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Questions and Answers
What is the primary factor contributing to the malignant transformation risk in erythroplakia?
Which statement correctly describes the aggressiveness of squamous cell carcinoma (SCC)?
What distinguishes early stage squamous cell carcinoma from advanced stage SCC?
Which histologic pattern is NOT associated with squamous cell carcinoma?
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Which of the following is a common risk factor for squamous cell carcinoma development in the oral cavity?
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Which clinical form of oral candidiasis is characterized by a superficial infection that can manifest as a white patch in the mouth?
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What is the defining characteristic of leukoplakia as described by the World Health Organization?
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Which condition is NOT considered an inflammatory lesion of the oral cavity?
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What is the main treatment option for chronic fibroma in the oral cavity?
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Which population is most commonly affected by pyogenic granuloma?
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What is a common characteristic associated with erythroplakia?
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What is the effect of broad-spectrum antibiotics on the oral microbial flora?
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What type of lesion is fibrous hyperplasia commonly classified as?
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Which of the following is the most common primary malignant tumor of the salivary glands?
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Which condition is characterized by a high probability of malignancy in tumors of the sublingual glands?
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What histologic feature is associated with Warthin tumor?
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Which salivary gland tumor is most likely to cause recurrence if left untreated?
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What type of infiltration is noted in Sjögren's syndrome?
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Which factor significantly increases the risk of developing Warthin tumor?
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In which salivary gland neoplasm is a poorly developed capsule a characteristic feature?
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What is a common consequence of untreated pleomorphic adenoma?
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What is a main characteristic of mucoepidermoid carcinoma?
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Which condition is associated with extra glandular manifestations and specific antibody levels?
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Study Notes
Oral Cavity Lesions
- Prevalence of oral cavity lesions: 40-70 years of age
- Oral cavity lesions occur 2:1 male to female
- Tobacco use is a risk factor for oral cavity lesions
- Erythroplakia is a precancerous lesion with a high risk of malignant transformation
Hyperkeratosis
- Hyperkeratosis is a proliferative oral cavity lesion
- Hyperkeratosis is a thickened epithelial layer
- Dysplasia is a change in the epithelium
- Carcinoma in situ is a precancerous condition
Squamous Cell Carcinoma
- Represents 95% of oral cavity cancers
- Squamous cell carcinoma is an aggressive epithelial malignancy
- Multiple primary tumors may occur
- Field cancerization can occur with chronic mucosal exposure to carcinogens, such as alcohol or tobacco
- Carcinogen exposure is a risk factor for the development of squamous cell carcinoma
- Tobacco and alcohol are the most common risk factors for the development of squamous cell carcinoma
- HPV infection, particularly type 16, is associated with squamous cell carcinoma
- A vaccine for HPV 16 is available and may be beneficial in preventing some squamous cell carcinoma
- TP53 and RAS mutations have also been implicated in pathogenesis of squamous cell carcinoma
- Squamous cell carcinoma commonly occurs in the ventral surface of the tongue, floor of the mouth, lower lip, soft palate, and gingiva
- HPV-related tumors tend to occur in the tonsillar crypts
- Early stage squamous cell carcinoma may resemble a simple wound
- Advanced stage squamous cell carcinoma presents as ulcerated and protruding masses with hardened and irregular borders
Squamous Cell Carcinoma Histology
- Squamous cell carcinoma may range in histology from well-differentiated to anaplastic, sometimes sarcomatoid
- Squamous cell carcinoma invades locally, including the cervical lymph nodes
- Squamous cell carcinoma can metastasize distantly, including the mediastinal lymph nodes, lungs, and liver
Diseases of Salivary Glands
- Sjögren syndrome affects both the lacrimal and salivary glands, causing dryness in both areas
- Anti-SS-A and anti-SS-B antibodies, along with other autoantibodies like rheumatoid factor and ANAs occur in Sjögren syndrome
- Sjögren syndrome is characterized by lymphocytic infiltration within both glands, primarily consisting of CD4+ helper T cells, plasma cells, and some B cells
- Sjögren syndrome follows a periductal and perivascular pattern of lymphocytic infiltration with germinal center formation
- Sjögren syndrome results in fibrosis and atrophy of the acini
- Sjögren syndrome presents with drying of the corneal epithelium, inflammation, ulceration, and atrophy
- Sjögren syndrome is associated with an increased risk of B-cell lymphoma
Salivary Gland Neoplasms
- The parotid gland is the most common site for salivary gland tumors, followed by the submandibular gland, and lastly the minor salivary glands
- The size of the gland impacts the probability of a tumor being malignant, with a higher likelihood of malignancy in smaller glands
- Salivary gland tumors are more common in adults, especially women
- Definitive diagnosis of salivary gland tumors requires a biopsy
Pleomorphic Adenoma
- Pleomorphic adenoma is the most common salivary gland tumor
- Pleomorphic adenomas often develop in the parotid gland
- Pleomorphic adenomas are typically painless, mobile, and discrete masses
- Recurrence is a risk associated with pleomorphic adenomas
Pleomorphic Adenoma Histology
- Pleomorphic adenomas are benign tumors that are mixed in nature, containing both ductal (epithelial) and myoepithelial cells
- Pleomorphic adenomas demonstrate differentiation along both epithelial and mesenchymal lines, with myxoid, hyaline, cartilaginous, and osseous structures
- Pleomorphic adenomas can transform into malignant mixed tumors or carcinoma ex pleomorphic adenoma if left untreated
- Pleomorphic adenomas are typically encapsulated
- Protrusions into surrounding tissues may occur with poorly developed capsules.
