Systems Pathology II - Exam 1 (Part 1)

What is a condition that causes painful swelling or sores inside the mouth that can be caused by disease, infection/gingivitis, allergies, irritating foods/chemicals, drugs, radiation, or trauma?

Stomatitis

What are some concerns with Stomatitis? What are 2 types?

Can disrupt a persons ability to eat, talk, sleep

1) Canker sores

2) Cold sores

What is an oral inflammatory ulceration/lesion that involves the superficial oral mucosa & pharynx that is painful, self limiting (7-10 days), has no scarring, is only a few millimeters, and can recur 3-4 times a year?

Aphthous Ulcers (Canker sore, recurrent aphthous stomatitis)

What type of Aphthous Ulcers may recur monthly, from childhood to age 40?

Recurrent Aphthous Ulcers

What type of Aphthous Ulcers are lesions >1 cm, are more painful and recur frequently, and take 10-30 days to hear with possibility of scarring?

Major Aphthous Ulcers

What type of Aphthous Ulcers typically affects females and are tiny, discrete ulcers that coalesce into ulcerated patches, healing in about 10 days and recurs frequently?

Herpetiform Ulcers

NOTE: NOT linked to herpes (just looks like it)

What are some risks of Aphthous Ulcers? What percent of the population does it affect?

Usually idiopathic

- females (<20 hormonal)

- genetics, celiac disease, or IBD

- smokeless tobacco, stress, trauma, fever

- certain foods

20% of population (really anybody affected)

T/F: Only the Herpetiform ulcers type of Aphthous Ulcers are contagious

FALSE

NONE are contagious

-- they do last 7-10 days

What vitamin can be a simple, inexpensive, and low-risk reductive treatment for aphthous ulcers, regardless of the serum level of this vitamin?

Vitamin B12

What is a rare condition that involves widespread vasculitis (inflammation of the blood vessels), mouth sores, eye inflammation, skin rashes/lesions, genital sores, and can vary from person to person and recurs?

Behcet Disease

What is an infectious condition that develops following a herpes simplex virus with grouped vesicles (1-3mm) on the outside of the mouth with itching, burning, tingling and headaches, pharyngitis, and fever/malaise and is self-limiting, lasting 7-10 days where vesicles rupture & heal?

Oral Herpes (Cold sores, fever blisters, herpetic labialis, herpetic gingivostomatitis)

T/F: All types of Oral Herpes is contagious

TRUE

What virus often develops in the orofacial region in oral herpes? What virus often develops in the genital area in oral herpes?

Herpes simplex 1 = orofacial (labial, nasal, buccal, gingival, hard palate)

Herpes simplex 2 = genital

What age is most commonly affected by HSV infection and oral herpes?

Childhood (age 2-4)

Oral herpes is often asymptomatic (80%) in children, but when it is symptomatic (cold/flu symptoms and/or lesions), what is it called?

Acute herpetic gingibostomatitis

Most adults are carriers (60%) of oral herpes, and recurrent herpetic stomatitis is dormant in what 2 ganglions where it can be triggered to recur?

1) Trigeminal ganglion (CN V)

2) Olfactory ganglion

What stimuli can reactivate oral herpes to cause acute blistering?

Trauma, UV light, fever, cold, URTI, pregnancy, stress

T/F: The cure for oral herpes is antiviral drugs

FALSE

-- not CURE; antiviral drugs will just decrease replication (just a treatment)

What is it called when oral herpes spreads to the CNS with a 70% fatal rate in the absence of antiretrovirals and symptoms such as decreased consciousness, confusion, changes in personality with spinal tap being diagnostic, predilution for temporal lobe, IV antivirals, and few regain cognitive function? Which virus most commonly causes this?

Herpesviral Encephalitis

HSV-1

What amino acid is considered a potential cold sore remedy because its known to slow down the body's production of arginine which helps HSV virus to spread?

Lysine

NOTE: Other homeopathic methods include tea tree oil, ice/wet tea bag, lemon balm, alcohol, witch hazel, vanilla extract

What condition develops following an OPPORTUNISTIC infection with Candida albicans which occurs on the tongue, cheeks, gums, or tonsils, resulting in gray/white pseudomembranous which CAN be scraped off, and has underlying erythema (red tissue)?

