Oral Path Exam 1

Neoplasm

New growth

The definitions of tumor and neoplasm are _____________

interchangable

T/F:

All cancers are neoplasms, but not all neoplasms are cancer?

True

3 multiple choice options

The suffix "oma" usually refers to..

Benign lesions

Benign lesions typically _____ the nearby structures

push

The suffix "caricnoma" or "sarcoma" usually refers to...

Malignant lesions

A failure of an extraction site to properly heal could be an indication of what?

A malignant lesion

What is the #1 route of tumor metastasis?

Lymphatic spread

What are the 3 routes of tumor metastasis?

Lymphatic spread

Hematologic spread

Seeding within body cavities

If the lesion can be seen radiographically and appears corticated, this is typically a ______ lesion

benign

Smooth root resorption and displacement of structures radiographically is indicative of a ______ lesion

benign

Spiky root resorption and a sunburst appearance are indicative of a _______ lesion

Malignant

What locations are salivary glands not present?

-Gingiva

-Attached alveolar mucosa

-Mid Palatine raphe

- Dorsum tongue anterior to CV papillae

What is the most common salivary tumor?

(video lecture question)

Pleomorphic Adenoma

Salivary gland aplasia

A rare condition where there is lost or missing of a salivary tissue, typically the gland fails to develop

Can occur in more than 1 gland

Sialorrhea

Excess salivation

Sialadenitis

Inflammation of the salivary gland

Sialadenosis

Non-inflammatory salivary gland enlargement

Xerostomia

Dry Mouth

What can cause Sialadenitis?

Infections

Recent surgery

Dehydration

Debilitation

Medication

Which endocrine disorders can cause Sialadenosis?

Diabetes

Acromegaly

Hypothyroidism

What nutritional conditions can cause sialadenosis?

Malnutrition

Alcoholism

Anorexia

Bulimia

What can cause xerostomia?

Local factors

Systemic factors

Iatrogenic factors

Water/Metabolite loss

Developmental

What causes a mucocele?

Damage or the severing of a saliva gland duct

*NOT a true cyst

What is one of the most common oral soft tissue enlargements?

Mucocele

These clinical characteristics indicate what oral pathology?

Fluctuant & fluid filled

Dome shaped mucosal swelling

Fluctuates in size

Bluish

Non-blanching

Mucocele

Where is a mucocele most commonly found?

Lower lip

Mucoceles typically only arise in _____ salivary glands

minor

Mucocele

These histology characteristics are indicative of what oral pathology?

-Granulation tissue

-Spilled mucin

-inflamed salivary gland tissue

What oral pathology can mimic mucoceles in appearance?

Salivary Duct Cyst

*This is a true cyst

What sites can salivary duct cysts occur?

Major and minor salivary glands

What is the treatment for mucoceles?

Local surgical excision

Removable of adjacent salivary gland tissue to prevent recurrence

What is the most common site for Ranulas to develop?

Floor of the mouth

Ranulas involve what salivary gland?

Sublingual*

Can be submandibular too

What oral pathology is considered the "less common type of mucocele?"

Ranula

These clinical characteristics are indicative of what oral pathology?

-Blue, dome-shaped mass

-May fill the floor of the mouth and elevate tongue

Lateral to midline

Ranula

What is it called when this oral pathology can dissect through the mylohyoid and cause swelling into the neck?

Plunging ranula

What is the treatment for a ranula?

Removal of feeder gland

Marsupialization for smaller lesions

Sialolith (Sialolithiasis)

Deposits of calcium salts in the salivary gland/duct

Decreased salivary

What can cause a Sialolith?

A decrease in salivary flow or increased viscosity of saliva

What is the least common site for a mucocele?

(video lecture question)

Upper lip

What gland is the most common location for sialoliths?

Submandibular gland/duct

These clinical characteristics are indicative of what oral pathology?

Pain & swelling of affected gland usually with mealtime

Pus may be extruded from the gland

*Radiographic appearance is a round radiopaque mass

Sialolith

Sialolith

These histologic characteristics are indicative of what oral pathology?

calcified mass surrounded by inflamed and fibrotic salivary glands

What is the treatment for sialoliths?

Gentle massage

sialogogues to increase flow

Increased fluid intake

Lithotripsy

*May need to remove gland

These clinical characteristics are indicative of what oral pathology?

Ischemia of salivary glands of hard palate

Often bilateral & symmetrical

*Can mimic squamous cell carcinoma

Necrotizing Sialometaplasia

Necrotizing Sialometaplasia

These histologic characteristics are indicative of what oral pathology?

-Pseudoepitheliomatous Hyperplasia

-Sialometaplasia

-Coagulative necrosis of the adjacent glands

What is Sjogren syndrome (SS)?

Autoimmune disease

Enlargement of salivary glands

What are the classic signs of primary Sjogren syndrome?

Dry mouth + Dry eyes

What are the classic signs of secondary Sjogren syndrome?

Dry mouth + Dry Eyes + Some other autoimmune disorder (RA, SLE)

What are the symptoms of Sjogrens Syndrome?

Xerostomia, pain, burning

Erythematous tissues

Increased caries

Increased perio

Increased candidiasis

Xerophthalmia is a clinical feature of what oral pathology?

Sjogren Syndrome

Anti-SSA and Anti-SSB are lab values used to diagnose what oral pathology?

Sjogren Syndrome

T/F: You can biopsy minor salivary glands to diagnose Sjogren Syndrome

True

3 multiple choice options

Which oral pathology prognosis is considered a "chronic"?

Sjogren Syndrome

3 multiple choice options

What oral pathology puts patients at an increased risk for MALT lymphoma?

