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GI Lecture 2
Diseases of the Mouth
68
Medical
Graduate
12/01/2010

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Cards

Term
Name the Developmental Disturbances
Definition

1. Peutz-Jeghers

2. Median Rhomboid Glossitis

3. Fissured Tongue

4. Benign Migratory Glossitis (BMG)

5. Tori

Term
Name 3 Reactive Lesions
Definition

1. Pyogenic Granuloma (Pregnancy tumor)

2. Peripheral Giant Cell Reparative Granuloma

3. Chronic Inflammatory Fibrous Hyperplasia

Term
Examples of Leukoplakia
Definition

1. White Sponge Nevus

2. Lichen Planus

3. Candidiasis

 

Term
Examples of Mucous Membrane Neoplasia
Definition

1. Squamous Cell Papilloma

2. Squamous Cell Carcinoma

3. Verrucous Carcinoma

Term
What are the 2 components of Peutz-Jeghers?
Definition

1. hyperpigmentation on oral and labial mucosa (due to increased melanin)

2. intestinal polyposis

Term
What kind of trait is Peutz-Jeghers?
Definition
Mendelian dominant
Term
What is Median Rhomboid Glossitis?
Definition
development of red color in diamond/rhomboid shape anterior to circumvallate papillae due to loss of filiform papillae of the tongue, NOT associated with inflammation
Term
Fissured Tongue
Definition
grooves on dorsum of tongue in 5% of older patients secondary to trauma or vitamin deficiency
Term
What is the management for fissured tongue?
Definition
Painless except for ulcer, but can treat with CLEANSING
Term
What genetic condition is fissured tongue associated with?
Definition
30% of patients have TRISOMY 21
Term
What is BMG (aka geographic tongue)?
Definition

-oral mucous analogue of psoriasis

-painless, multiple foci of desquamation of filiform papillae that have circular pattern, with red color and yellow border

-1-2% in young adults

-20% of patients with fissured tongue --> BMG

Term
What are Tori?
Definition

-benign protrusion of bone, covered by thin mucosa

-25% - in palate

-6-8% - in mandible

Term
What is the treatment for Tori?
Definition
No Rx, but should be removed before prostheses are placed
Term
What is the genetic inheritance pattern for Tori?
Definition
Mendelian Dominant
Term
What is a Reactive Lesion?
Definition

Results from injury during mastication to squamous mucosa --> hyperkeratosis + parakeratosis + acanthosis

 

These changes induce acute and chronic inflammation of the subepithelium

Term
What are the characteristics of pyogenic granuloma?
Definition
Painless, ulcerated lesion occurring as an exaggerated response to minor trauma on the interdental gingiva and in the oral cavity. 
Term
What kind of tissue can you find in a pyogenic granuloma?
Definition
well vascularized tissue full of inflammatory cells
Term
What patient population gets the same pathology as pyogenic granuloma and why?
Definition
Pregnant women due to hormonal changes in pregnancy
Term
What is the treatment for pyogenic granuloma?
Definition
EXCISION
Term
What are the characteristics of Peripheral Giant cell Reparative Granuloma?
Definition

-tumorfactive, non-neoplastic lesion of gingival/alveolar tissues secondary to trauma

-3-4cm vascular, red lesion

-increased number of multinucleated giant cells with chronic inflammation

Term
What is the demographic for Peripheral Giant Cell Reparative Granuloma?
Definition
females 2:1
Term
What is the treatment for Peripheral Giant Cell Reparative Granuloma?
Definition
EXCISION
Term
What are the characteristics of Chronic Inflammatory Fibrous Hyperplasia?
Definition

-MOST COMMON abnormality

-exophytic nodules of well collagenized CT on traumatized areas of oral mucosa (i.e. lateral tongue, buccal mucosa)

-AKA - fibroma, fibrous polyp, fibroepithelial lesion

 

Term
What other pathology is chronic inflammatory fibrous hyperplasia analogous to?
Definition
keloids
Term
What is the etiology of chronic inflammatory fibrous hyperplasia?
Definition
chronic irritation from rubbing from ill-fitting dentures against edge of oral mucosa
Term
What does the term leukoplakia mean?
Definition

white patch of oral mucosa that CANNOT be rubbed off

-usually genetic, inflammatory, premalignant or invasive malignant

Term
What is a White Sponge Nevus?
Definition
thick white spongy plaques anywhere on oral mucosa that show thickened epithelium with parakeratosis (nucleated stratum corneum)
Term
What is the pattern of inheritance for White Sponge Nevus?
Definition
Autosomal Domimant usually seen by puberty
Term
How do you confirm diagnosis for white Sponge Nevus?
Definition
history of familiar pattern and long duration + BIOPSY
Term
What is Lichen Planus?
Definition
mucocutaneous inflammatory disorder of unknown etiology that presents with scaly erythematous papules on skin
Term
What is the clinical presentation of Lichen Planus?
Definition

-fine lacework of white hyperkeratotic papules (Wickham's Striae)

-ulcerations and bullous lesion may be seen

 

Term

What could cause Lichen Planus?

