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235 Cards in this Set

  • Front
  • Back
squamous papilloma is associated with what virus
HPV
what are the common intraoral locations for a squamous papilloma
soft palate or tongue
what is the differential diagnosis for squamous papilloma
verruca vulgaris, condyloma accuminatum, or squamous papilloma
what are the virus altered epithelial clear cells with small dark, pyknotic nuclei that are sometimes seen in association with squamous papilloma
koilocytes
what is the tx for squamous papilloma
surgical excision
what is a rare potentially devastating disease of the larynx and hypopharynx associated with squamous papilloma
laryngeal papillomatosis
what are the two types of laryngeal papillomatosis and which is associated with possible morbidity
juvenile onset and adult onset. juvenile onset can cause death if it obstructs the airway causing asphyxiation
squamous papilloma is pre-malignant, spreads to other parts of the oral cavity and continuously enlarges T/F
false: not pre-malignant, does not spread to other parts of the oral cavity, or continuously enlarge
what is the term for the common wart
verruca vulgaris
verruca vulgaris typically present as: single lesions or multiple lesions?
multiple lesions
when orally involved where is verruca vulgaris commonly seen
vermillion border, labial mucosa, or anterior tongue
verruca vulgaris spreads easily via what
autoinocculation
what is the tx for verruca vulgaris
surgical excision, liquid nitrogen therapy, curettage, topical keratinolytic agents
squamous papilloma is often associated with cutaneous horns (keratin horns) T/F
false: associated with verruca vulgaris
is verruca vulgaris premalignant
no
what amount of verruca vulgaris will disappear spontaneously
2/3
what is the term for venereal wart? what virus is associated with this?
condyloma accuminatum associated with HPV (16 and 18)
what can be done to make a diagnosis for condyloma accuminatum
antibody tests for HPV 16 and 18 (both are associated with increased risk of malignant transformation)
condyloma accuminatum is considered an STD and is about 20% of all STDs T/F
true
condyloma accuminatum is associated with a virus induced proliferation of stratified squamous epithelium in what areas
genitalia, perianal region, mouth, and larynx
what is the tx for condyloma accuminatum
surgical excision in oral cavity
which is larger papilloma or condyloma accuminatum
condyloma accuminatum and is usually clustered with other condylomata
focal epithelial hyperplasia is associated with which strains of HPV
13 and 32
when stretched will focal epithelial hyperplasia disappear
yes
what cells are associated with focal epithelial hyperplasia
mitosoid cells
what is the tx for focal epithelial hyperplasia
surgical excision in the oral cavity
verruciform xanthoma is what
hyperplastic condition of the epithelium of the mouth, skin, and genitalia. most cases involved oral cavity and on attached gingiva
what foamy lipid filled histiocytes that are involved beneath the epithelium are associated with verruciform xanthoma
xanthoma cells
which of the following is not HPV associated: condyloma accuminatum, veruca vulgaris, verruciform xanthoma, or squamous papilloma
verruciform xanthoma
verruciform xanthoma is seen more often in what sex
female (2:1)
what is the tx for verruciform xanthoma
conservative surgical excision
what is the differential dx for oral melanotic macule
melanin, vascular, or metal
what are the ways of ruling out the differential dx for oral melanotic macule
take an x-ray to visualize possible metal cause, palpate for blanching to determine vascular possibility. if not these then biopsy should be done to check for melanoma
what is the term for a mole
acquired melanocytic nevus
nevus cells and melanocytes both come from what embryologic origin
neural crest
what are the stages for acquired melanocytic nevus
1. junctional nevus, 2. compound nevus, 3. intradermal nevus,
what is the most common type of acquired melanocytic nevus
intradermal ( or intraoral) nevus
why are blue nevi blue
because of the tyndall effect (is the interaction of light within particles in a colloidal suspension
what is the clinical term used to characterize a white patch that cant be clinically or pathologically identified as any other disease
leukoplakia
leukoplakia is a disease primarily of what sex and habit
adults males and smokers
leukoplakia should be biopsied if it is still present after how long
2 weeks
if leukoplakia is found in the floor of the mouth what is the change it will be squamous cell carcinoma? tongue? llip?
