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63 Cards in this Set
- Front
- Back
What is squamous cell carcinoma?
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A malignant epithelial neoplasm
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Epidemiology of squamous cell cancer?
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4% of all cancers
>90% of oral cancers male>female 5th-9th decades |
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Etiology of squamous cell canrcinoma?
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tobacco
alcohol (betel nut, HPV) |
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Precursor lesions to squamous cell carcinoma?
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LEUKOPLAKIA
-- most are reactive keratosis -- 20% are dysplastic -- 4% are carcinoma ERYTHROPLASIA -- 80% in high-risk areas are carcinoma |
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Common sites of squamous cell carcinoma?
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ventrolateral tongue - 50%
floor of mouth - 20% soft palate-tonsillar pillar complex - 6% gingiva-alveolar ridge |
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Clinical presentation of squamous cell carcinoma?
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dysphagia
odynophagia otalgia |
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Gross presentation of squamous cell carcinoma?
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painless undurated ulcer OR
exophytic fungating mass |
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Histology of squamous cell carcinoma?
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-- invasive neoplastic nests of squamous epithelial cells
-- pleomorphism -- hyperchromatism -- increased nuclear:cytoplasm -- mitotic figures -- intercellular bridges -- keratinization "PEARLS" |
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Treatment for squamous cell carcinoma?
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surgical resection
radiation therapy chemotherapy |
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Prognosis for squamous cell carcinoma?
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poor
overall 40-50% 5 year survival |
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Therapeutic morbidity of squamous cell carcinoma?
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pain
dysfxn (mastication, deglutition, speech/communication) malnutrition, esthetics xerostomia, caries mucositis, candidiasis sensory deficit, trismus osteoradionecrosis aspiration/airway compromise psychosocial inpact |
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List other cancers of the head and neck.
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Adenocarcinomas
Lymphoma Bone Sarcomas Soft tissue sarcomas Neuroendocrine tumors Skin cancer/melanoma Metastatic disease to head/neck |
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Name the three different types of odontogenic cysts.
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1. Radicular Cyst
2. Dentigerous Cyst 3. Odontogenic Keratocyst |
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Describe the radicular cyst
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- inflammatory
- common incidence - arises in periapical granuloma/abcess assoc w/ non-vital tooth - periapical unilocular radiolucency |
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Treatment and prognosis for radicular cyst?
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endodontic therapy
extraction/curettage Prognosis: good |
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Describe the dentigerous cyst.
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- developmental cyst
- common incidence - arises from dental follicle assoc w/ impacted/unerupted tooth - pericoronal unilocular radiolucency - may reach destructive size |
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Treatment and prognosis of dentigerous cyst?
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surgical removal/curettage
Prognosis: good -- rare neoplastic transformation |
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Describe a odontogenic keratocyst.
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- developmental vs. neoplastic cystic lesion
- incidence in 3-11% of odontogenic cysts - arises from odontogenic epithelium - aggressive/destructive lesion |
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Treatment and prognosis of odontogenic keratocyst?
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Curettage w/ peripheral ostectomy, resection
High recurrence rate - assoc w/ nevoid basal cell carcinoid syndrome (Gorlin syndrome) |
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List the two types of odontogenic tumors.
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1. Odontoma
2. Ameloblastoma |
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Describe the odontoma.
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- most common odontogenic tumor
- hamartomatous malformation of tooth structure - may interfere w/ tooth eruption |
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Treatment and prognosis of odontomas?
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surgical removal
prognosis: good |
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Describe an ameloblastoma.
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- epithelial odontogenic neoplasm
- uncommon incidence - found at the posterior mandible in the 4th decade - expansile multiocular radiolucency - locally invasive/destructive |
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Treatment and prognosis of ameloblastomas?
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resection
prognosis: high recurrence rate, rare malignant behavior |
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List the common problems with salivary glands.
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1. mucocele
2. sialolithiasis 3. siadadenitis 4. xerostomia 5. sjogren's syndrome 6. salivary gland tumors |
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Describe a mucocele.
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(mucous extravatation phenomenon)
- bluish submucosal swelling - mucin spillage - ruptured salivary excretory duct secondary to trauma - very common - found in children and young adults - lower lip or ranula (lesion in floor of mouth) |
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Treatment and prognosis of a mucocele?
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excision
prognosis: good |
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Describe sialolithiasis.
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- calcium salt deposition in salivary duct system - nidus
- submandibular gland most commonly involved - obstruciton w/ episodic pain and swelling related to meals - salivary gland inflammation and atrophy |
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Treatment for sialolithiasis?
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surgical removal
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Describe sialadenitis.
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- inflammation of salivary glands
- viral - mumps - bacterial - acute parotitis (perioperative period) - chronic sclerosing sialadenitis -- obstruction |
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Describe xerostomia.
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- reduced salivary flow -- dry mouth
- common incidence |
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What are common causes of xerostomia?
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medications
radiation therapy Sjogren's syndrome DM Sarcoidosis HIV infection Smoking Mouth breathing |
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What are complications of xerostomia?
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mucositis
dental caries candidiasis difficulty w/ mastication dysphagia speech problems altered taste difficulty wearing denture prostheses |
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How do you manage xerostomia?
