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72 Cards in this Set
- Front
- Back
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What are histologic features of B mucosa, L mucosa, soft palate, FOM, alveolar mucosa, ventral tongue?
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Strat squam ep
SHALLOW rete pegs NON-keratinized Loose CT |
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What is stippled if healthy?
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Attached gingiva
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What is the histology of attached gingiva?
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Strat squam ep
Elongated, pointed rete ridges Thin, PARA-KERATINIZED Dense fibrous CT NO SALIVARY GLAND LOBULES |
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What is the histology of the hard palate?
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Strat squam ep
Elongated, pointed rete pegs Thin, ORTHO-KERATINIZED Dense fibrous CT Prominent BV and NERVES |
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What is the histology of the dorsum of the tongue?
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Strat squam ep
PROMINENT ROUNDED rete pegs ROUGH, PARAKERATINNIZED, bact colonies Taste buds Fibrous CT |
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What describes surface architecture?
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Macule--color change (not raised or depressed)
Plaque--slightly elevated (usually ep) Papule--solid, round, raised <5mm (usually ep) Nodule--solid round, raised, >5mm (usually submucosal) Mass--solid, raised, larger than nodule (ep or submuc) Growth, lesion--if no other describes |
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What’s the difference b/ a vesicle and a bulla?
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Vesicle:
Blister, clear fluid/blood, <5mm Bulla Blister, clear fluid/blood, >5mm |
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What’s the difference between erosion and an ulcer?
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Both lose surface epithelium, but ulcer lose connective tissue too!
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What does a corticated radiolucency have?
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Thin sclerotic rim
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What is acanthosis?
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increase in intercellular edema in spinous layer
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What is the differencr in para and ortho keratinized?
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Ortho has NO nucleus!
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What can mimic squamous cell carcinoma?
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Pseudoepitheliomatous hyperplasia:
benign reactive overgrowth of squam ep |
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What is leukoplakia?
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White plaque like lesion that can't be wiped of AND can't be clinically dx
(Clinical term,not a histological dx) |
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What percent of leukoplakia is dx as epithelial dysplasia?
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5-25% of leukplakias --> ep dysplasia (pre cancer)
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What percent of leukoplakia are dx as SCC?
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4% are SCC
Depends on clinical presentation, may be 47% |
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What is a true leukoplakia?
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TRUE leukoplakias are considered potentially premalignant lesions!!
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What percent of leukoplakias occur in smokers?
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80% occur in smokers
(alcohol is synergistic) |
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What are other etiologies of leukoplakia?
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Sanguineria (viadent products)
UV radiation (transplant pts) Microbes (syph, HPV) Trauma (NOT malignant) |
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Why aren’t trauma caused leukoplakias true leokoplakias?
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NO malignant potential!
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What is the most common oral precancer?
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Leukoplakia
(90% have dysplasia) |
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What shape are the rete pegs of epithelial dysplasia?
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Bulbous tear drop rete ridges
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What is the grading of dysplasia?
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Mild dysplasia--lower 1/3 of ep
Moderate dysplasia--lower 2/3 of ep Severe dysplasia--extends into upper 1/3 of ep Carcinoma in situ--dysplasia in entire thickness |
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What is the tx for moderate or worse dysplasia?
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Complete removal, biopsy
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What increases risk of leukoplakia developing into SCC?
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persistent lesion, female patient, non smoker, FOM or ventral tongue
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What is the biomarker for malignant transformation of leukoplakia?
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Loss of heterozygosity (LOH) of chrom arms 3p and 9p
(LOH of other sites) |
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What can cause SCC?
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Smoking
Dry snuff Betel quid (paan) Drinking Radiation Iron def Vit A def Syphilis Virus Immunosuppressed Genes |
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What is the SCC risk associated with tertiary syphilis?
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Dorsal tongue SCC
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What are the cancerous HPVs?
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16,18,31,33
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What are oncogene examples?
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Oncogenes--ras, myc, EGFR
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What are tumor suppressor genes?
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Tumor suppressor genes-- p53, pRb, p16, E cadherin
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What location of SCC has a higher risk of a second primary malignancy?
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Floor of mouth
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What does the x-ray of SCC look like?
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Radiolucency, ill defined borders, “moth eaten”
Mimics perio disease |
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Does SCC invade bone?
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Yes
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What is the most common benign soft tissue lesion of mouth?
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Fibroma
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What is the key histology of a fibroma?
