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Epithelial Pathology4
Oral Pathology
35
Dentistry
Professional
09/03/2013

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Cards

Term
Definition of Oral submucous Fibrosis
Definition
Chronic, progressive, scarring, high-risk precancerous condition of oral mucosa linked to chronic oral use of betel nute quid (paan)
Term
What is quid?
Definition
Nut from areca palm tree mixed w/ slaked lime, usually w/ tobacco and sometimes sweeteners and flavoring agents, wrapped in betel leaf
Term
What effects of slaked lime have?
Definition
Releases alkaloids from areca nut producing sense of euphoria and well being
Term
What do areca nut alkaloid (arecoline) and flavonoids do?
Definition
Stimulate collagen synthesis and are carcinogenic
Term
What is process of fibrosis?
Definition
Increased collagen synthesis and reduced matrix degradation mediated through transforming growth factor-beta leads to fibrosis
Term
Clinical features of Oral submucous Fibrosis
Definition

-Progressive pallor, fibrosis, and marble-like rigidity of tissues usually beginning in soft palate and fauces, then involving buccal mucosa, lips and tongue

-Ulcers, areas of erythema, vesicles, petechiae, melanosis, xerostomia, and symptoms of burning usually first signs/symptoms; then dev marble-like pallor and progressive stiffness of subepithelial tissues

-Palpable fibrous bands run vertically down buccal mucosa in advanced lesions leading to reduction in mouth opening and trismus

Term
Histopathologic features of oral submucous fibrosis
Definition

CT shows dense, hypovascular collagen w/ varying # of inflammatory cells

Epithelium may show subepithelial vesicles, then hyperkeratosis, epi atrophy

Epithelial dysplasia present in 10-15% of cases; carcinoma in 6-8%

Term
Treatment and prognosis of oral submucous fibrosis
Definition

TX: Following biopsy to exclude dysplasia or carcinoma, mild cases may be treated with intralesional corticosteroids to reduce symptoms; surgical splitting or excision of fibrous bands

PX: must be following carefully for dev of epidermoid carcinoma - 8%

Term
Definition of Actinic Cheilosis
Definition
Premalignant alteration of lip vermillion resulting from excessive exposure to UV radiation of sunlight
Term
Most common location for actinic cheilosis is?
Definition
Lower light, in light complexion people who burn more easily
Term
Clinical features of actinic cheilosis
Definition

Most common after age 45; M/F up to 10:1

Slowly dev; atrophy of vermillion border, blurring of margin between vermillion and skin

Becomes scaly, dry, thick, leukoplakic, peeling, ulcerative

Term
Histopathologic features of actinic cheilosis
Definition

Epithelial atrophy, hyperkeratosis, varying degrees of epi dysplasia

Underlying CT shows band of amorphous, acellular basophilic change (solar or actinic elastosis) due to UV induced alteration of collagen and elastic fibers

Term
Treatment and prognosis of Actinic Cheilosis
Definition

Lip balm w/ sunscreen for mild cases

Surgical lip or laser ablation

6-10% dev epidermoid carcinoma, usually well-differentiated, usually after age 60

Term
Keratoacanthoma definition
Definition

Self-limiting, epithelial proliferation w/ strong clinical and histopathologic similarity to well-differenctiated squamous cell carcinoma.

Known as well-differentiated form of SCC

Term
Types of lesions of keratoacanthoma
Definition

Cutaneous lesions arise from infundibulum of hair follicles

Oral lesions are rare (some don't accept as intraoral disease)

Term
Cause of keratoacanthoma
Definition
Unknown but thought sun exposure and HPV subtypes 26 and 37 have been proposed.
Term
Increased lesions of keratoacanthoma could be associated with what disease?
Definition
Muir-Torre syndrome
Term
Clinical features of Keratoacanthoma
Definition

Males mostly over 45

95% found on sun exposed skin

Firm, nontender, well-demarcated, sessile, dome-shaped nodule w/ a central plug of keratin

