Spring Pathology

Front 1

Cyst Histology
(True Cyst)

Back 1

A true cyst has an epithelial lining that surrounds a central cavity (simple stratified squamous)

Front 2

Odontogenic Cysts

Back 2

These cysts are derived from the tooth forming epithelium within the jaws

Front 3

Radicular Cyst

Back 3

-Aka Periapical cyst
-Inflammatory origin (inflammation, subsequent to the presence of bacteria in the periodontal ligament area, stimulates the epithelial rests of Malassez, which creates Hertwig's epithelial root sheath)


Can occur at the bottom or sides of the root
Stratified squamous epithelium

Bacteria may cause ulceration in the eipthelium & may allow cholesterol to accumulate

Front 4

2 Most Common Cysts

Back 4

1. Radicular cyst --> at the apex or side of the root
2. Follicular (Dentigerous) cyst --> not caused by inflammation or bacteria; most often seen around the crown of impacted teeth

Front 5

Periradicular Cyst

Back 5

Radiolucency at the apex of a non-vital tooth (this radiographic appearance can be many things)

Must remove all cyst material when extracting a tooth or a residual cyst will develop

Lined with epithelium, but most is connective tissue

Front 6

4 Most Common Inflammatory Cells in a Periradicular Cyst

Back 6

Neutrophils, Lymphocytes, Histiocytes, Plasma cells

Front 7

Rests of Malassez

Back 7

Oxygen diffuses through the rests

Front 8

Dentigerous Cyst

Back 8

-Forms around the crown of an impacted tooth (often attached to the CEJ upon extraction)
-Considered to be developmental in origin (error during development)
-Stratified squamous epithelium

Front 9

Dentigerous Cyst
(Mechanisms of Development)

Back 9

1) Degeneration of the stellate reticulum of the enamel organ
2) Accumulation of the fluid between the reduced enamel epithelium & the crown of the tooth

Front 10

Concerns for leaving in third molars

Back 10

-epithelium lining the cyst can turn into some other problem epithelium transforms into something bad (ameloblastoma, squamous cell carcinoma etc)
-if cyst size increases it can cause jaw fracture

Front 11

Dentigerous Cysts

Back 11

-rubbery in feeling
-may have pathologic fracture during removal
-during the teenage years there are hormones that will cause the cysts to grow very large
-cholesterol in cyst wall and giant cells

Front 12

Eruption Cyst

Back 12

-usually present in children
-most common around incisors or 1st mandibular molars
-presents clinically as a bump on the crest of the alveolar ridge where a tooth should be
-a radiograph will confirm the diagnosis
-on the crest of the ridge where the tooth should be
-tooth will erupt and the bump will go away, normal and will go away

Front 13

Residual Cyst

Back 13

-left over cyst from an extraction that doesn't get the remaining cyst tissue from a previous radicular or dentigerous cyst

Front 14

Lateral Periodontal Cyst

Back 14

-developmental cyst that arises from the rest of the dental lamina
-the intrabony counterpart of the gingival cyst of the adult
-most common in the mandibular premolar-canine-lateral incisor area
-thin epithelial lining with focal thickenings

Front 15

Gingival Cyst of the Adult

Back 15

-arises form remnants of the dental lamina (Rests of Serres)
-is primarily a soft tissue lesion
-it is a soft, freely movable, painless mass which sometimes has a bluish tinge
-it may erode cortical bone

Front 16

Gingival Cyst of the Newborn

Back 16

-white/pink papules on the alveolar mucosa of neonates
-histologically they display flattened epithelium with a parakeratotic surface.
-lumen contains keratinaceous debris

Front 17

Cause of Gingival Cyst of Newborn

Back 17

-alveolar mucosa has invaginations, keratin containing dead cells build up and they get stuck in the invaginations of the surface.
-they do go away with time when palpated they are some what firm

Front 18

Palatal Cysts of the Newborn

Back 18

-aka Epstein's pearls:white papules in the midline of the palate
-Bohn's nodules: white papules in multiple non-midline palatal locations

Front 19

Odontogenic Keratocyst

Back 19

-called OKC for short
-Recently renamed by the WHO to reflect its aggressive behavior compared to other odontogentic cysts
-NEW NAME: Keratocystic odonotgenic tumor (KCOT)
-considered to be primordial cysts
-develop where a tooth otherwise would

Front 20

Histologic Criteria for KCOT

Back 20

-corrugated layer of parakeratin lining the certain cavity
-6-8 cell thickness of the epithelial lining
-prominent palisading of basal cell nuclei

Front 21

OKC treatment

Back 21

-mandate more aggressive treatment and follow-up than other odontogenic cysts:
-peripheral ostectomy
-6 month radiographic follow-up

Front 22

OKC associated with syndrome

Back 22

-NEVOID BASAL CELL CARCINOMA SYNDROME (Gorlin syndrome)
-multiple OKC's
-multiple basal cell carcinomas
-epidermal cysts of the skin
-palmar/plantar pits
-rib anomalies
*can kill pt

Front 23

Nevoid Basal cell carcinomas

Back 23

-appearance like acne,can invade through the scalp and go through the bone and go into the brain and cause a hemorrhage, can invade into the eye and may have to remove the eye in order to remove these

Front 24

Gorlin Cyst renamed

Back 24

-renamed to calcifying cystic odontogenic tumor due to its more aggressive behavior
-bone looks moth eaten, normally can be removed with a peripheral ostectomy

Front 25

Ghost Cells

Back 25

-cant see nuclei where there should be nuclei
-more in the mandible than the maxilla

Front 26

Nasopalatine Duct Cyst

Back 26

-most common fissural cyst
-located in the midline of the anterior hard palate
-do vitality testing, molars take longer to respond
-can get a cyst in the soft tissue only
-stratified squamous epithelial lining with connective tissue wall
-collagen, numerous vascular channels

Front 27

Nasopalatine Duct Cyst Appearance

Back 27

-inverted pear shape
-take an x-ray to see what is happening in the bone
-sclerotic border (very white area around the cyst)
-teeths 8&9 should test vital

Front 28

Lymphoepithelial Cyst

Back 28

-most frequent locations- floor of mouth and posterior lateral tongue
-color- light yellow
-size: small, less than 6mm
-lymphoid tissue present
-caused by invagination of epithelium in which keratin is trapped (similar to epstein pearls)
-should remove to ensure it isnt malignant (epithelium lining this can transform into something malignant)

Front 29

Mucocele

Back 29

-pseudocyst created by trauma
-most common location - lower lip
-Clinical features-pale bluish translucent fluctuant lesion
-remove pool of mucin and gland associated with it.
-can have macrophages on periphery waiting to engulf mucin

Front 30

Ranula

Back 30

-essentially a mucocele in the floor of the mouth
-named after a frog's belly

Front 31

Thyroglossal duct cyst

Back 31

-located in neck
-caused from residual thyroglossal duct that failed to resorb

Front 32

Dermoid cyst

Back 32

-developmental true cyst, with keratin in the middle

Front 33

Periapical granuloma

Back 33

-sequela of dental caries
-identical etiology to the radicular cyst, but there is no epithelium bc the rest of Malassez have not proliferated
-resorption of bone, creating a radiolucent lesion, is caused by the inflammatory process
-teeth usually require extraction and site needs curetting
-sclerotic border

Front 34

Median Palatal Cyst

Back 34

-fissural cyst in the midline of the hard palate
-locatd posterior to palatine papilla
-lined by stratified squamous or respiratory epithelium
-not very common compared to nasopalatine cyst
-occurs because two halves of the palatal shelves are coming together and epithelium fails to breakdown and is caught between the two shelves, creating rest cells
-related to vital teeth

Front 35

Globulomaxillary Cyst

Back 35

-fissural cyst that does not exist
-inverted pear shaped radiolucency between maxillary lateral incisor and canine
-now believed to be : lateral periodontal cyst, lateral radicular cyst, or KCOT (keratocystic odontogenic tumor)
-conceptual error in embrologic development

Front 36

Nasolabial Cyst

Back 36

-may arise from remnants of the nasolacrimal duct or from fusion of the maxillary, median nasal and lateral nasal processes
-clinically presents as a swelling in the nasolabial fold area
-lined by respiratory epithelium
-present in younger individuals because it is a developmental cyst and grows slowly over time
-rubbery mass
-not very common
-doesn't transform into a malignancy

Front 37

Midline Mandibular Cyst

Back 37

-median mandibular cyst, or glandualr odontogenic cyst
-not associated with inflammation or dead teeth
-not developmental in origin
-considered rather aggressive, and can be considered a low grade mucoepidermoid carcinoma
-must be removed in block where a chunk of the mandible is removed so that it doesnt come back

Front 38

Branchial Cleft cyst

Back 38

-lesion of the lateral neck in young adults
-located in cervical lymph node chain area close to the anterior border of the SCM
-lined by stratified squamous epithelium or respiratory epithelium and surrounded by lymphoid tissue
-more common in males
-grows for years until large enough to be visible/palable
-can become secondarily infected via skin

Front 39

Pseudocysts

Back 39

-Aneurysmal bone cyst
-traumatic bone cyst
-stafne bone cyst
-mucocele (in soft tissue)
-ranula (in soft tissue)
*not lined by epithelium

Front 40

Traumatic Bone cyst

Back 40

-painless radiographic lesion: unicystic radiolucency scalloping around tooth roots
-teeth must be vital
-etiologic theory: trauma which does not cause fracture creates an intraosseous hematoma that liquefies and causes a defect
-histology: bone and CT fragments
-Tx: vigorous curettage to stimulate bleeding, radiographic follow-up

Front 41

Aneurysmal Bone cyst

Back 41

-radiolucency which may cause a blow out distention of the affected bone
-expansile and more common in the mandible
-Histology : cystic lakes of blood surrounded by fibrous CT with giant cells
-in young ppl (25 and younder)
-high recurrence rate
-looks like a lot of air in bone

Front 42

Stafne Bone Cyst

Back 42

-normal anatomy masquerading as a pathologic condition
-concavity of bone and not true space,
- due to submandibular gland pressing against adjacent bone
-not tx required

Front 43

Classification Epithelial Odontogenic Tumors

Back 43

-Ameloblastoma: benign
1. unicystic
2. traditional
-Amelobalstoma -Malignant
1. malignant ameloblastoma
2. ameloblastic carcinoma
-clear cell odontogenic carcinoma
-calcifying epithelial odontogenic tumor
-squamous odontogenic tumor

Front 44

Histologic Criteria of Ameloblastoma

Back 44

1. Stellate Reticulum
2. columnar ameloblasts with nuclei polarized toward the stellate reticulum
3. apical clearing of the cytoplasm of the columnar ameloblasts

Front 45

Unicystic Ameloblastoma

Back 45

-arises within the epithelium of a dentigerous cyst
-can be treated more conservatively than conventional ameloblastoma
-should not be treated conservatively if there is a mural component

Front 46

calcifying epithelial odontogenic tumor
radiographic features

Back 46

-also called pindborg tumor
-considerable variation
-uniocular or multilocular
-flecks of calcium ("dirven snow")
-can be radiolucent
-50% associated with unerupted tooth
-root resorption common

Front 47

Calcifying epithelial odontogenic tumor (pindborg)
microscopic features

Back 47

-considerable variation
-polyhedral epithelial cells
-intercellular bridges often prominent
-cementum-like lamellar calcifications
-homogeneous eosinophilic substance

Front 48

Calcifying Epithelial Odontogenic Tumor (pindborg)
Treatment and Prognosis

Back 48

-slow growth, locally invasive
-no metastic potential
-few cases w/long term follow up
-recurrence rate 14%
-complete, conservative removal

