Red-Blue Lesions (Midterms) PDF

RED-BLUE LESIONS (MIDTERMS) Congenital Vascular Anomalies Congenital Hemangiomas and Congenital Vascular Malformations - vascular proliferations, during or around birth - common in females - difficult to classify, confusion about their origin - red to blue -...

RED-BLUE LESIONS (MIDTERMS) Congenital Vascular Anomalies Congenital Hemangiomas and Congenital Vascular Malformations - vascular proliferations, during or around birth - common in females - difficult to classify, confusion about their origin - red to blue - flat, nodular or bosselated - Diascopy -> separate lesions from hemorrhagic lesions in soft tissue Congenital hemangiomas - benign endothelial cell neoplasms - microscopic types: capillary and cavernous (vessel diameters) - strawberry nevus - appears at birth but not till early childhood - rapid growth phase -> involution phase - abundant capillary spaces lined by endothelium, no muscular support - Consist of capillaries, venous, arteriolar, and lymphatic channels, arteriovenous communications - Lesions is one or multiple, and vascular morphology determines the flow rate - Involution in early childhood - Propranolol - beta-adrenergic blocker congenital vascular malformations - abnormal vessel morphogenetic lesions - vascular channels, arteries and veins - persistent lesions, grow with individual, doesn’t involute - arteriovenous shunts, exhibit a bruit or thrill on auscultation - Doesn’t involve - sclerosant therapy & laser therapy Vascular malformations - called blue rubber bleb nevus syndrome (Bean's syndrome) - multiple small and large cavernous hemangiomas in skin, GI tract and mouth - childhood or young adulthood - life-threatening gastroenteritis bleeding/blood loss with severe anemia and iron deficiency Encephalotrigeminal Angiomatosis (Sturge-Weber Syndrome) - noninherited neurocutaneous syndrome - vascular malformations in cerebral cortex's leptomeninges - facial malformations - port-wine stain or nevus flammeus, innervated by trigeminal nerve, isolated lesions - mental retardation - Hemiparesis - seizure disorders - Phenytoin- control the condition - gingival hyperplasia Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Syndrome) - rare condition affecting 1 in 5000 to 8000 people - mutations in two genes: - endoglin chromosome 9 (HHT type 1) - activin receptor-like kinase 1 (ALK 1) on chromosome 12 - abnormal and fragile vascular dilations in skin, mucous membranes - arteriovenous malformations in lungs, brain, and liver - Telangiectatic vessels is red macules or papules - appear in early in life and throughout adulthood Intranasal telangiectasias - Epistaxis - common - Bleeding from oral lesions - Chronic low-level bleeding -> iron deficiency anemia Reactive Lesions Varix and Other Acquired Vascular Malformations - Venous varix, or varicosity - focal dilation of single vein in oral mucosa and lips - common developmental abnormality - common in older adults -> chronic sun exposure and subsequent dilation - blue and blanch with compression - thrombosis occurs -> firm texture - No treatment Vascular malformations - complex than simple varices - asual in adults - undetermined cause - May be vessel trauma and abnormal repair - red-blue discrete - asymptomatic tumescences, easily excised Pyogenic Granuloma - red mass - hyperplastic granulation tissue, prominent capillaries - not a granulomatous inflammation - Doesnt produce pus - Not a red mass due to its composition - second decade of life - Common on attached gingiva (75%), tongue, lower lip, and buccal mucosa - Hormonal changes during puberty and pregnancy -> pregnancy tumors - multiple gingival lesions or generalized gingival hyperplasia - red, smooth, hemorrhagic, and compressible lesions - ulcerated due to secondary trauma - pedunculated or broad-based - millimeters to several centimeters - Older lesions -> pink and collagenized, occur at any age, common in females, 5% of pregnancies Peripheral Giant Cell Granuloma Etiology Peripheral giant cell granuloma is a rare hyperplastic connective tissue response to gingival tissue injury, a "reactive hyperplasia" commonly found in oral mucous membranes. Its unique feature is the appearance of multinucleated giant cells, but the reason for their presence remains unknown. This lesion represents an exuberant reparative process in association with local trauma or irritation. Clinical Features Peripheral giant cell granulomas are found in gingiva, typically between the first permanent molars and the incisors, and may arise from periodontal ligament or periosteum. They can cause alveolar bone resorption, sometimes resulting in a cup-shaped radiolucency on the edentulous ridge. These red to blue, broad-based masses appear as red to blue masses, and secondary ulceration caused by trauma may result in a fibrin clot over the ulcer. They can occur at any age and are more common in females. Histopathology Fibroblasts form peripheral giant cell granules, with abundant multinucleated giant cells found in fibroblasts. These cells are nonfunctional in terms of phagocytosis and bone resorption. Metaplastic bone islands may appear in these lesions, but this has no clinical significance. Chronic inflammatory cells and neutrophils are present in ulcer bases. Differential Diagnosis Peripheral giant cell granuloma is clinically distinct from pyogenic granuloma, but more likely to cause bone resorption. A biopsy provides definitive diagnostic results, and it is microscopically identical to its central counterpart, the central giant cell granuloma. Differences are minimal. Treatment Surgical excision is the preferred treatment for peripheral giant cell granulomas, requiring removal of local factors and irritants. Recurrences are often due to the absence of the periosteum or periodontal ligament in the excised specimen. Scarlet Fever Scarlet fever is an acute exanthematous bacterial infection caused by three exotoxin-producing, antigenically dissimilar streptococcal strains (A, B, or C) typically observed between 1 and 10 years of age. The symptoms are a systemic bacterial infection resulting from an erythrogenic toxin that causes capillary damage. Some strains of group A streptococci produce the toxin, while others can cause pharyngitis without the red skin rash and oral signs. All group A streptococcal infections are spread through droplets from contact with an infected individual or carrier. Crowded living conditions also promote the spread of streptococcal infections, with the upper respiratory tract being the most common entry point. Children typically experience a red skin rash after several days of infection, exhibiting symptoms of group A streptococcal infections. The rash spreads to other surfaces, and the face is flushed except for a circumoral pallor. The palate may show nonspecific inflammatory changes, and the tongue may become covered with a white coat, enlarged and reddened, or red strawberry tongue. The coat is lost, leaving a beefy red tongue. In untreated cases, the disease subsides quickly. Penicillin is the preferred treatment for group A streptococcal infections, with erythromycin used for patients allergic to penicillin. Antibiotics are used to prevent complications like rheumatic fever and glomerulonephritis. Neoplasms Erythroplakia Etiology Erythroplakia is a red patch on oral mucous membranes, often found as severe dysplasia or carcinoma after a biopsy. Its causes are believed to be similar to those for oral cancer. Tobacco use and heavy alcohol consumption are believed to play a significant role in inducing these lesions, with nutritional deficits and other factors potentially playing modifying roles. Clinical Features Erythroplakia is a less common lesion than leukoplakia, but it is more serious due to its higher percentage of malignancies. It appears as a velvety red patch with well-defined margins and is usually affected by individuals aged 50-70. Common sites of involvement include the mouth floor, tongue, retromolar mucosa, and soft palate. Erythroplakia is usually supple to the touch unless invasive, in which case induration may be noted. It is strongly associated with tobacco consumption and alcohol use. Histopathology Around 40% of erythroplakias show severe dysplasia, 50% are squamous cell carcinoma, and 9% mild or moderate dysplasia. These lesions have a reduced keratin production and increased vascularity, resulting in a color similar to Bowen's disease. The histologic variant of carcinoma in situ has microscopical features like disordered growth, multinucleated keratinocytes, large hyperchromatic keratinocyte nuclei, and atypical individual cell keratinization. Kaposi Sarcoma - neoplastic proliferation of endothelial cells - dendrocytes, macrophages, lymphocytes, and mast cells - Human herpesvirus 8 -> Kaposi sarcoma herpesvirus (KSHV) - etiologic agent of all forms of Kaposi sarcoma lesions - AIDS body cavity lymphomas - Castleman's disease -> induce and maintain Kaposi sarcoma Metabolic-Endocrine Conditions Vitamin B Deficiencies - common in poorer socioeconomic areas -> inadequate dietary intake, uncommon in USA - malnutrition, malnutrition from alcoholism, starvation, or fad diets - oral changes -> cheilitis and glossitis, angular cheilitis -> exaggerated cracking and fissuring at mouth corners - tongue reddishes, papillae atrophy -> pain, tenderness, and burning Riboflavin deficiency - eye keratitis - scaly dermatitis in nasolabial area and genitalia Niacin deficiency - extraoral problems - dermatitis, diarrhea, dementia, and death - symmetrically distributed dermatitis - thickening and pigmentary changes Dementia - disorientation and forgetfulness Folic acid deficiency - enlarged bone marrow, macrocytic anemia, and GI abnormalities -> diarrhea and oral lesions Pernicious Anemia - deficiency in vitamin B12, DNA synthesis - intestinal mucosa cannot transport vitamin B12 -> lack of an intrinsic factor - producing parietal cells in the gastric mucosa is believed to be the cause - atrophic gastritis, achlorhydria, neurologic changes, megaloblastic bone marrow, and macrocytic anemia, with significant oral manifestations. - adults of both genders - weakness, pallor, shortness of breath, difficulty breathing, fatigue - Severe cases -> CNS & GI symptoms -> headache, dizziness, and tinnitus - Hunter's glossitis or Moeller's glossitis = pain and burning in tongue, reddish appearance -> papillae atrophy. - Angular cheilitis, oral candidiasis, recurrent ulcers, and diffuse erythematous mucositis. Iron Deficiency Anemia - anemia caused by iron deficiency - inadequate dietary intake, gastroenteritis, chronic blood loss - childhood and pregnancy - cause