floor of mouth- 40%, tongue-24%, lip-24%
what is the histology associated with leukoplakia
thickened keratin layer of surface epithelium (hyperkeratosis) with or without thickened spinous layer (acanthosis)
bulbous/teardrop shaped rete ridges are associated with the histological appearance of leukoplakia T/F
true
what is the tx for leukoplakia
first step is to arrive at a definite histo dx (biopsy is mandatory). luekoplakia with moderate eithelial dysplasia or worse warrants complete destruction or removal
what is a red patch known as
erythroplakia
when erythroplakia does not clear what is the chances of cancer
90-100%
almost all true erythroplakias demonstrate what
significant epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma
what oral alterations are associated with smokeless tobacco keratosis
1. characteristic painless loss of gingival and periodontal tissues in area of contact, 2. gingival recession, 3. more prevalent dental caries, 5. halitosis, 6. characteristic white plaque produced in direct contact with snuff
how long does it typically take for smokeless tobacco keratosis to develop
1-5 years
what is the histology associated with smokeless tobacco keratosis
squamous epithelium is hyperkeratinized and acanthotic. parakeratin chevrons may be seen as pointed projections above or within superficial epithelial layers. increased subepithelial vascularity and vessel engorgement. amorphous eosinophilic material within CT and salivary glands. epithelial dysplasia is uncommon and mild when present
what is the most common malignancy associated with smokeless tobacco keratosis
squamous cell carcinoma
what is the low grade malignancy associated with smokeless tobacco keratosis
verrucous carcinoma
what is nicotine stomatitis
generalized hyperkeratosis with red inflamed centers, representing ducts from salivary glands
when can nicotine stomatitis regression be seen with cessation of irritation
14 days
any white lesion of the palatal mucosa that persists after 1 month of habit cessation (smoking) should be considered what
leukoplakia
what is the cause of nicotine stomatitis
excessive heat irritation from pipes, hot food, reverse smoking
what is the histology for nicotine stomatitis
hyperkeratosis and acanthosis of palatal epithelium
is nicotine stomatitis pre-malignant
no
actinic keratosis and actinic cheilosis are both associated with what common cause
sun exposure
what is actinic cheilosis
sun damage to the lower lip vermillion
what is the ideal preventive tx for actinic keratosis and actinic cheilosis
vaseline with sunblock (chapstick with paraffin wax is not good)
are actinic keratosis and actinic cheilosis premalignant
yes
what is the tx for actinic keratosis and actinic cheilosis
destruction by cryotherapy (liquid nitrogen), 5-fluorouracil, curettage, electrodesiccation, and surgical excision
what is the differential diagnosis for keratoacanthoma
squamous cell carcinoma, basal cell carcinoma, and keratoacanthoma
what is the appearance of keratoacanthoma
on the skin (can be found intraorally rarely), resembles squamous cell carcinoma with a rolled raised border with an ulcerated center with rapid enlargement, a big central core of keratin, firm, nontender, well demarcated, sessile, and dome shaped nodule, that is not long persisting because it is self resolving
a lesion of the lower lip that appear to be keratoacanthoma that does not self resolve is usually what? on the upper lip?