Front 49

Mixed Odontogenic Tumors

Back 49

1. Adenomatoid odontogenic tumor
2. ameloblastic fibroma
3. ameloblastic fibro-odontoma
4. ameloblastic fibrosarcoma
5. odontoameloblastoma (ameloblastic odontoma)
6. compound odontoma
7. complex odontoma

Front 50

Adenomatoid Odontogenic Tumor (AOT)

Back 50

-location in anterior maxilla
-asymptomatic radiolucency with Radioopaque flecks
-around the crown of impacted canines
-Histo: whorled masses of ondontogenic epithelium which form duct-like structures
-foci of calcification
-nuclei of the cuboidal or columnar cells are polarized away from the duct-like central areas

Front 51

Adenomatoid Odontogenic Tumor facts (AOT)

Back 51

-affects younger patients: two thirds are 10-19
-anterior jaws-usually maxilla
-in 75% of cases, the tumor presents as a circumscribed RL, usually around the crown of an impacted tooth, most often a canine

Front 52

AOT additional Histo

Back 52

-amorphous eosinophilic material may represent amyloid
-central area of cavitation where tooth crown was located

Front 53

Compound Odontoma

Back 53

-Age: 10-20 years
-Location: anterior maxilla
-Clinical: Asymmetrical eruption pattern
-Radiograph: <1 cm radiopacity in tooth-bearing area
-Gross appearance: Multiple "toothlets"
-Histo: Regular enamel, dentin an dpulp
-Tx: conservative removal

Front 54

Complex Odontoma

Back 54

-Age: 10-20 years
-Location: posterior mandible
-Clinical: eruption asymmetry
-Radiograph: Irregular radiopacity
-Haphazard deposition of enamel, dentin, pulp-like tissue, often surrounded by odontogenic epithelium
-Tx: conservative removal

Front 55

Ameloblastic fibroma

Back 55

-Age <20 years
-Location: Mandible (molar/premolar area)
-clinical: painless swelling
-Radiographic: circumscribed radiolucency
-Histology: Pulp-like immature stroma with islands of ameloblastic epithelium
-Tx: through conservative surgical removal

Front 56

Ameloblastic fibro-odontoma

Back 56

-age <20 years
-locations: posterior jaws, more frequently the mandible
-Clinical: painless swelling
-Radiographic: Circumscribed RL containing "spiky" radiopacities associated with the crown of an impacted tooth
-Histo: that of ameloblastic fibroma plus odontoma
-Tx: thorough conservative surgical removal

Front 57

Two exceptions to posterior mandible rule

Back 57

-AOT and Compound Odontoma- these are both usually found in the anterior maxilla as oppposed to the posterior mandible

Front 58

Odontogenic Tumors of ectomesenchyme

Back 58

-Odontogenic Fibroma
1. simple
2. WHO type
-Granular cell odontogenic tumor
-odontogenic myxoma
-cementoblastom

Front 59

odontogenic fibroma WHO type

Back 59

-45% of lesions in maxilla (in maxilla, the tumors are located more anteriorly)
-mandibular tumors are usually posterior to the first molar
-Radiolucent lesions
-Histo: dense collagen with interspersed odontogenic epithelial rests and small cementum-like calcifications or dentinoid

Front 60

HPVs

Back 60

-double stranded DNA viruses of the papovavirus subgroup A
-they are capable of integrating with the host cell DNA or may exist episomally within the affected cell
-over 100 known HPV subtypes

Front 61

Benign Oral Epithelial Lesions related to HPV infection

Back 61

-squamous papilloma
-condyloma acuminatum
-verruca vulgaris
-focal epithelial hyperplasia

Front 62

Relationship of Specific Viral Subtypes to Specific Lesions

Back 62

-squamous papilloma 6,11
-condyloma acuminatum 6,11, 16,18
-verruca vulgaris 2,4,40
-focal epithelial hyperplasia 13, 32

Front 63

Squamous Papilloma

Back 63

-papillary projections of any shape
-hyperparakeratosis
-acanthosis
-mild basilar hyperplasia and scattered mitotic figures
-mild chronic inflammatory cell infiltrate in connective tissue

Front 64

Verruca vulagris

Back 64

-autoinnoculation is a common type of spread
-usually in children
-spreads most commonly to oral mucossa from hands

Front 65

Verruca vulgaris

Back 65

-autoinnoculation is a common type of spread (people try to smash it)
-usually in children
-spreads most commonly to oral mucosa from hands

Front 66

Verruca vulgaris histology

Back 66

-hyperorthokeratosis
-hypergnaulosis
-koilocytes in superficial spinous layer
-convergence of rete ridges toward center

Front 67

verruca vulgaris treatment

Back 67

-conservative excision
-cryotherapy
-keratinolytic agents
-two thirds spontaneously disappear within two years

Front 68

Condyloma acuminatum

Back 68

-20% of STD's
-genital, perianal, laryngeal, oral
-sessile, pink, short, blunt, papillary projections
-labial mucosa, soft palate, lingual frenum and uvula are common locations

Front 69

Focal Epithelial Hyperplasia (heck's disease) Histology

Back 69

-slight papillary appearance
-marked acanthosis
-broad rete ridges
-mitosoid or mitotic cells in spinous layer

Front 70

Focal epithelial hyperplaisa (heck's disease) treatment

Back 70

-conservative excisions
-spontaneous regression has been reported

Front 71

Verruciform xanthoma

Back 71

-a hyperplastic condition of the epithelium with a characteristic accumulation of lipid laden histiocytes with the connective tissue
-etiology unknown, although NOT associated with HPV
-may be due to localized epithelium trauma

Front 72

Verruciform xanthoma facts

Back 72

-age: 40-70 years
-Sex: female predilection 2:1
-sites: gingiva and alveolar mucosa are most common
-Clinical features: Painless, sessile, well-demarcated mass with a roughened surface. Color may vary from white to yellowish to red.

Front 73

Verruciform xanthoma treatment

Back 73

-simple excision
-prognosis: excellent
-caveat: two cases have been reported where a VX was associated with a squamous cell carcinoma or carcinoma in situ

Front 74

Keratoacanthoma ("self-healing carcinoma")

Back 74

-Etiology: Sun damage and HPV (36,37)
-Clinical: On sun-exposed skin in patients over 45 years of age
-Firm, non-tender, well-demarcated nodule with a central keratin plug that is yellowish, brown or black with a verruciform surface

Front 75

Keratoacanthoma

Back 75

-will regress spontaneously with scarring
-since it looks like cancer should one wait to see whether it regresses? NO
- most frequently located on the vermillion border at junction of vermilion and the skin
-rapid enlargement occurs to 1-2 cm within 6 weeks
-lesions regress 6-12 months from onset

Front 76

Keratoacanthoma Histiology

Back 76

-surface epithelium at lateral edge is normal
-hyperparakeratotic verruciform stratified squamous epithelium centrally with broad bands of epithelium growing downward.
-margins are constricted at the surface to give an "ice-tong" effect.
-pronounced chronic inflammatory response which demarcates the lesion
-lesion is said to be "crater-like"

Front 77

HPV detection

Back 77

-immunohistochemistry
-in situ hybridization
-polymerase chain reaction

Front 78

High risk HPV's

Back 78

-16 and 18
-have been associated with uterine cervical, anogenital and oropharyngeal cancers
-GARDASIL vaccine is now available in the US for HPV 6,11, 16 and 18 targets very young women

Front 79

Premalignant and malignant lesions related to infection with HPV

Back 79

-koilocytic dysplasia
-verrucous carcinoma
-squamous carcinoma

Front 80

Squamous cell carcinoma of the anterior 2/3s of the oral cavity =

Back 80

much less likely to be due to HPV

Front 81

Verrucous carcinoma

Back 81

-long been related to smokeless tobacco, but can also harbor HPV
-presense of verrucous carcinoma in genital regions suggests an etiologic role for HPV

Front 82

Proliferative Verrucous Leukoplakia (PVL)

Back 82

1. assoicated with HPV
2. predominant in females
3. progresses to SCC

Front 83

Oral Melanotic Macule

Back 83

Etiology: Possibly trauma
Age: avg is 43
sex: femal predilection 2:1
site: vermilion border, buccal mucosa, gingiva and palate

Front 84

Oral melanotic Macule Histiology

Back 84

-Increased melanin in the basal layer
-melanophages in the connective tissue
-epithelium is normal

Front 85

Oral melanotic Macule treatmetn

Back 85

-should excise in order to rule out melanoma.cannot tell the difference on clinical appearance alone with early lesion

Front 86

Melanotic Nevus

Back 86

-begins to develop in childhood and most are present by age 35
-clinical appearance: localized brown to blue to black flat or raised non-enlarging lesions, most frequent on palate or maxillary gingiva
-not common intraorally, compared to the skin

Front 87

Melanotic Nevus types:

Back 87

Intramucosal
compound
junctional
blue

Front 88

Melanotic Nevus Histo

Back 88

-small rounded cells with benign nuclei and varying amounts of melanin in the cytoplasm lying singly, either at the junction between the epithelium and th connective tissue or entirely within the connective tissue
-blue nevi have spindle shaped nuvus cells
-nevus cells arise from the neural crest during development

Front 89

Carcinoma in Situ

Back 89

-top to bottom cellular abnormality
-most common as erythroplakia, clinically
-CIS in the oral cavity and pharynx will appear primariliy on non-keratinizing stratified squamous epithelium
-very curable because invasion has not occurred

Front 90

oral cancer facts

Back 90

-1 person dies every hour from oral cancer
-4 people per hour are diagnosed with head and neck cancer

Front 91

Verrucous carcinoma

Back 91

-associated with topical tobacco use (snuff dippers cancer)
-considered a low grade variant of SCC
-slow growing
-invades as a moving front
-associated with HPV 16,18,2,32
- up to 20% have been assoicated with conventional squamous cell carcinoma

Front 92

Dysplastic nevus

Back 92

-one considered to be premalignant

Front 93

leukoplakia

Back 93

-a white patch that cannot rub off and that cannot be identified as any other lesion
-this is clinical description only is NOT A diagnosis

Front 94

Types of Odontogenic Cysts

Back 94

-Radicular Cyst (periapical cyst, apical periodontal cyst)
-Dentigerous cyst (follicular cyst)
-Eruption Cyst (eruption hematoma
-lateral periodontal cyst
-gingival cyst of the adult
-ginigival cysts of the newborn (Epstein pearls, Bohn's nodules_
-Primordial cyst
-Odontogenic keratocyst
-Calcifying odontogenic cyst (Gorlin cyst & keratinizing and calcifying odontogenic cyst)

Front 95

Types of Fissural Cysts

Back 95

-nasopalatine duct cyst (incisive canal cyst)
-median palatal cyst (median palatine cyst)
-globulomaxillary cyst ( Avoid use of this term, no longer considered a TRUE fissural cyst)

Front 96

Types of Soft Tissue Developmental Cysts

Back 96

-Oral/lymphoepthelial cyst
-Branchial cleft cyst (lymphoepithelial cyst)
-Thyroglossal duct cyst

Front 97

Types of Pseudocysts

Back 97

-Aneurysmal bone cyst
-Traumatic bone cyst (unicameral bone cyst, solitary bone cyst, simple bone cyst, hemorrhagic bone cyst)
-Stafne bone defect (static bone cyst, lingual mandibular salivary gland depression)
-Mucocele (mucous extravasation or retention phenomenon)
-Ranula (retention cyst)

Front 98

Periapical lesions that appear radiographically as cysts

Back 98

-Dental granuloma (periapical granuloma)
-apical scar

Front 99

Radicular Cyst: Age/Sex prevalence, clinical features,

Back 99

-odontogenic
-aka periapical cyst or apical periodontal cyst
-Age/Sex: any age, M=F
-Clinical: either jaw, esp. in anterior maxilla at apex of non-vital teeth, may be painful esp. to percussion. May expand bone or erode cortex.
-Radiograph: Radiolucent compromising lamina dura and periodontal space.
-Cannot distinguish radiographically from dental granuloma

Front 100

Radicular Cyst: Histology, treatment, prognosis

Back 100

-Histology: cyst lined by stratified squamous epithelium, surrounded by chronic inflammation
-Treatment: endodontic therapy and apical surgery or extraction and apical curettage
-Prognosis: Good

Front 101

Dentigerous Cyst: Age/Sex, Clinical

Back 101

- aka follicular cyst
-Age/Sex: usually young adults <15yrs, M=F
-Clinical: impacted mandibular 3rd molars most often, followed by maxillary 3rd molars, then maxillary cuspids. Circumscribed radiolucency around crown of unerupted tooth. May result in jaw expansion.

