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Oral Pathology p67-116 of 149

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oeshnoeugo123's version from 2018-02-19 20:04

Oral Pathology Review (2018) - p67-94/149

Question Answer
Plummer-Vinson Syndrome• Common in Scandinavian females
• Esophageal and oral SCCA
• Iron deficiency anemia
• Gastritis
• Koilonychia
• Dysphagia
Verrucous Carcinoma• Well differentiated variant of SCCA
• Papillary appearance
• May be associated with smokeless tobacco usage
• Most common site is mandibular vestibule
• Improved prognosis compared to conventional
SCCA
Basal Cell Carcinoma• Painless ulcer of upper lip or other skin, generally in sunexposed
sites
• Raised margins
• Does NOT occur intraorally
• Can be highly destructive if not treated
• Rarely metastasizes
Field Cancerization• Patients with one carcinoma of mouth or
throat are at increased risk of second
primary tumors
– 9-25% develop synchronous or metachronous
tumors
Melanocytic Nevus• “Common mole”
• Rare intraoral congenital malformation
• Progress through junctional, compound,
and intramucosal stages
Melanotic Neuroectoermal Tumor of Infancy– Neoplasm of newborns
– Notable for rapid onset and destructive behavior
– Seen in anterior maxilla
– Mobile teeth
– Increase of vanillylmandelic acid (VMA)
– Aggressive but generally benign
Heavy Metal Toxicity• Line of pigmentation along free
marginal gingiva
Peutz-Jeghers Syndrome• Oral and perioral pigmentation
• Intestinal polyposis with
predisposition to adenocarcinoma
Oral Mucosal Melaoma• 70-80% located on maxillary gingiva or
hard palatal mucosa
• 5 year survival= 10-25%
Mucocele• Trauma
• Lower lip is most
common site
• Vesicle/bulla, domeshaped
• Blue or mucosal colored
• History of increasing and
decreasing in size
Ranula• Mucocele of floor of mouth
• May elevate tongue
• Usually from sublingual gland
• Plunging ranula variant dissects
through mylohyoid muscle into
neck
Antral Pseudocyst– Asymptomatic
– Dome-shaped radiopacity on floor of maxillary
sinus
– No treatment necessary
Xerostomia vs. Hyposalivation– Subjective vs. objective sensation of
dry mouth
– Hyposalivation may result in retrograde
infection of the salivary glands; baldish,
inflamed tongue
Necrotizing Sialometaplasia– Benign, self-limiting condition but may be
mistaken for malignancy based on clinical
and/or histopathologic findings
– Deep ulcer of the palate due to ischemia
Cheilitis Glandularis• Rare condition of unknown etiology
• Reports of malignant transformation
• Lower labial mucosa
• Most often in middle-aged males
Sjögren Syndrome• Chronic autoimmune disorder
• Antinuclear antibodies (SS-A/Ro and SS-B/La)
• Female predilection 80-90%
• Affects salivary glands and/or lacrimal glands
• Primary Sjögren syndrome
• Secondary Sjögren syndrome
• Underlying autoimmune disorder
• Rheumatoid arthritis (15%)
• Systemic lupus erythematosus (30%)
• 40-fold increased risk of lymphoma
– #1= Pleomorphic adenoma
– #2= Mucoepidermoid carcinoma
Most common salivary gland tumors
Salivary Gland Tumors
• Generally more common in females
Salivary Gland Tumors
• Generally more common in males/females?
Most likely sites for development
– Major salivary glands= parotid (especially body)
– Minor salivary glands= palate
Most likely sites for development
– Major salivary glands= ___
– Minor salivary glands= ___
Salivary Gland Tumors
-Adenoid cystic carcinoma
– Often exhibits perineural invasion
– Characteristic cribriform (“swiss-cheese”)
histopathology
Canalicular Adenoma• Benign salivary gland tumor
• 75% on upper lip
– Clinically similar to mucocele
• Slight female predilection
Warthin Tumor– Papillary cystadenoma lymphomatosum
– Benign salivary gland tumor of major
glands
– Most common tumor to present bilaterally
– More common in males
Fibroma• Reactive, not true neoplasm
• Most common connective tissue tumor
• Firm, smooth, pink, elevated
papule/nodule
Epulis Fissuratum• Tumor-like hyperplasia associated
with flange of poorly-fitting denture
– Epulis= tumor of gingiva or alveolar
mucosa
Pyogenic Granuloma• Occurs at any age
• Gingiva is most common intraoral location but may
be seen at any site
• Reactive nodule may be indistinguishable clinically
from peripheral giant cell granuloma or peripheral
ossifying fibroma
• Bleeds readily
Peripheral Ossifying Fibroma• Not to be mistaken for peripheral
odontogenic fibroma or for central
ossifying fibroma
• Occurs on gingiva only
• Pedunculated or sessile nodule
• Frequently ulcerated
• Red-pink in color
• Usually < 2cm
Peripheral Giant Cell Granuloma (PGCG)• Similar in appearance to pyogenic
granuloma, though often more purple
in color
• Reactive nodule exclusively located
on gingiva
Central Giant Cell Granuloma• Intra-osseous counterpart to PGCG
• Histopathologic features of a giant cell
lesion
– Peripheral giant cell granuloma
– Brown tumor of hyperparathyroidism
– Cherubism
– Aneurysmal bone cyst
Granular Cell Tumor• Benign neoplasm more common on
dorsal tongue than anywhere else
• Histopathology reveals cells with
granular cytoplasm
– 50% exhibit pseudoepitheliomatous
hyperplasia- may mimic SCCA
Traumatic Neuroma• Transected nerve with scar tissue
• Painful or tender, firm lump or nodule
• Oral lesions common in mental nerve
region, lip, or tongue
Neurofibromatosis type I• Multiple neurofibromas of the skin
and oral cavity (especially tongue)
• Café au lait pigmentation
• Crowe sign (axillary freckling)
• Lisch nodules
memorize