Sjogren Syndrome

3 multiple choice options

Which salivary gland do most salivary gland tumors occur?

Parotid gland

Most salivary tumors are ______ lesions

benign

Most salivary gland tumors in the Parotid gland are _______

benign

Most salivary gland tumors in the submandibular glands are _____________

50% benign - 50% malignant

Most salivary gland tumors in the Sublingual gland are ________

malignant

Minor salivary Gland tumors that occur in the palate and buccal mucosa are ______

benign

Minor salivary Gland tumors that occur in the upper lip are _______

benign

Minor salivary Gland tumors that occur in the lower lip are _______

malignant

Minor salivary Gland tumors that occur in the tongue are _______

malignant

Minor salivary Gland tumors that occur in the floor of the mouth are _______

malignant

Minor salivary Gland tumors that occur in the retromolar pad are _______

malignant

What is the most common site for a minor salivary gland tumor?

Palate

These clinical characteristics are indicative of what oral pathology?

Most common salivary gland neoplasm

Mix of epithelial and mesenchymal elements

painless, slow growing, firm mass

Seen in middle aged adults

Female predilection

Pleomorphic Adenoma

Pleomorphic Adenoma

These histologic characteristics are indicative of what oral pathology?

Various patterns within tumor

Encapsulated

Double layer ductal structures

Stroma appear myxoid, cartilaginous, & hylanized

What is the most common site for Canalicular Adenoma?

Upper lip

Canalicular Adenoma

These histologic characteristics are indicative of what oral pathology?

Well encapsulated

Cells are similar in appearance

Look like canals

What oral pathology is an uncommon tumor found primarily in the parotid gland?

Basal cell adenoma

These clinical characteristics are indicative of what oral pathology?

Most common site is upper lip

Seen in middle aged females (>50 years)

Painless, slow growing

Bluish

Canalicular Adenoma

Basal Cell Adenoma

These histologic characteristics are indicative of what oral pathology?

Encapsulated Islands with palisaded cells or Jigsaw pattern

May form ducts

Once surgically removed, recurrence IS common for what benign oral pathology?

Basal cell adenoma

3 multiple choice options

These clinical characteristics are indicative of what oral pathology?

exophytic & papillary

involves minor salivary glands

can look like an indentation

Ductal Papilloma

Ductal Papilloma

These histologic characteristics are indicative of what oral pathology?

Papillary projections

Inflammation

Intraductal

These clinical characteristics are indicative of what oral pathology?

Associated with smoking (8x)

Proliferation of oncocytic cells AND lymphoid cells

More common in males (6th-7th decade of life)

Slow growing mass of parotid gland

Warthin Tumor

Warthin Tumor

These histologic characteristics are indicative of what oral pathology?

Cyst lined by uniform rows of oncocytic (pink) cells

The lining is papillary in appearance

The cyst call is composted of abundant lymphocytes (purple)

Oncocytoma is a ______ parotid salivary gland tumor

Rare

3 multiple choice options

Oncocytoma

These histologic characteristics are indicative of what oral pathology?

-Large polyhedral cells with abundant granular cytoplasm -- Mitochondria!

-Cells are separated by thin fibrous septal

*Very pink histology~oncocytic means eosinophilic cytoplasm which always stains PINK!

What is the most common malignant salivary gland tumor?

Mucoepidermoid Carcinoma

What is the most common malignant salivary gland tumor in children?

Mucoepidermoid Carcinoma

These clinical characteristics are indicative of what oral pathology?

Usually asymptomatic, but can have pain or palsy

Bluish mass & swelling

MAY mimic mucocele

Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma

These histologic characteristics are indicative of what oral pathology?

Epidermoid cells

Mucous cell

Ductal structures

Cystic spaces

What stain is used to identify mucus cells and secretion?

Mucicarmine stain

For a lot of the malignant salivary gland tumors, treatment depends on what few things?

Grade, stage, and location of the tumor

or if its inoperable

These clinical characteristics are indicative of what oral pathology?

Painful or present with facial paralysis

50% in minor glands

Middle aged females

Adenoid cystic carcinoma

Adenoid cystic carcinoma

These histologic characteristics are indicative of what oral pathology?

Swiss cheese pattern

Islands with cribiform pattern

Myoepithelial cells and ductal cells present

Perineural and perivascular invasion

Which oral pathology is known as the "relentless tumor" and the survival rate decreases the longer the patient lives?

Adenoid cystic carcinoma

Which oral pathology occurs almost exclusively in the minor salivary glands?

Polymorphous Adenocarcinoma

Polymorphous Adenocarcinoma

What histologic characteristics are indicative of this oral pathology?

Various histologic patterns

Cells line up single file line like "Kindergarten filing"

Perineural and perivascular invasion

With surgical excision of the tumor, recurrence and death is rare for which oral pathology?

Polymorphous Adenocarcinoma

These clinical characteristics are indicative of what oral pathology?

Low grade malignant tumor

Serous acinar cells

most common site is parotid

Acinic Cell Carcinoma

Acinic Cell Carcinoma

These histologic characteristics are indicative of what oral pathology?

Well circumscribed

May show infiltration

Serous acinar cells ---(cells containing abundant granular cytoplasm

Zymogen granules )

What type oral pathology used to be part of acinic cell carcinoma until it recently gained its own name/diagnosis?

Secretory Carcinoma

These histologic characteristics are indicative of what oral pathology?

Zymogen poor

Very bland cytology

"Hobnail cells"

Carcinoma Ex PA is a malignant salivary tumor that can arise from which benign salivary tumor?

Pleomorphic adenoma

What can cause Carcinoma Ex PA?

History of pleomorphic adenoma that has been present for many years