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Questions and Answers
Questions and Answers
Lymphoid hyperplasia clinically manifests as what?
Lymphoid hyperplasia clinically manifests as what?
- Enlargement of the lymphoid tissue. (correct)
- Malignant transformation of lymphoid cells.
- Atrophy of lymphoid tissue.
- Decrease in the size of lymphoid tissue.
Which anatomical locations in the oral cavity are commonly affected by lymphoid hyperplasia?
Which anatomical locations in the oral cavity are commonly affected by lymphoid hyperplasia?
- The nasal cavity, maxillary sinuses, and the larynx.
- The esophagus, stomach, and the small intestine.
- The oropharynx, soft palate, lateral tongue, and floor of the mouth. (correct)
- Attached gingiva, the hard palate, and the anterior tongue.
Which of the following is a typical clinical feature of lymphoid hyperplasia?
Which of the following is a typical clinical feature of lymphoid hyperplasia?
- Discrete, nontender, submucosal swellings, usually less than 1 cm in diameter. (correct)
- Extensive bone involvement and expansion.
- Rapidly growing, fixed, and ulcerated masses.
- Painful, ulcerated lesions with irregular borders.
What clinical feature warrants further evaluation as a potentially serious sign in the context of tonsillar presentation?
What clinical feature warrants further evaluation as a potentially serious sign in the context of tonsillar presentation?
Which of the following is the most appropriate management approach for lymphoid hyperplasia once the diagnosis is confirmed?
Which of the following is the most appropriate management approach for lymphoid hyperplasia once the diagnosis is confirmed?
Which cell type is characterized by the proliferation in Langerhans Cell Histiocytosis (LCH)?
Which cell type is characterized by the proliferation in Langerhans Cell Histiocytosis (LCH)?
In what age group is Langerhans Cell Histiocytosis (LCH) most commonly observed?
In what age group is Langerhans Cell Histiocytosis (LCH) most commonly observed?
What is the typical radiographic appearance of bone lesions in Langerhans Cell Histiocytosis (LCH)?
What is the typical radiographic appearance of bone lesions in Langerhans Cell Histiocytosis (LCH)?
A patient presents with a chief complaint of loosening of teeth. Radiographic examination reveals a "scooped out" appearance in the posterior mandible. Which condition is most likely?
A patient presents with a chief complaint of loosening of teeth. Radiographic examination reveals a "scooped out" appearance in the posterior mandible. Which condition is most likely?
Dull pain and tenderness often accompany the bone lesions of which disease?
Dull pain and tenderness often accompany the bone lesions of which disease?
How does leukemia typically spread through the body?
How does leukemia typically spread through the body?
Where does lymphoma typically originate?
Where does lymphoma typically originate?
Which factor distinguishes Hodgkin lymphomas from non-Hodgkin lymphomas?
Which factor distinguishes Hodgkin lymphomas from non-Hodgkin lymphomas?
What is a common oral manifestation of leukemia related to reduced platelet count?
What is a common oral manifestation of leukemia related to reduced platelet count?
If a patient has oral infections, reduced RBC counts, and reduced WBC counts, what condition should you consider?
If a patient has oral infections, reduced RBC counts, and reduced WBC counts, what condition should you consider?
What is the primary method of diagnosis for leukemia?
What is the primary method of diagnosis for leukemia?
The neoplastic cells in Hodgkin Lymphoma account for what percentage of cells in the enlarged lymph nodes.
The neoplastic cells in Hodgkin Lymphoma account for what percentage of cells in the enlarged lymph nodes.
Which of the following best describes the typical presentation of Hodgkin lymphoma in its early stages?
Which of the following best describes the typical presentation of Hodgkin lymphoma in its early stages?
Which of the following is a characteristic histopathologic feature of classical Hodgkin lymphoma?
Which of the following is a characteristic histopathologic feature of classical Hodgkin lymphoma?
What is the prognosis for patients with Hodgkin lymphoma, considering the advancements in cancer therapy?
What is the prognosis for patients with Hodgkin lymphoma, considering the advancements in cancer therapy?