Front 102

Dentigerous Cyst: Histology, Treatment, prognosis

Back 102

-Histology: cyst lining of squamous epithelium may be hyperplastic. Surrounding fibrous connective tissue contains islands of odontogenic epithelium.
-Treatment: complete removal
-Prognosis: good but follow patient, cyst may be source of odontogenic tumor or pathologic fracture.

Front 103

Eruption Cyst: Age/Sex, Clinical

Back 103

-aka eruption hematoma
-Age/Sex: mainly in children, M=F
-Clinical: over erupting teeth, soft, dome-like often red lesion; radiograph shows normal erupting tooth.

Front 104

Eruption Cyst: Histology, Treatment, Prognosis

Back 104

-Histology: Cyst-like lesion filled with sero-sanginous fluid rimmed by epithelium
-Treatment: no treatment, or conservatively remove overlying tissue
-Prognosis: Excellent

Front 105

Lateral Periodontal Cyst: Age/Sex, Clinical

Back 105

-may arise from rest of the dental lamina
-Age/Sex: any age, M=F
-Clinical: Mandible>maxilla, mandibular and maxillary premolar and cuspid areas; teeth vital. Usually, asymptomatic; occasionally painless swelling; radiographically a well circumscribed radiolucency on lateral surface of a tooth; may be multiloculated (botryoid odontogenic cyst)

Front 106

Lateral periodontal Cyst: Histology, Treatment, Prognosis

Back 106

-Histology: Cyst lined by thin epithelium with occasional focal thickenings with clear cells. There is no inflammation in the cyst wall
-Treatment: Complete removal
-Prognosis: Excellent, recurrence unlikely

Front 107

Gingival Cyst of Adult: Age/sex, Clinical

Back 107

-arises from rests of the dental lamina
-Age/Sex: adults, M=F
-Clinical: mandibular premolar region in soft tissue. Soft freely movable, painless mass. May erode cortical bone and show shadow on radiograph.

Front 108

Gingival Cyst of Adult: Histology,Treatment, Prognosis

Back 108

-Histology: Same a lateral periodontal, but located beneath the mucosal epithelium within the soft tissue
-Treatment: complete removal
-Prognosis: excellent recurrence unlikely

Front 109

Gingival Cysts of the Newborn: Age/Sex, Clinical

Back 109

-includes epstein's pearls, Bohns nodules
-Age/Sex: newborn, M=F
-Clinical: Superficial white papules on the alveolar mucosa of infants (GCN) the midline of the palate (EP) or the lateral hard and soft palate (BN)

Front 110

Gingival cysts of Newborn: Histology, Treatment, prognosis

Back 110

-Histology: cyst lined by parakeratotic epithelium with central keratinaceous debris
-Treatment: no tx, cysts involute as infant grows
-Prognosis: Excellent

Front 111

Primordial Cyst: Age/Sex, Clinical

Back 111

-a cyst which develops where a tooth would have formed
-Age/Sex: any age, but usually adults. M=F
-Clinical: Mandible>maxilla, third molar region most often

Front 112

Primordial Cyst: Histology, Treatment, prognosis

Back 112

-Histology: cyst lining of stratified squamous epithelium that is often keratinized. Fibrous connective tissue usually not inflamed. Does not have basal layer palisading.
-Treatment: complete removal
-Prognosis: Good but follow patients

Front 113

Odontogenic Keratocyst: Age/Sex, Clinical

Back 113

-Age/Sex: Majority between 10 and 40 years of age, but can occur at any age, M>F
-Clinical: 60%-80% in mandible usually posterior and ascending ramus, sharply circumscibed radiolucency, either unilocular or multilocular

Front 114

Odontogenic Keratocyst: Histology, Treatment, Prognosis

Back 114

-Histology: corrugated parakeratinized stratified squamous epithelial lining of 6-8 cells in thickness. Prominent hyperchromatism and palisading of the basal layer.
-Treatment: Complete removal
-Prognosis: Moderate to good, Carefully follow, recurrence rate high (33-50%) Rule out nevoid basal cell carcinoma syndrome.

Front 115

Carcinoma in situ

Back 115

-top to bottom cellular abnormality
-most common as an erythroplakia clinically (sublingual caruncles)
-CIS in the oral cavity and pharynx will appear primarily on non-keratinizing stratified squamous epithelium
-very curable because invasion has not occured

Front 116

Smokeless tobacco facts

Back 116

-1 person dies every hour from oral cancer
-4 people per hour are diagnosed with head and neck cancer

Front 117

Verrucous carcinoma

Back 117

-associated with topical tobacco use
-nicknamed "snuff dippers cancer"
-low grade variant of SCC
-slow-growing
-invades as a "moving front"
-associated with HPV 16,18,2,32
-up to 20% have been assoicated iwth conventional squamous cell carcinomas

Front 118

Nuvus

Back 118

-intradermal (intramucosal)
-compound
-unctional
-dysplastic nevus: one considered to be premalignant

Front 119

Melanoma

Back 119

-use ABCD crteria to determine need for biopsy

Front 120

Verruciform xanthoma

Back 120

-hyperplastic condition of epithelium with a characteristic accumulation of lipid-laden histiocytes within the connective tissue
-etiology unknown, although not associated with HPV
-may be due to localized epithelial trauma
-benign epithelial neoplasm
-40-70 years
-females 2:1
-gingiva and alveolar mucosa most commonly
-painless, sessile, well-demarcated mass with a roughened surface. color may vary from white to yellowish to red
-simple excision w/excellent prognosis
-2 cases reported wher a VX was associated with SCC or CIS

Front 121

keratoacanthoma ("self-healing carcinoma")

Back 121

-benign epithelial neoplasm
-sun damage and HPV (26,37)
-on sun-exposed skin in patients over 45 yrs
-firm, non-tender, well-demarcated nodule with a central keratin plug that is yellowish, brown or black with a verruciform surface
-regress spontaneously with scarring
- should biopsy because looks like cancer
-frequently located on vermilion border at the junction of the vermilion and the skin
-rapid enlargement occurs to 1-2 cm within 6 weeks
-lesions regress 6-12 months from onset

Front 122

keratoacanthoma Histology

Back 122

-surface epithelium at lateral edge appears normal.
-Hyperkeratotic verruciform stratified squamoust epithelium centrally with broad bands of epithelium growing downwards. Margins are constricted at the surface to give an "ice-ton" effect. Pronounced chronic inflamatory response which demarcates the lesion. Lesion is said to be "crater-like"

Front 123

Oral Melanotic Macule (focal melanosis)

Back 123

-possibley from traume
-avg age is 43
-female 2:1
-should excise in order to rule melanoma. cannot tell difference on clinical appearance alone

Front 124

Oral Melanotic Macule Histology

Back 124

-increased melanin in the basal layer. Melanophages in the connective tissue. Epithelium is normal.

Front 125

Melanocytic nevus

Back 125

-begins to develop in chilhood nd most present by age 35
-localized brown to blue to black flat or raised non-enlargin lesions, most frequent on plalate or maxilary gingiva
-not common intraorally, compared to the skin
types: intramucosal, compound, junctional, blue

Front 126

Melanocytic Nevus histology

Back 126

-small rounded cells with benign nuclei and varying amounts of melanin in the cytoplasm lying singly or in theques, either at junction between the epithelium and the connective tissue or entirely within the connective tissue
-blue nevi have spindle shaped nevus cells
-nevus cells arise from the neural crest during development
-intramucosal nevus has no junctional activity

Front 127

Leukoplakia

Back 127

-a white patch that cannot rub off and that cannot be identified as any other lesion
-clinical description only Is NOT A DIAGNOSIS

Front 128

Oral and Pharyngeal Cancer

Back 128

-6th leading sie globally
-2nd leading site in men in southeast Asia
-31,000 new cases each year in USA
-4th leading cancer in black men
-7th leading cancer in white men
-9,000 deaths each year
-90% SCC
-90% over 45 years of age

Front 129

Oral cancers can resemble benign lesions

Back 129

-malignancies initially presumed to be benign lesions can cause delays in diagnosis

Front 130

Advanced Cancers: tongue and mouth floor

Back 130

-patients used tobacco and drank alcohol
-diagnosis delayed more than five months
-agressive treatment: surgery & radiation
-patients survived less than six months

Front 131

Diagnosis

Back 131

-incisional biopsy (deifnitive diagnosis)
-adjunctive techniques
-toluidine blue (vital stain)
-chemiluminescence (vizlite)
-brush biopsy

Front 132

Toluidine Blue Mechanisms

Back 132

-binds to DNA and sulfated mucopolysachharides
-both high in malignant and dysplastic cells
-electrical potential of mitochondrial membranes
-negative charged membranes atract dye and are high in malignant and dysplastic cells
-technique: rinse, apply 1% toluidine blue, rinse, apply 1% acetic acid, rinse

Front 133

Chemiluminescnece (ViziLite)

Back 133

-low energy, low wave length light (430-580 nm)
-pretreat epithelium with 1% acetic acid
-dehydrates cytoplasm; cells more dense
-dysplastic and malignant cells of squamous epithelium of the cervix appear as "acetowhite"

Front 134

Brush Biopsy Technique

Back 134

-description analysis of cells representing full thickness of stratified squamous epithelium
-topical or local anesthesia is not required- minimal or no pain
-slightly moisten the biopsy brush with water or the patient's saliva if the lesion is dry
-the flat surface or cylindrical edge of the biopsy brush is placed against the surface of the lesion
-apply firm pressure against the surface of the lesion while rotating 5-10 times
-pink tissue or micro-bleeding indicates that the brush has penetrated to the desired depth, the basement membrane

Front 135

Brush biopsy report

Back 135

-negative: no cellular abnormalities
-positive: definitive cellular evidence or epithelial dysplasia or carcinoma
-atypical: abnormal epithelial changes warranting further investigation

Front 136

Early detection of oral cancer

Back 136

-clinical features: ulcer, lump, white and/or red changes
-may be with or without symptoms
-diagnosis: incisional biopsy adjunctive techniques

Front 137

oral Squamous carcinomas: problems in early detection

Back 137

-squamous cell carcinomas account for more than 90% of oral cancers
-these carcinomas can resemble numerous benign lesions

Front 138

Histopathology

Back 138

-more than 90% of oral cancers are SCC
-normal histology reflects regulated maturation of epithelial cells
-dysplasia reflects discrepancy in maturation
-SCC reflects invasion of connective tissue

