Block 7 Week 1 Mon 8Am Pathology Of The Head & Neck

Front 1

What is the name for a cyst that forms due to blockage of a salivary duct?

Back 1

Mucocele

Front 2

What does a mucocele need to be distinguished from? (not in notes)

Back 2

basal cell carcinoma

Front 3

What does a mucocele look like histologically?

Back 3

space lined by granulation tissue & histiocytes

Front 4

What does the luman of a mucocele contain?

Back 4

mucus & macrophages

Front 5

Where do >70% of mucoceles occur?

Back 5

on the lower lip

Front 6

Over what age do people typically develop mucoceles? What gender is more commonly develops mucocels?

Back 6

>40 years old
males

Front 7

What causes mucoceles?

Back 7

results from trauma to ducts of minor salivary glands

Front 8

What are 2 variations of mucoceles?

Back 8

1) mucous retention cyst - (partial duct obstruction)
2) ranula - floor of mouth (sublingual gland) - blockage of duct of sublingual gland

Front 9

What is the name of a white patch of the oral mucosa that cannot be characterized clinically or pathologically as any other disease?

Back 9

leukoplakia

Front 10

What is leukoplakia due to & why is it worrisome? (not in notes)

Back 10

Leukoplakia is due to hyperkeritosis (thickening of keratin) & is pre-neoplastic condition

Front 11

What are 4 appearances leukoplakia might have?

Back 11

1) homogenous
2) verrucous (warty)
3) white w/ erythematous areas, errosions, fissures
4) Erythematous base with white patches

Front 12

What are 4 etiologies of leukoplakia?

Back 12

1) smoking
2) alcohol
3) irritants
4) dentures

Front 13

At what age is the typical onset of leukoplakia & what is the male:female ratio of occurance?

Back 13

Onset @ >40 years; Peak <50 yrs
Male:Female 2-3:1

Front 14

Where in the oral mucosa are 3 typical locations for leukoplakia?

Back 14

1) buccal mucosa
2) commisures
3) Uncommon on alveolar ridge, soft palate, gingiva

Front 15

What are 3 characteristics of the hislotogy of leukoplakia?

Back 15

1) hyperkeratosis
2) epithelial hyperplasia
3) +/- dysplasia (carcinoma next step)
gross pic - clouds in the sky

Front 16

What type of leukoplakia is a white lesion, homogenous keratinised, slightly elevated? What is the malignant risk?

Back 16

Leukoplakia simplex
Lowest malignat transformation

Front 17

What type of leukoplakia has a red, velvety appearance?
What is the malignant risk?

Back 17

Erythroplakia
Highest risk of malignant transformation
90% severe dysplasia or carcinoma

Front 18

What sign & what symptom in patients w/ chronic oral leukoplakia should raise suspicion?

Back 18

sign: erythematous component
symptom: discomfort

Front 19

What is done when dysplasia is found histologically in a leukoplakia lesion?

Back 19

b/c there is a risk of malignancy when dysplasia is found, surgical removal is indicated

Front 20

What forms of leukoplakia (besides reddness) are associated w/ a high risk of malignant transformation & must be aggressively treated?

Back 20

proliferative verrucuous (warty) forms

Front 21

Are patients w/ mild dysplasia or patients w/out any dysplasia still @ risk for malignant transformation?

Back 21

yes for both

Front 22

What is the name of a malignacy of the oral cavity?

Back 22

squamous cell carcinoma

Front 23

What is the incidence of squamous cell carcinoma? What gender is most affected? What race? What age?

Back 23

3-4% of all cancers
males>females
white>black
incidence increases with age (often overlooked in elderly)

Front 24

What is the survival rate in five years if Dx with squamous cell carcinoma?

Back 24

overall <50% five years (low survival rate)

Front 25

What are the 5 most common sites according to the diagram?

Back 25

1) lower lip (prognosis better)
2) lower part of mouth
3) tongue
4) palate
5) back of tongue

Front 26

What is the risk of alcohol & smoking on squamous cell carcinoma?