lower lip: squamous cell carcinoma, upper lip: basal cell carcinoma
keratoacanthoma is found on sun exposed areas 95% of the time T/F
true
what is the tx for keratoacanthoma
excision of a large lesion because of scarring
what are the causitive theories for keratoacanthoma
1. viral (HPV-26 or 37) 2. well differentiated squamous cell that is defeated by immunity 3. sun damage
what is the occurrence rate in order of occurrence from most to least for the following: SCC, BCC, and melanoma
basal cell carcinoma, squamous cell carcinoma, and melanoma
most (94%) of intraoral CA is what type
squamous cell carcinoma
what is the etiology for SCC
alcohol and smoking tobacco
what is the most common extraoral and intraoral locations for squamous cell carcinoma
extraoral: lip intraoral: tongue
SCC of the lower lip has a bad prognosis T/F
false: it has a good prognosiss
carcinoma in situe means what
dysplasia is above basement membrane
invasive CA means the cancer has broken through what
the basement membrane
what is the occurrence rate in order from greatest to least in AIDS pts for the following: SCC, kaposi's sarcoma, and lymphomas
kaposi's sarcoma, lymphoma, SCC
what is the tx for SCC of the lower lip
surgery. chemo is not effective, so excision and or radiation is used
what are the clinical presentation rates of SCC in order from greatest to least for the following locations: palate, floor of mouth, tongue, and gingiva
tongue, floor of mouth, palate, and gingiva
what dye is used to stain DNA and can be used on exophytic masses to stain for dysplasia
toludine blue
carcinomas tend to spread how? sarcomas tend to spread how?
carcinomas spread via lymphatically. sarcomas tend to spread hematologically
describe the measurement of differentiation for SCC
well: 75% or more of the carcinomas are producing keratin. poor: few if any cells are producing keratin
what is syncramous vs. metacromous
syncomous: CA occurring simultaneously, metacromous: CA occurring at variable times
what is verrucous carcinoma
low grade variant of oral SCC, usually located in mandibular vestibule location, can be white, papillary, exophytic, acanthotic, parakeratin, and clefting present
what is the prognosis for verrucous carcinoma
good, due to lack of perforation through basement membrane
what is the tx for verrucous carcinoma
surgical excision without radical neck dissection or radiation therapy to a lesser extent
why is chemo ineffective for verrucous carcinoma
not a lot of mitotic activity
what is the most common form of CA and skin CA
basal cell carcinoma
BCC usually occurs in what 1/3 of the face
middle 1/3
what is the appearance of BCC
usually present as a raised rolled border with central depression and telangiectasia vessels coursing over the rolled border
what is the tx for BCC
surgical excision
what is the most common cause of BCC
sun exposure
what is the differential diagnosis for basal cell carcinoma
BCC, keratoacanthoma, or squamous cell carcinoma
what type of BCC is the most common type
nodular type which begins as a firm, painless papule that slowly enlarges and gradually develops the central depression
what is the prognosis for BCC
excellent (95-58% cure rate)
what is the 3rd most common type of skin carcinoma
melanoma
what are the 4 types of melanoma
1. superficial spreading 2. nodular melanoma 3. lentigo maligna melanoma 4. acral lentiginous melanoma
what are the 2 growth phases of melanoma
radial growth and vertical growth
ABCD's of melanoma pg 377
actually go look at that page.
what is the tx for melanoma? what aren't good tx options?
radiation and chemo are not effective. immunotherapy has been tried, but surgical excision is the only treatment
what is the survival rate of oral melanoma
0%
worst prognosis for melanoma is designated as what?
BANS (intrascapular area of back, posterior upper arms, posterior and lateral neck, and scalp
if melanoma is disseminated at the time of diagnosis (stage 3) the tumor is usually fatal T/F
true
what is the differential diagnosis for ulcerative and vesiculo-bulbous lesions
HSV, apthous stomatitis, erosive lichen planus, lupus erythematous, cicatricial pemphigoid, pemphigus vulgaris, and erythema multiform
what are tissues that are ectodermal in origin that develop abnormally, oligodontia and malformed teeth is seen with a lack of sweat glands upon biopsy
ectodermal dysplasia
white sponge nevus is genetically inherited by what method
autosomal dominant
white sponge nevus is what
white plaques on the tongue, buccal mucosa, and throughout the oral cavity
hereditary hemorrhagic telangiectasia (pg 654)
look
what is a hereditary syndrome, that presents with perioral pigmentation and benign multiple intestinal polyposis
peutz-jeghers syndrome
what is the cause of lichen planus
immunologically mediated mucocutaneous disorder
what is a major sign for lichen planus
wickham's striae (sun ray appearance)
how does lichen planus appear histologically
epithelium is hyperkeratotic and hyperplastic with elongation of rete ridges and a band of lymphocytic infiltrate with liquifactive degeneration of basal layer. saw tooth rete ridges.
