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Juvenile Rheumatoid Arthritis (JRA) 7
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Date created
Mar 1, 2020
Cards (119)
Section 1
(50 cards)
Juvenile Rheumatoid Arthritis (JRA) 7
1. Juvenile idiopathic arthritis 2. Juvenile scleroderma 3. Juvenile lupus 4. Juvenile dermatomyositis 5. Fibromyalgia 6. Mixed Connective Tissue Disease 7. Kawasaki Disease
Medium Malignant Potential 3
Actinic Cheilosis Smooth thick leukoplakia Smooth red tongue (Plummer Vinson)
Adenoid cystic carcinoma Histo
Swiss cheese Perineural invasion Uncapsulated
Neck dissection area 1b borders
Mandible Hyoid Anterior and Posterior Digastric
Functional neck dissection
Preserve all of above structures (SCM, CN11, IJV) Indicated if N0 or N1
Keratoacanthoma Clinic
Sun exposed skin - 8% vermillion, Firm, well-demarcated, dome shaped nodule with crusted central plug of keratin. *Rapid enlargement typical
CREST
Calsinosis Raynoud syndrome Esophageal dismotility Sclerodachtily Telangiectasia
ADENOID CYSTIC CARCINOMA survival
5 year - 70% 10 year- 50%
Precancerous lesions in SCC development 5
Actinic Keratosis Actinic chelosis Leukoplakia Erythroplakia Submucous fibrosis
indications of neck dissection
1. palpable lymph nodes 2. positive lymph nodes identified with imaging CT, MR, PET 3. if malignancy identified without lymph node presence
Verrucous Carcinoma Treatment
Metastasis is rare Surgical excision w margin (1-2 cm), Less than SCC margin No neck dissection Chemo not recommended 90% survival at 5 years
Types of fibrous dysplasia
Monostotic Polyostotic Polyostotic+ Cafe au Lait - Jaffe-Lichtenstein syndrome Polyostotic+ Cafe au Lait+ multiple endocrine disorders - McCune-Albright syndrome
Radiotherapy indications for SCC 6
1. Positive soft tissue margin 2. >1 lymph nodes without extracapsular invasion 3. =>1 lymph nodes with extracapsular invasion 4. Bone invasion 5. Perineural invasion 6. Comorbid immunosuppressive disease
Workup if biopsy shows SCC
1) History and physical 2) CXR/CT chest 3) CT head/neck 4) Panendoscopy - look for 2nd primary 5) Abdominal ultrasound (liver) or CT 6) CBC/LFT's/PFT's
Polymorphous low-grade adenocarcinoma age
50-60
Adenoid cystic carcinoma gender
M=F
SCC ratio to oral cancers
25 to 30 % of all oral cancers 3% of cancers in men 2% of cancers in women
Adenoid cystic carcinoma
Malignant tumor of the salivary glands; has propensity to invade nerves
Survival rate of SCC by location
floor of mouth 61% tongue 69% oropharyngeal 73%
Polymorphous low-grade adenocarcinoma location
palate only minor glands
Keratoacanthoma rare intraorally
benign neoplasm, mimics SCC Resolves spontaneously 1) UV 2) HPV
Squamous cell carcinoma risk factors
Radiation UV Smoking Alcohol HPV 16,18 Sphylis Iron deficiency (Plummer Vinson Syndrome) Vitamin A deficiency Genetic mutations Candidia albicans Smokeless tobacco Chronic irritation
Adenoid cystic carcinoma clinic symptoms
Pain Ulceration Slow relentless growing
Most common location of SCC
Lower lip Tongue Floor of mouth Buccal mucosa Palate
Neck dissection area 1a borders
Superior - mandibular margin inferior- hyoid bone anterior- anterior belly of digastric muscle posterior- posterior belly of digastric muscle
Adenoid cystic carcinoma age
40-50
Differential diagnosis of fibrous dysplasia 6
1. Central ossifying fibroma (COF), 2. Central giant cell granuloma (CGCG), 3. Paget disease 4. Aneurysmal bone cyst, 5. Osteomyelitis 6. Early fibro-osseous lesions
Low Malignant Potential 2
Smokeless Tobacco Smooth thin leukoplakia
Verrucous Carcinoma Location Low grade variant of SCC, related to tobbacoö HPV 16 and 18
Mandible vestibule, buccal mucosa, hard palate
histopathology of squamous cell carcinoma
Keratin pearls Individual cell keratinization Inflammatory cell invasion
Polymorphous low-grade adenocarcinoma gender
F
Polymorphous low-grade adenocarcinoma
Malignant, Minor salivary glands, Cribriform pattern mimics adenoid cystic carcinoma, perineural invasion common, good prognosis
Adenoid cystic carcinoma prognosis
5-year survival rate - 70%, 10-year survival rate -50%,
Verrucous Carcinoma Histo 3
Wide/elongated bulbous rete ridges, pushing into CT Parakeratin, Parakeratin plugs between surface projections Sometimes no cellular atypia
Other tissue involvements in Sjogren Syndrome
1. Dry skin 2. Dry nose 3. Dry vagina 4. Interstitial pulmonary fibrosis 5. Vasculitis 6. Lymphoma 7. Fatigue 8. Raynoud syndrome ------- CREST
Differential diagnosis for palatal swelling of a newborn infant. 7
Melanocytic Neuroectodermal Tumor Hemangioma Lymphangioma Congenital epulis Granular cell Tumor Gingival cyst of newborn Juvenile Ossifying Fibroma
High Malignant Potential 5
Proliferative verrucous leukoplakia Reverse smoker's palate Erythroleukoplakia Oral submucous fibrosis Granular/verrucous Leukoplakia
PLGA treatment
surgery
Polymorphous low-grade adenocarcinoma clinic
pain minor salivary gland palate
Mc Cune Albright clinical findings
1. Polyostotic fibrous dysplasia 2. Cafe au lait skin 3. Endocrine issues like early puberty gigantism
treatment of squamous cell carcinoma
surgical excition 10 to 15mm margins Neck dissection Radiotherapy
Adenoid cystic carcinoma location
palate tongue floor of mouth lip
overall survival rate of squamous cell carcinoma
67%
SCC age
50 - 70
differential diagnosis of squamous cell carcinoma
Tuberculosis Syphilis Fungal infections Chronic trauma Necrotizing sialometaplasia
Gardner's syndrome is associated with 4
Multiple osteomas, Polyps of intestine Epidermal skin cysts Impacted teeth
Adenoid cystic carcinoma metastasis
Lung Liver Bone Brain
Modified radical neck dissection
Removal of lymph nodes from level I-V, Preservation of 1 or more of the nonlymphatic structures (SCM, CN XI, internal jugular vein) indicated if N2/N3
Selective Neck Dissection
only those lymph nodes where cancer is very likely to spread.
Adenoid cystic carcinoma Tx
Surgery <5 mm and Radiation
Section 2
(50 cards)
Fibrous Dysplasia Histo
Dense fibrous CT Fibroblasts Chinese script writing
Dysplasia 4 morphological features
Bulbous Rete Ridges Loss of Polarity Keratin Pearls Loss of cellular cohesiveness
SCC Survival
Stage I - 85% Stage 2 - 65% Stage 3 - 40% Stage 4 - <10%
Histopathologic alterations of dysplastic cells 12
1. Enlarged nuclei and cells 2. Large and prominent nucleoli 3. Increased nuclear-to-cytoplasmic ratio 4. Hyperchromatic nuclei 5. Pleomorphic nuclei and cells 6. Dyskeratosis 7. Increased mitotic activity 8. Abnormal mitotic figures 9. Bulbous or teardrop-shaped rete ridges 10. Loss of polarity 11. Keratin or epithelial pearls 12. Loss of cellular cohesiveness (acantholysis)
American Burkitt's or sporadic from
- abdominal mass
Paget disease gene
PDB2
Ossifying Fibroma Histo
Decreased hemmorhage Not encapsulated Fibrous CT Increased # of cells Osteoblastic rimming
Nicotinic Stomatitis not premalignant
reverse smoker's palate high risk of SCC
Erythroplakia DDX 6 90% are severe dysplasia, CIS, SCC at time of biopsy
1. Aphthous ulcer 2. Mucositis (eg. GVHD) 3. Candidiasis 4. Vascular lesion 5. Erosive lichen planus 6. Vesiculobullous disease
Multiple Myeloma SS 8
1. Bone pain, 2. Fatigue, 3. Fever, 4. Neutrpenia, 5. Anemia, 6. Susceptible to infections, 7. Renal insufficiency 8. Deposition of amyloid (tongue enlarges and becomes firm/nodular).
Focal Cementosseous Dysplasia Rady
Well-defined Mixed radiolucent/radiopaque THIN radiolucent rim
Juvenile ossifying fibroma
<15 yrs of age Maxilla and paranasal sinuses (90%) Rapid growth and expansion Distinctive histopathology Recurrence is common
Fibrous Dysplasia Rady 5
Poorly demarcated Expansion Ground glass Loss of lamina No periosteal reaction
Carnoy's solution
60% ethanol 30% chloroform 10% glacial acetic acid 1gm ferric chloride
Risk factor for malignant transformation:
1) Persistence of lesion with removal of habit 2) Female 3) Non-smoker occurrence 4) Occurrence on floor of mouth or ventral tongue
Ann Arbor Staging system for lymphomas
1: 1 node or 1 site 2: 2 or more sites on same side as diaphragm 3: Both sides of diaphragm 4: Widely disseminated A: no sx / B: sx
Periapical Cementoosseous Dysplasia Rady and Tx
Lamina dura intact No treatment
Keratoacanthoma Differs from SCC 4
1) Self-limiting - can self regress 2) Rapid enlargement, up to 1-2 cm in 6 weeks 3) Acute angle between normal epithelium and neoplastic epithelium 4) Painless
Periapical Cementoosseous Dysplasia
Blacks 30-50 years Females Lower anterior incisor apex Vital teeth
Focal Cementosseous Dysplasia Clin
20's to 50's Female White Posterior mandible Painless Self-limiting
Ossifying Fibroma Rady
Thin radiolucent rim Unilocular Root's divergent or resorbed
Juvenile ossifying fibroma Tx -Prgnz
Smaller lesions - local excision, Larger/aggressive lesions (wide excision). Recurrence 30-50%
Histologic Features of Odontogenic Keratocysts
1. Thin lining of parakeratinized squamous epithelium of 6 to 10 cells 2. Corrugated parakeratin on the luminal surface 3. Lack of rete peg formation 4. Focal separation of epithelial lining from the connective tissue 5. Lumen containing variable amounts of desquamated parakeratin 6. Dental lamina rests and microcysts occasionally present in capsule wall 7. Generally lacks inflammatory response in capsule
SCC Locations 90% of all oral cancers
50% Tongue (post/lat/ventral) 35% FOM Gingiva/alveolar ridge Buccal mucosa/soft palate Lower lip > upper lip
Burkitt's Lymphoma Types 3
1. African 2. American 3. HIV related
Focal Cementosseous Dysplasia Tx
No treatment, but should biopsy to rule out ossifying fibroma
Malignant Transformation Potential: Based on morphology:
1) Thin leukoplakia - seldom if ever 2) Homogenous thick - 1-7% 3) Granular/Verrucous form - 4-15%
Florid Cemento-osseous Dysplasia Rady
Multiple radiopaque/radiolucent lesions Simple bone cysts may be present
Fibrous dysplasia gene
GNAS1
Multiple Myeloma Description
Malignancy of plasma B cells Older males, Blacks most likely
Multiple Myeloma Dx
1. Serum M protein, and urine will show Bence Jones protein 2. Increase calcium 3. Anemia
Malignant Transformation Potential: Based on histology:
1) Moderate dysplasia 4-11% 2) Severe dysplasia 20-35%
SCC Etiology
Smoking Smokeless tobacco Alcohol Malnutrition (Iron, Vit A) UV Radiation HPV 16-18 Syphilis Candidiasis Immune Suppression
HIV related lymphoma or immunodeficiency type -
most will die in 6 months if not treated 90% response to treatment
Florid Cemento-osseous Dysplasia Tx
Prevent infection - excellent OH, frequent recall, no elective surgery, prevent exposed bone/cementum
Hodkin's Lymphoma CLinical
15-30 or > 50 Male Reed Sternberg cell -proliferation of B cell
Blue Lesion oral mucosa 4
1. Lymphangioma 2. Hemangioma 3. Dermoid cyst 4. Mucoepidermoid CA or other salivary gland tumor
Florid Cemento-osseous Dysplasia Clin
Middle age Black Female All 4 quadrants Enlargement of affected bones
Focal Cementosseous Dysplasia Histo
+++Hemorrhage Fibrous CT +/- cementum +/- osteoid.
Ossifying Fibroma Clinic no self limiting
20's-30's Female Posterior Mandible
Non-Hodgkin's Lymphoma SS 2
swellings with boggy consistency - (Hard palate, Retromolar triangle, Buccal vestibule, Gingiva), *non-healing extraction socket
Fibrous Dysplasia Tx
Recontour can do orthognathic surgery and can use ORIF on fibrous dysplasia
Dysplasia 8 histological features
Enlarged nuclei Enlarged prominent nucleoli Increased nuclear: cytoplasmic ratio Hyperchromatic nuclei Pleomorphic nuclei and cells Dyskeratosis Increased mitotic activity Abnormal mitotic activity
Fibrous Dysplasia Clinic
1st-2nd decade Female=Male Maxilla Self-limiting(stops at maturity)
Multiple Myeloma Treatment
Steroids, Chemotherapy
Ossifying Fibroma Tx
Enucleate and curretage - easy to peel, if very large may need resection.
Pseudoepitheliomatous hyperplasia 8
1) Necrotizing Sialometoplasia 2) Granular cell tumor 3) Epulis Fissuratum 4) Denture Papillomatosis 5) Nicotine Stomatitis 6) Blastomycosis 7) Tertiary Syphillis 8) Wegener's Granulomatosis
Maxillary Mass in Infant - Differential Diagnosis 5
1. Melanotic Neuroectodermal Tumour of Infancy 2. Neuroblastoma 3. Rhabdomyosarcoma 4. Hemangioma 5. Lymphangioma
Gorlin-Goltz syndrome
Multiple basal cell carcinomas Multiple odontogenic keratocysts Bifid ribs Palmar plantar pits Calcification of flax cerebri Frontal bossing Hypertelorism
African Burkitt's or endemic form
1. one to know* affects Jaws!! 50-70% present in jaws! 2. Young Male (average age 7 years old), Maxilla posterior 3. If diagnosed in < 8 years old, 90% jaw involvement. 4. If diagnosed > 15 years old, 25% jaw involvement.
Section 3
(19 cards)