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273 Cards in this Set

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Most common salivary gland tumor

pleomorphic adenoma (Benign mixed tumor)

Most common malignant salivary gland tumor

Mucoepidermoid carcinom


Most common site for salivary gland tumors

Parotid gland

Most common intraoral site for salivary gland tumors

Palate

Bilateral parotid gland (most likely)


M >> F

Warthin’s tumor

Upper lip tumor (most likely)


Monomorphic adenoma

Associated with pain due to perineural invasion

Adenoid cystic carcinoma

Facial nerve paralysis


Parotid malignant Salivary Gland tumors

Pleomorphic Adenoma


(Parotid 69%, Asymptomatic swelling)

Pleomorphic Adenoma


(Parotid 69%, Asymptomatic swelling)


Pleomorphic Adenoma


(multiple cells, chondroid, myxoid)

Pleomorphic Adenoma


(multiple cells, chondroid, myxoid)

Pleomorphic Adenoma treatment

Surgical excision
95% Cure rate


Has potential to become malignant in 5%



Pleomorphic Adenoma

Malignant Mixed Tumor


(60-70 yo
Major glands 80%)


Overabundance of mitochondria = granularit


 

Overabundance of mitochondria = granularit


Oncocytoma


(Parotid 78%


Older adults 50-70yo
F> M
Slow growing painless mass)


older smoking MALES



M>>>F 10:1

Papillary Cystadenoma Lymphomatosum (Warthin Tumor)

Papillary Cystadenoma Lymphomatosum (Warthin Tumor)


- bilateral

Papillary Cystadenoma Lymphomatosum (Warthin Tumor)



Double row of oncocytes in Lymphoid stroma


Upper lip


Older Female


Monomorphic Adenoma


(Canalicular adenoma
Basal cell adenom)


Minor salivary gland

Minor salivary gland

Canalicular Adenoma


(upper lip


older females)

Minor salivary gland

Minor salivary gland

Canalicular Adenoma


(upper lip


older females)

Parotid 


older female

Parotid


older female

Basal Cell Adenoma

No association with HP


 

No association with HP


Ductal Papillomas


Sialadenoma papilliferum

Inverted Ductal papilloma

Only in the minor SG
Adults
Lower lip and mandibular vestibule most common locations
Lesion usually appears as an asymptomatic nodule


Inverted Ductal papilloma

Ductal epithelium line the projection


 

Ductal epithelium line the projection


Sialadenoma papilliferum

Papillary intraductal proliferation located beneath the mucosal surface

Papillary intraductal proliferation located beneath the mucosal surface

Inverted Ductal papilloma

Mucoepidermoid Carcinoma

most common Salivary Gland maligancy in children


parotid 48%

Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma

Ductal and cystic spaces surrounded by mucous & squamous cell


 

Ductal and cystic spaces surrounded by mucous & squamous cell


Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma

Most common and best-recognized intra-bony salivary tumor


Intraosseous Mucoepidermoid Carcinoma

50% to 60% develop within the minor SG


Slow growing PAINFUL mass


Middle Aged


Adenoid Cystic Ca

Swiss cheese” appearance


+Neural Invasion


 


 

Swiss cheese” appearance


+Neural Invasion



Adenoid Cystic Ca

Adenoid Cystic Ca treatment

excision


radiation


recurrence is high

Polymorphous Low Grade Adenocarcinoma PLGA

Minor SG only
65% Hard or soft palate


Older adults


Painless


Can erode underlying bon


Polymorphous Low Grade Adenocarcinoma PLGA

Polymorphous Low Grade Adenocarcinoma PLGA

Polymorphous Low Grade Adenocarcinoma PLGA

Stensen's duct

Parotid Gland


(watery secretion)


Wharton’s duct

Submandibular Gland


Bartholin’s duct

Sublingual Gland


Immune defense of saliva


+ digestion

IgA


Amylase

Drug-induced hyposalivation

Anti-cholinergics
Anti-histamines
Anti-depressants, antipsychotics
Sedative and hypnotic agents
Anti-hypertensives
Anti-Parkinson drug


Unstimulated saliva (which cells and glands)

Basal production


Mostly minor & submandibular outpu


Stimulated saliva (which gland)

Mostly Parotid

Salivary Gland Aplasia syndromes

Treacher Collins


Hemifacial Microsomia Syndrome


Mucocele


(lower lip more often)

Mucocele


(lower lip more often)

No epithelial lining


Granulation tissue lines the central space


 

No epithelial lining


Granulation tissue lines the central space


Mucocele


(lower lip more often)

No epithelial lining


Granulation tissue lines the central spac

No epithelial lining


Granulation tissue lines the central spac

Mucocele


(lower lip more often)

