Oral Pathology Quiz: Herpes & Candidiasis

Herpes Simplex

• Herpes simplex is a neurotropic virus.
• It travels to the nerve root and has a dermatomal distribution.

Candidiasis

• Pseudomembrane is composed of squamous cells of the oral cavity covered by fungal structures and hyphae.
• Periodic Acid Shift (PAS) stain can help identify Candida.
• Candida spores are the inactive form.
• Candida hyphae is the active form.
• Leukoplakia is a white lesion covering the tongue with characteristics:
  • Cannot be removed.
  • Patient is a smoker.
• Erythroplakia is seen when the entire oral cavity is red.

Fibrous Epulis

• Occurs on the lateral borders of the tongue commonly.
• Rare on the upper lip.
• Common on the lower lip.
• Factors that can contribute to Fibrous Epulis:
  • Pregnancy hormones (progesterone).
  • Trauma.
  • Staphylococcus infection.

Differentiating Ulcers

• Differentiate between aphthous ulcers, malignant ulcers, and HSV ulcers.

Aphthous Ulcers

• Have a normal, erythematous, regular border.
• Not very prominent.
• Resolves on its own.
• Recurrent.
• Painful.

Malignant Ulcers

• Have an irregular, raised border.
• May have lumps in the cervical lymph nodes indicating metastasis.
• Imaging should be done for staging.
• Does not resolve on its own.
• Painless.
• Requires biopsy.

HSV Ulcers

• Associated with vesicles.
• Resolves in 7-10 days, except in immunocompromised individuals.
• Recurrent.

Sjogren's Syndrome

• Can cause dry eyes and mouth.
• More common in women over 40.
• It is an autoimmune disorder.
• Complications include:
  • Antidepressants.
  • Antihistamines.

Mumps

• Can lead to infertility in male children.
• Painful swelling helps differentiate it from tumors.

Torulopsis

• A yeast-like fungal organism.
• Often found in the mouth and throat.
• Can cause infections in people with weakened immune systems.

Granuloma

• A mass of inflammatory tissue.
• Can be caused by a variety of factors, including infection, trauma, and autoimmune disease.

Pyogenic Granuloma

• A type of granuloma that is typically red in color and bleeds easily.
• Commonly found in the mouth, but can occur elsewhere.
• Benign but can be surgically removed in some cases.

Exophytic SCC

• A type of squamous cell carcinoma that grows outward from the surface of the skin or mucous membranes.
• Can be distinguished from other lesions based on its irregular border.

Mucous Membrane

• The lining of the internal organs.
• Can be affected by various conditions.
• Affected by:
  • Fluctuation upon pressing.
  • Changes in size after being irritated by meals.

Salivary Gland Tumours

• Young patients:
  • Appear in few days.
  • Painful swelling.
  • Suggests a viral infection.
• Old patients:
  • Slow growing.
  • Painless.
  • Suggests a tumor.

Epithelial Myoepithelial Tumours

• Comprise two types:
  • Epithelial.
  • Myoepithelial.
• Myxoid Stroma:
  • Distinctive characteristic of these tumors.
  • Characterized by elongate nuclei in a basophilic background.

Mucus

• The major macromolecular components of mucus are the mucin glycoproteins.

Tracheoesophageal Fistula (TEF)

• Atresia is the absence or abnormal closure of an orifice or passage.
• Fistula is an abnormal opening between two hollow organs.
• TEF can cause:
  • Immediately throwing food up.
  • Weight loss.
  • Chocking.
• Investigations include:
  • NG tube:
    • Confirm placement via negative vacuum.
    • Confirm placement by pushing air and hearing it with a stethoscope.
  • X-ray.
  • Ultrasound (pre-birth):
    • Can detect high amounts of amniotic fluid.

Esophageal Varices

• Caused by cirrhosis of the liver.
• Scar tissue in the liver increases pressure on the liver veins, causing backflow.
• Backflow causes pressure on the esophageal veins.
• Symptoms include:
  • Melena (black, tarry stool).
  • Hematemesis (vomiting blood).
  • Jaundice.
  • High alcohol intake.
  • Forceful vomiting after alcohol intake.

Boerhaave Syndrome

• A transmural (full-thickness) tear in the esophagus.
• Requires immediate surgical intervention.

Candida

• Yeast-like fungus.
• Seen in two forms:
  • Budding yeast (inactive).
  • Pseudohyphae (active infection).

Hiatal Hernia

• Protrusion of the stomach through the diaphragm opening.
• Can be caused by:
  • Pregnancy.
  • Obesity.
  • Enlarged diaphragm opening due to age or congenital factors.

Barrett's Esophagus

• Basal cell hyperplasia (more than four layers).
• Connective tissue elongation into the upper one-third of the epithelium.
• Epithelium becomes columnar with goblet cells.
• 95% of adenocarcinomas originate from Barrett's esophagus.
• Other causes of adenocarcinoma may be due to smoking.

Esophageal and Oral Cancers

• Patients may experience:
  • Weight loss.
  • Loss of appetite.
  • Dysphagia (difficulty swallowing).
• TNF-α released by cancer cells can cause muscle wasting.