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-- correct underlying cause
-- saliva replacement: water rinses, artificial saliva -- sialogogues - parasympathomimetic drugs -- dental preventive care -- antifungal medication |
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Describe Sjogren's syndrome.
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- autoimmune exocrinopathy
- xerostomia -- salivary glands - keratoconjuntivitis sicca (dry eyes) -- lacrimal glands - 0.2-0.3% of population and 80-90% of those affected are middle-aged females - associated autoimmune disease -- RA |
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Complications of Sjogren's?
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ocular dryness -- blindness
mucositis dental caries candidiasis dysphagia speech difficulties altered taste enlarged salivary glands increased risk of lymphoma |
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Extraglandular manifestations of Sjogren's syndrome?
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nephritis
pneumonitis vasculitus neuropathy biliary cirrhosis Reynaud's phenomenon fatigue depression lymphadenopathy |
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How do we diagnose Sjogren's?
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DRY EYES - Schirmer test, Rose Bengal staining
DRY MOUTH - reduced salivary flow rate, "cracker" sign Labial salivary gland/parotid biopsy -- focus score >1.0 Serologic evidence of autoimmune disease -- RA, ANA, SS-A, SS-B |
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How do we manage Sjogren's?
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rheumatologist
opthalmologist - eye care dentist - preventive dental care supportive care: saliva substitutes, sialogogues, antifungal therapy Moisture Seekers support group -- Sjogren's Syndrome Foundation |
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List the 4 types of salivary gland tumors.
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1. Pleomorphic Adenoma (benign mixed tumor)
2. Papillary Cystadenoma Lymphomatosum (Warthin's tumor) 3. Mucoepidermoid Carcinoma 4. Adenoid Cystic Carcinoma |
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General features and epidemiology of pleomorphic adenoma (benign mixed tumor)?
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- benign neoplasm of salivary gland origin
- most common salivary gland neoplasm (70%) - female>male - 3rd - 6th decade - found on the parotid gland |
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Clinical presentation of the pleomorphic adenoma (benign mixed tumor)?
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slow growing painless mass
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Gross pathology of the pleomorphic adenoma (benign mixed tumor)?
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well demarcated firm tan white solid/cystic mass
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Histopathology of the pleomorphic adenoma (benign mixed tumor)?
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ductal epithelial cells
myoepithelial cells stroma -- myxoid, chondroid, fibrous, hyaline |
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Treatment and prognosis of the pleomorphic adenoma (benign mixed tumor)?
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surgical excision (superficial parotidectomy)
Prognosis: excellent |
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Complications of pleomorphic adenoma (benign mixed tumor)?
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recurrence -- multifocal
malignant transformation - carcinoma |
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General features and epidemiology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
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- benign salivary gland tumor
- common incidence - male>female - 5th - 7th decades - found at the parotid - multifocal/bilateral in 14% |
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Symptoms and etiology of papillary cystadenoma lymphomatosum (Warthin's tumor)?
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symptoms: painless mass
etiology: smoking (8x risk) |
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Gross pathology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
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well circumscribed cystic mass - "machine oil fluid"
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Histopathology of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
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cystic lesion w/ papillary fronds lined by bilayered oncocytic epithelial cells w/ associated lymphoid stroma
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Treatment and prognosis of the papillary cystadenoma lymphomatosum (Warthin's tumor)?
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surgical excision
prognosis: excellent |
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Complications from papillary cystadenoma lymphomatosum (Warthin's tumor)?
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recurrence
malignant transformation is very rare |
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General features and epidemiology of mucoepidermoid carcinoma?
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- malignant salivary gland neoplasm
- most common malignant salivary gland tumor (30%) - male = female - wide age range, 3-6th decades - found at the parotid, palate |
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Gross pathology of the mucoepidermoid carcinoma?
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unencapsulated tan white solid and cystic tumor
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Histopathology of the mucoepidermoid carcinoma?
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- epidermoid cells
- mucous cells - intermediate cells - cystic/solid growth patterns - low - intermediate - high grades |
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Treatment of mucoepidermoid carcinoma?
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surgical excision
neck dissection radiation therapy |
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Prognosis of mucoepidermoid carcinoma?
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Low to intermediate grade - 90% 5-year survival
High grade - 40% 5-year survival Metastasis --> lymph nodes, lung, bone |
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General features and epidemiology of adenoid cystic carcinoma?
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- malignant epithelial cell neoplasm
- 12% of malignant salivary gland tumors - male = female - 5th-7th decades - found at parotid, submandibular gland, palate |
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Clinical symptoms of adenoid cystic carcinoma?
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painful mass
cranial nerve deficit |
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Gross pathology of adenoid cystic carcinoma?
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solid firm tan mass
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Histopathology of adenoid cystic carcinoma?
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highly infiltrative
cribriform ("swiss cheese"), tubular and solid growth patterns perineural invasion mucohyaline stroma |
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Treatment for adenoid cystic carcinoma?
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surgical excision
radiation therapy |
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Prognosis for adenoid cystic carcinoma?
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protracted relentless course
5-year survival - 75% 20-year survival - 13% Multiple local recurrences Metastasis - late in clinical course to lymph nodes, lung, bone |