OPATH 2012 W #2

what is:
a strictly clinical term, more descriptive actually
clinical dx of exclusion
clinically a white patch/plaque
premalignant
prognosis varies on location

what is:
something occurs > 40 yr, ave 60
70% males
recognized more now than past
4% transform to malignant
biopsy mandatory, unless obviously benign cause

name 3 things that are considered possible causes of Leukoplaki

what is:
similar to actinic kearatosis, but on mucosa (lower lip)
fair skinned >45 yr, 10X male
blotchy pale area, blurr vermillion border
epi atrophy, solar elastosis, hyperkeratosis
permalignant, ulcerations. tx w sunscreen, biopsy suspicious

3 clinical features of Leukoplakia are: 1. homogenous or thick leukoplaka
2. thin leukoplakia 3 granular or nodular leukoplakia
what are other 3?

you see leukoplakia on floor of mouth, you're thinking
1
2
3

you see leukoplakia on tongue, ventral or lateral, you're thinking
1
2
3

you see leukoplakias on tongue (dorsal), you're thinking
1
2
3

what is:
associated w/ toothpaste/rinse containing something (what something? 80%) Pt develops a true leukoplakia
located in mx vestibule or mx alveolar mucosa
epi may show dysplasia but cancer risk unk

what is PVL?

what is:
concept: simple leukoplakia --> verrucal hyperplasia --> cancer
go thru verrucous carcinoma stage then to invasive SSE w/in 8 yrs
1:4 male female (tobacco no association)
lesions tend to slowly spread, rarely progress, dificult to eradicate despite therapy

what is:
5% to 25% oral leukoplakias
microscopic changes (premalignant)
graded mild to ...

what is:
enlarged nuclei & cells
large/prominant nucleoli
increased nuclear/cytoplasmic ratio
hyperchromatic nuclei
nuclear & cellular pleomorpism dyskeratosis, increased mitosis, abnormal mitosis

what else is seen with dysplasia microscopically?

leukoplakia is 77X more common
up to 90% of all erythroplakias represent severe epi dysplasia or worse
clinically red patch, clearly this

what is:
well demarcated erythematous macule/plaque w/ soft/velvety texture. old men
floor of mouth, tongue,soft tissue often
symptomatic
may be adjacent or associated with leukoplakia

why might a lesion be of concern clinically?

name 3

how is population doing on SCC?

what causes SCC?

name 5

what is:
young - less alcohol/tobacco
sexually transmitted, late dx
in oropharynx often, low differentiation = better prognosis

oral cancer in oregon a problem

clinical features of SCC

name 3

grading of SCC
grade 1 -
grade 2 -
grade 3 -
grade 4 -

what is:
low grade SCC 1-10% oral carcinomas
spit related, other sites too
may be HPV associated
65-70 ave age, men mostly
metastasis rare, 90% 5 yr disease free

what is:
rare SCC, dysplastic surface epi & invasive spindle element
sarcoma looking
often after radiotherapy
polypoid, rapidly growing, ave 57 yr
30% 5 yr disease free (high grade)

what is:
rare SCC (variant) combo of adenocarcinoma & SCC
posterior tongue, floor of mouth
prognosis?

what is:
symptomatic for long time until fills sinus
elderly, few more males. palatal pain, "toothache"
protrusion of eye, nasal drainage
surgery & radiation tx, survival?

25X more common in south China. age 50-55 ave,
cervical lymph node involvement 1st sign 60% of time
tx? prognosis?

what is:
new lesion of upper aerodigestive tract, in hypopharynx/tongue base. in older smoking/drinking men
ave survival? Tx?

what is:
locally invasive, spreads slow
80% of all skin cancers (85 H&N) b/c sun exposure
rarely metastasizes,
tx? prognosis?

what is:
age spots, liver spots (Senile Lentigo), benign frecle, macular lesion, brown/tan, sun damage, 90% whites over 70, dorsa hands, face/arms
Tx?

what is:
macular pigmentations of unk cause, sun exposed skin usually
in children, but any age
increased # of melanocytes increased pigmentation of basal cells, Tx?

what is:
oral pigmentation, focal increase of basal melanin pigmentation, b/c increased # of melanocytes
ave age 43, 2:1 female
lowe lip then buccal mucosa, solitary
Tx?

what is:
benign & uncommon pigmented lesion of oral mucosa, brown/black
melanocytes scattered throughout thickness of epi
aquired & appears reactive
in blacks, females common, buccal mucosa 30-40's.
growth?

