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PATH-Neoplasia
Neoplasia
| Question | Answer |
|---|---|
| neoplasia | new, abnormal growth, uncontrolled cells proliferation (multiplication, irreversible |
| tumor | "swelling", used as a synonym for neoplasm |
| what behavior do neoplasms exhibit? | unlimited growth and unregulated growth |
| what are causes of neoplasia | chemicals viruses (aka oncogenic viruses) radiation (sunlight, xrays, nuclear fission) (can occur spontaneously secondary to a genetic mutation |
| what are tumor classifications? | benign and malignant |
| benign tumor (neoplasia) | localized, encapsulated w/ fibrous CT, invade adjacent tissue, resemble normal ctissue tx. surgical excision, either local excision or enucleation |
| malignant tumor (cancerous) | invades and destroys surrounding tiss., can spread, well differentiated-neoplasic cells resemble normal cells poorly diferentiated- do not undifferentiated/anaplastic-do not resemble tiss. derived from at all |
| pleomorphic | cells of malignant tumors vary in size and shape |
| hyperchromatic | nuclei of cells darkers than those of normal cells, exhibit an increased nuclear-cytoplasmic ratio |
| mitotic figures | normal and abnormalmitotic figures seen in nucleus of neoplastic cells tx. surgery, chemotherapy, radiation therapy (often combo) |
| classification of tumors(benign) | usually well-differentiated usually slow growth mitotic figures are rare usually encapsulated no metastasis |
| classfication of tumors (malignant) | well differentiated to anaplastic slow-to-rapid growth mitotic figures may be numerous invasive and unencapsulated metastasis likely |
| what is the suffix "-oma" used to indicate | a tumor *prefix is determined by tissue or cell of origin |
| lipoma | benign tumor of fat |
| osteoma | benign tumor of bone |
| carcinoma | malignant tumor of epithelium |
| sarcoma | malignant tumor of CT |
| squamous cell carcinoma or epidermoid carcinoma | malignant tumor of squamous epithelium |
| osteosarcoma | malignant tumor of bone |
| what can epithelial tumors derive from? | squamous epithelium salivary gland epithelium odontogenic epithelium |
| papilloma | small, benign tumor of squamous epithelium, exophytic pedunculated or sessile growth |
| what are the papillary projections of papilloma? | *cauliflower most often on soft palate or tongue occurs any age or sex DDX w/ verruca vulgaris and condyloma acuminatum (venereal wart) |
| how does pailloma appear microscopically? | numerous fingerlike or papillary projections w/ central core of fibrous CT surfaced by normal stratified squamous epithelium |
| tx for papilloma? | surgical excision removal of base to prevent reoccurance |
| what are 3 premalignant lesions? | leukoplakia erythoplakia epithelial dysplasia |
| leukoplakia | "white plaque" (clinical term not histologic term) biopsy needed to establish definitive Dx most due to hyperkeratosis or epithelial hyperplasia and hyperkeratosis can't be rubbed off |
| how does leukoplakia appear microscopically? | may show epithelial dysplasia (premalignant condition) or squamous cell carcinoma ~5-25% reveal epithelial dysplasia |
| tx for leukoplakia | dependent on histologic finding |
| leukoplakia-Snuffer's keratosis | aka. tobacco pouch keratosis |
| most leukoplakia are: | asymptomatic result of hyperkeratosis result of hyperkeratosis comboed w/ epithelial hyperplasia tx depends on histo findings area at increased risk for SCC |
| erythroplakia | located on floor or mouth, tongue, soft palate can appear as: smooth red patch, granular red and velvety patch <common than leukoplakia >serious than leukoplakia |
| what is speckled leukoplakia? | subcatogory of erythroplakia lesion shows a mix of red and white areas |
| how does erythroplakia appear microscopically? | 90% of cases demonstartes epithelial dysplasia or squamous cell carcinoma |
| tx of erythroplakia | dependent on histologic Dx |
| epithelial dysplasia | premalignant, disordered growth, precedes squamous cell carcinoma, changes may revert to normal if stimulus is removed |
| how can epithelial dysplasia appear clinically? | erythematous, white, mixed erythematous and white |
| (T/F)Dysplasia in other tissues is not considered a premalignant process | True. |
| tx of epithelial dysplasia | surgical excision |
| (T/F) epithelial dysplasia is carcinoma in situ | True. severe dysplasia involving full thickness of epithelium |
| squamous cell carcinoma | aka. epidermoid carcinoma malignant tumor of squamous epithelium *most primary common primary malignancy of oral cavity can infiltrate adjacent tiss. and form distant metastases (lymph nodes in neck, lungs, <3) can infiltrate and destroy bone |
| how does squamous carinoma appear clinically? | exophytic ulcerative mass |
| how does SCC microscopically? | tumor cells invade CT underlying epithelial basement membrane well-differentiated tumors show keratin -keratin pearls, usually seen in individual cells w/in tumor |
| where can SCC appear in the oral cavity? | *most often on floor of mouth ventrolateral tongue, soft palate, tonsillar pillar, retromolar areas *vermillion border of lips, skin of face locations have better Px than of oral mucosa |