Questions and Answers
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Flashcards
Flashcards
Lymphoid Hyperplasia
Lymphoid Hyperplasia
The lymphoid tissue's proliferation leading to its enlargement, clinically observed in the oral cavity such as the oropharynx, soft palate, lateral tongue, and floor of the mouth.
Clinical Features of Lymphoid Hyperplasia
Clinical Features of Lymphoid Hyperplasia
Discrete, nontender, submucosal swellings, usually less than 1 cm in diameter, with a normal or dark pink color if the aggregate is deeper; or creamy yellow-orange to amber hue if the collection of lymphocytes is closer to the surface.
Langerhans Cell Histiocytosis (LCH)
Langerhans Cell Histiocytosis (LCH)
A range of clinicopathologic disorders characterized by Langerhans cell proliferation, accompanied by eosinophils, lymphocytes, plasma cells, and multinucleated giant cells.
Radiographic Appearance of LCH Lesions
Radiographic Appearance of LCH Lesions
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Leukemia vs. Lymphoma
Leukemia vs. Lymphoma
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Lymphomas Definition
Lymphomas Definition
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Age of Leukemia Onset
Age of Leukemia Onset
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Hodgkin Lymphoma Definition
Hodgkin Lymphoma Definition
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Histopathologic appearance of Hodgkin lymphoma
Histopathologic appearance of Hodgkin lymphoma
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Study Notes
Study Notes
- Study notes on Hematologic Neoplasms I
Lymphoid Hyperplasia
- Lymphoid tissue recognizes and processes foreign antigens like viruses, fungi, and bacteria.
- Lymphoid tissue functions protectively through direct and indirect mechanisms.
- Lymphoid cells proliferate in response to antigenic challenges leading to lymphoid hyperplasia.
- Lymphoid hyperplasia is the enlargement of lymphoid tissue.
Clinical Features
- Lymphoid hyperplasia occurs in the lymph nodes, Waldeyer's ring, or scattered lymphoid tissue in the oral cavity, especially in the oropharynx, soft palate, lateral tongue, and floor of the mouth.
- The location a lymph node drains can identify the source of recent/active infection.
- The anterior cervical chain is most commonly involved in the head and neck region although any lymph node in the region can be affected.
- Appears as discrete, nontender, submucosal swellings, usually less than 1 cm.
- Deeper aggregates appear normal or dark pink, while superficial collections appear creamy yellow-orange to amber.
- Lymphoid tissue is typically more prominent in younger individuals.
- Large tonsils in some patients may occlude the airway, referred to as kissing tonsils.
- Large tonsils are likely normal as long as they are symmetrical and asymptomatic.
- Tonsillar asymmetry is a potentially serious sign and should be evaluated further.
- Lymphadenopathy with acute infections appears as enlarged, tender, relatively soft, freely movable nodules.
- Chronic inflammatory conditions produce enlarged, rubbery firm, nontender, freely movable nodules.
- Distinguishing chronic hyperplastic lymph nodes from lymphoma can be difficult clinically.
- Human immunodeficiency virus should be considered in the differential diagnosis for multiple persistently enlarged nontender lymph nodes.
Histopathologic Features
- Sheets of small, well-differentiated lymphocytes with sharply demarcated collections of reactive lymphoblast referred to as germinal centers are seen.
Treatment and Prognosis
- Lymphoid hyperplasia generally requires no treatment, as it's a benign process.
Langerhans Cell Histiocytosis (LCH)
- LCH is characterized by proliferation of Langerhans cells.
- LCH is accompanied by varying numbers of eosinophils, lymphocytes, plasma cells, and multinucleated giant cells.
- Langerhans cells are dendritic mononuclear cells found in the epidermis, mucosa, lymph nodes, and bone marrow.
- These cells process and present antigens to T lymphocytes.
- Studies have shown this to be a monoclonal proliferation consistent with a neoplastic process.
- BRAF oncogene mutations have been identified in 40% to 60% of Langerhans cell histiocytosis lesions.