Mucoepidermoid Carcinoma

Ranula

Ranula

Ranula

Ranula

Ranula

Ranula

Ranula

Ranula

Mucus Retention Cyst


(Salivary Duct cyst)

Lining converts to squamous epithelium (true cyst)


Looks like mucocele


More likely in cystic fibrosis

Mucus Retention Cyst

Calcification


Usually: submandibular gland duc


Sialolithiasis

Sialolithiasis

Sialolithiasis

--Hyperparathyroidism


-- Hypercalcemia


Sialolithiasis

Sialolithiasis

Sialolithiasis

Sialolithiasis

Sialolithiasis

Sialolithiasis

Sialadenitis

Sialadenitis where first

Infections of salivary glands
-- Parotid >>> Submandibular >> Others


puss coming out

puss coming out

Sialadenitis

Sialadenitis

Sialadenitis

Cheilitis Glandularis


(minor salivary glands of lip)


Increased SCCA


lower lip most often

Sjögren's syndrome

Immune attack against ductal cells


Loss of tolerance in CD4+ T cells
Females = 90%


Sjögren's syndrome

Sjögren's syndrome


3 things

Immune attack against ductal cells


Loss of tolerance in CD4+ T cells
Females = 90%

Sjögren's syndrome

Sjögren's syndrome

Sicca syndrome (dry eyes) (dry mouth)


– RA (rheumatoid arthritis)


– SLE (systemic lupus erythematosus)
– Vasculitis
– Polymyositis
– Systemic sclerosis
– Thyroiditis

40x increased risk of non-Hodgkin B cell lymphoma

Sjögren's syndrome

Lymphoepithelial Lesion

HIV + Sjögren's syndrome

salivary gland enlargement, non-inflamatory

Sialadenosis

bilateral or unilateral

bilateral or unilateral

Sialadenosis

Sialadenosis (conditions associated)

ENDOCRINE DISORDERS
• Diabetes
• Acromegaly


Nutritional


Drugs


rare lesion of minor salivary glands

rare lesion of minor salivary glands

Adenamatoid Hyperplasia

locally destructive inflammatory condition

locally destructive inflammatory condition

Necrotizing Sialametaplasia

dental injection

Necrotizing Sialametaplasia

Necrotizing Sialametaplasia

Necrotizing Sialametaplasia

Acinar necrosis 

Acinar necrosis

Necrotizing Sialametaplasia

Lymphoid Hyperplasia


(Cervical Lymphadenitis)

Lymphoid Hyperplasia


(Cervical Lymphadenitis)

Lymphoid Hyperplasia


(Cervical Lymphadenitis)

movable

movable

Lymphadenopathy infectious mononucleosis

draining

draining

Lymphadenopathy tuberculosis

Tonsillitis

Tonsillitis

Tingible bodies

Tonsillitis

Hyperplastic Lingual Tonsil

Hyperplastic Lingual Tonsil

Hyperplastic Lingual Tonsil

keratin plugs

keratin plugs

Lymphoid hyperplasia



differen:


(Tonsillolithiasis


Actinomycosis - bacterial


Lymphoepithelial cyst)

Tonsillolithiasis


 

Tonsillolithiasis


Lymphoid hyperplasia



differen:


(Actinomycosis - bacterial


Lymphoepithelial cyst


keratin plugs)

teenagers and young adults


 

teenagers and young adults


lymphonodular Pharyngitis

Diffuse, apparently benign proliferation of lymphoid cells


 

Diffuse, apparently benign proliferation of lymphoid cells


Benign Lymphoid Hyperplasia


(Antibiotic therapy)

Hemophilia A

classic


clotting factor 8


x linked recessive

Hemophilia B

clotting factor 9


Christmas disease


x linked recessive

Von Willebrands hemaphilia

Plasma glycoprotein that binds to VIII and aids in adhesion of platelet


Autosomal dominant


Pernicious Anemia


(iron deficiency)

Anemias

-Iron deficiency anemia


-Pernicious anemia (Hypovitaminosis B12)


-Folic acid anemia


-Hemolytic anemia



Females >>> males



Anemia

Anemia

Howell-Jolly Bodies

Howell-Jolly Bodies

Anemia

Horse shoe cell in bone marrow

Horse shoe cell in bone marrow

Anemia

Burning Tongue Syndrome

Burning Tongue Syndrome

Early Symptom of Vitamin B Deficiency

shovel shape fingernails (koilonychia)


Atrophic Glossitis

Iron Deficiency Anemia


(no epi in these patients)

Plummer-Vinson Disease


(Chronic, Severe Iron Deficiency )

Plummer-Vinson Disease


(Chronic, Severe Iron Deficiency )

Plummer-Vinson Disease


(Chronic, Severe Iron Deficiency )