the erosive form of lichen planus can present either unilaterally or bilaterally and is associated with chronic low grade pain T/F
true
what is the tx for erosive form of lichen planus
steroids
where should a biopsy be taken for lichen planus
at striae region
what seems to be the trigger for lichen planus
stress
what are the 3 types of lichenoid rxns
1. amalgam restorations 2. reaction reactions 3. graft vs. host disease and lupus erythematosis
what are the 3 types of lupus erythematosus
1. chronic/discoid 2. subacute 3. systemic
what is the characteristic sign of lupus erythematosus
malar rash
what is the tx for lupus erythematosus
immunosuppressants
lupus is often associated with varying degrees of ulcerations, pain, erythema, and hyperkeratosis T/F
true
what oral complaints often are associated with lupus erythematous
xerostomia, stomatodynia, candidiasis, dysgeusia
what is cicatricial pemphigoid
when antibodies to the hemidesmosomes that connect the epithelium to the basement membranes causing subepithelial blistering and sloughing of epithelium
edentulous areas are typically affected with cicatricial pemphigoid T/F
false: these areas are usually unaffected
what is the test that will seperate lichen planus from pemphigoid by rubbing a spot with cotton applicator and if it hemorrhages after a couple of minutes it is a positive result
nikolsky test
cicatricial pemphigoid must be specifically diagnosed with what
direct immunofluorescence
what is the tx for cicatricial pemphigoid
topical steroids, systemic steroids, or dapsone
what is pemphigus vulgaris
hemidesmosomes break down and begin to seperate with tzanck cells beginning to develop
what are tzanck cells
rounded up cells where the desmosomes have broken loose
what is the tx for erythema multiforme
systemic steroids such as prednisone
erythema multiforme has a gradual onset T/F
false: acute onset
what syndrome is associated with erythema multiforme
steven johnson syndrome
what is the most common location of geographic tongue
dorsal surface of tongue
what is a pathological cavity, epithelial lined that contains fluid or semi-solid material
cyst
dentigerous cyst is associated with what location
impacted/embedded (unerupted) teeth
what is the source of the epithelium associated with a dentigerous cyst
reduced enamel epithelium
what is the differential diagnosis for denitigerous cyst
OKC and ameloblastoma
what is the tx for a dentigerous cyst
careful enucleation of the cyst with removal of unerupted tooth
dentigerous cyst is said to have what origin
developmental (meaning non-inflammatory)
dentigerous cyst will rarely transform into what
ameloblastoma or can develop SCC in the lining. also can develop mucoepidermoide carcinoma
what dentition is usually involved with eruption cyst
mixed dentition
what specific teeth are typically associated with an eruption cyst
1st permanent molars and maxillary incisors
eruption cyst is a soft tissue cyst that develops as a result of what
seperation of the dental follicle from around the crown of an erupting tooth that is within the soft tissue overlying the alveolar bone
eruption cyst is a specific sub-type of what kind of cyst
dentigerous cyst
surface trauma to an eruption cyst may cause a collection of blood int he cystic fluid, imparting a blue to purplish brown color known as what
eruption hematoma
primordial cyst is considered what now
odontogenic keratocyst
what are the 3 important features associated with odontogenic keratocyst
1. very aggressive behavior 2. unique histological features 3. associated with nevoid basal cell carcinoma when many lesions occur and other symptoms are present
most cases of odontogenic keratocyst are found in which arch
60-80% found in mandible, especially posterior body and or ascending ramus
what are the 4 features of the epithelial lining associated with an OKC
1. uniform thickness (5-8 cells) 2. basal cell nuclei are hyper chromatic palisades 3. surface corrugated layer of parakeratin 4. lack rete pegs, lumen has desquamated parakeratine, and has daughter cells
what is the differential diagnosis for OKC
