Lecture 4 - OMFS (Exam2): Principles of Differential Diagnosis and Biopsy of Pathologic Lesions

- site

- morphology

- color

When clinically identifying an oral pathology, you want to describe 3 things:

Leukoerythroplakia

What lesion color should raise suspicion of malignancy:

- ulceration persisting more than 2 week

- rapid growth

- bleeding

- indurated/firm

- fixation/immoblie

What lesion characteristics should raise suspicion of malignancy:

2 weeks

a lesion that has persisted over _______ should raise concern for malignancy

panoramic

what type of imaging is the gold standard for aiding in diagnosis after clinical exam and med history?

Nasopalatine duct cyst

All of the following are odontogenic developmental cysts or tumors EXCEPT:

- Odontogenic keratocyst (KOT)

- Dentigerous cyst

- Eruption cysts

- Nasopalatine duct cyst

- Lateral periodontal cyst

- Gingival cyst

- Glandular odontogenic cyst

- KOT

- Ameloblastoma

Dentigerous cyst

All of the following are non-odontogenic developmental cysts or tumors EXCEPT:

- Nasopalatine duct cyst

- Dentigerous cyst

- Nasolabial cyst

- Median cyst

false

t/f: if you see any lesion, it always requires a biopsy

smoking

What social habits of patients should raise suspicion for developing oral malignancy:

- floor of mouth

- ventral lateral tongue

An ulcer in what location of the mouth should raise suspicion for oral malignancy:

biopsy

Removal of tissue from a living individual for diagnostic examination:

- Aspiration

- Cytology

- Incisional

- Excisional

What are the 4 types of biopsies we can preform?

Incisional

a patient presents with a non-healing leukoerythroplakic ulcerated lesion on the ventral latereral border of the tongue. The lesion has been there for 3 weeks. What type of biopsy should you take?

- Aspiration

- Cytology

- Incisional

- Excisional

•Any lesion that persists for more than 2 weeks with no apparent etiology

•Any inflammatory lesion that does not respond to local treatment after 10 to 14 days (after removing local irritant)

•Persistent changes in surface tissue (lips or oral mucosa)

•Any persistent tumescence, either visible or palpable beneath relatively normal tissue

•Lesion that interfere with local function (fibroma)

•Bone lesions where inflammatory conditions can be ruled out

What are the indications for a biopsy:

aspiration biopsy

the use of a needle and syringe to penetrate a lesion for aspiration of cells or content:

Aspiration

Your patient presents with a fluctuant mass in the area of the neck. You are pretty sure it contains fluid. What type of biopsy should you take?

- Aspiration

- Cytology

- Incisional

- Excisional

cytology smear

When a brush is placed in contact with oral epithelium and rotated with firm pressure 5 to 10 times

•The brush collects cells from all three layers of epithelium: superficial, intermediate and basal

•Brush is smeared onto glass slide and placed in container with fixative solution

computer

Cytology smears are evaluated by both pathologist and a computer. Which one determines if adequate specimen was obtained?

- pathologist

- computer

computer

Cytology smears are evaluated by both pathologist and a computer. Which one determines if the cells are dysplastic or malignant?

- pathologist

- computer

pathologist

Cytology smears are evaluated by both pathologist and a computer. Which one classifies the findings into three categories: negative, positive, or atypia?

- pathologist

- computer

false

t/f: oral brush biopsies require either topical or local anesthesia to obtain from patients

- true

- false

false/s

t/f: you can do a brush biopsy as a substitute for a scalpel biopsy

- true

- false

Incisional

If the lesion is large or has different characteristics at different locations, What type of biopsy should you take?

- Aspiration

- Cytology

- Incisional

- Excisional

true

t/f: if the lesion is large or has different characteristics at different locations, more than one area of the lesion may require biopsy

- true

- false

false.

t/f: if a lesion is suspicious for malignancy, you should do an excisional biopsy to remove it from the patient immediately

- true

- false

true

t/f: Small lesions with high degree of suspicion should undergo incisional biopsy

- true

- false

Should not include normal tissue

all of the following are true about incisional biopsy principles EXCEPT:

- Wedge shape

- Selected area that shows complete tissue changes

- Should not include normal tissue

- Necrotic tissue should be avoided

- Narrow better than broad

Should include normal tissue

all of the following are true about incisional biopsy principles EXCEPT:

- Wedge shape

- Selected area that shows complete tissue changes

- Should include normal tissue

- Necrotic tissue should be included

- Narrow better than broad

tissue punch

What tool can be used to take a incisional biopsy?

Excisional Biopsy

The removal of the entire lesion, along with 2 to 3 mm of normal-appearing surrounding tissue, is excised

2 to 3

In an Excisional Biopsy, the entire lesion, along with _____ mm of normal-appearing surrounding tissue, is excised

- Oncologic margin

- Closure

What are 2 reasons you would include a perimeter of normal tissue surrounding the lesion in an excisional biopsy?

Excisional

Your patient presents will a yellow 1cm x 1cm nodule on the lateral border of the tongue. It looks mostly like a lipoma.

What type of biopsy should you take?

- Aspiration

- Cytology

- Incisional

- Excisional

true

t/f: LA should not be injected within the tissues to be removed

- true

- false

use of suction device

Which of the following is not suggested when considering the principle of hemostasis during a biopsy:

- use of suction device

- Gauze only

- Gauze over suction device

traction suture

The use of a ________ through the specimen is an excellent method for avoiding specimen trauma

take two biopsies, put one in 10% formalin solution, and one in Michel's solution for immunofluorescence studies

If your suspect an autoimmune disease is the cause of your patients oral pathologies, how should you take a biopsy?

the defect

Undermine the wound margins by at least the width of _____ in each direction which allows approximation of the tissue with little to no tension

Aspiration

You patient presents with a pano exhibiting a well defined, corticated, unilocular radiolucency associated with the crown of an unerupted #16. What type of biopsy should you take first?

- Aspiration

- Cytology

- Incisional

- Excisional

cental curette

A _____ is used keeping the concave surface in contact with the osseous surfaces of the bony cavity

•All specimens need to be labeled

•History and clinical description

•Radiographs / pictures

What all should you include on your biopsy sheet?

7 to 10 days

After a biopsy, you can follow up with a patient within _____