Blacks & Asians


stepladder trabecular pattern


hair on end skull

Blacks & Asians


stepladder trabecular pattern


hair on end skull

Sickle Cell Anemia

Hematopoietic Precursor Cells diminished


in bone marrow

Aplastic Anemia


(Neutropenia
Leukopenia
Granulocytopenia
Pancytopenia)


oral ulcers


susceptible to infections

oral ulcers


susceptible to infections

Aplastic Anemia

Decrease in the number of the circulating neutrophils below 1500/mm3 in an adult


Neutropenia

Uniformed spaced episodes of neutrophil deficiency


Severe periodontal bone loss (premature)


Cyclic Neutropenia

Cyclic Neutropenia

Defective gene for beta or alpha Hgb
Reduced hemoglobin synthesis


Thalassemia

Beta-thalassemia

(2 genes involved):


Thalassemia minor - one bad gene


Thalassemia major - both genes are bad
-- Cooley’s anemia
-- Mediterranean fever

Alpha-thalassemia

(4 genes involved):
One bad gene = no disease
Two bad genes = Alpha-thalassemia trait
Three bad genes = HB (hemoglobin) disease
Four bad genes = Hydrops fetalis (fatal)


Hair-on-end skull radiograph

Hair-on-end skull radiograph

Thalassemia

Frontal bossing


 


Bone marrow hyperplasia = 

osteoporosis and enlarged jaws


 


 

Frontal bossing



Bone marrow hyperplasia =
osteoporosis and enlarged jaws



Thalassemia

increased brusing


Petechiae and ecchymosis

  Hematoma

  Gingival hemorrhag


Fibrin deposits

increased brusing


Petechiae and ecchymosis
Hematoma
Gingival hemorrhag


Fibrin deposits

Thrombocytopenia


(Decreased number of platelet)

increased brusing


Petechiae and ecchymosis

  Hematoma

  Gingival hemorrhag


Fibrin deposits

increased brusing


Petechiae and ecchymosis
Hematoma
Gingival hemorrhag


Fibrin deposits

Thrombocytopenia


(Decreased number of platelet)

Thrombocytopenia with AIDS

diascopy positive (blanching)

diascopy positive (blanching)

Hereditary Hemorrhagic Telangiectasia

diascopy positive (blanching)

diascopy positive (blanching)

Hereditary Hemorrhagic Telangiectasia

Hereditary Hemorrhagic Telangiectasia


which genes? AD? HHT1-2.

HHT1: endoglin gene mutation
-- On chromosome 9
HHT2: ALK-1 mutation
-- Activin receptor-like kinase-1



AD


Hereditary Hemorrhagic Telangiectasia

Dilated capillaries beneath epithelium


 

Dilated capillaries beneath epithelium


Hereditary Hemorrhagic Telangiectasia

Hereditary Hemorrhagic Telangiectasia

Hereditary Hemorrhagic Telangiectasia

Leukemia

Leukemia

Leukemia

Leukemia in adluts


in children

adults CML


older adults CLL - most common


children ALL


all ages AML

Leukemia

Leukemia treatment

Bone marrow biopsy


Treatment = Chemo


CLL - incurable

Langerhans Cell Histiocytosis


(first 2 decades of life, Posterior mandible )

Langerhans Cell Histiocytosis

Proliferation of Langerhans cells


 


coffee bean shape

Proliferation of Langerhans cells



coffee bean shape

Langerhans Cell Histiocytosis

Acute disseminated histiocytosis


Letterer-Siwe disease

Chronic disseminated histiocytosis


Hand-Schüller-Christian disease

bone and tooth loss that does not make sense

bone and tooth loss that does not make sense

Langerhans Cell Histiocytosis

 


 


Hodgkin's Lymphoma


(Malignancy of B-cells)


(Cervical & supraclavicular lymph nodes
-- 75% of all cases)


Unique tumor cell: Reed-
Sternberg cell


-- A macrophage-like B-cell


Binucleated :“owl eyes”

Hodgkin's Lymphoma


(Malignancy of B-cells)


(Cervical & supraclavicular lymph nodes
-- 75% of all cases)


Hodgkin Disease


nodular sclerosing (70%)


MOST COMMON

Hodgkin Disease


Lymphocyte rich

Non-Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma

85% B-cell type


Most common form of lymphoma

Non-Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma

Helicobacter pylori infection


Epstein-Barr virus (EBV)


Bloom syndrome
-- Wiskott-Aldrich syndrome


Non-Hodgkin's Lymphoma

 


 


Non-Hodgkin's Lymphoma


Mikulicz syndrome = lymphoma of
parotid nodes (often bilateral)

 


 


MALT lymphoma


Non-Hodgkin's Lymphoma

 


 


MALT lymphoma


Non-Hodgkin's Lymphoma

 


 