Term
Evolution stages of Keratoacanthoma
Definition
Growth phase, Stationary phase, involution phase
Term
Treatment for Keratoacanthoma
Definition
Surgical excision is preferred treatment and 4-8% if pts experience regrowth
Term
Definition of SCC (sqamous cell carcinoma)
Definition
Malignant neoplasm of squamous epi
Term
Etiology of SCC
Definition

Most common malignancy of oral cavity (94%)

22,000 new cases/year in US; 5,300 die

SCC of lip not as aggressive, behaves more like SCC of skin

Term
Key to reducing incidence of SCC:
Definition

Increasing understanding, awareness, and avoidance of etiologic factors

WHERE PTs COME IN!

Term
Causes of SCC
Definition

Candidal infection

Oncogenic viruses: HPV 16, 18, 31, 33; HPV 16 pos better prognosis than HPV neg; EBV esp in nasopharyngeal Ca; HSV evidence less compelling

Immunosuppression

Oncogenes and tumor suppressor genes (p53)

Term
Key to reducing death rate w/ SCC:
Definition

High index of suspicion leading to early diagnosis

THATS WHERE WE COME IN!

Term
General clinical features of SCC
Definition

- US most common in older adults (exceptions)

Male to female: 3:1

Often painless and hides in dark places, leading to tragic delay in diagnosis and consequent advancement in stage before treatment

Can mimic other more harmless conditions

Term
Clinical presentations of SCC
Definition

Exophytic (mass forming, fungating, papillary, verruciform)

Endophytic (invasive, burrowing, ulcerated)

Leukoplakic

Erythroplakic

Erythroleukoplakic

Term
Principle regions of oral cancer involvement in SCC:
Definition
Lips, intraoral, oropharyngeal
Term
Histopathologic Features of SCC
Definition

-Neoplastic islands, strands, sheets and individual cells invade underlying tissue including fibrous CT, muscle, nerves, and blood vessels

-Neoplastic epi characterized by all changes listed as dysplastic

-Neoplasms vary in differentiation from well to moderately to poorly to undifferentiated: well differentiated appears much like normal epi cells and tissue; undifferentiated very difficult to recognize


Term
Histopathologic Criteria for Epithelial dysplasia
Definition
Enlarged nuclei & cells, large & prominent nucleoli, increased nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, pleomorphic nuclei and cells, dyskeratosis and individual cell keratinization, increased mitotic activity, abnormal mitotic figures, bulbous or teardrop-shaped rete ridges, loss of polarity, keratin or epi pearls, loss of typical epi cell cohesiveness
Term
Metastasis from oral SCC
Definition

Most common: ipsilateral cervical nodes: stony hard, nontender, enlarged and may be fixed; occasionally contralateral or bilateral nodes; small % have distant metastasis: most commonly lungs, liver, bone but any site may be involved

SCC of lowerl ip and oral floor: submental nodes

SSC from posterior oral cav: superior jugular and digastric nodes, retropharyngeal nodes

Farther posterior primary, greater chance of local and distant metastasis

Term
Histologic Grading of SCC
Definition

Degree to which histologically resembles its parent tissue (squamous epi) reflected in histologic grade (grade 1-3 or 4)

Can also be graded according to degree of differentiation (well, moderately, poor, undifferentiated)

Higher grade number (3 or 4) more poorly differentiated the tumor vice versa

Term
Clincal staging of SCC
Definition

Most reliable indicator of prognosis of most malignancies

TNM system used: T = size of primary tumor in cm; N = involvedment of local lymph nodes; M = presence of distant metastasis

Term
Treatment of SCC
Definition

Anterior 2/3s is wide surgical excision often following by radiation;chemo

Posterior 1/3 solely radiation w/ or w/out chemo

Lymph node dissection (radical neck dissection) may be done if involved clinically or risk of involvement is high

Term
Prognosis of SCC
Definition

Overall 5-year survival of Oral SCC remains at 5-59%

Tends to be better anteriorly than posteriorly

Early detection can minimize advancement of cancer

Increased risk (6-44%) of getting other malignancies

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