what is:
very common, 10-4- nevi/person
childhood develops to max before age 35, white women mostly. above waist w/ head & neck common site. w
what are 3 basic clinical types?

what is:
uncommon, palate & gingiva are most common sites
2/3 in females, 35 ave age
intradermal type most common

what are the variants of melanocytic vevus?

there's 4. 1. congenital melanocytic nevus. 2.3.4.

congenital melanocytic nevus, present at age? _% population, 2 types: LG & SM b/c __cm, % in head and neck?
malignant?

what is:
melanocytic nevus, pale hypopigmented border, immune attack of adjacent melanocytes
nevus often regresses, 2nd decade of life, location?

what is:
uncommon, benign, most in childhood, extremities & face (not mouth)
architecture of compound nevus w/ spindle/ epithelioid cells TX?

what is:
b/c proliferation of dermal melanocytes, blue/black appearance
2nd common orally, usually where?
elongated, dendritic, dermal mealocytes in subepithelial location

what is:
malignant neoplasm of melanocytes

what is:
3rd most common skin cancer?
annual incidence increasing dramatically. 1 in 100 lifetime risk. ___% head and neck, __% extermities. prognosis bad if how thick?

what are 4 melanoma types?
1. lentigo maligna melanoma
2. ssm
3. nm
4. alm

ABCD's of melanoma

BANS have worse prognosis
BANS?

What is?
commoner in Japan/Uganda
<1% melanomas, 50's+. 4of 5 max mucosa.
starts brown/black and spreads - nodular then ulcerates
prognosis/Tx?

3 types of salivary glands?

what is:
largest gland? almost completely what type? it's encapsulated, escapes from ___duct. nerve passes thru? contains lymph nodes

what is:
2nd largest gland. encapsulated. in submandibular triangle.
type of gland? duct name?

what is:
smallest of glands (composite of 1 larger & several sm). No Capsule
location? duct?

what is:
mostly mucous, throughout submucosa
Type? 3 glands (bn,ve,lg)

what is:
severance of salivary duct, spills mucin into CT
kids/young adults common
where?

what is:
lined by ductal epi, partial obstruction of duct. age 42.8 yr old
Tx? rule out?

what is:
calcified mass, in duct
rare under age 20, 3:2 female
where? symptoms?

what is:
benign, inflammatory, self healing. arises spontaneously, afe age 48, male slightly more, asymptomatic palatal ulcer, confused w/ malignancy

what is:
most mucous, located throughout submucosa. lingual glands mostly mucous, some all mucous
glands: B&N, goVE

s
Salivary Gland neoplasms
PEARLS
for every 100 parotid tubors
X minor gland tumors
X submandibular gland tubors
X sublingual gland tumor

s of 200+ cases of oral minor salivary gland tumors
X = benign neoplasms
X= pleomorphic adenoma
X= canalicular ademoma
X= Oncocytoma

s 5 most common minor salivary gland tumors
X - mixed tumor
X- Mucoepidermoid carcinoma
X- polymorphous low grade Ca
X - Canalicular adenoma
X - Adenoid Cystic Carcinoma

s what is: most common neoplasm of salivary gland origin, mixed tumors in mn glands rarely have capsules (well developed at least) mixed tumors of minor glands have litle propensity for reoccurance
locations?

s what is:
occur in young, hard palate especially. salivary galnd tumors rare in lwoer lip, rare in upper lip yet most commin salivary gland tumor in lower (mimics mucocele). can occur central w/in jaw.

s what is:
favors upper lip (75%), misdx b/c non-encapsulated, multifocal, features of tubular pattern (adenoid cystic carcinoma)

s what is:
called "Wolf in sheeps clothing" & "always gets a man"
tumors of minor glands may have worse prognosis
microscopic pattern makes a difference in survival rates

s what is:
commonly misDx as adenoid cystic carcinoma, but better prognosis, occur in minor glands and never metastasize.

s what is:
"not otherwise specified" Pearl

s Other Pearls
Ca ex mixed tumor
Acinic cell carcinoma
Cystadenocarcinoma
Papillary cystadenocarcinoma
ages & locations?

s SUMMARY - ratio of benign to malignant is consistent w/ other reports. Pleomorphic adenoma is most common minor salivary gland neoplasm - excision of overlying mucosa might be indicated during excisional biopsy more (flip)

s what is:
benign growth of blood vessels, common non-epi salivary gland tumor
most common salivary gland tumor <1yr, 85% parotid, 2X females, involute by school age

s Reactive/inflammatory lymph nodes, metastases to lymph nodes
tumor associated lymphoid response
lymphoma infiltrating gland/node
benign lymphoepithelial lesion BLEL - rare

s

what are the 5 epithelial neoplams Major glands - Benign
?

