or protrusions such that simple enucleation of the tumor will lead to a recurrence rate of 25%.
pleomorphic adenoma
SECOND most common salivary gland tumor
PAROTID GLAND
Multifocal in 10% and 10% are bilateral
Smokers have 8 times the risk of developing this tumor than nonsmokers.
NELSON’S FAVORITE “you won’t forget it”
DISTINCT MICROSCOPIC APPEARANCE, demonstrating a papillary, cystic lesion with a dual layer of bland, neoplastic, eosinophilic (oncocytic) epithelium, associated with reactive lymphoid stroma.
Warthin Tumor
Slide 47
Most common MALIGNANT salivary gland tumor
most common malignant salivary gland tumor in CHILDREN
60-70% occur in the parotid gland.
squamous cells, mucus-secreting cells, and intermediate cells.
While tumors grossly appear encapsulated, they often infiltrate at the margins microscopically.
Mucoepidermoid carcinoma
Slow growing, relentless salivary gland carcinoma
NEURAL INVASION
“Cribriform pattern”
50% occur in the minor salivary glands most common malignant tumor of the minor salivary glands
Despite surgical resection, 50% disseminate to lungs, bone, liver, and brain, often decades after removal. While 5-year survival rate is 60-70%, survival drops to 30% at 10 years and 15% at 15 years.
Adenoid cystic carcinoma
Most common BENIGN salivary gland tumor?
Pleomorphic adenoma
Most common MALIGNANT salivary gland tumor?
Mucoepidermoid carcinoma
Difference between esophageal webs and Schatzki rings?
Webs are upper, rings lower
rings are circumferential
Above upper esophageal sphincter
outpouching of mucosa and submucosa through a weakend posterior cricopharyngeus muscle
not a true diverticulum.
This diverticulum can become large enough to accumulate food, producing a mass and symptoms of painful swallowing, halitosis, regurgitation, and diverticulitis.
Zenker’s diverticulum
presence of longitudinal mucosal lacerations in the distal esophagus and proximal stomach
usually associated with severe retching or vomiting
history of heavy alcohol use leading to vomiting is seen in 40-80% of patients
can be one cause of upper GI bleeding.
Mallory-Weiss Syndrome
Most common type of Hiatal hernia?
sliding type (type I)
Three most common types of infectious esophagitis in immunocompromised patients:
Candida esophagitis
Herpes simplex
cytomegovirus (CMV)
Likely pathogenic mechanism of eosinophilic esophagitis:
food allergy
conversion of the normal squamous mucosa of the esophagus to intestinal metaplastic columnar epithelium (including goblet cells)
result of chronic GERD
Barrett’s esophagus
Risk factors and common location of esophageal adenocarcinoma:
Barrett’s
GERD
lower third
Risk factors and location for esophageal SCC:
alcohol and tobacco
caustic esophageal injury
achalasia
tylosis (genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles)
Plummer-Vinson syndrome
frequent consumption of very hot beverages
Rarely, HPV infection
Common cause of squamous papilloma:
HPV
Most common BENIGN mesenchymal tumor of the esophagus:
leiomyoma
