Leukoplaqia

"White Plaques"

 •Causes include use of tobacco products, alcoholism, and local irritation (cheek biting or malformed dentures) and HPV infection.

Squamous Cell Carcinoma frequenly involves what structures?

What would are the ratio for male to female?

Frequently involves tongue, followed by floor of mouth, palate, and buccal mucosa.

Male:Female ratio 2:1

Metasis lesions may take ____ to ____ to progress to invasive lesions.

What presentation does this have?

Months to Years

Neoplasms of Salivary Glands consists of less than ___ of human cancers.

65-85% arise from ______

10-15% of tumours of the ____ are malignant, but 40% in the _________

2%

Parotid Gland

Parotid

Submandibular

Pleomorphic Adenoma

(Mixed Tumor)

Pleomorphic Adeonomas have a clinical presentation of:

Where is it typically seen:

Microsopically shows a mixture of:

Pleomorphic Adenoma cells form:

What type of exposure may increase the risk?

In Infrrequent cases a carcinoma may arise can take the form of what?

Pleomorphic Adenoma if large enough may protrude into:

If the recurrent tumor is removed what nerve maybe sacrificed?

Where do Malignant Tumors Mucoepidermmoid Carcinomas Originate?

Most tumors are seen in who and affect who?

What types of foods could cause or increase the risk of cancers?

A Carcinogen found in the soil or food in highly endemic areas:

Smoked Foods

Nitrosamines

In Esophagus Pathology what portion involve the lower third:

     1. Polypoid, which projects into the lumen.

     2. Ulcerating, a crater-like lesion which bleeds.

     3. Infiltrating, in which the principal plane of the tumor growth is in the wall.

All Squamous Cell Carcinomas:

3. Infiltrating with aggressive carcinomas

Cancer of the mid-third metastisize to the:

PUD:

Breaks in muscosa of stomach and proximal duodenum are produced by action of:

Dudoenal ulcers have a predominat to what sex:

Gastric Ulcers is:

Identical twins have what percentage of concordance for PUD:

The risk of duodenal ulcers is about 30% higher in person with what blood type:

50%

Type O blood

All patients with duodenal ulcers and most gastric ulcers are:

Hypersecrtion of acid is present in many of what type of ulcer:

Gastric Acid secetors

Dudodenal Ulcers

1.  A superficial zone of fibrinopurulent exudate

2.  Necrotic tissue

3.  Granulation tissue

4.  Fibrotic tissue at the base of the ulcer, which exhibits variable degrees of chronic inflammation.

      1.  Hemorrhage:  the most common complication, occurring in up to 20% of pt’s.

       -In many cases, the bleeding is occult and the pt may manifest an iron-deficiency anemia, or as occult blood in the stools. (erodes into vein)

       -Massive life-threatening hemorrhage is a well-recognized danger in patients with active peptic ulcers. 

Commonly seen with duodenal ulcers, on anterior wall than gastric. 

     -Results in luminal contents freely escaping into the peritoneal cavity, and continue to be associated with a high mortality (10-40%)

     -Can also penetrate into the pancreas, liver, and greater omentum, with shock, bleeding and pain

Complications of PUD:

Malignant Transformation:

 Malignant transformation:  It is difficult to distinguish a cancer arising  in a preexisting gastric ulcer from an ulcerated primary carcinoma.

     -Malignant transformation of a duodenal ulcer is virtually unknown

     -Those cancers that do arise from preexisting gastric ulcers make up only 1%.

Stomach Cancer- Pathogenesis

Dietary factors in what large amounts can cause stomach cancer:

Stomach cancer is uncommon in what age group but has a sharp incidence in people over___.

Stomach Cancer - Pathogenesis

What strong heredity traits have been identified in most cases of gastric cancer, involving what blood type:

Atrophic Gastritis, Pernicious Anemia(antibodies to insintric factors)  Subtotal Gastrectomy, Gastric Adenomatous Polyps, and Helicobacter pylori.

What type of carcinoma accounts for 95% of malignant gastric tumors:

What portion of the stomach:

       1.  Polypoid (fungating) adenocarcinomas: accounts for one-third of advanced cancers.  It is a solid tumor that projects into the lumen.  The surface may be partially ulcerated, and the deeper tissue may or may not be infiltrated.