s what is:
most common salivary gland neoplasm 60-70% where? 40-70% where? ave age 41 yrs, female 2:1, Tx? recur?

s
what is:
2nd most common benign tumor, 73% where? ave age 58, 2:1 female, tx? recur?

s what is:
95% where? ave age 57, 1.2:1 male 96% white, 5-10% bilateral,
Pathognomonic microscopic pattern
superficial parotidectomy

s
what is:
78% parotids, 1 cell type, 64 yr old ave, may be multifocal, usually superficial parotidectomy

s
what is:
not one of other recognized tumors, 66% mj glands, ave age 56 yrs, mor common in 5th-8th decades
intermediate to high grades
prognosis variable

s What is:
usually low grade, 81% parotid, 59% female, ave age 44, seen on superficail parotidectomy
best prognosis of all tumors

s what is:
carcinoma ex mixed tumor
carcinosarcoma
malignant mixed tumor

s what is:
develops in previous benign pleomorphic adenoma
age 56 64% paraotid
histologic patterns
Agressive Tumor, Tx?

s What is:
reactive hyperplasia of fibrous tissue, commonmost along bite line
usually smooth surfaced & normal color or pale, usually <1.5cm in diameter
4th to 6th decades, Tx?

s 5% of oral fibrous proliferations
sessile or pedunculated, usually <1cm
surface papillary, may look papilloma-y. most common first 3 decades. 1/2 on gingiva.
microscope sees? Tx?

s What is:
reactive fibrous & epithelial hyperplasia due to flange of ill fitting denture, older women more
1-2 rolls of redundant tissue facial to alveolar ridge.
firm, fibrous, may be focally ulcerated & erythematous
Tx?

s what is:
reactive fibrous & epi hyperplasia, related to ill fitting denture, bad hygiene, in hard palate
red, papillary surface. see pseudoepitheliomatous hyperplasia
excie reactive tissue, new denture & leave denture out at night

s what is:
reactive tumor like growth on gingiva
exuberant tissue response to trauma, red/purple tissue, freq. ulcerated, females, often prego, complete excision & removal of irritation

s what is:
reactive tumor-like growth, on gingiva, ant. to molars, dark red/ulcerated, females.
cellular vascular stroma with osteoclast-like multinucleated giant cells, tx? recur?

s what is:
reactive lesion seen only on gingiva, teens, young adults
2/3 female, ulcerated. fibrous proliferation w/ reactive bone or other calcified tissue
Tx? Recurrance?

s what is:
benign umor of adipose tissue, ver common - but less in oral cavity
most common lcoations are buccal mucosa and vestibule, tongue, floor of mouth then lips
most pts age 40+ Tx?

s what is:
exuberant attempt at repair of injured nerve
painful, common oral location is mental foramen, tx?

s what is: benign neural neoplasm composed of schwann cells. painless, well circumscribed, 25-5-% head/neck, in tongue or bone, usually solitary but may be neurofibromatosis associated.
encapsulated with Antoni A tissue & verocay bodies
Tx?

s what is:
peripheral never neoplasm composed of mix of nerve lements: antoni A tissue not seen
slow growing painless, not enapsulated
solitary, associated w/ neurofibromatosis
skin is most freq location, but oral cavity too, tongue, buccal mucosa or bone, Tx?

s made of granular cells of disputed histogenesis, favor schwann cell origin
any age, most tongue, 10% show pseudoepitheliomatous hyperplasia.
tx? recur?

s what is:
present at birth, 90%female, 2X max gingiva/ant, 10% multiple
Does not have pseudoepitheliomatous hyperplasia
Tx?

s what is:
benign proliferation of blood vessels, many are hamartomatous in nature. 12% kids have 1+, most common head/neck, Tx?

s what is:
congenital hemangiomas, involves 1 side of face & meninges. may have neruologic disorders
convolutional calcifications on skill
may involve oral mucosa and jaws (vascular gingiva proliferations can resemble pyogenic granulomas

s what is:
benign hamartomatous tumors of lymph vessels. Arbitrary classification: lymphaginoma simplex, cavernous lymphangioma, cystic lymphangioma
75% head/neck, post triangle, 90% by age 2. oral lesions on ant 2/3 tongue, Tx?

s what is:
markedly dilated lymph vessels
most common in neck/axilla
may become massive
mortality 2-6%

s benign muscle neoplams vs malignant muscle neoplasms. name striated muscle vs smooth muscle.

