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78 Cards in this Set
- Front
- Back
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Desmosome |
structures on each side of 2 adjacent cells and function as spot welds between the cells |
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Hemidesmosomes |
Connect epithelial cells adjacent to the basement membrane |
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Epithelium |
avascular receives nourishment by diffusion of nutrients from contiguous vascularized connective tissue |
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Cytokeratin |
characterizes epithelial cells utrastructurally intermediate filament |
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Basement membrane |
layer of extracellular material at the interface with contiguous fibrous tissue Made of type IV and VII collagen, adhesive glycoproteins and proteoglycans Connected to fibrous tissue by anchoring fibrils made of type VII collagen Helps regulate passage of molecules Provides a limiting barrier and support for epithelial cells |
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Epidermis |
keratinized stratified squamous epithelium |
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Dermis |
projects with papillae and interdigitate with evaginations of epidermis called epidermal ridges (tete ridges or RETE pegs) rich network of blood vessels and nerves and lymphatic vessels which nourish the overlying epidermis |
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Hypodermis |
loose connective tissue underneath the dermis binds skin loosely to subjacent organs contains fat cells (adipose tissue) |
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Adenexal structures |
hair, sweat glands, sebaceous glands, nails and mammary glands which are collectively called the integumentary system |
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Mucosa |
covers the inner body cavities which open to the outside oral cavity/GI tract/upper respiratorytract and genitourinary tract
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Mucosa components |
epithelium not epidermis - epithelium may or may not be keratinized depending on location lamina propria not dermis - sometimes this layer goes directly into periosteum - mucoperiosteum sometimes there is a submosa (like the hypodermis) - loose connective tissue, minor salivary glands and/or connective tissue
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Adnexal structures in the oral cavity |
sebaceous glands - Fordyce's granules minor salivary glands |
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Epithelial cells |
majority of cells in the epithelium keratinizing cells are called keratinocytes always include stratum basale and spinosum sometimes include granulosum and corneum |
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Orthokeratin |
nuclei of keratinocytes are lost
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Parakeratin |
small shrunken nuclei are retained in the keratin layer |
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Melanocytes |
dendritic cells that produce melanin granules called melanosomes are packaged and transported to keratinocytes where they can protect the cell from UV radiation constant ratio of melanocytes to keratinocytes regardless of sex and race difference in skin colour is due to lack of degradation of the granules carotene and pigments in subcutaneous fats, blood vessels and colour affect skin colour |
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Langerhans cells |
dendritic phagocytic cells solitary clear cells Bierbeck granule - tennis racket/rod shaped structure MHC type II - antigen presenting cells
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Merkel cells |
sensory mechanoreceptors
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Oral mucosa |
lining mucosa - max. flexibility but sacrifices toughness masticatory mucosa - well keratinized to resist forces of mastication specialized mucosa (dorsum of tongue) - support tastebuds and resist masticatory forces |
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Anaplasia |
Neoplastic cells that are so poorly differentiated that it is difficult or impossible to determine morphologically the tissue of origin |
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Benign |
Neoplasms in which the cells do not metastasize Could still cause local destruction and may result in death if they extend into local vital structures. |
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Differentiation |
Degree to which the neoplastic cells resemble the cells in normal parent tissue. Well differentiated has a higher degree of resemblance, poor differentiated has little resemblance |
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Epithelial dysplasia |
Alterations of epithelial cells which correlate with an increased potential for malignancy |
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Malignant |
Neoplasms which have the potential for metastatic spread More aggressive in growth and more likely to cause death. |
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Metastasis |
The detachment of neoplastic cells from the original growth site and migration to other sites Cells usually migrate through lymphatic system or blood vessels
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Neoplasm |
New growth An autonomous growth which does not respond to the normal growth regulatory mechanisms |
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Oncology |
The study of neoplasms |
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Oncogenes |
found in all cells control growth code for growth factors signal transduction code for proteins in the nucleus which help control other genes if damaged normal mechanisms of growth are altered |
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Clonal growth |
Most tumours arise form a single cell which has changed sufficiently to permit it to proliferate in an autonomous fashion |
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Histological attributes of a cancer cells |
Nuclear hyperchromatism Nuclear and cellular pleomorphism Altered nuclear/cytoplasmic ratio Increased and abnormal mitotic figures |
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Nomenclature |
Oma - benign |
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Malignant nomenclature |
Carcinoma (epithelial) Sarcoma (connective tissue) Lymphoma or Leukemia or Myeloma (hematopoetic origin) |
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Grading |
Histopathologic determination Based on differentiation Grade 1, 2, 3 Well differentiated is better than poorly differentiated |
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Staging |
Clinical determination Extent to which a malignant has spread Size, crossed natural barriers or metastasized 1, 2, 3, 4 4 is the worst |
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Oral cancer |
3% of the population in NA 40% in India |
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Most common malignancy in the mouth |
Epithelial malignancy derived from lining mucosa |
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Squamous cell carcinoma |
90% of all oral cancers atypical epithelial cells infiltrate through the basement membrane into sub adjacent tissues bad prognosis, metastisize |
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Verrucous carcinoma |
unusual form associated with smokeless tobacco use well differentiated epithelial cels grow in a cohesive mass into sub adjacent tissues usually does not metastasize may transform to SCC good prognosis underestimated cells are well differentiated and features suggest malignancy is not present epithelial cells do not show detachment from mucosal lining like SCCs papillomas or verrucae can mimic the warty projections which characterize verrucous carcinoma heavy inflammatory cell infiltrate endophytic (downward into connective tissue) component represents a reactive hyperplasia
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Age |
risk of SCC increases with age 95% over 40 average age 60 |
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Sex |
male predilection 3:1 decreased since 1950 from 5:1 |
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Oral sites |
lower lip, later-ventral aspects of the tongue, floor of the mouth and the oropharynx are at greater risk |
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Chewing Tobacco |
white lesion (snuff dippers keratosis) malignancy most common is verrucous carcinoma, SCC can occur |
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Nicotine stomatitis |
diffuse white change occurring on palate central red punctuate lesion - inflamed duct from minor salivary gland white change from hyperkeratosis and epithelial hyperplasia reactive change to heat/smoke not a high pre-malignant potential reversible with smoking cessation |
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Alcohol |
acts synergistically with smoking |
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Siedropenic dysphasia |
middle aged women dysphasia, upper esophagus webs, anemia and hypochlorydia upper aerodigestive tract shows malignant change |
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Sunlight |
Actinic chelitis premalginant lesions - lip change to hyperkeratosis and erythema loss of demarcation between vermillion and skin swelling of tissues just below vermillion |
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Oral submucous fibrosis |
related to pan chewing eating chili occurs in East Indians mucositis, ulcers, burning mouth stiffening of the oral mucosa as a result of sub epithelial fibroplasia can cause truisms |
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Lichen planus |
autoimmune mucocutaneous disease white lace lesions erythematous and ulcerated areas (erosive lichen planus) Malignant transformation in 1-3%
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Viruses |
HPV 16 and 18 closely associated with oral cancer in the posterior oropharyngeal area Increased oral cancer with AIDS |
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Candidiasis |
candidal yeasts are often found in malignant or premalignant mucosal lesions |
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Syphilis |
leukoplakia and SCC of the tongue arsenic treatment may have been the causative agents |
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Viadent mouthwash |
associated with leukoplakia in the mucobuccal fold region Sanguinarine |
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Young women |
increasing numbers of leukoplakia involving the lateral ventral aspect of the tongue |
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Xeroderma pigmentosum Dyskeratosis congenita |
associated with oral SCCs |
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Verrucous carcinoma |
well demarcated spreading whitish wart like or rough surfaced growth |
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SCC |
red patch - erythroplakia white patch - leukoplakia white and red change - erythroleukoplakia alteration in normal mucosal surface morphology (rough, granular, irregular, exophytic) mass of fixation to adjacent tissue ulcer combinations of above features failure of lesions to resolve regional spread may lead to lymphodenopathy |
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Erythoplakias |
usually show malignancy or premalignant changes |
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Leukoplakias |
variable profile 4% malignant over lifetime |
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Leukoplakia |
women affected more than men only ⅓ of patients smoke persistent and typically recur following attempts at eradication histologic presentation in the early stages can be misleading
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Proliferative verrucous leukoplakia |
leukoplakia lesions develop into verrucous or SCCs diagnosis made retrospectively repeated recurrences difficult to manage |
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Proliferative verrucous leukoplakia of the gingiva |
confined to the gingiva |
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Hairy leukoplakia |
white lesions occurring on the border of the tongue HIV patients Epstein Barr virus Half have candidiasis infection Not related to carcinoma |
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Stage 1 |
<2cm no lymph node involvement or metastases 5 yr survival rate 85%
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Stage 2 |
2-4cm 66% survival |
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Stage 3 |
>4cm or a single lymph node is involved 41% survival rate |
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Grade |
Well differentiated tumours do better than poorly differentiated tumours |
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70% of all oral SCCs are not diagnosed |
until stage 2 >2cm |
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Epithelial dysplasia |
precancerous changes, noted by light microscopy |
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Carcinoma-in-situ |
end of the premalignant spectrum tumour islands have not penetrated basement membrane |
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Premalignant changes |
redness whiteness alterations in normal surface mucosal morphology including ulceration parallel presentation of SCCs fixation to adjacent tissues or presentation as a mass are not present
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Malignancy diagnosis |
biopsy is mandatory to confirm the diagnosis |
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Clinical pathologic correlation |
mandatory lesion might represent a premalignant condition in which the early histologic appearance is misleadingly reassuring (proliferative verrucous leukoplakia) |
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Papilloma |
cauliflower like HPV 6 and 11 finger like projections formed by epithelium covered fibrous cores low virulence and infectivity mode of transmission uncertain complete excision curative |
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Verruca vulgaris |
common wart skin or oral mucosa HPV 2, 4, 6, 40 contagious raised pebbly or granular lesion chemical agents, cryotherapy and surgical ablaton |
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Condyloma acuminatum |
STD raised granular masses HPV 2, 6, 11, 16, 18, 53, 64 |
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Multifocal epithelial hypoplasia (Heck's disease) |
multiple soft papules more common in young children and adults acanthotic epithelium affects family members HPV 13 and 32 Inuit and Native Americans Regression can occur |
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Verruciform xanthoma |
focal papillary lesion of unknown origin lipid filled macrophages in the papilla between rete pegs excisional biopsy is usually definitive treatment |
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Sebaceous hyperplasia |
Fordyce's granules Yellow white nodules Innocuous |