Clinical and Radiographic Features
- LCH is particularly a childhood disease, but can arise in virtually any organ system.
- LCH has a particular affinity for bone and often presents as an incidental lytic lesion.
- Bone lesions can be solitary or multiple (unifocal or multifocal).
- Skull, ribs, vertebrae, and mandible are among the most frequent sites affected.
- The jaws are affected in 10% to 20% of all cases.
- Dull pain and tenderness may accompany bone lesions.
- Sharply punched-out radiolucencies without a corticated rim are seen radiographically.
- Lesions may simulate a periapical inflammatory condition within the body of the mandible/maxilla.
- Mandibular involvement usually occurs in the posterior areas, resulting in a characteristic "scooped out" appearance when superficial alveolar bone is destroyed.
- Bone destruction/loosening of teeth may clinically resemble severe periodontitis.
- Extensive alveolar involvement causes teeth to appear as if they are floating in air.
- Ulcerative or proliferative mucosal lesions / proliferative gingival mass may develop if disease breaks out of bone or affects only the oral soft tissues.
Histopathologic Features
- Diffuse infiltration of large, pale-staining mononuclear cells that resemble histiocytes is present.
- Varying numbers of eosinophils, plasma cells, lymphocytes, and multinucleated giant cells are often seen, with areas of necrosis and hemorrhage potentially present.
- Immunohistochemical markers are necessary when trying to identify lesional Langerhans cells in order to confirm the diagnosis.
Treatment and Prognosis
- Most patients with oral involvement have single-organ disease affecting the jaws, although other skeletal lesions may be present.
- Accessible bone lesions are usually treated by curettage. Less accessible bone lesions are treated by radiation or intralesional injection with corticosteroids.
- Prognosis for bone lesions is generally good when there is no significant visceral involvement.
- Chemotherapy is dependent on the severity of the case, as multiple organs may be involved.
- Prognosis is better for older patients compared to younger patients developing the disease
Leukemia & Lymphoma
- Both leukemia and lymphoma originate in lymphocytes.
- Leukemia typically originates in bone marrow, spreading through the bloodstream.
- Lymphoma usually originates in lymph nodes or the spleen, spreading through the lymphatic system.
- Lymphomas are a diverse group of malignant lymphoproliferative disorders, classified by the World Health Organization (WHO) based on lymphocytic origin.
- Hodgkin lymphomas arise from precursor B cells.
- Non-Hodgkin lymphomas arise from monoclonal expansion of malignant B or T cells.
Leukemia
- Leukemias are malignancies derived from hematopoietic stem cells.
- The malignant transformation and proliferation of one stem cell in bone marrow, eventually overflowing into peripheral blood.
- Leukemias are classified by histogenesis (myeloid or lymphoid) and clinical behavior (acute or chronic).
- It's probably related to a combination of environmental factors and genetic factors
- Specific chromosomal abnormalities occur in certain types of leukemia (ex: Philadelphia chromosome)
- Environmental agents such as pesticides can increase risk
- Ionizing radiation increases frequency of chronic myeloid leukemia among atomic bomb blasts
- Viruses (ex: retrovirus human T-cell leukemia/lymphoma virus type 1) can cause a rare form of malignancy of T lymphocytes.
Clinical Features
- Crowding out of normal hematopoietic stem cells causing a potential reduction in red blood cells, white blood cells, and platelets.
- Malignant cells may infiltrate other organs specifically causing splenomegaly, hepatomegaly, and lymphadenopathy or more generally oral tissues.
- Leukemic cell infiltration of oral soft tissues (most frequently myeloid types) results in a diffuse, nontender swelling or prominent tumor-like growth (myeloid sarcoma).
- Infiltration of the periapical tissues can cause a simulation of periapical inflammatory disease clinically and radiographically.
- Reduced RBC counts can cause fatigue, easy tiring, and dyspnea on mild exertion.
- Reduced WBC counts can cause fever associated with infection, perirectal infections, pneumonia, urinary tract infections, and septicemia.
- Oral infections may occur, including oral ulceration (most severely affecting gingiva), deep and punched-out ulcers with a gray-white necrotic base, diffuse oral candidiasis, and herpetic infections.