Back 26

individually risk of alcohol or smoking is 2-4X risk
alcohol & smoking combined, risk increases to 7X
unknown risk chew or snuff

Front 27

What are 7 additional risk factors for squamous cell carcinoma (besides alcohol & smoking)?

Back 27

1) HPV infection
2) sun exposure/radiation
3) low socioeconomic status
4) poor dentition & diet
5) employment in textile industries
6) chronic infections
7) Plummer Vinson

Front 28

What is the Plummer Vinson trid?

Back 28

1) Esophageal webs
2) Iron deficient anemia
3) atrophic glossitis

Front 29

What are 8 sites of Squamous cell carcinoma from most to least common?

Back 29

1) lower lip - 38% - most common
2) tongue - 22%
3) floor of mouth - 17%
4) gingiva - 6%
5) Palate - 5.5% (almost all on soft palate)
6) Upper lip 4%
7) buccal mucosa 2%
8) Uvula 0.5%

Front 30

What are 4 possible characteristics of squamous cell carcinoma found on the lip?

Back 30

1) exophytic (tumor grows out from surface of lip)
2) ulcerating
3) verrucous - wartylike
4) usuall well differentiated - slow growth

Front 31

Are sqamous cell carcinoma found on the upper lip more or less aggressive?

Back 31

more aggresive

Front 32

What is the cure reate of squamous cell carcinoma found on the lower lip?

Back 32

90% cure rate

Front 33

What are 3 locations on the tongue where squamous cell carcinoma occurs & what is the differentiation & prognosis of each?

Back 33

1) lateral border of middle 1/3
2) 75% on oral (mobile) portion of tongue - well differentiated (better prognosis)
3) Posterior 1/3 of tongue poorly differentiated, poor prognosis

Front 34

What particular population of people have an increasing incidence of squamous cell carcinoma of the tongue w/ no apparent risk factors?

Back 34

young women

Front 35

As you go farther back in the oral cavity w/ squamous cell carcinoma, how does the prognosis change?

Back 35

farther you go back in the oral cavity w/ squamous cell carcinoma, poorer the prognosis

Front 36

Squamous cell carcinoma of the floor of the mouth is most common in what population & where does it occur on the floor of the mouth?

Back 36

blacks
midline or lateral to frenulum of tongue

Front 37

List 2 characteristics of the spread squamous cell carcinoma found on the floor of the mouth?

Back 37

often advanced when diagnosed
metastases to cervical nodes later than tongue

Front 38

What are 3 functions of salivary glands?

Back 38

1)moistens mucous membranes (750-1000)
2)prepares food for digestion (amylases)
3)controls bacterial flora of mouth

Front 39

What are salivary glands derived from embryologically?

Back 39

Develops as thickenings of epithelium of stomodeum

Front 40

What germ layer are each of the 3 salivary glands derived from?

Back 40

1)Parotid - oral ectoderm (larges gland, serous, CN IX glossopharyngeal)
2)Submandibular - oral endoderm (mixed, mainly serous, CN VI Facial)
3)Sublingual - oral endoderm, mucous, CN Facial)

Front 41

Where are myoepithelial cells & what stimulates them to contract?

Back 41

myoepithelial cells are in the acinus between epithelial cells & basement membrane
parasympathetic nervous system (mainly) stimulates them to contract

Front 42

What are 3 cell types in salivary glands?

Back 42

1) mucous - clear
2) serous (protein) - pink
3) myoepithelium

Front 43

What are 2 functions of mucous secretions?

Back 43

1)surface lubricant
2)block epithelial binding sites for bacteria

Front 44

What type of granules do serous cells contain & what are 3 things in these granules? (include functions)

Back 44

zygomen granules
1)amylase/ptyaline: split starch into water soluble CHO
2)lactoferrin: antibacterial
3)lysozyme: antibacterial

Front 45

Where are myoepithelial cells located & what are 2 functions?

Back 45

lie between epithelium & basement lamina
1)contractile (speed flow of saliva)
2)participate in elaboration of basal lamina

Front 46

What is the main role of saliva?

Back 46

lubricate food so it can get down to the esophagus