Warthin Tumor (Papillary Cystadenoma Lymphomatosum)
- The second most common type of salivary gland tumor
- Benign tumors that usually present in the parotid gland
- More common in men between the ages of 50-70
- Approximately 10% of Warthin tumors are multifocal and 10% bilateral
- A strong association with喫煙, smoking habits, exists
- Warthin tumors typically present as superficial, encapsulated masses
- Warthin tumors are characterized by cystic cavities, two cell rows, lymphocyte infiltration with germinal centers, and oncocytic cells with abundant mitochondria
- Recurrence of Werthin tumors is rare, occurring in only 2% of cases
Mucoepidermoid Carcinoma
- The most common form of primary malignant salivary gland tumor
- 60-70% occur in the parotids, however, they are the majority of malignancies in minor salivary glands
- Mucoepidermoid carcinomas do not have a capsule, but are invasive with larger tumor size
- Macroscopically, they may have cystic areas and contain mucus
- Histologically, they have a mixture of squamous cells, mucus-secreting cells, and intermediate cells
- Prognosis and clinical course are determined by the histological grade of the tumor
Adenoid Cystic Carcinoma
- Often occurs in minor salivary glands, especially the palatine glands
- Adenoid cystic carcinomas are slow-growing, poorly encapsulated, invasive, and prone to recurrence
- Metastasis to bone, liver, and brain can occur
- Perineural invasion is common
Oral Candidiasis
- Oral candidiasis, or thrush, is a superficial infection caused by the fungus Candida albicans
- Oral candidiasis is usually caused by the fungus Candida albicans
- The composition of the oral microbial flora and broad-spectrum antibiotics may influence the severity and occurrence of infection
- Clinical presentations of oral candidiasis include pseudomembranous (thrush), erythematous, and hyperplastic forms
- Deep infection can occur in individuals with severe immunosuppression
Oral Inflammatory Lesions
- Chronic fibroma is a reactive, nodular, submucosal fibrous tissue hyperplasia as a response to chronic irritation
- Chronic fibroma can be treated with complete surgical excision along with removal of the irritating source
- Oral fibroma can form on the buccal mucosa along the bite line
- Pyogenic granuloma is an inflammatory lesion that commonly occurs on the gingiva of children, young adults, and pregnant women (pregnancy tumor)
Pyogenic Granuloma Histology
- Pyogenic granuloma is characterized by proliferation of immature blood vessels, often with epithelial ulceration
- Pyogenic granuloma may mature into a dense fibrous mass or develop into a peripheral ossifying fibroma
- Pyogenic granuloma is typically treated with complete surgical excision
Leukoplakia and Erythroplakia
- Leukoplakia is a white plaque that can't be scraped off and can't be clinically or pathologically characterized by other diseases
- Leukoplakia is a precancerous condition
- Erythroplakia is a red plaque that can't be scraped off and can't be clinically or pathologically characterized by other diseases
- Erythroplakia is a precancerous condition
- Lichen planus and candidiasis are not considered leukoplakia.
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Description
Test your knowledge on oral cavity lesions, their prevalence, and associated risks. This quiz covers topics like hyperkeratosis, dysplasia, and squamous cell carcinoma, highlighting the significance of tobacco and alcohol as risk factors. Understand the implications of these lesions and their potential for malignant transformation.