Front 139

Precancerous Lesions

Back 139

-leukoplakia, erythroplakia, erythroplakia
-recognizing and treating these lesions with a risk for malignant transformation may prevent some oral cancers from occuring
-risks of different clinical forms
-Histopathology: hyperkeratosis, dysplasia
-management: surgical

Front 140

leukoplakia forms

Back 140

-homogeneous
-erythroleukoplaki
-dysplasia
-frictional
-candidal (cancer risk?)
-proliferative verrucous

Front 141

Proliferative Verrucous leukoplakia

Back 141

-diagnosis: clinical-microscopic
-women non smoking, elderly
-HPV 16
-malignant transformation >50%
-management: surgical, chemoprevention ineffective

Front 142

Importance of Follow up

Back 142

-all leukoplakias should be followed since even seemingly innocuous appearing lesions (asymptomatic hyperkeratosis) may transform to carcinoma with time

Front 143

Leukoplakia Control

Back 143

-remove irritant
-definitive diagnosis
-adjunctive techniques
-treatment, surgical, chemoprevention, follow-up
-re-biopsy if change in signs and/or symptoms

Front 144

Screening

Back 144

The application of a test or tests to people who are apparently free from the disease in question in order to sort out those who probably have the disease from those who probably do not

Front 145

Case-finding

Back 145

A diagnostic test or method that is applied to a patient who has abnormal signs and symptoms in order to establish a diagnosis and bring the patient to treatment

Front 146

Velscope

Back 146

hand held device that is based on the direct visualization of tissue fluorescence and the changes in fluorescence that result when abnormal tissue is present. Healthy tissue appears bright green and abnormal tissue will appear dark

Front 147

Trimera visual detection

Back 147

-Brilliant white- to detect lesion
-violet-normal blue, abnormal tissue dark
-amber/green- to show vascular pattern

Front 148

Problems with visual detection

Back 148

-velscope or vizilite or trimera
-brush biopsy
possible addition of up to $300 and 3 appointments vs 1 to final dx.

Front 149

Effects of involuntary smoking

Back 149

-25% greater than expected for women co-habitants
-35% greater than expected for men co-habitants
-20% greater than expected for non-smoking women exposed to smoking in the workplace

Front 150

Smoking during pregnancy

Back 150

increased incidence of:
-fetal death and stillbirth
-SIDS
-reduced fertility
-low birth weight
-placenta previa
-placenta abruption
-pre-term delivery

Front 151

Bidis

Back 151

-small brown cigarettes of tobacco hand-rolled in tendu leaf
-imported from india and southeast asia
-available in a variety of flavors
-produce higher tar and carbon monoxide levels
-nicotine concentration (21.2mg/g) significantly greater than traditional filtered cigarettes
-meta-analysis demonstrated increased risk for oral cancer for bidi smokers compared to non-smokers

Front 152

Clove cigarettes-Kretek

Back 152

-delivers significant quantities of nicotine and carbon monoxide
-taste, aromatic odor, and novelty contribute to appeal
-hemorrhagic pulmonary edema and aspiration pneumonia have been reported as a consequence of laryngeal anesthesia from eugenol

Front 153

Hookah Bars

Back 153

-increasingly popular social venue
-water cools the smoke and filters some of particulate matter
-nicotine levels rose from 1.11ng/ml at baseline to a mx of 60.31ng/ml 45 minutes

Front 154

Spit tobacco

Back 154

significant health risks
-numerous carcinogens
-nicotine addiction
-physical dependence
-withdrawal symptoms after abstinence

Front 155

Nitrosamines in Spit Tobacco

Back 155

Nitrosamines levels in spit tobacco are 10-100 times higher than the levels in the inhaled smoke from one cigarette and 20,000 times higher than the level allowed in food by the FDA and the department of Agriculture

Front 156

non-oral cancers associated with spit tobacco use

Back 156

-laryngeal cancer
-esophageal cancer
-colorectal cancer
-bladder cancer

Front 157

Health risks assoicated with cigar smoking

Back 157

-a cigar smoker's intake of nicotine and other toxins may exceed that of a typical cigarette smoker's
-cigar smoking is associated with increased risk of early death from coronary heart disease
-increased risk of lung cancer, oral cavity/pharyngeal cancer, laryngeal cancer, esophageal cancer

Front 158

Smoking and Periodontal disease

Back 158

-evidence suggests an immune mechanism exists whereby the effects of smoking on local and systemic immune factors may make the smoker more susceptible to bacterial infection
-substantial evidence also indicates that smoking impairs he regeneration and repair of periodontal tissues
-evidence is sufficient to infer a causal relationship between smoking and periodontitis

Front 159

Nicotine effects

Back 159

-increase in heart rate/blood pressure
-enhances information processing
-reduce fatigue
-sedative action
-reduces anxiety
-induces euphoria

Front 160

Criteria for substance dependence dx

Back 160

-development of tolerance
-withdrawal syndrome
-used in larger amounts or over a longer period than intended
-social, occupational, recreational activities reduced or given up
-use continues despite knowledge of problem

Front 161

The dental team a perfect match for tobacco cessation

Back 161

-22-40 yr old population more likely to have regular dental visits than physician visits and can benefit substantially from dental practice cessation efforts
-appeal of esthetics in conjunction with the practice of cosmetic dentistry is appealing
-recurrent follow-up visits provide opportunity
-#D1320- tobacco counseling for the control and prevention of oral disease
-tobacco prevention and cessation improves oral health

Front 162

clincal practice

Back 162

-identify, document and treat every tobacco user
-three types of behavioral conseling are effective: practial couseling, intra-tx, extra tx
-one or more pharmacoptherapies should be offered to all pts attempting to quit

Front 163

The 5A's

Back 163

-ask
-advise
-assess
-assist
-arrange (follow up)

Front 164

behavior change

Back 164

-individuals resist change
-faced with change, most people are not ready to act
-change is not a single step, but a process
-change may involve cyclic repetition
-intervention will be more effective if it is appropriate to he patient's readiness to change

Front 165

The 5Rs to enhance motivation for patients not ready to quit

Back 165

-Relevance
-Risks
-Rewards
-Roadblocks
-Repetition

Front 166

Is Weight gain a roadblock

Back 166

-fear of weight gain is cited as the reason for returning to smoking by 1/5 of male and 1/3 female smokers
-the average patient will gain 4-10lbs
-appropriate pharmacotherapy can help delay or decrease weight gain
-the average weight gain at 2 year tobacco-free anniversary is about 5lbs

Front 167

Assiting the Patient

Back 167

TRIPS
-Tirggers and challenges
-Reasons for wanting to quit
-Importance/confidence in ability to quit
-Pharmacotherapy and a quit date
-Social and emotional support

Front 168

1st line pharmacotherapies

Back 168

-safe and effective for tobacco dependence treatment, approved for use by US FDA
-NRT: gum, lozenge, patch, inahler, nasal spray
-buproprion SR

Front 169

factors to consider when Rx Pharmacotherapy

Back 169

-contraindications for individual patients
-patient preference
-patients previous experience with meds
-patient characteristics
co-morbidities (alcohol and drug use)
history of depression
concern about weight gain

Front 170

NRT

Back 170

-not recommended for use in adolescents or women who are pregnant or breastfeeding
-no evidence of increased CV risk with NRT except with acute disease
Major medical contraindications
-immediate myocardial infarction (<2 weeks)
-serious arrhythmia
-serious or worsening angina pectoris
-accelerated hypertension

Front 171

Nicotine Gum

Back 171

contraindicated in patients with TMJ disorders
-cause mouth soreness, hiccups, stomach upset, jaw aches

Front 172

Nicotine Lozenge

Back 172

-approved for OTC use in 2002
-delivers 25% more nicotine than equivalent gum dose
-nausea, headache, cough, heartburn, flatulence, hiccups
-have to be dissoved in mouth- 20-30 minutes

Front 173

Nicotine Transdermal Patch

Back 173

-lowest addiction potential of all NRTs
-delivers steady dose of nicotine
-available OTC and Rx
- headache, local skin reactions, vivid dreams

Front 174

Nicotine Oral Inhaler

Back 174

-Rx
-nicotine inhalation system
-replacs hand to mouth habit
Precautions
-asthma or chronic pulmonary disease
-recent MI, angina pectoris, serious arrhythmia or vasopastic disease
-severe renal impairment
-peptic ulcer disease
-hyperthyroidism, pheochromocytoma or insulin-dependent diabetes
most comon side effects
-mild and improve with time
-local irritation throat/mouth (40%)
-coughing (32%)
-rhinitis (23%)

Front 175

Nicotine Nasal Spray

Back 175

-Rx
-Highest addiction potential of all NRTs
Precautions
-reactive airway disease (asthma, bronchitis)
-chronic nasal disorders
-patients with a history of MI and/or angina pectoris, serious cardiac arrhthmias, or vasospastic disease
-hepatic or renal insufficiency due to reduced drug clearance
-use with caution in patients with endocrine disease as nicotine causes release of catecholamines by the adrenal medulla
-active peptic ulcer disease due to impaired healing
-accelerated hypertension
Side effects
-moderate to severe nasal irritation
-nasal congestion
transient change in sense of smell/taste

Front 176

Buproprion SR

Back 176

-marketed as Zyban for smoking cesation or Wellbutrin SR for depression
-doubles abstines rates vs. pacebo
-only non-nicotine medication approved by FDA for smoking cessation treatment
-mechanism: presumably blocks neural reuptake of dopamine and/or NE

Front 177

Zyban contraindications

Back 177

-seizure disorder or previous seizure
-current or prior diagnosis of anorexia or bullimia
-using an MAO inhibitor in previous 14 days
-using other medication containing buproprion
-patients undergoing abrupt discontinuation of alcohol or sedative (including benzodiazepines)
-other meds that lower the seizure threshold
side effects: insomnia and dry mouth

Front 178

Epulis Fissuratum

Back 178

-denture inury tumor
-official path dx: infammatory epithelial and fibrous hyperplasia (exophytic reactive lesions)

Front 179

Exophytic reactive lesions

Back 179

-epulis fissuratum
-inflammatory papillary hyperplasia
-pyogenic granuloma
-peripheral ossifying fibroma
-peripheral giant cell granuloma
-traumatic neuroma
-torus

Front 180

Traumatic Fibroma

Back 180

-focal fibrous hyperplasia
-buccal mucosa
-also on the tongue, but can be on any site exposed to trauma
-pink,firm,painless. has a smooth surface
-covering a stratified squamous epithelium
-connective tissue is composed of a nodule of excessive collagen
-little inflammation
-small vascular channels

Front 181

Giant cell fibroma

Back 181

-smooth surfaced pink papule
-gingiva, palate, lip, tongue
-characterized by unusual fibroblasts that are stellate with multiple nuclei. Collagen is often whorling or hyalinized
-treatment is excision. does not recur

Front 182

Retrocuspid Papillae

Back 182

-microscopically looks like giant cell fibroma
-normal anatomic variants

Front 183

lipoma

Back 183

-rare in the oral cavity
-non-ulcerated, painless
-surface is delicate and smooth and may exhibit small vessels
-soft and light yellow and most common on buccal mucosa

Front 184

Granular cell tumor

Back 184

-raised, non-ulcerated firm yellowish nodule
-most common on the tongue
-painless
-female predilection
-granular cells are positive for S-100 protein indicating tumor origin from the neural crest
-most distinctive microscopic feature is the psedoepitheliomatous hyperplasia (PEH), which can be mistaken for SCCA
-excisional biopsy can be transected at the deep margin and still not recur