    2.  Ulcerating Adenocarcinoma:  constitutes another one-third and is visualized as a shallow ulcer of variable size with surrounding tissue that is firm, raised and nodular.  The lateral margins are irregular and the base is ragged.  This appearance is in contrast to the benign peptic ulcer, which exhibits punched-out margins and a smooth base.

    3.  Diffuse or Infiltrating Adenocarcinoma:  No true tumor mass is seen macroscopically, instead, the wall of the stomach is thickened and firm, and when the entire stomach is involved, the term “Linitis Plastica” (leather bottle stomach) is applied.  The invading tumor cells induce extensive fibrosis in the submucosa and muscularis, therefore, the entire wall is stiff and therefore does not stretch.

Stomach Carcinoma - Pathology

Tumor cells may be arrange in:

Carcino Embroynic Antigen (CEA) is increased in the blood of 1/4 of patient with:

The CEA is helpful in regards to:

Advanced Gastric Cancer.

Monitoring the course of metastatic disease. 

IBD affect:

Both diseases peak in:

the same populations, more common in whites than blacks, and are especially more common among E. European Jews.

3rd Decade

Have morphologic changes often indistinguishable from one another.

are diarrhea, abdominal pain, and weight loss, characterized by exacerbations and remissions.

(False Tumors) Due to Reddened, inflammed mucosa.

Inflammed mucosa is where malignant formation has a chance to occur.

Of the 95% of cases involve what type of tissue origin:

Tumors protrude into the lumen of the intestine and can be seen by:

Epithelial.

Endoscopy or X-ray with barium enema.

Tumors of the rectum can be reached by anal digital palpation.

     2.  Fat:  Presumably can be degraded to potential carcinogens during intestinal digestion, which acts on the intestinal epithelial cells.  Fat in the food also stimulates the release of bile, which is a source of intestinal carcinogens, presumably derived from degraded bile acids.

3.  Foods rich in refined carbohydrates: (and low in vegetable fibers) produce low volume waste.  Because colonic peristalsis depends on the volume of feces in the lumen, the transit time in the large intestines is prolonged and this allows for longer contact between the carcinogens in the intestinal contents and the intestinal mucosal cells.

Proposed that the epithelial cells undergo malignant transformation through the action of

Benign collection of normal cells and tissue that are indigenous to that area but within a tumor mass. 

•developmental abnormalities in which the normal components of the tissue aggregate in an abnormal manner.

Most are solitary, 1-3 cm, and are located in the rectum as lobulated, sessile lesions, that can become inflamed and ulcerated, giving symptoms of bleeding and rectal irritation

 •Histologically, they are composed of glands lined by normal epithelium with a well-differentiated stroma.

Tubular adenoma: the risk is about 20%

-Tubulovillous adenoma: the risk is 30-35%

-Villous adenoma: the risk is over 50%

1.  Their incidence increases with age.

 2.  They are more common in males (2:1)

 3.  They are more often multiple.

 4.  Seventy percent (70%)of the large polyps are located in the rectosigmoid area.

cuboidal epithelium with no obvious nuclear or cytoplasmic atypia.  Malignant transformation can be recognized by nuclear atypia, abnormal mitotic figures and the malignant glands are more crowded and show a back to back arrangement.

 •Defined as predominantly tubular tumors that appear villous on at least 25% of their surface.

BAD ONE:

 •Sessile, large, broad-based tumors, composed of epithelial cells aligned into elongated villi.

lined with a single cell type that does not show signs of differentiation.

Adeonocarcinoma of Rectosigmoid Colon likes to evade:

Patients have a constriction of rectus sigmoid will C/O:

Mucous and goes out and surrounds the colon.

Red blood, stool is thin and stringy pencil like.

Because of long transit time what would you expect blood in the stool to look like.

Extent of local invasion and the presence of lymph node metastasis (stages A to C) and distant visceral metastaes (stage D).

Similar to Dukes ( Stages A to D also) but has numeral subtypes based on the extent of tumor or lymp node metastasis.

Stage A:  Tumor confined to the mucosa.