Git Anatomical Pathology (T9S1) Upper: Oesophagus And Oral Cavity

Front 1

Oral Hairy leukoplakia

Back 1

White confluent patches of hairy hyperkeratotic thickenings, almost always situated on the lateral borders of the tongue.

(80% of pt are HIV+)

Front 2

Oral Hairy leukoplakia: diagnosis

Back 2

1) Hyperparakeratosis and acathosis (dark discolouration) with "balloon cells" in the upper spinous layer.

2) Occasionally koilocytosis of superficial nucleated cells suggest HPV
3) EBV found in most cells is now accepted as the cause

Front 3

Leukoplakia

Back 3

Leucoplakia is a white patch or plaque that cannot be scrapped off and cannot be characterised clinically or pathologically as any other condition.

- anywhere in oral cavity
- histologically - spectrum: from hyperkeratosis overlying a thickened acanthotic but orderly mucosal epithelium, to dysplasia/carcinoma in-situ

Front 4

Candiasis

Back 4

MOST COMMON oral cavity fungal infection.

C. albicans is a normal oral flora in +-50% of the population.

Front 5

Candiasis: 3 factors that influence the likelihood of clinical infection

Back 5

1) immune status

2) strain of candida albicans

3) composition of individual flora

Front 6

Candiasis: 3 main clinical forms

Back 6

1) Pseudomembranous: superficial curdy gray-white inlammatory membrane - easily scraped off to reveal an erythematous inflammatory base

2) Erythematous
3) Hyperplastic

Front 7

Benign Salivary Tumours

Back 7

1) Pleomorphic adenoma (2/3)(80% Parotid)
2) Monomorphic adenoma

3) Warthin's tumour 4) Oncocytoma

5) Cystadenoma 6) Sabaceous adenoma

7) Siladenoma 8) Dectal pappillomas

pg 327

Front 8

Benign Salivary tumours: General characteristics

Back 8

- painless, slow growing, discrete
- 60% in parotids
- radiation exposure increases with risk

- myoepithelial or ductal reserve cell origin

Front 9

Benign Salivary tumours: Macroscopic characteristics

Back 9

- round well demarcated
- < 6cm
- encapsulated
- grayish white with myxoid and blue translucent chondriod areas

Front 10

Oesophagitis categories

Back 10

Acute
Chronic
Carcinoma

Front 11

A) Acute Oesophagitis

Back 11

- Infectious: viral (HSV, CMV, HIV), fungal, bacterial(rare)
- ingestion or pill/corrosive substances

- only of minor clinical importance

- dysphagia

Front 12

B) Chronic Oesophagitis

Back 12

Usually reflux associated with subsequent Barrett's oesophagus

E.g. eosinophilic oesophagitis

Front 13

C) Carcinoma

Back 13

a. squamous

b. adenocarcinoma e.g. Barrett's Oesophagus

Front 14

Acute Oesophagitis: Cytomegalovirus

Back 14

- High Mobidity in immunocompromised pt - CD4<50, and in post-transplant pt
- CMV oesophagitis frequent in AIDS pt. -> most pt have multiple, well-circumscribed ulcers, in the distal oesophagus -> often presents with erythema, erosions and an inflammatory exudate

Front 15

Acute Oesophagitis: Herpes Oesophagitis

Back 15

- common in immunocompromised pt

- my occur in healthy young adults
- symptoms (sometimes asymptomatic): chest pain, odynophagia, dysphagia, upper GI bleeding

- histology: herpetic ulcers (shallow, sharply punched out, and surrounded by normal-appearing mucosa)

Front 16

Acute Oesophagitis: Fungal Oesophagitis

Back 16

Commonly due to Candida albicans & C. tropicalis
- primarily in pt w/ underlying disease - AIDS, DM.
- Symptoms: dysphagia and odynophagia

- Histology: white plaques with fibrinopurulent exudate with pseudohyphae and budding yeast

Front 17

Chronic Oesophagitis: risk factors asssoc w/ GERD

Back 17

- GERD

- Advanced age
- lifestyle habits - alcohol + smoking

Front 18

Chronic Oesophagitis: symptoms asssoc w/ GERD

Back 18

- heartburn
- acid reguritation

- dysphagia
- atypical/supraoesophageal: asthma, chronic cough, chronic sore throat, pharyngitis, laryngitis, a globus sensation, and non-cardiac chest pain.

Front 19

Chronic Oesophagitis:

GERD: 3 basic phenotypic presentations

Back 19

1) non-erosive GERD

2) erosive GERD

3) Barrett's oesophagus

Front 20

GERD-induced oesophagitis- cause= reflux -> injury of oesophageal mucosa

Contributing factors:

Back 20

1) Weak lower oesophageal sphincter

2) Presence of a sliding hiatal hernia
3) Delayed gastric emptying

4) Increased gastric acid production

5) Bile reflux

6) Impaired oesophageal peristalsis with transient LES relaxation

7) Decreased salivary gland secretions

Front 21

Accurate diagnosis of "reflux" oesophagitis requires correlation with the patient's

Back 21

- clinical

- endoscopic- GEJ (most proximal aspect of the gastric folds) and the SCJ (squamo-columnar junction)

- manometric and

- histologic data

Front 22

Reflux Oesophagitis characteristics

Back 22

1) Basal cell hyperplasia

2) Elongation and congestion of lamina propria papillae

3) Epithelial cell necrosis
4) Increased intraepithelial inflammation
5) Lack of surface maturation

6) Ballooning degeneration of squamous ells

7) Intercellular edema (acatholysis)

8) (Sever cases) Surface erosions/ulcerations

Front 23

With progression... Barrett's Oesophagus

Back 23

- salmon-pink "gastric-type" mucosa

- "intestinal-type" epithelium is at high risk for neoplastic progression.

Front 24

Adenocarcinoma devlopes in patients with BE though

Back 24

a sequence of molecular and phenotypic changes that begin with intestinal metaplasia and progress through various grades of dysplasia to adenocarcinoma.

Front 25

Squamous cell carcinoma of the oesophagus

Back 25

- Common in SA.
- Unknown cause

- middle/lower oesophagus

- Presentation: Dysphagia and weight loss

- Poor prognosis