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Dense fibrous CT
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T/F—Recurrence is common in fibromas.
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FALSE. Recurrence is rare.
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What may grow rapidly at 1st and is more common in females?
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Pyogenic granuloma
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What is a pregnancy tumor?
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Pyogenic granuloma during preggo
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What is an epulis granulomatosum?
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PG in healing extraction socket.
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What happens to a long standing pyogenic granuloma?
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Fibrous matration à fibroma
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What is the most common salivary gland tumor in general and in childhood?
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Pleiomorphic adenoma
(benign mixed tumor of duct and myoep cells) |
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What is the histology of a pleiomorphic adenoma?
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Well circumscribedàMostly encapsule
Ductal ep cells (Cuboidal) àForm islands/ducts Myoepithelial cells Variable Angled, spindled, "plasmacytoid" Chondromyxoid stroma ….May have fat or bone |
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What is the malignant transformation rate of a pleiomorphic adenoma?
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5%
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What is an ameloblastoma?
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Benign but locally aggressive odontogenic epithelial neoplasm
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What is the most common type and site of an ameloblastoma?
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Solid, mandible (ramus)
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What does the xray of a solid ameloblastoma look like?
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Radiolucent, well defined borders, soap bubble loculations
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What are “ameloblast” epithelium factors?
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Palisaded peripheral cellsà reversed polarity!
Stellate reticulum cells |
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What are the 2 main forms of transmission of HIV?
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Sex (MSM)
Parenteral (iv drugs) |
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What are classified as group 1 strongly associated with HIV?
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Candidiasis
Hairy leukoplakia KS NHL Perio disease |
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What are the CD4 counts for Pseudomembranous candidiasis and
Erythematous candidiasis? |
Pseudomemb ---CD4 < 200
Erythematous ---CD4 < 400 |
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What causes angular chelitis?
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Co-infection with candida and staph aureus
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What stain is used to test candidiasis?
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Periodic acid Schiff stain (PAS)
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What coinfection is cmmon with HSV?
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CMV
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What should you do to any persistent ulcer in an immunocompromised pt?
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Biopsy
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What are Tzank cells?
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Free floating cells in vesicle with
Viral cytopathic effect HSV!! And VZV |
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What are the 3M's of herpes cells (Viral Cytopathic Effect)?
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Multinucleation
Chromatin Margination Nuclear Molding |
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What is used to treat active HSV infection in immunocompromised patients?
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IV antivirals
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What is used to treat an HSV and CMV co-infection?
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Gancyclovir
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What HHV is EBV?
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HHV 4
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What type of cells are in the upper epithelial layer of EBV oral hairy leukoplakia?
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Balloon cells:
Perinuclear halo Chromatin beading EBV + |
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What type of cells are in the upper epithelial layer of HPV?
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KOILOCYTES
--> vacuolated cells, shrunken nuclei --> HPV + |
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When should there be long term observation of HPV sites?
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Especially when there’s dysplasia
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What is the most common malignancy in AIDS?
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Karposi Sarcoma (15-20%)
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What do early KS lesions look like? And late lesions?
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Early:
Flat brown red areas (macules, patches) Do NOT blanch Later: Raised (plaques, nodules) Pain, bleed, necrosis, Can invade bone---> tooth mobility |
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What is unique about the histology of KS?
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Small slit like blood vessels
Spindled endo cells w/ Minimal atypia Blood cells in and out of vessels |
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What is the 2nd most common AIDS cancer?
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Lymphoma (NHL)
3-5% |
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What is the prognosis for lymphoma?
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Poor
(months) |
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How is HIV diagnosed?
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ENZYME IMMUNOASSAY (EIA)
Most common screening test Detects HIV antibodies False + and - though Followed by western blot |
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What is HAART?
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Highly Active Antiretroviral Therapy (HAART)
--2 nucleoside analogue reverse transcriptase inhibitors --1+ protease inhibitor OR 1 non-nucleoside reverse transcriptase inhibitor |
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When does HIV progress to AIDS?
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AIDS--- CD4 less than 200 cells/mm3
<14% of total lymphocytes (about 11 yrs) |
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What is AIDs defining?
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Candidiasis of bronchi, trach, lungs, esoph
Cervical cancer (invasive) HSV, chronic ulcers or bronchitism pneumonitis, esophagitis KS Lymphoma Pneumocystis carinii pneumonia |
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What is the 2 year survival rate of AIDs now with HAART?>
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85%
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