| what's the interaction of SCC and sun exposure? | causes lips to turn from dark pink to mottled grayish pink interface becomes blurred, linear fissures seen at right angles to line of interface |
| who does SCC affect the most? | over 40s mostly men, incidence has increased in women |
| solar cheilitis | subcategory of squamous cell carcinoma condition in which mild to severe epithelial dysplasia occurs |
| risk factors of squamous cell caricnoma | tobacco alcohol consumption |
| tx and px of squamous cell carinoma | surgical excision, radion therapy, chemotherapy (these patients may have xerostomia) TNM can be used to determine px (higher stage, worse px) |
| TNM Staging- Tumor | T1- <2cm in diameter T2- 2-4cm in diameter T3- > 4cm in diameter T4- invades adjacent structures |
| TNM Staging- Node | N0- no palpable nodes N1- ipsilateral palpable nodes N2- contralateral or bilateral nodes N3- fixed palpable nodes |
| TMN Staging- Metastasis | M0- no distant metastasis (so none at all?) M1- clinical metastasis |
| verrucous carcinoma | form of SCC slow growing exophytic tumor w/ pebbly red and white surface *msot cases in men 55+ and involve vestibule and buccal mucosa |
| how does verrucous carcinoma appear microscopically? | tumor w/ numerous papillary epithelial projections papillary projections filled w/ keratin epithelium well differentiated, doesn't contain atypical cells, exhibits broad-based rete pegs, tumor doesn't show invasion through basement membrane |
| tx of verrucous carcinoma | surgical excision |
| basal cell carcinoma | malignant skin tumor assoc. w/ excesive exposure sun arises on skin of face appears as nonhealing ulcer w/ charct. rolled borders white adults w/ no sex predilection |
| how does basal cell carcinoma appear microscopically? | composed of basal cells into underlying CT |
| tx of basal cell carcinoma | surgical excision radiation therapy rarely metastasizes |
| name 4 salivary tumors | pelomorphic adenoma monomorphic adenoma adenoid cystic carcinoma (cylindroma) mucoepidermoid carcinoma |
| salivary gland tumors | may arise in either major or minor salivary glands -minor salivary gland tumors most often located at junction of hard and soft palate |
| adenomas/adenocarcinomas | benign/malignant tumors of salivary glands |
| pleomorphic adenoma (benign mixed tumor) | benign salivary gland tumor 90% of all salivary gland tumors |
| how does pelomorphic adenoma appear microscopically? | encapsulated tumor composed of tiss. that appears to be a mix of both epithelium and CT |
| what is the most common extraoral location of pleomorphic adenoma? | parotid gland |
| what is the most common intraoral location of pleomorphic adenoma? | palate |
| how does pleomorphic adenoma appear clinically? | appears as slowly enlarging, nonulcerated, painless, dome-shaped mass occurs individuals <40 yrs more often in women than men |
| tx of pleomorphic adenoma | surgical excision reoccurence related to success of initial surgical removal |
| does carcinoma arise in a pleomorphic adenoma? | yes, these lesions have been known to undergo malignant transformation |
| monomorphic adenoma | benign, encapsulated salivary gland tumor *occurs < often than pleomorphic tumor uniform pattern of epithelial cells *occurs most commonly adult females upper lip + buccal mucosa |
| tx of monomorphic adenoma | surgical excision |
| Warthin tumor-monomorphic adenoma | aka.papillary cystadenoma lymphomatosum encapsulated tumor w/ epithelial + lymphoid tiss. (painless, soft, fluctuant mass) occurs parotid gland occurs adult malen |
| tx of warthin tumor-monomorphic adenoma | surgical excision |
| adenoid cystic carcinoma | aka. clindroma slow growing malignant tumor of salivary gland organ most common extraoral-parotid most common inftraoral-palate > common women > common 5th and 6th decades |
| how does adenoid cystic carcinoma appear microscopically? | unencapsulated, infiltrates surrounding tiss. small, deeply staining, uniform epithelial cells resembles "swiss cheese" |
| tx for adenoid cystic carcinoma | surgical excision, radiation, reoccurence is common, poor Px is distant metastases |
| mucoepidermoid carcinoma | malignant salivary gland tumor nonencapsulated, infiltrating females made of mucous cells w/ epidermoid cells |
| how does mucoepidermoid carcinoma appear clinically? | slowly enlarging mass, usually adults *most common malignant salivary gland tumor in kids major glands-parotid minor gland-palate |
| tx of mucoepidermoid carcinoma | surgical excision w/ follow-up survival rate low as 50% after 5 yrs |
| random mucoepidermoid carcinoma shit | may occur w/in bone (r/l) in mandibular premolar/molar region, can be salivary tiss. trapped in bone or from tranformed epithelial lining of dentigerous cyst |
| odontogenic tumors | derived from tooth-forming tiss. composed of epithelium, mesenchyme or mixed most benign |
| epithelial odontogenic tumors | ameloblastoma calcifying epithelial odontogenic tumor calcifying odontogenic cyst |