Front 185

congenital epulis of the newborn

Back 185

-female predilection
-more common on maxillary gingiva
-soft, round exophytic mass attached to alveolar mucosa
-no pseudoepitheliomatous hyperplasia
-does not contain S-100 protein
-simple surgical removal

Front 186

neurofibroma

Back 186

-benign tumor of schwann cells
-painless, non-ulcerated
-intraoral lesions most commonly on tongue or palate
-smooth-surfaced, non-ulcerated
-look for signs of von Recklinghausen's disease
-usually a solitary tumor in adults
-patients with neurofibromatosis may die of sarcomas

Front 187

Neurilemmoma

Back 187

-circumscribed, smooth surfaced nodule
-pink
-location: tongue and palate are most comon
-encapsulated
-painless
-verocay body (histology)

Front 188

Multiple endocrine Neoplasia Syndrome III

Back 188

(Multiple Mucosl neuroma syndrome) (MEN III)
-multiple mucosal neuromas
-pheochromocytoma
-medullary carcinoma of the thyroid
-dentist can detect and save persons life

Front 189

Mesenchymal tumors

Back 189

-traumatic fibroma
-giant cell fibroma
-retrocusid papillae
-lipoma
-granular cell tumor
-congenital epulis of the newborn
-neurofibroma
-neurilemmoma
-multiple endocrine neoplasia syndrome III
-hemangioma
-lymphangioma
-cystic hygroma
-peripheral giant cell granuloma
-peripheral ossifying fibroma

Front 190

Calcifying odontogenic cyst Age/Sex, Clinical

Back 190

-aka Gorlin Cyst; keratinizing and calcifying odontogenic cyst
-Age/Sex: any age, second decade most often, either sex
-Clinical: May be cystic (86%) or solid (14%) intraosseous 87%, extraosseous 13% mandible>maxilla, may be associated with other odontogenic lesions and tumors; radiographically intraosseous COC's are seen as localized radiolucencies with varying amounts of radiodensities; extraoseous COC's are tender swellings

Front 191

Calcifying odontogenic cyst Histology, Treatment and Prognosis

Back 191

-Histology: Odontogenic epithelium; ghost cells adn dystrophic calcification. other odontogenic tissue/tumors may be found in association
-Treatment : complete conservative surgical removal
-Prognosis: Good. Recurrences are rare

Front 192

Nasopalatine duct cyst Age/Sex, Clinical

Back 192

- aka incisive canal cyst or if located in incisive papilla, cyst of palatine papilla
-most common non odontogenic cyst of the oral cavity
-Age/Sex: Adults, M=F
-Clinical: Mid-line of anterior maxilla; behind maxillary incisors, may be asymptomatic or may present as swelling with pt complaining of drainage. radiograph is heart shaped circumscribed radiolucency

Front 193

Nasopalatine Histology, Treatment, Prognosis

Back 193

-Histology: Cyst lined by repiratory and stratified squamous epithelium, surround connective tissues contains nerves mucous glands, thick walled vessels and perhaps cartilage
-Treatment: remove if symptomatic or >1.0cm in diameter radiographically
-Prognosis: good

Front 194

Median palatal cyst Age/Sex, Clinical

Back 194

-Age/Sex: Adults, M=F
-Clinical: midline of hard palate posterior to incisive canal. Firm or fluctuant swelling of midline of hard palate posterior to palatine papilla

Front 195

Medial palatal cyst Histology, Treatment, Prognosis

Back 195

-Histology: cystic space lined by squamous epithelium or respiratory epithelium surrounding connective tissue may contain chronic inflammatory cells
-Treatment: complete removal
-Prognosis : good

Front 196

Globulomaxillary Cyst Age/Sex, Clinical

Back 196

- No longer considered a true fissural cyst. AVOID USING THIS TERM
-Age/Sex: Adults M=F
-Clinical: swelling between maxillary lateral and cuspid. Roots are spread and there is a circumscibed radiolucency resembling an inverted pear

Front 197

Globulomaxillary Cyst Histology, Treatment, Prognosis

Back 197

-Histology: Lesion most often has the histology of one of the following: lateral radicular cyst, lateral periodontal cyst, OKC
-Treatment: complete removal
-Prognosis: Good, recurrence not unusual historically a developmental cyst but pathologically most like a primordial cyst

Front 198

Nasolabial Cyst Age/Sex, Clinical

Back 198

-aka Nasoalveolar cyst, Klestadt's cyst
-may arise from remnants of nasolacrimal duct or from fusion of maxillary medial nasal and lateral nasal processes
-Age/Sex: Adults, F>M by 3:1
-Clinical: soft tissue swelling in nasolabial fold, may elevate fold, may elevate floor of nostril. Radiograph shows occasional shadow (ill defined radiolucency) over area

Front 199

Nasolabial Cyst Histology, Treatment, Prognosis

Back 199

-Histology: Cyst lined by respiratory epithelium rimmed by inflamed fibrous connective tissue
-Treatment : complete removal via an intraoral approach , may be necessary to sacrifice a portion of the nasal mucosa
-Prognosis: Good

Front 200

Oral Lymphoepithelial cyst Age/Sex, Clinical

Back 200

-Age/Sex: Young adults
-Clinical: soft small .5-1cm, yellow, rounded, subepithelial mass in floor of mouth or in Waldeyer's ring

Front 201

Oral Lymphoepithelial cyst Histology, treatment, prognosis

Back 201

-Histology: Cystic Space usually filled with keratin rimmed by stratified squamous epithelium, surrounded by lymphoid tissue
-Treatment: conservative surgical removal
-Prognosis: excellent

Front 202

Branchial Cleft cyst Age/Sex, Clinical

Back 202

-aka lymphoepithelial cyst
-Age/Sex: young adults, ages 20-24
-Clinical: soft circumscribed swelling, 1-2cm in diameter in cervical chain, close to anterior border of SCM muscle. May be also seen in submandibular and parotid region

Front 203

Branchial Cleft Cyst Histology, treatment, prognosis

Back 203

-Histology: Cyst lined by stratified squamous epithelium or columnar epithelium surrounded by lymphoid tissue
-Treatment: Surgical removal with node
-Prognosis: Good, but there is a question of malignant potential of epithelium

Front 204

Thyroglossal duct cyst Age/Sex, Clinical

Back 204

-Age/Sex: most common in the first two decades of life
-Clinical: fluctuant, movable mass in midline of anterior neck. Elevates on swallowing or protruding of tongue. May be seen from base of tongue to base of neck. Size about 3cm. If high in neck or in tongue may cause dysphagia or choking. fi in lower neck draining sinus may be found in skin.

Front 205

Thyroglossal duct cyst Histology, Treatment, prognosis

Back 205

-Histology: Cyst lined by stratified squamous epithelium or columnar epithelium. In fibrous connective tissue wall, thyroid tissue may be seen.
-Treatment: Surgical removal via Sistrunk procedure
-Prognosis: good

Front 206

Sistrunk Procedure

Back 206

-for removal of thyroglossal duct cysts
-Cyst is remove in addition to the midline segment of the hyoid bone, and a generous portion of the muscular tissue along the entire thyroglossal tract

Front 207

Aneurysmal Bone cyst Age/Sex, Clinical

Back 207

-Age/Sex: <20 years, F>M
-Clinical: Mandible>maxilla; expansile, painless with radiolucency which may be soap bubble like, Blow out disention of contour of affected bone

Front 208

Aneurysmal bone cyst Histology, Treatment, prognosis

Back 208

-Histology: pools of blood rimmed by immature connective tissue containing giant cells, bone, hemosiderin. May be associated with other benign lesions
-Treatment: conservative complete surgical removal
-Prognosis: moderate, recurrence rates as high as 50%

Front 209

Traumatic bone cyst Age/Sex, Clinical

Back 209

-Aka univameral bone cyst, solitary bone cyst, simple bone cyst, hemorrhagic bone cyst
-Controversial etiology, trauma that doesnt cause fracture results in intraosseous hematoma which may liquefy and cause a cystic defect
-Age/Sex: <25 years, M>F
-Clinical: usually painless with unicystic radiolucency scalloping around tooth roots, mandible most often

Front 210

Traumatic bone cyst histology, treatment, prognosis

Back 210

-Histology : no epithelium, granulation tissue, viable bone
-Treatment: open surgically create fresh hemorrhage then close
-Prognosis: Good

Front 211

Stafne Bone cyst Age/Sex, Clinical

Back 211

-aka static bone cyst, lingual mandibular salivary gland depression
-Age/Sex: Adults, 80-90% of cases in males
-Clinical: asymptomatic sharply defined radiolucency usually in posterior mandible below the mandibular canal. Linugal cortex of mandible missing

Front 212

Stafne Bone Cyst Histology, treatment, prognosis

Back 212

-Histology: when surgically explored these reveal salivary gland or loose connective tisse
-Treatment: None; radiographic diagnosis is sufficient. Anterior lesions may be biopsied to r/o other pathoses
-Prognosis: excellent

Front 213

Mucocele Age/Sex, Clinical

Back 213

-aka mucous extravasation or retention phenomenon
-Age: any age; usually children and young adults. Most common swelling of lower lip
-Clinical: Most common location- lower lip but also on cheek tongue palate (very, rarely on upper lip) due to trauma to salivary gland duct. Are raised soft, painless translucent-often regress in size only to re-enlarge. Also occur in sinus. May appear translucent and bluish if superficial

Front 214

Mucocele Histology, Treatment, Prognosis

Back 214

-Histology: Cyst like space containing mucus and inflammatory cells, rimmed by granulation tissue . Salivary gland noted at base
-Treatment: surgical excision to include underlying salivary gland. In sinus (umbrella cyst) no treatment, as lesions regress spontaneously
-Prognosis: good, recurrence unlikely if associated gland is also removed

Front 215

Ranula Age/Sex, Clinical

Back 215

-aka retention cyst
-usually due to mucus spillage from the sublingual glands.
-Age/Sex any age, M=F
-Clinical: Associated with submandibular or sublingual glands Larger than mucocele in floor of mouth. Lies laeral to midline. When superficial, has bluish hue (like frod belly) but may be deep and penetrate mylohyoid muscle (plunging ranula)

Front 216

Ranular Histology, Treatment, Prognosis

Back 216

-Histology: similar to mucocele, deep or plunging ranula may appear like granulation tisue with many macrophages
-Treatment: complete excision but may marsupialize
-Prognosis: good, recurrrence rate is high with tx. by marzupialization

Front 217

Dental granuloma Age/Sex, Clinical

Back 217

-aka periapical granuloma
-Age/Sex: any age, M=F
-Clinical: same as radicular cyst

Front 218

Dental Granuloma Histology, treatment and prognosis

Back 218

-Histology: immature fibrous connective tissue with dense infiltrate of chronic inflammatory cells
-Treatment: Endodontic therapy
-Prognosis: good

Front 219

Apical Scar Age/Sex, Clinical

Back 219

-Age/Sex: Adults, M=F
-Clinical: Endodontically treated tooth with periapical surgery which has perforated and destroyed periosteum.Otherwise asymptomatic

Front 220

Apical Scar Histology, treatment, prognosis

Back 220

-Histology: Scar tissue
-treatment: none
-Prognosis: good

Front 221

Types of odontogenic tumors

Back 221

-Ameloblastoma
-malignant ameoloblastoma
-ameloblastic carcinoma
-Pindborg tumor
-Squamous odontogenic tumor
-clear cell odontogenic tumor

Front 222

Ameoloblastoma age/sex, clinical, signs symptoms

Back 222

- aka plexiform, acanthomatous, follicular, basaloid, granular subtypes)
-age/sex: 20-70 years,
-Clinical: mandible 85%: 3/4 in posterior,a unilocular or multilocular radiolucency
-Signs/Symptoms: painless; swelling

Front 223

Ameloblastoma Histology, treatment, prognosis

Back 223

-histology: strands, cords, sheets, islands of odontogenic epithelium showing features noted below: loosely arranged epithelial cells resembling the stellate reticulum of the enamel organ. Columnar peripheral cells resembling ameloblasts with reverse polarity of their nuclei
-treatment: wide excision
-Prognosis: fair to good

Front 224

Unicystic Ameloblastoma Age/Sex, Clinical, Signs/symptoms

Back 224

-age/sex: 10-30yrs, either sex
-Clinical: mandibular molar region, unilocular radiolucency
-signs/symptoms: failure of tooth eruption and discovery of pericoronal radiolucency

Front 225

Unicystic ameoloblastoma histology, treatment, prognosis

Back 225

-Histology: cystic lesion has rimming epthelium showing: a columnar epithelium with hyperchromatic nuclei and reveral of nuclear polarity; hyperplasia of cystic lining wtih loss of epithelial cohesion; budding of epithelium into adjacent connective tissue
Treatment: Curettage
-prognosis: good, rate of recurrence <20%

Front 226

Malignant Ameloblastoma Age/Sex, Clinical, Signs/Symptoms

Back 226

-Age/sex: 4-75yrs
-Clinical: lungs, may be seen on chest x-ray
-Signs/symptoms: often a symptomatic

Front 227

Malignant Ameloblastoma histology, treatment, prognosis

Back 227

-Histology: identical to benign jaw lesion
-treatment: wide excision
-Prognosis: guarded, 50% die of disease

Front 228

Ameloblastic Carcinoma age/sex, clinical, signs/symptoms

Back 228

-Age/Sex: 6th decade
-Clinical: mandible>maxilla, irregular jaw destruction
-signs/symptoms: Rapid jaw expansion

Front 229

Ameloblastic Carcinoma Histology, treatment

Back 229

-Histology: microscopic features of ameloblastoma and cytologic features of malignancy
-treatment: surgery, radiation, chemotherapy, similar to SCC

Front 230

Pindborg Tumor age/sex, clinical, signs/symptoms

Back 230

-aka CEOT, calcifying epithelial odontogenic tumor
-age/sex, 30-50yrs
-Clinical: posterior mandible, frequently associated with crown of impacted tooth. Loculated radiolucency with strands of calcifications of varying amounts
-Sign/symptoms: painless; swelling

Front 231

Pindborg Tumor Histology, treatment, prognosis

Back 231

-Histology: pleomorphic odontogenic epithelium, desmosomes, amyloid and calcification
-treatment: conservative surgical removal
-Prognosis : good

Front 232

Squamous odontogenic tumor age/sex, clinical, signs/symptoms

Back 232

-age/sex: 10-70yrs
-Clinical: throughout mandible and maxilla. may involve multiple sites most often. Triangular or semicircular radiolucencies with sclerotic borders associated with cervical portion of tooth root.
-Signs/symptoms: probably arises from rest of Malassez in periodontal ligament tooth mobility, vague pain; teeth sensitive to percussion

Front 233

Sqaumous odontogenic tumor histology, treatment, prognosis

Back 233

-Histology: islands of mature squamous epithelium without atypia, mature collagenized fibrous connective tissue stroma, foci of calcification of the epithelium, hyalinized eosinophilic structures
-Treatment: conservative surgical removal, maxillary lesions may be more widespread
-prognosis: good

Front 234

Clear Cell odontogenic tumor age/sex, clinical, signs/symptoms

Back 234

-Age/Sex: >50yrs
-Clinical: either jaw, unilocular or multilocular radiolucencies
-signs/symptoms: some complain of pain and swelling. Others are symptom free

Front 235

Clear cell odontogenic tumor histology, treatment, signs/symptoms

Back 235

-histology: nests of epithelial cells with clear cytoplasm separated by thin strands of hyalinized connective tissue
-treatment: radical surgery, work-up for metastatic disease
-prognosis: fair

Front 236

Types of mixed Epithelial-mesenchymal tumors

Back 236

-adenomatoid odontogenic tumor
-odontoma comound
-odontoma complex
-ameloblastic fibroma
-ameloblastic fibro-odontoma
-ameloblastic fibrosarcoma

Front 237

Types of odontogenic ectomesenchyme tumors

Back 237

-odontogenic fibroma
-granular cell odontongenic tumor
-odontogenic myxoma
-benign cementoblastoma

Front 238

Adenomatoid Odontogenic Tumor age/sex, clinical, signs/symptoms

Back 238

-aka AOT, OAT
-age/sex: <30yrs
-clinical anterior maxilla most often, circumscribed radiolucency around crown of impacted canine
-signs/symptoms: asymptomatic radiolucency

Front 239

Adenomatoid odontogenic tumor histology, treatment, prognosis

Back 239

-histology: whorled masses of odontogenic epithelium that form rosette-like or duct like structures. Nuclei are polarized away from the center of the duct. foci of calcification are observed.
-treatment: conservative surgical removal
-prognosis: excellent

Front 240

Odontoma Compound age/sex, clinical, signs/symptoms

Back 240

-age/sex: 10-20yrs
-clinical: anterior maxilla most often. usually <1cm tooth like radiopacity in tooth-bearing area
-Signs/symptoms: asymmetry in eruption pattern most often

Front 241

Odontoma compound histology, treatment, prognosis

Back 241

-histology: regular enamel, dentin, pulp, cementum
-treatment: conservative surgical removal
-prognosis; excellent

Front 242

Odontoma Complex age/sex, clinical, signs/symptoms

Back 242

-Age/sex: 10-20 yrs
-clinical: posterior mandible most often, irregular radiodensity
-signs/symptoms: eruption asymmetry

Front 243

Odontoma Complex histology, treatment, prognosis

Back 243

-histology: haphazard deposition of enamel, dentin,etc
-treatment: conservative surgical removal
-prognosis: excellent

Front 244

Ameloblastic Fibroma age/sex, clinical, signs/symptoms

Back 244

-aka soft odontoma
-Age/sex: <20yrs
-clinical: mandible, premolar/molar, circumscribed radiolucency
-signs/symptoms: painless swelling

Front 245

Ameloblastic Fibroma histology, treatment, prognosis

Back 245

-histology: pulp-like stroma with islands of ameloblastic epithelium
-treatment: complete surgical removal
-Prognosis: recurrence frequent

Front 246

Ameloblastic Fibro-odontoma age/sex, clinical, signs/symptoms

Back 246

-age/sex: <20yrs
-clinical: mand<maxilla, posterior jaw , circumscribd radiolucency containing radiopacity with crown of tooth
-signs/symptoms: slow growing asymmetry in eruption

Front 247

Ameloblastic fibro-odontoma histology, treatment, prognosis

Back 247

-histology: ameloblastic fibroma+odontoma
-treatment: complete surgical removal
-prognosis: good

Front 248

Ameloblastic fibrosarcoma age/sex, clinical,signs/symptoms

Back 248

-age/sex: M>F
-Clinical 80% in mandible, ill-defined destructive radiolucency
-signs/symptoms: pain + swelling with rapid clinical growth

Front 249

Ameloblastic fibrosarcoma histology, treatment, prognosis

Back 249

-histology: epithelial component like ameloblastic fibroma, mesenchymal component is cellular and pleomorphic with mitoses
-Treatment: radical surgical excision
-prognosis: guarded/

Front 250

Types of Tumors of Odontogenic Ectomesenchyme

Back 250

-odontogenic fibroma (simple type, WHO type Peripheral odontogenic fibroma
-granular cell odontogenic tumor
-odontogenic myxoma (myxoma, myxofibroma)
-Benign Cementoblastoma

Front 251

Odontogenic Fibroma Age/sex clinical, signs/symptoms

Back 251

-has a simple and a WHO type peripheral odontogenic fibroma (soft tissue counterpart)
-Age/sex 4-80 yrs
-Clinical: located in posterior mandibular = anterior maxilla, circumscribed radiolucency. WHO type may have radiopaque flecks.
-Signs/symptoms: painless, slow growth in bone

Front 252

Odontogenic Fibroma histology, treatment, prognosis

Back 252

-fibrous connective tissue with evenly spaced cuneiform cells
-WHO type has more prominent odontogenic epithelial rests and calcifications
-treatment: enucleation and curettage
-prognosis: good

Front 253

Granular Cell Odontogenic tumor Age/sex, clinical, signs/symptoms

Back 253

-age/sex: adults
-Clinical: located in premolar/molar region of mandible. Radiographically circumscribed radiolucency occasional calcifications
-Signs/Symptoms: asymptomatic radiolucency, occasional calcifications

Front 254

Granular Cell odontogenic histology, treatment, prognosis

Back 254

-histology: islands of odontogenic epithelium scattered among granular cells
-Treatment: curettage
-prognosis: good

Front 255

Odontogenic Myxoma Age/sex, clinical, signs/symptoms

Back 255

-aka myxoma, myxofibroma
-age/sex 50% between 10-30 yrs; rarely >50 yrs
-Clinical: located posterior of jaws; mandible=maxilla, circumscribed radiolucency uni or multilocular

Front 256

Odontogenic Myxoma histology, treatment, prognosis

Back 256

-histology: pulp-like juicy mucoid
-treatment surgery with cautery
-prognosis: good by 25% recurrence

Front 257

Benign Cementoblastoma age/sex, clinical, signs/symptoms

Back 257

-aka true tumor of cementum
-age/sex: 10-25 yrs
-clinical : located in mandible, molar-premolar region. circular radiolucency containing round radiopacity; eroding tooth roots
-signs/symptoms: swelling with or without pain

Front 258

Benign Cemtoblastoma histology, treatment, prognosis

Back 258

-histology: cellular, vascular stoma+ cementum
-treatment: surgical removal, usually involves extraction of the involved tooth
-prognosis: good but follow

Front 259

Papilloma age/sex, clinical

Back 259

-age/sex: 30-50 yrs, M=F
-Clinical: caused by human papillomavirus cauliflower-like exophytic painless, non indurated, soft variable duratio. Location: palate uvula, tongue, lip gingiva, buccal mucosa, floor of mouth; multiple in 4% of cases. Color varies with location: from keratinized surface-white from non-keratinized surface- red/pink. Large lesions, >2 cm, should consider condyloma acuminatum (HIV a consideration)

Front 260

Papilloma histology, treatment, prognosis

Back 260

-histology: papillary lesion of stratified squamous epithelium may be keratinized may see mitoses, supporting core of immature vascular fibrous connective tissue, similar to verruca vulgaris
-treatment: excision at base
-prognosis: excellent

Front 261

Verruca Vulgaris age/sex, clinical

Back 261

- aka common wart
-caused by HPV 2, 4, 40
-age/sex: any age, but frequent in children, M=F
-Clinical: caused by HPV, exophytic sessile, white, painless, non-indurated, usually <6 months duration. Search for other lesions on skin of fingers, etc.

Front 262

Verruca Vulgaris Histology, treatment, prognosis

Back 262

-histology: cauliflower like covered by keratotic stratified squamous epithelium; constricted at the base by a collarette.
-treatment: excision may even spontaneously regress
-prognosis: excellent

Front 263

Condyloma acuminatum age/sex, clinical

Back 263

-Caused by HPV 6,11,16,18
-age/sex: usually in teenagers and young adults. M>F
-clinical: sexually transmitted. appearance similar to papilloma

Front 264

Condyloma acuminatum histology, treatment, prognosis

Back 264

-Histology: similar to papilloma, may be larger and multiple
-Treatment: excision
-prognosis: recurrence common

Front 265

Focal epithelial hyperplasia age/sex, clinical

Back 265

- aka Heck's disease
-caused by HPV 13, 32
-age/sex: more often in childhood, M=F
-Clinical: multiple cauliflower-like lesions found in ppl living in crowded unsanitary conditions

Front 266

Focal epithelial hyperplasia histology, treatment, prognosis

Back 266

-histology: no hyperkeratosis, mitotic/mitosoid figures in spinous layer of epithelium
-treatment: excision may regress
-prognosis: excellent

Front 267

Verruciform Xanthoma age/sex, clinical

Back 267

- adult: 40-70 yrs, F>M by 2:1
-clinical: slightly raised, soft pebbly surfaced; <1.5cm; asymptomatic; white, yellow/white;red;pink. Most often on gingiva and alveolar ridge. Idiopathic

Front 268

Verruciform Xanthoma histology, treatment, prognosis

Back 268

-Histology: covered by warty keratinized stratified squamous epithelial; underlying connective tissue contains large foamy cells lying just beneath epithelium
-treatment: excision
-prognosis: excellent

Front 269

Types of benign oral epithelial lesions

Back 269

-papilloma
-verruca vulgaris
-condyloma acuminatum
-focal epithelial hyperplasia
-verruciform xanthoma
-oral melanotic macule
-melanocytic nevus
-keratocanthoma

Front 270

Oral melanotic macule age/sex, clinical

Back 270

-aka focal melanosis
-age/sex: F>M by 2:1, average age=43
-clinical: solitary oval lesion <7mm, vermillion border, buccal mucosa, gingiva, palate

Front 271

Oral melanotic macule histology, treatment, prognosis

Back 271

-histology: increased melanin in basal layer. Epithelium is normal. Melanin incontinence (melanophages in upper connective tissue)
-treatment: prophylactic excision
-prognosis: good

Front 272

Melanocytic nevus age/sex, clinical

Back 272

-aka nevocelluar nevus; mole
-age/sex: begins to develop in childhood and most are present before age 35. Involution in elderly
-clinical: localized pigmented brown to dark blue to black, flat or slightly raised, painless, static lesions, usually on palate maxillary gingiva

Front 273

Melanocytic nevus histology, treatment, prognosis:

Back 273

-histology: presence of small rounded cells with benign nuclei and variable amounts of melanin in cytoplasm lying singly or in theques (clusters) either at basal lamina (junctional nevus) or in underlying connective tissue (intramucosa) or both locations (compound) may present spindle shaped cells (blue nevi)
-treatment: prophylactic excision
-prognosis: good

Front 274

Keratocanthoma age/sex, clinical

Back 274

-aka: pseudoepitheliomatous hyperplasia (P.E.H)
-caused by HPV 26 or 37?
-age/sex: >45 years; M>X, 3:1
-clinical: rapidly growing (4-8 weeks), crusting nodule, 1-2cm in diameter, keratin-filled core, painless, usually on lip, will spontaneously regress with scarring

Front 275

Keratocanthoma histology, treatment, prognosis

Back 275

-histology: hyperparakeratotic stratified squamous epithelium, elevated at periphery with broad epithelial bands growing downward; margins at surface are constricted at surface are constricted in ice-tong effect cellular atypia noted; subepithelial chronic inflammation
-treatment: complete excision
-prognosis: good

Front 276

Types of Premalignant and malignant epithelial neoplasms

Back 276

-leukoplakia
-erythroplakia
- carcinoma in situ
-squamous cell carcinoma
-verrucous carcinoma
-proliferative verrucous leukoplakia
-basal cell carcinoma
-melanoma

Front 277

Leukoplakia age/sex, risk factors

Back 277

-a white plaque that doesnt wipe off and not recognizable as any other disease
-age/sex: > age 40, M>F
-risk/factors: tobacco usage and EtOH abuse increase risk of malignancy

Front 278

Leukoplakia histology, treatment, prognosis

Back 278

-histology: hyperorthokeratosis, hyperparakeratosis, acanthosis in most cases. dysplasia ; irregular epithelial maturation (loss of polarity, altered nuclear/cytoplasmic, ratios, pleomorphism, enlarged nucleoli, hyperchromatic nuclei, drop-shaped (bulbous) rete ridges.
-treatment: surgical removal
-prognosis: good tempered by side, change of habits, if untreated, 4% progress to cancer

Front 279

Erythroplakia age/sex, risk factors

Back 279

-erythroplasia (red plaquethat is not recognizable as any other disease, three types: homogenous, mixed speckled; granular
-age/sex: peak prevalence 65-74. M>F
-risk factors: locations; most often floor of mouth, ventral tongue, lower lip, palate, retromolar area

Front 280

Erythroplakia histology, treatment, prognosis

Back 280

-histology: 91% are dysplastic! See leukoplakia
-treatment: surgical removal
-prognosis: guarded., follow patient closely e.g. every 6 months

Front 281

Carcinoma in situ age/sex, risk factors

Back 281

-aka Bowen's disease, CIS, squamous cell CA grade 1/2
-A histologic diagnosis
-age/sex: M>F but sexual predominance decreasing
-risk factors: locations as above, tobacco and alcohol abuse contributory

Front 282

Carcinoma in site histology, treatment, prognosis

Back 282

-histology: marked dysplasia through entire thickness of mucosa but not yet invading
-treatment: surgical removal
-prognosis: guarded. Follow patient very closely, e.g every 3 months

Front 283

Squamous Cell carcinoma age/sex., risk factors

Back 283

-aka epidermoid carcinoma
-age/sex: usually >40 age group, M>F, but sexual predominance decreasing
-risks: tobacco, EtOH-synergizes with tobacco to create greater risk. Sunlight. Location floor of mouth, lateral tongue, lower lip

Front 284

Squamous cell carcinoma histology, treatment, prognosis

Back 284

-histology: microscopic features of dysplasia plus invasion of underlying lamina propria
-treatment: surgical removal, radiation, or chemotherapy
-prognosis: guarded; depending on location, lesion size, tempered by habit change

Front 285

Verrucous carcinoma age/sex, risk factors

Back 285

-aka Snuff Dipper's carcinoma
->55 years of age. Predominantly in males
-risk factors: directly related to snuff or chewing tobacco. Location: mucobuccal fold; alveolar ridge; palate

Front 286

Verrucous Carcinoma histology, treatment, prognosis

Back 286

-histology: exophytic, well differentiated, keratinized. Superficially invasive. Little dysplasia
-treatment: surgical removal preferred to radiation treatment
-prognosis: good if completely removed

Front 287

Proliferative Verrucous leukoplakia age/sex, risk factors

Back 287

-progressive clinical condition eventuating in SCC
-age/sex: F>M
-risk factor: tobacco may be a factor

Front 288

Proliferative Verrucous leukoplakia histology, treatment, prognosis

Back 288

-histology: varies from grade 1 through verroucous carcinoma, to papillary squamous cell carcinoma, to less differentiated squamous carcinoma
-treatment: surgery radiation
-prognosis: guarded; many die of the condition

Front 289

Basal Cell Carcinoma age/sex, risk factors

Back 289

-aka basal cell epithelioma
-age/sex: skin of adults;slowly enlarging long-standing ulcer
-risk factor: fair complexion, exposure to strong sunlight, sun-exposed skin of mid-face, upper>lower lip

Front 290

Basal Cell Carcinoma histology, treatment, prognosis

Back 290

-histology: invasive strands, islands of epithelium, peripheral cells columnar like basal layer of mucosa, inner cells polyhedral. Stroma proliferates with tumor in strands parallel to tumor surface
-treatment: eradicate lesions by surgery, cautery, radiation, cryotherapy
-prognosis: good

Front 291

Melanoma age/sex, risk factors

Back 291

-4 types: lentigo maligna, superficial spreading, nodular, acral lentiginous
-age/sex: 30-80 years of age. Increased risk associated with family history and increased sun exposure.
-risk factors: Long-standing pigmented spot (1-5 years). A,B,C,D. May be difficult to distinguish between other pigmentations and melanoma

Front 292

Melanoma histology, treatment, prognosis

Back 292

-histology: melanocytes growing toward 1 surface as well as penetrating deeply. Cellular atypia. Abnormal mitoses, lymphocytic infiltrate present
-treatment: aggressive surgery, supplemental immunotherapy
-prognosis: poor especially for intraoral lesions

Front 293

Types of Benign mesenchymal oral lesions

Back 293

-fibroma
-giant cell fibroma
-lipoma
-granular cell tumor
-congenital epulis of the newborn
-neurofibroma
-neurilemoma
-multiple mucosal neuroma syndrome

Front 294

Fibroma age/sex, clinical

Back 294

-aka focal fibrous hyperplasia, traumatic or irritation fibroma
-age/sex: any age, either sex
-clinical: firm, pink, exophytic nodule, found on tungue and cheek, most often but can be on any mucosal site of trauma

Front 295

Fibroma histology, treatment, prognosis

Back 295

-histology: tumor of densely collagenized fibrous connective tissue; moderately vascularized; little inflammation; covered by stratified squamous epithelium
-treatment: surgical removal
-prognosis: no recurrence if trauma is eliminated

Front 296

Giant Cell fibroma age/sex, clinical

Back 296

-Age/sex: any age, either sex
-clinical: soft pink, exophytic on gingiva, palate, lip tongue

Front 297

Giant Cell Fibroma histology, treatment, prognosis

Back 297

-histology: elevated mass of moderately collagenized fibrous connectivetissue with single or multi-nucleated fibroblasts showing a stellate appearance. Little inflammation . Covered by stratified squamous epithelium
-treatment: surgical removal
-prognosis: no recurrence

Front 298

Lipoma age/sex, clinical

Back 298

-age/sex: any age
-clinical: soft, light yellow (when superficial in loaction), non-ulcerated, painless, evenly rounded, raised mass, static or slowly growing, in cheek, tongue, floor of mouth; delicate smooth covering that exhibits small vessels

Front 299

Lipoma histology, treatment, prognosis

Back 299

-histology: lobules of mature fat in a loos fibrous stroma, a little inflammation; floats in fixative
-treatment: surgical removal
-prognosis: good

Front 300

Granular cell tumor age/sex, clinical

Back 300

-aka granular cell myoblastoma, granular cell schwannoma, granular cell neurofibroma
-age/sex: any age; 2:1 female pedilection
-clincial: slightly raised, non-ulcerated; small (<2cm), painless, firm nodules of varying duration; tongue most often, but also on palate, lips, gingiva

Front 301

Granular cell tumor histology, treatment, Prognosis

Back 301

-histology: fibrous connective tissue containing nests of large cells with granular cytoplasm prominent cell membranes and centrally placed, benign nuclei; covering stratified squamous epithelium may be hyperplastic; simulating squamous cell carcinoma (P.E.H)
-treatment: surgical removal
-prognosis: good

Front 302

Congenital Epulis of the newborn age/sex, clinical

Back 302

-aka congenital gingival granular cell tumor
- age/sex: newborn, female predilection
- clinical: maxillary gingiva > mandibular, 4:1 soft rounded, exophytic, non-ulcerated mass attached to alveolar ridge

Front 303

Congenital Epulis of the newborn histology, treatment, prognosis

Back 303

-histology: sheets of cells exactly like granular cells above with little stroma, no epithelial hyperplasia. S-100 negative
-treatment: surgical removal
-prognosis: good