ameloblastoma, OKC, or dentigerous cyst
diagnosis of OKC is made how
by unique histology
what is the tx for OKC
enucleation and curettage
what is the difference b/w orthokeratinized odontogenic cyst and OKC
both are keratin filled but the lining is different (orthokeratinized). may have uniform epithelial thickness but not a prominent basal layer like OKC
what is the tx for orthokeratinized odontogenic cyst
enucleation with curettage
which has greater recurrence: orthokeratinized odontogenic cyst or OKC
OKC (30%) compared to orthokeratinized odontogenic cyst (2%)
orthokeratinized odontogenic cyst is associated with what syndrome
nevoid basal cell carcinoma syndrome (gorlin syndrome)
gorlin syndrome is inherited how
autosomal dominant
gorlin syndrome is caused by what
mutations in patched, a tumor supressor gene mapped to chromosome 9q22.3-q31
what are the chief components of gorlin syndrome
multiple basal cell carcinomas of the skin, OKCs, intracranial calcification (falx cerebri), palmar/plantar pits, enlarged head circumference, and rib and vertebral anomalies (bifid rib, spina bifida occulta, etc(
what signs of gorlin syndrome contribute to increased cranial circumference
facies with frontal and temporoparietal bossing
what is seen in gorlin syndrome that relates to the eyes
usually widely seperated with true ocular hypertelorism
basal cell carcinoma of the skin is the major component of gorlin syndrome T/F
true (aka nevoid basal cell carcinoma syndrome)
what are the most constant feature of gorlin syndrome
multiple jaw cysts (OKC) that appear at a significantly younger age than normal
the cysts associated with gorlin syndrome demonstrate an overexpression of what
p53 and cyclin D1 oncoproteins
what is the tx for gorlin syndrome
jaw cysts are treated by enucleation other anomalies are mostly not life threatening
gingival cyst of newborn is a hard tissue cyst from the reduced enamel epithelial remnants T/F
false: soft tissue cyst from the dental lamina remnants
what arch is mainly involved in gingival cyst of newborn
maxilla
gingival cyst of newborn is found on what intraoral structure
alveolar ridge
gingival cyst of newborn are usually self limiting and have to be present at birth T/F
true
gingival cyst of the adult looks like what other gingival lesion
mucocele but wrong location
where is gingival cyst of the adult and lateral periodontal cyst usually found
in buccal region around cuspid/bicuspid area (60-75%)
gingival cyst of the adult is an inflammatory hard tissue cyst T/F
false: developmental soft tissue cyst
what can be done to help diagnose a gingival cyst of the adult
take x-ray, probe sulcus, and test tooth vitality because the teeth associated with the cyst are vital with no periodontal disease
what is the tx for gingival cyst of the adult
surgical excision
what is the intrabony counterpart of the gingival cyst of the adult
lateral periodontal cyst (intraosseous location)
what is the DD for lateral periodontal cyst
OKC
where do most cases of lateral periodontal cyst occur
mandibular premolar-canine-lateral incisor area 75-80%
can lateral periodontal cyst be diagnosed by x-ray alone
no
what is the tx for lateral periodontal cyst
conservative enucleation usually without damage to the adjacent tooth
where is calcifying odontogenic cyst usually located
anterior jaws
what is the tx for calcifying odontogenic cyst
enucleation
what are the eosinophillic altered epithelial cells that are characterized by loss of nuclei wtih preservation of basic cell outline
ghost cells
carinoma arising in odontogenic cysts is usually derived from what
ameloblastomas, rarely from other odontogenic tumors, de novo, or from the epithelial lining of odontogenic cysts
what is the tx for carcinoma arising in odontogenic cysts
local block excision to radical resection, with or without radiation or adjunctive chemo
carcinoma is of what origin
epithelial
the prefix adno designates what origin
glandular
sarcoma indicates what origin
mesenchymal origin
what is hamartoma
limited growth potential that is normal tissue for that area (tumor like malformation)
what is choristoma