| mesenchymal odontogenic tumors | odontogenic myxoma cementifying fibroma ossifying fibroma and ossifying fibroma benign cementoblastoma |
| mixed odontogenic tumors | amelobastic fibroma ameloblastic fibro-odontoma odontoma |
| peripheral odontognic tumors | peripheral ossifying fibroma other peripheral odontogenic tumors |
| ameloblastoma | benign slow-growing, locally aggressive epithelial odontogenci tumor occurs max. and man. most often mandible in molar/ramus area unencapsulated, infiltrates into surrounding tiss. |
| how do ameloblastomas appear radiographically? | multiocular soap-bubble, or honey-combed r/l occurs anywhere w/in jaw, can occur in assoc. w/ dentigerous cyst causes bone expansion occurs in adults |
| tx of ameloblastoma | surgical removal, reoccurence coomon |
| calcifying epithelial odontogenic tumor | aka. pindborg tumor benign epithelial odontogenic tumor composed of polyhedral epithelial cells, amyloid like material abnormal enamel seen w/ calcifications occurs in adults |
| how does the calcifying epithelial odontogenic tumor appear radiographically? | uniocular or mutliocular r/l occurs >mandible than max., most often bicuspid/molar area |
| tx for calcifying epithelial odontogenic tumor | surgical excision |
| calcifying odontogenic cyst | nonaggressive lined by odontogenic epithelium ghost cell shit > common indivudals under 40 |
| how do calcifying odontogenic cysts appear radiographically? | well defined lesion r/l uniocular or multiocular calcifications may be r/o |
| tx for calcifying odontogenic cysts | surgical enuleation usually doesn't reoccur |
| odontogenic myxoma | benign, well circumscribed composed of fibrous tiss. w/ calcifications classified as fibroosseous lesion |
| ossifying fibromas | benign well circumscribed tumor composed fibrous CT, calcifications occurs in adults, 3-4th decades most cases in mandible |
| how does ossifying fibromas appear microscopically | contains fibrous CT and calcifications cemento-ossifying tiss. |
| how does ossifying fibromas appear radiographically? | varies r/l to r/o depending on amount of calcified tiss. |
| tx of ossifying fibromas | surgical excision reoccurence rare |
| perpherial ossifying fibroma | well demarcated sessile or pedunculated lesion orgins-interdental papilla derives from pdl cells > common in women |
| tx of peripheral ossifying fibroma | surgical ecision w/ thorough scaling of adjacent teeth to remove irritants that can induce regrowth 16% recurrence rate |
| benign cementoblastoma | cementum-producing lesion fused to roots of vital teeth |
| how does benign cementoblastoma appear radiographically | well defined r/o mass surrounded w/ radiolucent halo seen mandibular molar or premolar teeth occurs young adults pain frequent symptom |
| how does benign cementoblastoma appear microscopically? | proliferation of cellular cementum fused to root or roots of affected tooth |
| tx of benign cementoblastoma | enulceation of tumor, removal of involved tooth doesn't reoccur |
| ameloblastic fibroma | benign, non encapsulated odontogenic tumor tiss. resembles dental papilla most cases in <20yr old > in males > common in mandibular bicuspid and molar region |
| how does ameloblastic fibroma appear radiographically? | well defined or poorly defined uniocular or multiocular r/l |
| tx for ameloblastic fibroma | surgical excision low recurrence rate |
| odontoma | odontogenic tumor composed of enamel, dentin, cementum, pulp tiss. occurs young adults + yound adults most common clinical manifestations is failure of permanent tooth to erupt 2 types- complex and compound |
| odontoma- complex | mass (odontogenic tiss.) doesn't resemble teeth (posterior mandible) radio.-r/o mass |
| odontoma- compound | collection of numerous of small teeth (usually in anterior maxilla) radio. cluster of miniture teeth |
| tx of odontoma | surgical ecision |
| osteosarcoma | malignant tumor of bone forming tiss. >common primary malignancy of bone in pt under 40 painful, diffuse swelling, destructive may initally present as toothache/mobility |
| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space |
| tx of osteosarcoma | chemo followed by surgery 20% survival rate of Syra |
| peripheral ossifying fibroma | |
| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space |
| tx of osteosarcoma | chemo followed by surgery 20% survival rate of Syra |
| peripheral ossifying fibroma | |
| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space |
| tx of osteosarcoma | chemo followed by surgery 20% survival rate of Syra |
| peripheral ossifying fibroma | well demarcated sessile, or pedunculated lesion, females origins gingival interdental papilla (most likely from pdl cells) composed fibrous CT w/ bone and calcifications |
| what other fibromas is peripheral ossifying fibroma similar to? | cementifying and ossifying fibromas |
| other peripheral odontogenic tumors | rare lesions occur in gingiva, no bone invvolvment -peripheral ameloblastoma -peripheral calcifying epithelial odontogenic tumor tx.surgical excision |
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