brittle nails, hair, koilonychia, red, painful tongue, and angular cheilitis - Plummer-Vinson syndrome/Paterson-Kelly - dysphagia, upper alimentary tract atrophy, predisposition to oral cancer Burning Mouth Syndrome - vitamin B deficiency, pernicious anemia, iron deficiency anemia, chronic atrophic candidiasis - do not show clinically detectable lesions - no clear cause, once conditions are ruled out and no treatment is present - pain and burning symptoms - Microorganisms -> Candida albicans; bacteria -> staphylococci, streptococci, anaerobes - Xerostomia -> Sjögren’s syndrome, anxiety, or drugs - Nutritional deficiencies -> B vitamin complex or iron, zinc - Pernicious anemia and iron deficiency anemia - Hormone imbalance, postmenopausal changes  - Neuropsychiatric abnormalities, depression, anxiety, cancer phobia, psychogenic problems - Diabetes mellitus - Oral habit, chronic denture irritation, or sharp teeth - Idiopathic causes, including idiopathic peripheral neuropathy - middle-aged women, with men experiencing it later - Over 40 years old, less in children and teenagers - Pain, burning, altered taste, and xerostomia with normal-appearing oral mucosa, intact tissue, and normal distribution of tongue papillae Other Oral-Facial Pain Conditions Trigeminal Neuralgia - sharp, stabbing pain along fifth cranial nerve, maxillary or second division - severe episodic or paroxysmal pain - older individuals, women, sixth and seventh decades - rare in individuals under 40, multiple sclerosis is 1% to 4% - unilateral pain -> right side of the face, few in bilateral - Short-lasting, "lancinating," "shooting," "stabbing," or "electric shock-like." - tinger spots on skin or mouth -> from smiling, eating, or washing - Microvascular decompression (MVD) Glossopharyngeal Neuralgia - painful pain in glossopharyngeal nerve - neoplasm at tonsillar region, base of tongue/oropharynx to ear - swallowing, chewing, or coughing - May cause neurally mediated syncope, resulting in bradycardia, hypotension, and cardiac arrest. Postherpetic Neuralgia - Recurrent varicella zoster infection of trigeminal nerve - 10% of patients to develop persistent neuralgia - episodic shooting pain to constant burning sensations - postinflammatory pigmentation or scarring - Lasts weeks to months - challenging to manage Giant Cell Arteritis (Temporal Arteritis) - multifocal granulomatous vasculitis or temporal arteritis  - head or neck vessels. If untreated -> retinal vasculitis and blindness - over 60 years old, women - unilateral headache in temporal or occipital region - causes of orofacial pain, weight loss, muscle weakness, lethargy - polymyalgia rheumatica -> systemic muscular and joint pain - initiated by eating, limiting normal eating and causing ischemic jaw claudication - raised erythrocyte sedimentation rate (ESR) - unfractionated C-reactive protein - prednisone doses of 40-60 mg -> low maintenance dose for 3 to 6 months. ESR to monitor Atypical Facial Pain - chronic, unknown pain - women over 30 years old - constant, dull ache, doesn't wake the patient from sleep - depression or sleep disturbances, early morning waking - one side of the maxilla, midline of the maxilla or mandible - nature of this relationship is unclear - tricyclic antidepressants (TCA) - SSRIs -> results have been mixed Atypical Odontalgia - closely related to AFP, psychological component - constant dull ache in one tooth or an edentulous area - TCAs before sleep Immunologic Abnormalities Plasma Cell Gingivitis - plasma cell gingivostomatitis -> prominent plasma cell infiltrate - allergic gingivostomatitis -> chewing gum & allergic reaction/hypersensitivity reaction - Allegic to cinnamon flavoring, cinnamic aldehyde-containing toothpaste - rarely encountered today - adults and children - burning of the mouth, tongue, or lips - Gingiva is fiery red - edematous but not ulcerated - tongue mucosa is atrophic and red - epithelium is spongiotic - infiltrated by various inflammatory cells, Langerhans cells, and apoptotic keratinocytes - lamina propria - prominent capillaries, infiltrated by normal plasma cells Drug Reactions and Contact Allergies - skin and oral mucous membranes -> predisposition to allergies - red, erythematous lesions, urticarial rash, or vesiculoulcerative eruptions - Less: generalized and diffuse redness - Pattern is similar to vitamin B deficiency and anemia when the tongue is the primary target Extravascular Lesions Petechiae and Ecchymoses - Soft tissue hemorrhages cause by trauma or blood disease - Traumatic injuries -> blood leakage -> red to purple lesions - cheek biting, forceful coughing, fellatio, prosthetic appliance trauma, improper hygiene, iatrogenic dental injuries Blood dyscrasias  - minor trauma -> oral red to purple - referred to an internist or hematologist - Platelet and coagulation defects - Problems are qualitative or quantitative - unknown origins or systemic factors like drug ingestion, infection, or immunologic disease - buccal mucosa, tongue surface, lips, and the hard and soft palate junction - gingival enlargement, gingivitis, spontaneous gingival hemorrhage, prolonged bleeding after oral surgery, loose teeth, and mucosal ulcers leukemia types - intraoral lesions - monocytic leukemia (most frequently), myelocytic leukemia (granulocyte serous), and lymphocytic leukemia (lymphocytes) -