s what is:
benign neoplasm of smooth m. rare in oral cavity, often uterus & GI. most oral cases from blood vessels (vascular leiomyomas)
other locations?
pain?
Tx?

s what is:
benign neoplasm of skeletal m.
head/neck main sites, oral, FOM, tongue soft palate, buccal, multinodular or multifocal,
Tx?

s what is:
unusual vascular neoplasm, seen w/ HHV8, multicentric, 4 clinical presentations?

s Kaposi's 3 stages?

microscopic features range from granulation tissue type appearance to fibrosarcoma type spindle cell proliferation
Prognosis?

s what is:
effects 90% men, late adult life, "chronic" form of disease, italian, jwish, slvic descent, lsow growing red plaques & nodules on skin & lower extermities,
often get lymphoreticular malignancy
10-20% mortality in 8-13 years

s there are four types of African Endemic type of Kaposi's sarcoma:
1. BN - similar to classic but in young adults
2. A or I - progressive development and invasive
3. F - rapidly progressive & widely disseminated, often visceral involvement
4. L - primarily young black kids, generalized rapidly growing tumors of lymph nodes & viscera

s Kaposis sarcoma type ?
it is most often in organ transplant pt's, .4% of kidney transplant pt's , probably due to loss of cellular immunity
similar racial predilection as classic form
may run more aggressive course than classic

s What is:
most common in usa, begins a single lesion on skin/mucosa
trunk,arms,head & neck common
oral lesions seen in 50% of AIDS Kaposi's pt's
Progressive w/ wide dissemination to lymph nodes & organ systems, Tx how?

s what is:
malignant neoplasm of striated muscle, common soft tissue sarcoma of children. 1st decade, 40% head & neck, painless, rapidly growing mass, may be botryoid, before 60's, 90% fatal now 63%
microscopic pattern?

s what is:
malignant peripheral nerve tissue, 50% of neurofibromatosis, most commin in proximal portions of extremitites & trunk
mandible, lips, buccal muclosa
Tx? 5 yr? common w/ who?

s What is:
malignant tumor of fibroblasts, most common in extremities, 10% head/neck - most in nose/paranasal sinuses, more in young adults/kids
slow growing mass. Tx? 5 yr? Spindle cells often in herringbone pattern

s what is:
has both fibroblastic & histocytic differentiation - used to be most common soft tissue sarcoma in adults (older)
extermitites & retroperitoneum most common, rare head/neck
Tx? recurrance?

s what is:
malignant tumor of muscle (smooth), most common in GI tract (rare orally), middle age/older, appears nonspecific mass, microscopic spindle shaped cells w/ pink cytoplasm
Tx? prognosis?

s What is: malignant neoplasm of fatty origin, 2nd most common soft tissue malignancy in adults. most common thughs, retroperitoneum, & inguinal region, rare head/neck. peaks 40-60. soft/slow growing, ill defined mass
pain/tenderness uncommon
Tx? recurrance? 5 yr?

melanocytic lesion shave pigment in 2 says - endogenous & exogenous. 2 examples of each?

melanin pigmentation comes from melaocytes, tell 3 facts about melanocytes

what is:
occurs in mucosa/any race (dark's more affected)
symmetrical involment & flat (macular)
normal # melanocytes, increased amnt of melain in basal cell layer

what is:
common pigment of skin, <3mm, fair skin, dark b/c sun, increase in melanin w/ normal to slightly less # melanocytes
sunscreen/avoid sun will decrease / lighten lesions

what is sun induced/symmetrical hyperpigmentation of face/neck
midface/forehead, upper lip, chin. pregnant, or contraceptives, protect from sun helps

what is:
rare 1/100K, TB old #1 cause, now leukemic infiltrate/ amyloidosis
decreases adrenal cortical hormones, pit to increase ACTH which has MSH type effect on melaocytes
pigmentation is eary sign, dark elbows, knees, knuckles,

what is:
autosomal dominant, dark freckling around orifaces - oral mucosa/fingers, intestinal polyps common - hamartomatous, can be seen throught GI tract, esp Sm Intestine.

what is:
light brown macular pigmentation that may be associated w/ syndromes.
coast of cali / maine

match
mcCune Albright synd.,
Jaffe's type of fibrous dysplasia w/
- less severe w/o endocrine distrbances
- more severe w/ endocrine distrubances

what is:
common 10-40/person. max # by 35, white women, above waist, H&N, form these:

slip slap slop?

melanoma - changes that may hearld transformation of the bnign lesion to malignant one: