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Oral Cavity Pathology, Oral Cavity Pathology Inflammations GLOSSITIS Inflam of tongue or beefy-red tongue from defs -atrophy of papillae, thinned mucosa -can lead to inflammation, ulcerations Ulcers can be from jagged teeth, dentures, syphilis, inhalation burns, corrosive chemicals -Vit B12, riboflavin(2), niacin(3), pyridoxine(6) -Sprue, Fe deficiency -Fe def anemia, glossitis, esoph dysphagia-hints ->Plummer-Vinson or Paterson-Kelly Syn, Oral Cavity Pathology Tumorous, Precancerous Lesions SQUAMOUS CELL CA Months-Years of progression-PREVENTABLE -stage>grade for prognosis 95% of oral cavity CA, 3% of total cancer Link to EtOH, Tob (esp chewing), synergistic -also marijuana, betel nuts, pan -HPV 6, 16, 18 (Waldeyer’s Ring, tongue) -sunlight, pipe smoking (lip) -muts in 18q, 10p. 8p, 3p, p53, INT2, BCL1 Protective: fruits, veggies MORPH-floor, tongue, hard palate, tongue base Early-raised, firm, pearly or irreg, verrucous (like leukoplakia) Later-protruding mass, central necrosis, shaggy borders, ulcerated -keratin pearls, high H:C Mets to MS LNs, lungs, liver, bones -late discovery of primary lesion, Oral Cavity Pathology Tumorous, Precancerous Lesions LEUKOPLAKIA-clinical term (Keratosis) Any age, esp 40-70yo; 2:1 Male Via lichen planus, candidiasis, others Most caused by epidermal prolifs -can’t be removed by scraping All considered precancerous until R/O Risk factors: tob, esp chew/pouches (HPV-16) -EtOH, ill-fit dentures, persistent irritants -hot pizza MORPH-oral, not really tongue -solitary or multi, border or not -range from ordered to dys- and aplastic 1-16% risk to CA Ominous: speckled, warty, floor of mouth, Or ventral tongue, LEUKOPLAKIA-clinical term (Keratosis) Any age, esp 40-70yo; 2:1 Male Via lichen planus, candidiasis, others Most caused by epidermal prolifs -can’t be removed by scraping All considered precancerous until R/O Risk factors: tob, esp chew/pouches (HPV-16) -EtOH, ill-fit dentures, persistent irritants -hot pizza MORPH-oral, not really tongue -solitary or multi, border or not -range from ordered to dys- and aplastic 1-16% risk to CA Ominous: speckled, warty, floor of mouth, Or ventral tongue Intermed form:'Speckled LEP' ERYTHROPLAKIA=Thin Dysplasia Dysplastic leukoplakia – more OMINOUS -red, velvety, poss eroded – level or slightly depressed -more atypical epith changes ->higher risk of malignancy MORPH-rarely ordered -most w/ superficial erosions, dysplasia, CA in situ, or CA in margins already -red b/w subepith inflam, vasodilation 50% risk of malignant transformation, Oral Cavity Pathology Reactive Lesions -Bx all Peripheral (Irritation) fibroma -buccal mucosa or ging’dental margin; nodular mass of fibrous tissue -some inflam cells, squamous mucosa Pyogenic granuloma-very vascular, peduncular -gingiva of KIDS, TEENS, PREGNANT; stress, immune change (‘pregnancy tumors’) -type of cap hemangioma (differ by inflam) -resolve or mature, resembling fibroma Peripheral Giant Cell granuloma (GC epulis) -inflam lesion 1.5cm diameter -protrudes from gingiva at chronic inflam site -ulcerated or covered by NL mucosa -w/ multinuc giant cells, fibroangio stroma -well-delineated/excised Periph Ossifying Fibroma-fibroblasts lay bone -can extend to and destroy bone, Oral Cavity Pathology Systemic Dzs Peutz-Jeghers Syndrome -colonic hamartomas ->melanosis (brown papules) -on lip (inc. melanin in cells) Stevens-Johnson Syndrome ->mucosal ulcers Amyloidosis->macroglossia Measles->Koplik's spots on buccal mucosa-1st sign in febrile infant, Oral Cavity Pathology Systemic Dzs HAIRY LEUKOPLAKIA -almost only w/ HIV (80% of pts) -white, confluent, fluffy -anywhere on oral mucosa, esp. lateral tongue -piled-up keratotic squames -underlying acanthosis -EBV present in most cases -accepted as major cause -sometimes superimposed candida -AIDS manifestions about 2yr post, Oral Cavity Pathology Odontogenic Cysts, Tumors OG Cysts in jaw-part of Gorlin Syndrome -(nevoid basal cell CA syn)-away from sun Ameloblastoma-from OG epith-CYSTIC -NO ectomesenchymal diff'ation, local invasion -slow-forming, benign in most cases Odontoma-MOST COMMON OG TUMOR -arises from epith; enamel, dentin deposition -probably hamartomas, not true neoplasms -local excision Dentigerous Cyst-in impacted teeth, no keratin Periapical cyst-can penetrate max. sinus floor ->root canal, Oral Cavity Pathology Inflammations HSV INFECTIONS - Mostly HSV-1 Mostly->cold sores Kids 2-4yo can ->severe, diffuse in oropharynx Acute Herpetic Gingivostomatitis: -fiery redness, swelling->vesicle clusters -clear, serous fluid; can rupture->ulceration -acantholysis(intra,extracel edema)->vesicles -intranuc viral inc (Cowdry), multinuc polykaryons (syncytia) ->Tzanck test for Dx -clear w/in 3-4wk->to trigeminal nerve Recurrent H.GS-small vesicles on lips, nasal orifices, buccal mucosa – -dry up in 4-6d, heal w/in 7-10d Cold sores: w/ URI, cold exposure, wind, sun, Oral Cavity Pathology Inflammations XEROSTOMIA - Dry Mouth -In SJOGREN SYNDROME (dry eyes too) +inflam salivary gland enlargement -Radiation Tx effects, Anticholinergic Tx ->dry mucosa or ATROPHY of papillae w/ fissuring, ulcerations