Oral Candidiasis (Thrush)

What are three possible causes of Oral Candidiasis (Thrush)?

1) Decreased immune status

2) Broad-spectrum antibiotics

3) Diabetes

What are some differential diagnosis for Oral Candidiasis (Thrush)? (2)

1) Leukoplakia (as thrush can increase risk of precancerous lesions)

2) Consider milk (dried on tongue/dry mouth, not actually thrush)

How is Oral Candidiasis (Thrush) Treated?

Anti-fungal

What is a localized nodular oral lesion/mass following chronic irritation, hyperplasia, & fibrosis that affects 1-2% of adults, and occurs along the bite line where the upper and lower teeth meet?

Oral Fibroma

What is an inflammatory rapidly growing hemangioma that is red/purple (and bleeds a lot) which frequently developing on the gingiva, in pregnant women (2-10%), or children due to hormonal factors (progesterone)?

Pyogenic Granuloma ("Pregnancy Tumor")

NOTE: does NOT involve pus and does NOT involve granuloma (poorly named)

What is the treatment for oral proliferative lesions such as oral fibroma or pyogenic granulomas?

Remove irritant or surgery

T/F: Pyogenic granulomas only occur in the oral cavity

FALSE

-- can also occur on skin, so can be anywhere (gums, skin, nasal septum, from head to thigh)

What is an oral lesion that is a raised, thickened, withe patch inside the mouth that CAN'T be scraped off, with epithelial hyperplasia, keratosis, and dysplasia, affecting 3% of the population?

Leukoplakia

What is a thick/scaly patch that may become cancerous?

Keratosis

What is an increase in abnormal cell growth and development?

Dysplasia

What is an enlargement by increased in reproductive rate of cells?

Hyperplasia

What are risks of Leukoplakia?

1) Inflammation (tobacco use, alcohol use, candidiasis)

2) Males (40-70 years old)

Leukoplakia is diagnosed by exclusion. What does this mean?

Diagnose by ruling out other diagnosis first, needs biopsy (such as cancer, oral hairy leukoplasia, oral candidiasis)

What is often confused with leukoplakia since it is a white hyperkeratotic plaque usually distributed along the lateral border of the tongue, with vertical white striations that may appear "hairy", and CANNOT be scraped off, but is NOT precancerous (painless & benign), is associated with EBV, almost exclusive to HIV infected patients?

Oral Hairy Leukoplakia

What condition is virtually identical to leukoplakia and develops form the same inflammatory stimuli (ex: smokeless tobacco), but has a "red" and "velvety" oral lesion appearance with irregular borders and commonly occurs in males (40-70 years)?

Erythroplakia

________ % of leukoplakia & _______% of Erythroplakia is pre-cancerous, and both can transition to _______________.

25%

>50%

Oral squamous cell carcinoma

Is oral cancer rates significantly higher in men or women?

MEN

After what age does the increase in oral cancer rates become more rapid? What age does it peak?

50 years

60-70 years peak

______% 5-year relative survival for oral cancer if LOCALIZED at diagnosis

______% 5-year relative survival for oral cancer if REGIONAL at diagnosis

______% 5-year relative survival for oral cancer if DISTANT at diagnosis

85%

68%

40%

What is a term used to describe the presence of abnormal cells within a tissue or organ?

Dysplasia

What type of mutations are most common in oral cavity & oropharyngeal cancers, is diagnosed when advanced, and is treated by excision?

TP53 mutations

What is the most common type of oral cavity & oropharyngeal cancer with oropharyngeal pain/dysfunction, multiple primary tumors common, poor prognosis (<50% long-term survival), with raised firm lesions (plaque) that is whitish-gray or erythematous (red) with irregular borders & possible ulcerations?

Oral Squamous Cell Carcinoma

What are (3) risk factors for Oral Squamous Cell Carcinoma?