normal tissue growth in an abnormal location
what are the 3 classes of odontogenic tumors
1. tumors of odontogenic epithelium 2. mixed odontogenic tumor (epithelium and ectomesenchyme) 3. tumors of odontogenic ectomesenchyme
what are the tumors of odontogenic epithelium
ameloblastoma (malignant ameloblastoma or ameloblastic carcinoma), adenomatoid odontogenic tumor, and calcifying epithelial odontogenic tumor (pindborg tumor)
what is the most common clinically significant tumor, excluding odontoma
ameloblastoma
what are the 3 types of ameloblastoma in order of prevalence
multicystic (86%), unicystic (13%), peripheral (1%)
what is the tx for ameloblastoma
surgery
what is the DD for ameloblastoma
dentigerous cyst or OKC
ameloblastoma can present with soap bubble appearance and possible root resorption T/F
true
where do ameloblastoma usually appear
posterior mandible
what are the 6 histological forms of ameloblastoma
1. follicular pattern 2. plexiform 3. acanthomatous 4. granular cell pattern 5. desmoplastic 6. basal cell pattern
what histological form is most common to be found in ameloblastoma
follicular pattern
which has higher recurrence rate in ameloblastoma: multilocular or unilocular
multilocular (50-90%) compared to unilocular (15-20%)
malignant ameloblastoma or ameloblastic carcinoma metastisis usually found where
lungs
adenomatoid odontogenic tumor represents what % of odontogenic tumors
3-7%
what is the differential diagnosis for adenomatoid odontogenic tumor
dentigerous cyst
what is seen histologically with adenomatoid odontogenic tumor
fibrous capsule filled with a solid mass/ has ducteral structures lined with columnar cells, spindle cells, and calcifications
pindborg tumor usually is associated with what
embedded/impacted teeth
what is the DD for pindborg tumor
gorland cyst
what is the tx for pindborg tumor
surgery and enucleation
neoplastic cells in pindborg tumor are thought to be of what origin
stratum intermedium
liesegang ring calcifications are seen in what tumor
pindborg tumor
what stain is used to stain ameloid for diagnosis which shows an apple-green under polarized light
congo red
what are the mixed odontogenic tumors
ameloblastic fibroma, ameloblastic fibro-odontoma, and odontoma
ameloblastic fibroma are RL lesions, associated with impacted/embedded teeth (75%) T/F
true
ameloblastic fibroma is usually seen in adult pts T/F
false: peds pts
what is the tx for ameloblastic fibroma
surgery, extraction, or enucleation
what is the common location in ameloblastic fibroma
posterior mandible
ameloblastic fibro-odontoma is seen in what pts
peds pts
how does ameloblastic fibro-odontoma appear radiographically
RL/RO lesion with impacted/embedded teeth
what is the DD for ameloblastic fibro-odontoma
gorland cyst, calcifying epithelial odontoid tumor (pindborg tumor), odontoma
what is the tx for ameloblastic fibro-odontoma
tooth xct and enucleation
where is ameloblastic fibro-odontoma usually found
posterior mandible
what is the most common odontogenic tumor
odontoma
odontoma is a neoplasm not a hamartoma T/F
false: hamartoma not a neoplasm
odontoma is associated with what teeth
impacted/embedded teeth and can preven eruption of the tooth
compound type odontoma is usually found where? complex type?
compound: anterior maxilla, complex: posteriorly with impacted teeth
odontoma is usually found in pedo pts T/F
true
what are the tumors of odontogenic ectomesenchyme
odontogenic myxoma and cementoblastoma
what is the DD for odontogenic myxoma
OKC, ameloblastoma, etc(?)
what is the CC for odontogenic myxoma
usually assymmetry
what is the histological appearance for odontogenic myxoma
loose myxometous that does not stain (looks like loose areolar CT
what is the tx for odontogenic myxoma
surgical
cementoblastoma is a neoplasm of cementum T/F
true
what teeth are usually involved for cementoblastoma
mandibular molar teeth (50% involve the permanent 1st molar)
what is seen radiographically in cementoblastoma
RO, loose/obscured outline of root, and loos band/rim around lesion
what is the tx for cementoblastoma
surgical excision and extraction of involved teeth