 

Definition
correlated with emotional strain, anxiety and STRESS
Term
How does Lichen Planus present histologically?
Definition

-hyperkeratinized

-acanthosis

-saw tooth rete peg

-liquefaction degeneration of basement membrane

-band-like chronic inflammatory infiltrate at junction of basal cells and superficial subepithelial tissues

 

Term
What can Lichen Planus become?
Definition
malignant degeneration into squamous cell cancer (controversial)
Term
What is the clinical presentation of Candidiasis?
Definition

-curd-like lesions which can be removed

-supprative exudates with hyphae

Term
What patient population has a high risk of having Candidiasis?
Definition

-Diabetes Mellitus

-Immunocompromised (i.e. AIDS)

-patients on antibiotics (disturbs balance of oral flora)

Term
What the clinical aspects of squamous cell papilloma?
Definition

-cauliflower like exophytic lesions on pedicle (mm in diameter)

-MOST COMMON benign epithelial neoplasm

Term
What are some histological findings of squamous cell papilloma?
Definition

-finger-like projections of normally maturing stratified squamous epithelium surrounding a central core of vascular CT

Term

What are some demographics for Squamous cell Carcinoma?

 

Definition

-90% of all oral cancers

-6% male; 2% female

-35% of all causes in India/Asia due to Betel Nut

-potentially have a 5 year survival

-occurs in males in 6th-8th decade of life

Term
What are the potential causes of Squamous Cell Carcinoma?
Definition

1. Tobacco

2. Alcohol

3. Trauma from broken dentition

4. HPV (if no h/o smoking/EtOH)

5. family history

6. Lichen Planus (malignant transformation)

Term
What are the clinical manifestations of Squamous Cell Carcinoma?
Definition

-early signs are innocuous (mucosal thickening, leukoplakia)

-advanced disease - exophytic, ulcerated lesion that is indurated at margins/base

 

Term

What does Squamous Cell Carcinoma look like under microscope?

 

Definition

-wide range in squamous cell that could be well-differentiated, showing keratin/intracellular bridging

-Grade I-IV

-neutrophils within keratinized pearl nests

Term
What do patients with Squamous Cell Carcinoma die of?
Definition

1. primary disease 

2. metastatic disease --> blood vessels or base of brain

3. due to intercurrent disease (bronchopneumonia)

Term
How does Squamous Cell Carcinoma metastasize?
Definition
via lymphatics to REGIONAL lymph nodes
Term
How can you treat Squamous Cell Carcinoma?
Definition

1. excise primary lesion via commando procedure (radical neck dissection)

2. RADIATION Therapy**

Term
What are the clinical aspects of Verrucous Carcinoma?
Definition

1. low grade papillary exophytic lesions

2. on alveolar, buccal, mucobuccal folds of elderly patients

3. M = F

Term
What could potentially cause verrucous carcinoma?
Definition
snuff in the Southeastern USA
Term
What does verrucous carcinoma appear as on microscopy?
Definition

papillary, acanthotic with deep penetration of enlarged rete pegs that show infiltration with minimal atypia

Term
What is the prognosis for patients with verrucous carcinoma?
Definition

better than invasive squamous cell carcinoma with minimal metastasis

Term
What is the treatment for verrucous carcinoma?
Definition
SURGERY (not radiation)
Term
[image]
Definition
Peutz Jeghers
Term
What are the potential complications of Peutz-Jeghers Syndrome?
Definition

1. intussuception of bowel --> necrosis

2. association with malignancies - breast, pancreas, lung

Term
[image]
Definition
medial rhomboid glossitis
Term
[image]
Definition
fissured tongue
Term
[image]
Definition
benign migratory glossitis
Term
[image]
Definition
tori
Term
[image]
Definition
pyogenic granuloma (pregnancy tumor)
Term
[image]
Definition
peripheral giant cell reparative granuloma
Term
[image]
Definition
white sponge nevus
Term
[image]
Definition
white sponge nevus
Term
[image]
Definition
Lichen Planus (metallic taste in mouth)
Term
Why does Lichen Planus present as a white lesion?
Definition

1. keratinization

2. thickening of stratum spinosum (acanthosis)

3. inflammatory infiltrate at junction

Term
[image]
Definition
candidiasis
Term
[image]
Definition
squamous cell papilloma
Term
[image]
Definition
squamous cell carcinoma
Term
[image]
Definition
verrucous carcinoma
Term
[image]
Definition
verrucous carcinoma histology
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