Oral Pathology Review (2018) - p95-116/149

Question Answer
Multiple Endocrine Neoplasia TYPE 2B!!!– Medullary carcinoma of the thyroid
• Without prophylactic thyroidectomy before age
1, most patients will develop distant spread
during childhood or adolescence
– Pheochromocytomas of adrenal medulla
– Multiple mucosal neuromas
Kaposi Sarcoma– Vascular malignancy seen in
immunocompromised patients
– Associated with HHV-8 (though often in
patients who are immunocompromised
by HIV)
Vascular Anamolies
-Neoplasms
• Hemangioma of infancy
• Congenital hemangioma
• Kaposiform hemangioendothelioma
• Tufted angioma
Vascular Anomalies
-Simple malformations
• Capillary
• Venous
• Lymphatic
• Arteriovenous
capillary malformation (0.3% of newborns)port wine stain
-type of ___ malformation
macroglossiaLymphatic Malformation
-may cause ______ in the oral cavity
Benign Migratory Glossitis• Geographic tongue/ Erythema migrans
• Common immune-mediated condition
• One or more erythematous patches
incompletely bordered by yellow peripheries
• Generally asymptomatic
• Involves tongue or other mucosal surfaces
• Lesions resolve within days or weeks
Lichen Planus– May involve skin, oral mucosa, and/or genital mucosa
– Immune-mediated chronic disorder
– Predilection for middle aged females
– Skin lesions present as purple, polygonal, pruritic papules
– Oral lesions
• Bilateral
• May involve any site, especially buccal mucosa (most common), gingiva,
or tongue
• Characteristic Wickham striae
– Similar lesions may be induced by medications
– Asymptomatic patients require no treatment; patients with
erosive lichen planus reporting sensitivity may respond to
topical steroids
– <1% of patients may develop SCCA
Pemphigus Vulgaris• Potentially life-threatening skin and
mucous membrane disease
• Average age at diagnosis= 50
• Antibodies to desmosomes
• Intraepithelial separation above basal
layer (SUPRA-basilar cleavage)
• Acantholysis of spinous layer
• Rounded Tzanck cells
• Generally positive with DIF or IIF
Pemphigus Vulgaris• Painful chronic oral sores, dysphagia
• 50% show oral lesions first before skin
lesions
• Almost all show oral lesions eventually
• Positive Nikolsky sign
Mucous Membrane Pemphigoid– Autoimmune disease
– Antibodies vs. hemi-desmosomes
– Adult female predilection (typical of
many autoimmune diseases)
– Oral MMP may involve any site, but
gingiva is most common
• Desquamative gingivitis
• Vesicles develop into ulcers
– Pemphigoid variants present with
cutaneous and/or ocular lesions
Mucous Membrane PemphigoidHistopathology
– SUBepithelial cleft between epithelium and
connective tissue
– Direct immunofluorescence confirms diagnosis
Erythema Multiforme• Most cases secondary to infection
• Typically HSV or mycoplasma pneumoniae
• Male predilection; mostly age 20-40
• Characteristic rapid onset
• Ulcers and erythema
• Hemorrhagic crusts of lips
• Perimeter of tongue may be affected
• Targetoid cutaneous lesions
Stevens-Johnson Syndrome• Mucocutaneous disease often confused
with erythema multiforme
• Stevens-Johnson syndrome involves head
and trunk and is triggered by a drug
reaction rather than an infection
• Ocular or genital mucosa involved in
conjunction with the oral and skin lesions
• Treatment disputed: supportive/palliative
care vs high dose corticosteroids
Scleroderma• Progressive systemic sclerosis
• Induration of soft tissue (mask-like) and
generalized widening of the PDL space
• Trismus
White Sponge Nevus• Rare autosomal dominant disorder
• Defect of keratinization in mucosa
• Lesions appear at birth or in early childhood
• Symmetric, thick, white, velvety plaques on
bilateral buccal mucosa or other mucosal
surfaces
• Absence of ocular involvement helps
distinguish from hereditary benign
intraepithelial dyskeratosis (HBID)
111
Systemic Lupus Erythematosus
• Autoimmune disease
• Young adult female
predilection
• Butterfly rash of face
– Worsens with sun exposure
• Systemic involvement
– Endocarditis (50%)
– Renal involvement (40-50%)
Ectodermal Dysplasia• Associated with hypodontia (anodontia)
• Hypohidrotic - common type
– Lack of skin appendages and hair
– Heat intolerance
Dentigerous
(Follicular) Cyst
• associated with an UNERUPTED tooth
• most common developmental odontogenic
cyst
• most common site= mandibular 3rd molars
• seen most often ages 10-30
• unilocular radiolucency associated with the
crown of an unerupted tooth
• Epithelial lining may undergo neoplastic
transformation
Primordial Cyst• Cyst that develops in place of a tooth
– Cystic degeneration of enamel organ
before development of dental hard tissue
• Often prove to be keratocystic
odontogenic tumors
• Usually noted as incidental findings
Calcifying Odontogenic Cyst• Gorlin cyst
• Histopathology reveals ghost cells
and calcification
memorize

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