- Reduced platelet counts, or thrombocytopenia, is possible which can cause easy bruising and bleeding, petechial hemorrhages of posterior hard palate and soft palate, spontaneous gingival hemorrhage, and serious hemorrhagic complications (ex: bleeding into the CNS or the lungs).
- Myeloid leukemias generally affect adults, can still affect children
- Acute lymphoblastic leukemia are predominantly in children
- Chronic lymphocytic leukemia are most common in older adults
Histopathologic Features
- Microscopic examination of leukemia-affected tissue shows diffuse infiltration and destruction of normal host tissue by sheets of poorly differentiated cells with either myelomonocytic or lymphoid features.
Diagnosis
- Diagnosis is established by confirming poorly differentiated leukemic cells in peripheral blood and bone marrow.
- Bone marrow biopsy is performed because some patients enter an aleukemic phase in which the atypical cells are absent from the circulation.
- Immunohistochemical markers are used for classification, which involves immunophenotyping and cytogenetic/molecular characterization of the lesional cells.
- Results of these various studies are significant because the patient's prognosis is directly affected.
Treatment and Prognosis
- Chemotherapy depending on the type.
- Bone marrow transplant for suitable cases.
- Supportive care often involves platelet and RBC transfusions and control of infections for survival.
- Oral care, as many patients experience infections of the oral mucosa, optimal oral hygiene should be encouraged.
- Prompt investigation of any oral complaint can help prevent serious oral infectious complications.
- Prognosis depends on: type of leukemia, age, and cytogenetic alterations.
- Children with acute lymphoblastic leukemia have high cure rate (90%), but the 5-year survival rate is much lower in adults with the same diagnosis.
Hodgkin Lymphoma
- Hodgkin Lymphoma is a malignant lymphoproliferative disorder.
- Current evidence points to a B-lymphocyte origin of Reed-Sternberg cells.
- Neoplastic cells (Reed-Sternberg cells) make up only about 0.1% to 2% of cells in enlarged lymph nodes, unlike most other malignancies.
- Cause of condition is unknown; Epstein-Barr virus (EBV) infection can be linked to cases.
- Hodgkin lymphoma is classified as: nodular lymphocyte-predominant Hodgkin lymphoma or classical Hodgkin lymphoma.
Clinical Features
- Usually begins in lymph nodes with cervical and supraclavicular nodes being the most commonly affected.
- Overall male predilection.
- Bimodal pattern is noted with one peak between 15 and 35 years of age and another after age 50.
- Presenting sign: Persistent enlarging, nontender, discrete mass/masses in one lymph node region.
- Involved lymph nodes movable in early stages, becoming more matted and fixed as progresses.
- Condition can spread to lymph node groups, spleen, and extralymphatic tissues, as well as bone, liver, and lung without treatment.
- Oral involvement is rare.
- Systemic signs and symptoms: weight loss, fever, night sweats, and generalized pruritus.
- Absence of mentioned systemic signs and symptoms correlates to better prognosis.
Histopathologic Features
- Current immunohistochemical and molecular biologic techniques have allowed distinctions to be made among the various types.
- Common features include: Effacement of the normal nodal architecture by a diffuse, often mixed, infiltrate of inflammatory cells
- Features also include the presence of large, atypical neoplastic lymphoid cells.
- This atypical cell is known as a "Reed-Sternberg cell" in classical Hodgkin Lymphoma. Reed-Sternberg cells have prominent nucleoli and can be either multinucleated, or binucleated.
- The malignant cell in Nodular lymphocyte-predominant Hodgkin lymphoma is known as a "popcorn cell".
Treatment and Prognosis
- Condition can cause death without treatment.
- This cancer has one of the highest and most successful treatment rates.
- Treatment depends on the stage of involvement and include radiotherapy and chemotherapy.
- The prognosis for this disease is currently good.
- Stage I and II disease is 80% to 90% 10-year survival rate.
- Stage III and IV disease is 55% to 75% 10-year survival rate
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