Front 304

Neurofibroma age/sex, clinical

Back 304

-look for multiple lesions, consider von-recklinghausen's disease
-age/sex: solitary tumors most common in young adults
-clinical: firm solitary or multiple nodules, variable sized usually painless non ulcerated located on tongue most often, but no site immune, look for multiple lesions and cafe au lait spots on skin

Front 305

Neurfibroma histology, treatment, prognosis

Back 305

-histology: localized mass of interlacing Schwann cells and perineural fibroblasts that have spindled, round or comma shapes
-treatment: surgical removal
-prognosis: if V-R, disease is progressive with malignant potential

Front 306

Neurilemoma age/sex, clinical

Back 306

-aka Schwannoma
-age/sex: any age, but usually adults
-clinical: circumscribed firm nodule non-ulcerated usually painless, location, tongue most often but any location. Presents as circumscribed firm mass

Front 307

Neurilemoma histology, treatment, prognosis

Back 307

-histology: circumscribed mass with same microscopy as above (Antoni B tissue) plus oranoid collections of Schwann cells with solid center (verocay bodies/Antoni A tissue
-treatment: surgical removal
-prognosis: good

Front 308

Multiple mucosal neuroma syndrome age/sex, clinical

Back 308

-aka M.E.N III
- age/sex: young, neuromas may present by age 5
-clinical: tall persons with multiple nodules on anterior tongue, just below commissures of lips, cheeks, gingiva; painless, static, non-ulcerated

Front 309

Multiple Mucosal neuroma syndrome histology, treatment, prognosis

Back 309

-histology: neuromas with prominent perineurium, ganglion cells present
-treatment: remove thyroid or monitor calcitonin levels
-prognosis: carefully evaluate for pheochromocytoma, medullary carcinoma

Front 310

Sarcoma

Back 310

-a malignancy of connective tissue origin
-differs from a carcinoma by its mode of metastasis and growth rate

Front 311

Types of soft tissue sarcomas

Back 311

-fibrosarcoma
-fibrous histiocytoma
-liposarcoma
-neurofibrosarcoma
-angiosarcoma
-Kaposi sarcoma
-Leiomyosarcoma
-Rhabdomyosarcoma

Front 312

Fibrosarcoma

Back 312

-malignancy of fibroblasts
-young adults and children
-true fibrosarcomas are uncommon in the oral cavity

Front 313

Fibrous histiocytoma

Back 313

-malignancy with fibroblastic and histiocytic differentiation
-The most common soft tissue sarcoma in adults
-most common site : extremities
-rare in the head and neck
-very aggressive, high recurrence and metastatic rate

Front 314

Liposarcoma

Back 314

-malignancy of adipose tissue
-second most common soft tissue sarcoma of adults
-rare in the head and neck (neck is more common site)
-peak age group: 40-60

Front 315

Neurofibrosarcoma

Back 315

-principal malignancy of nerve sheath origin
-50% occur in patients with neurofibromatosis
-5 year survival rate with patients with neurofibromatosis is only 16%, for other it is 53%

Front 316

Angiosarcoma

Back 316

-a rare malignancy of vascular endothelium
-scalp and forehead are the most common head and neck sites

Front 317

Kaposi Sarcoma Etiology

Back 317

-propensity to develop in HIV+ individuals
-multicentricity
-geographic distribution
-patient population suggests a viral origin
-Human herpes virus -8 has been suggested as the most likely virus
-lesion most likely arises from endothelial cells with some evidence of lymphatic origin

Front 318

Kaposi Sarcoma Clinical types

Back 318

-classic: elderly jewish, slavic or italian males on lower extremities
-Endemic : african
-Iatrogenic Immunosuppression associated
-AIDS related

Front 319

Kaposi Sarcoma Histopath Stages

Back 319

-patch: proliferation of miniature vessels
-plaque: proliferation of vessels with spindle cells
-nodular: increased spindle cells to make a nodular tumor mass containing extravasated erythrocytes

Front 320

Kaposi Sarcoma treatment

Back 320

-systemic vinblastine
-intralesional vinblastine
-laser surgery

Front 321

Leiomyosarcoma

Back 321

-malignancy of smooth muscle cells
-middle aged to older adults
-rare in the oral cavity

Front 322

Rhabdomyosarcoma

Back 322

-the most common soft tissue sarcoma in children
-primarily occurs in first decade, 60% in males
-rapidly growing, painless infiltrating mass
-orbit>nasal cavity>nasopharynx
-palate=most frequent intraoral site
-in recent years the advent of multimodal chemotherapy has improved the prognosis drastically

Front 323

Oral cancer epidemiology

Back 323

-roughly 1,000,000 cases of new cancers are diagnosed annually in the US
-3-4% are cancers of the oral cavity and oropharynx
-if hypopharynx, nasopharynx, sinuses and major salivary glands are included--- 5%
-Cancer will develop in 1 person in every 4 and in two families of every three
-Between 57-60 million Americans now living will someday have cancer

Front 324

Oral Cancer Statistics

Back 324

-91% of oral malignancies are squamous cell carcinoma
-average age: >60
-more than 1/3 of americans are over 45
-the older age of oral cancer patients suggests that a time factor may be operating which involves predetermined processes in biochem/physio. of aging cells
-biologic processes include: DNA repair activity, enzymatic changes, metabolic factors, immunologic factors
-processes influenced by: chemicals, viruses, hormones, nutrients, physical irritants

Front 325

Predilections to oral cancer

Back 325

-site: posterior lateral tongue, lip cancer is down, possibly due to sunscreens
-sex: greater in males, ratios are changing though, was 6 male: 1 female in 1950, now 2 male: 1 female
-increase in smoking in women in last 20-30 yrs, age may also play some role
-over age 65, women exceed men by 45%

Front 326

Metastasis oral cancer

Back 326

-78% of posterior 1/3 tongue lesions had regional metastases at time of diagnosis
-the more posterior the lesion, the more likely metastasis is to occur

Front 327

Etiology and Predisposing Factors for cancer

Back 327

-immune competence and surveillance: down with age (older people are more likely to get cancer)
-additional problems which increase the likelihood of cancer (congenitally defective immune system, AIDS, radiation/chemotherapy)
-tobacco
-smokeless tobacco
-india
-genetics and ethnicity

Front 328

Tobacco

Back 328

-aromatic hydrocarbons(tars) are the most important carcinogens
-Nicotine: the habituating substance in tobacco
-filters can decrease harmful substances, but studies have shown them to be associated with increased smoking
-federal law requires 4 warnings to be rotated on cigarette packages

Front 329

Federal Warnings on Cigarette packages: Surgeon General's Warning

Back 329

- smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy
-Quitting smoking now greatly reduces serious risk to your health
-smoking by pregnant women may result in fetal injury, premature birth and lo birth weight
-cigarette smoke contains carbon monoxide

Front 330

Smokeless tobacco

Back 330

-question of threat for increased oral cancer in the future
-NC case study showed 50X the risk for cancer of the gingiva and buccal mucosa in habitual snuff dippers

Front 331

India (Risk and predisposing factor to cancer)

Back 331

-highest rate of oral cancer in the world
-50-65% of all cancers in this country are oral cancers
-different habits: use of betel nuts, slaked lime and spices in their tobacco
-reverse smoking- increased palatal cancer

Front 332

Genetics and Ethnicity

Back 332

-cancer in american blacks has increased at a greater rate than whites
-blacks have increased rates of oropharyngeal cancer compared to other racial groups
-cancer in nasopharynx: 20-30X more prevalent in chinese than whites (EBV association)

Front 333

Field cancerization phenomenon

Back 333

-if you've had one oral malignancy, your chances are greatly increased for another especially if your tobacco habits remained unchanged

Front 334

Morality (cancer)

Back 334

-death rate from cancer has risen uninterrupted for the past 6 decades
-oral cancer - 10,000 deaths yearly (2.2% of total)
-increased death rate of black males twice that of white males during the past 2 decades
-socioeconomic?, smoking/alcohol patterns?

Front 335

AIDS related oral malignancies

Back 335

-Kaposi's Sarcoma
-Squamous cell carcinoma
-Burkitt's Lymphoma

Front 336

Malignant Pleomorphic Adenoma age/sex, clinical

Back 336

-adenocarcinoma arising in pleomorphic adenoma malignant mixed tumor
-age/sex: >60's; F>M
-clinical: 7% long standing pleomorphic adenoma, sudden spurt of growth and pain

Front 337

Malignant Pleomorphic Adenoma pathology, treatment, prognosis

Back 337

-Pathology: pleomorphic adeonma plus area with malignant features eroding capsule
-treatment: aggressive surgery
-prognosis: guarded, 50% survive 2-3 years

Front 338

Low Grade Mucoepidermoid Carcinoma age/sex, clinical

Back 338

-aka mucoepidermoid tumor
-age/sex: adults M=F
-Clinical: slowly growing, painless, soft mass, may appear like a mucocele

Front 339

Low Grade Mucoepidermoid Carcinoma pathology, treatment, prognosis

Back 339

- pathology: four cell types: squamous epithelium, mucous cells, intermediate cells, clear cells
-treatment: complete surgical removal
-prognosis: good 90% survive 5 years

Front 340

High Grade Mucoepidermoid Carcinoma age/sex, clinical

Back 340

-age/sex: adults, M=F
-clinical: painful rapidly growing aggressive

Front 341

High Grade Mucoepidermoid Carcinoma pathology, treatment, prognosis

Back 341

-pathology: solid, cellular pleomorphism, squamous predominant, spreading widely
-treatment : aggressive surgery
-prognosis: poor; <10% survive 5 years

Front 342

Adenoid Cystic Carcinoma age/sex, clinical

Back 342

-aka adeonocystic carcinoma, cylindroma
-age/sex: 40-60 yrs, F>M
-clinical: palate, most common site; slowly growing, painful may be ulcerated may be freely movable

Front 343

Adenoid Cystic Carcinoma pathology, treatment, prognosis

Back 343

-pathology: small, uniform, basaloid cells, in a "cribform" or "swiss cheese" pattern involves nerves; may be solid; stroma may be hyalinezed; eosinophilic pools in cystic spaces
-treatment: aggressive surgery
-prognosis: short term good, long term poor

Front 344

Terminal Duct Cell carcinoma age/sex, clinical

Back 344

-aka polymorphous low grade adenocarcinoma
-age/sex: M=F, older adults
-clinical: always in intraoral, minor salivary glands

Front 345

Terminal Duct Cell Carcinoma pathology, treatment, prognosis

Back 345

-pathology: localized sheets of cells in middle of tumor with strands at periphery; larger cells, prominent cytoplasm; around nerves
-treatment: complete removal
-prognosis: good <10% metastasize

Front 346

Acinic cell carcinoma age/sex, clinical

Back 346

-age/sex: adults in 40's, F>M 2-3:1
-clinical: 2.5% in major glands; principally parotid; a long-standing " lump" usually painless

Front 347

Acinic Cell Carcinoma pathology, treatment, prognosis

Back 347

-pathology: serous cells with granular cytoplasm, clear cells in masses, lobules, small and large cystic spaces
-treatment: surgery
-prognosis: good but follow; 20 year survival 50%

Front 348

Adeno-Carcinoma Carcinoma age/sex, clinical

Back 348

-age/sex: adults in 60's , F>M
-clinical: 10% of salivary gland tumors; pain, poorly defined, rapidly growing of short duration

Front 349

Adeno-carcinoma Carcinoma pathology, treatment, prognosis

Back 349

-pathology: Sheets masses of anaplastic cells of ductal origin, ducts may be found
-treatment: aggressive surgery
-prognosis: poor