1) alcohol

2) Tobacco

3) HPV-16 infection

NOTE: >30 years old is also a risk

NOTE: Alcohol & Tobaccos has a worse prognosis

What are 5 common locations for Oral Squamous Cell Carcinoma, in order? (TQ)

1) Ventral (inferior) tongue

2) Floor of mouth

3) Lower lip

4) Soft palate

5) Gingiva

Oral/Oropharyngeal squamous cell carcinoma may develops atop a background of what two conditions?

Leukoplakia

Erythroplakia

Oral/Oropharyngeal squamous cell carcinoma most commonly has local invasion & metastasis to what 4 locations? What is the most common location (TQ)?

1) Cervical Nodes (MC)

2) Mediastinal nodes (chest)

3) Lungs

4) Liver

What type of oral/oropharyngeal squamous cell carcinoma is MORE favorable with fewer mutations, often seen in young people with no history of tobacco or alcohol use at the base of the tongue or tonsillar crypts?

HPV-associated (HPV-16)

What type of gland excretes saliva via ducts, with >99% of saliva H2O and also secretes IgA and enzymes?

Salivary gland

T/F: Pathologies of salivary glands are more common than other glands, resulting in inflammation and neoplasia

FALSE;

they are RARE

What are the 4 salivary glands? Which is the most commonly affected?

1) Parotid (MC)

2) Sublingual

3) Submandibular

4) Minor salivary glands

What is the clinical term for dry mouth due to decreased saliva production?

Xerostomia

What are some reasons as to why Xerostomia may occur? (2)

1) Age releated (>70 20% lose ability)

2) ADRs or irradiation

Xerostomia can lead to what three things?

1) Dysphagia & Dysarthria

2) Fissures/ulcerations

3) Risk for dental caries & candidiasis

What is an autoimmune attack to salivary and lacrimal glands?

Sjogren Syndrome

What is a noncancerous inflammation and enlargement of the salivary glands due to trauma, autoimmunity, or infections?

Sialadenitis

What is the most common VIRAL infection of the salivary glands (specifically parotid), and when occurs in pediatrics is self-limiting but in adults can lead to pancreatitis & orchitis?

Mumps

What is the most common BACTERIAL infection of the salivary glands, leading to risk of dehydration or obstruction?

Staph. aureus

What is a noncancerous cyst where saliva/mucus collects within tissue, leading to an inflamed cyst and ductal obstruction, often in the lower lip or postprandial?

Mucocele (Mucous cyst, Mucosal Ranula)

T/F: Larger gland tumors are less common, but are a greater cancer risk

FALSE

SMALLER gland tumors less common and greater cancer risk

NOTE: this is saying the smaller the gland size, NOT saying smaller sized tumor in the gland

Salivary Gland Neoplasms are rare, and are MC in what age & gender?

60-80 year olds

FEMALES

A salivary gland neoplasm occurs:

____% of the time in the parotid gland, with ____% being malignant.

____% of the time in the submandibular gland, with ____% being malignant

_____% of the time in the Sublingual & Minor Salivary glands, with ____% being malignant

Parotid: 75%; 25% malignant

Submandibular: 10%; 40% malignant

Sublingual & Minor Salivary: 15%; 75% malignant

Most parotid gland tumors are localized masses that are ____ in size with ____ growth

Large

Rapid

What type of parotid gland neoplasm/tumor is MC benign, making up 60% of parotid gland tumors, painless, encapsulated, mixed tissues (glandular, cartilage, bony tissue), may recur, and is treated via surgery?

Pleomorphic Adenoma

Pleomorphic adenoma with an early diagnosis (<5 years) has a ____% chance of being malignant, with a >15 year diagnosis has a ____% chance of being cancerous?

2%

10%

What type of parotid gland neoplasm is invasive, affixed, aggressive, and has a 30-50% prognosis over 5-years?

Carcinoma Ex Pleomorphic Adenoma (Malignant Mixed Tumor)

What type of parotid neoplasm makes up 15% of all salivary tumors an dis the most common form of primary malignant tumor of the salivary glands?

Mucoepidermoid Carcinoma

What anatomy is posterior to the trachea, representing the beginning of the GI tract with smooth muscles propelling the bolus, has specific mucosa, and has pathologies that are highly variable?

