Wk1 Oral cavity Esophageal pathology

Question 1

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

Answer 1

Aphthous ulcer (Canker sore)

Question 2

reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue

typically secondary to chronic irritation

Answer 2

Mucosal fibroma

Question 3

polypoid RED lesion

lobular reactive proliferation of capillaries (eruptive hemangioma)

gingiva in children, young adults, pregnant women.

Answer 3

Pyogenic granuloma

Question 4

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.

Answer 4

Glossitis

Question 5

Combination of iron-deficiency anemia, glossitis, and esophageal dysphagia associated with esophageal webs

Answer 5

Plummer-Vinson syndrome

Question 6

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.

Answer 6

Geographic tongue

Question 7

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.

Answer 7

Hairy leukoplakia

Question 8

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.

Answer 8

Squamous papilloma

Question 9

red, velvety patch in the oral cavity

may be flat or slightly eroded.

higher incidence of pre-cancerous dysplasia than leukoplakia

Answer 9

Erythroplakia

Question 10

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

Answer 10

actinic cheilitis

Question 11

Risk factors for oral, esophageal, pharyngeal SCC:

Answer 11

alcohol

tobacco

HPV

Question 12

Risk factors for nasopharyngeal SCC:

Answer 12

EBV

Africa/China

Question 13

Most common site of metastases for oral and pharyngeal SCC:

Answer 13

cervical neck lymphnodes

Question 14

dry mouth due to decrease in the production of saliva

Causes include Sjogren’s syndrome, previous radiation therapy, and side effect of prescribed medications.

Answer 14

Xerostomia

Question 15

inflammation of the salivary glands

trauma, bacterial or viral infections (e.g. mumps), and autoimmune disease (e.g. Sjogren’s syndrome)

Answer 15

Sialadentis

Question 16

stone in the salivary duct

can lead to obstruction and secondary bacterial infection (often Staphylococcus aureus or Streptococcus viridans

Answer 16

Sialolithiasis

Question 17

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.

Answer 17

Mucocele

Question 18

mucocele that arises when the sublingual duct is damaged.

can become quite large and dissect into the neck (plunging).

Answer 18

Ranula

Question 19

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).

Answer 19

LESA (lymphoepithelial sialidentis)

aka: Michlicz disease

Question 20

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%.

Answer 20

pleomorphic adenoma

Question 21

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.

Answer 21

Warthin Tumor

Slide 47

Question 22

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.

Answer 22

Mucoepidermoid carcinoma

Question 23

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.

Answer 23

Adenoid cystic carcinoma

Question 24

Most common BENIGN salivary gland tumor?

Answer 24

Pleomorphic adenoma

Question 25

Most common MALIGNANT salivary gland tumor?

Answer 25

Mucoepidermoid carcinoma

Question 26

Difference between esophageal webs and Schatzki rings?

Answer 26

Webs are upper, rings lower

rings are circumferential

Question 27

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.

Answer 27

Zenker’s diverticulum

Question 28

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.

Answer 28

Mallory-Weiss Syndrome

Question 29

Most common type of Hiatal hernia?

Answer 29

sliding type (type I)

Question 30

Three most common types of infectious esophagitis in immunocompromised patients:

Answer 30

Candida esophagitis

Herpes simplex

cytomegovirus (CMV)

Question 31

Likely pathogenic mechanism of eosinophilic esophagitis:

Answer 31

food allergy

Question 32

conversion of the normal squamous mucosa of the esophagus to intestinal metaplastic columnar epithelium (including goblet cells)

result of chronic GERD

Answer 32

Barrett’s esophagus

Question 33

Risk factors and common location of esophageal adenocarcinoma:

Answer 33

Barrett’s

GERD

lower third

Question 34

Risk factors and location for esophageal SCC:

Answer 34

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

Question 35

Common cause of squamous papilloma:

Answer 35

HPV

Question 36

Most common BENIGN mesenchymal tumor of the esophagus:

Answer 36

leiomyoma