Esophagus

NOTE: Esophageal mucosa is the mucosa

What are the two sphincters that occur from the epiglottis to the gastroesophageal junction?

upper esophageal sphincter (UES) and the lower esophageal sphincter (LES)

What is a lower pharyngeal outpouching that may be large, located superior to the UES from increased pressure in the pharynx, leading to bolus accumulation (halitosis) and therefore dysphagia, regurgitation, and aspiration?

Zenker's Diverticulum (Pharyngoesophageal Diverticulum)

What are two possible causes of increase pressure in Zenker's Diverticulum (Pharyngoesophageal Diverticulum)?

1) Uncoordinated swallowing

2) Cricopharyngeal muscle spasm (doesn't relax and food blocked from passing into esophagus since this is major muscular component of UES)

How is Zenker's Diverticulum (Pharyngoesophageal Diverticulum) diagnosed?

Barium swallow & video fluoroscopy

What is difficulty swallowing, and often the number one reason for esophageal lesions?

Dysphagia

What are the 4 types of mechanical obstruction leading to esophageal lesions?

1) Congenital atresia

2) Stenosis (narrowing)

3) Esophageal diverticula (outpouch)

4) Tumor (internal or external)

What type of mechanical obstruction leading to esophageal lesions is when the upper and lower esophageal segments are separated, so the upper section ends in a blind pouch, leading to regurgitation (just after birth), tracheal fistula in many cases, and needs surgical correction?

Congenital atresia

What type of mechanical obstruction leading to esophageal lesions is fibrosis or strictures duet o inflammation or scarring, and can be developmental or acquired?

Stenosis or narrowing

What type of esophageal malformation is MC?

Tracheoesophageal fistula where lower section is bound to trachea

NOTE: Other types are atresion where there is a noncanalized cord but no connection between upper and lower part, and another type of tracheoesophageal fistula where the upper an dlower sections both are connected to the trachea

What condition is the functional esophageal obstruction leading to dysphagia, regurgitation, chest pain ("heartburn"), & weight loss, leading to dilation of the esophagus, and is treated by pneumatic dilation or botulinum toxin?

Achalasia ("failure to relax"; stenosis)

What is the triad (3) of things occurring in the Achalasia?

1) Incomplete LES relaxation

2) Increased LES tone

3) Esophageal aperistalsis

What is the characteristic appearance of Achalasia on imaging?

Bird-beak sign

Which type of Achalasia is due to a loss of inhibitory innervation to the LES, is idiopathic, and is the MC cause?

Primary Achalasia

What type of Achalasia is due to a co-morbidity that impairs the LES function, such as Chagas disease (MC), irradiation, diabetes, polio, or inflammatory near Auerbach's plexus?

Secondary Achalasia

What type of esophageal lesion is the most frequent site of ectopic gastric mucosa in the upper 1/3 of the esophagus (inlet patch), and is often asymptomatic (MC) but can be irritating because it is acid releasing gastric mucosa leading to dysphagia, esophagitis, Barrett esophagus, and cancer risk (adenocarcinoma)?

Esophageal Ectopia

What type of esophageal lesion is due to portal hypertension from portal venous congestion due to bypassing of portal venous blood form the liver to the esophageal venous plexus, increasing venous pressure in the distal esophagus and dilated/tortuous, and is often asymptomatic but can lead to a risk of lethal hemorrhage?

Esophageal Varices

What are two causes of Varices? Which is MC in US and which is MC worldwide?

1) 90% cirrhosis cases -- most associated w/ alcoholic liver disease; MC in US

2) Hepatic schistosomiasis (flatworm) -- MC Worldwide, second MC cause of varices

What condition can lead to esophageal varices, is liver failure where toxins go into CNS an dcan lead to hepatic encephalopathy (hepatic coma) with dilated submucosal veins and with 50% of the bleeds being lethal?

Advanced Cirrhosis

What is a procedure in which a balloon is inflated within the esophagus or stomach, to apply pressure on bleeding blood vessels, compress the vessels, and stop the bleeding, and is used as a treatment of bleeding veins in the esophagus (esophageal varices) and stomach, which is diagnosed with an esophagoscopy and can treat also to deliver medications to area for vasoconstriction or transfusions?

Balloon Tamponade