MALT lymphoma


Non-Hodgkin's Lymphoma

MALT Lymphoma MALT = mucosa associated lymphoid tissue

MALT Lymphoma MALT = mucosa associated lymphoid tissue

MALT Lymphoma MALT = mucosa associated lymphoid tissue

MALT Lymphoma MALT = mucosa associated lymphoid tissue

Non-Hodgkin Lymphoma


(Mandible >>> maxilla)

Non-Hodgkin Lymphoma


(Mandible >>> maxilla)

Non-Hodgkin Lymphoma


(Mandible >>> maxilla)

penny on the plate

penny on the plate

Non-Hodgkin Lymphoma


(need immunohistochemistry)

Epstein-Barr virus in 90% of tumors

Epstein-Barr virus in 90% of tumors

Burkitt Lymphoma


Maligna cy of B-Lymphocytes; Undifferentiated Lymphoma

Epstein-Barr virus in 90% of tumors


Male >>females


Posterior jaws



Burkitt Lymphoma

Starry-sky appearance

Starry-sky appearance

Burkitt Lymphoma

Burkitt Lymphoma

Proliferation of malignant T-cells

Angiocentric T-Cell Lymphoma


​"midline lethal granuloma"

necrotic




"midline lethal granuloma"

necrotic



"midline lethal granuloma"

Angiocentric T-Cell Lymphoma

​"midline lethal granuloma"

​"midline lethal granuloma"

Angiocentric T-Cell Lymphoma


need immunohistochemistry

need immunohistochemistry

Angiocentric T-Cell Lymphoma

CD4+ T-helper cells


origin

CD4+ T-helper cells


origin

Mycosis Fungoides


Cutaneous T-Cell Lymphoma


Males >>> females


Epidermotropism


 


CD4+ T-helper cells


origin

Epidermotropism



CD4+ T-helper cells


origin

Mycosis Fungoides


Cutaneous T-Cell Lymphoma


Males >>> females


Most common cutaneous lymphoma


Mycosis Fungoides

Mycosis Fungoides

Mycosis Fungoides treatment

no true cure


Topical nitrogen mustard


photochemotherapy
(PUVA)


Multiple Myeloma

60-70 yrs
Black>>White


Multiple well defined RL


Bence jones protein



Multiple Myeloma

Sheets of malignant plasma cells with eccentric nuclei and stippled nuclear chromatin.


Plasmacytoma

Hunter syndrome exhibits the characteristic facial features of this disorder


 

Hunter syndrome exhibits the characteristic facial features of this disorder


Muccopolysaccharidosis



Muccopolysaccharidosis

-accumulation of glucosaminoglycans (impacted teeth)


-macroglossia


-thin enamel


-gingival hyperplasia

Gaucher disease 

Gaucher disease

Lipid Reticuloendotheliosis


(Results in an accumulation of the lipids within a variety of cells)

Gaucher disease
Niemann-Pick disease
Tay-Sachs disease


Ashkenazi Jewish heritage



Lipid Reticuloendotheliosis


(Results in an accumulation of the lipids within a variety of cells)

Lack glucocerebrosidase


Accumulation of glucosylceramide in lysosomes


Bone pain


accumulate glucosylceramide


most common Lipid Reticuloendotheliosis

Gaucher disease

Deficiency of acid sphingomyelinase


death early


accumulate sphyngomyelin


Neimann-Pick Disease


Lack of b-hexosaminidase A


die in 3-5 years


accumulation of ganglioside

Tay-Sachs disease

Thickened papules are present along margin of the eyelid


 

Thickened papules are present along margin of the eyelid


Lipoid Proteinosis

Deposition of waxy material in dermis and submucosal CT


 

Deposition of waxy material in dermis and submucosal CT


Lipoid Proteinosis

mucosa nodular, diffusely enlarged & thickened 

mucosa nodular, diffusely enlarged & thickened

Lipoid Proteinosis

lamellar

lamellar

Lipoid Proteinosis

extracellular proteinaceous substance called amyloid


 

extracellular proteinaceous substance called amyloid


Amyloidosis

macroglossia

macroglossia

Amyloidosis



(deposition of amyloid protein)

Vitamin A Deficiency

maintenance of vision


growth and tissue differentiation

Vitamin B-Thiamin Deficiency (B1)

Beriberi


functioning of neurons

Vitamin B-Riboflavin Deficiency

oxidation-reduction reactions



glossitis, angular cheilitis, sore throat, and swelling and erythema of the oral mucosa

Vitamin B-Riboflavin Deficiency

Vitamin B-Riboflavin Deficiency

Vitamin B-Niacin deficiency (B3)

Pellagra = rough skin


Triad of dermatitis, dementia, and diarrhea




stomatitis and glossitis, with the tongue appearing red, smooth, and raw


Vitamin B-Pyridoxine Deficiency (B6)

amino acid synthesis


healthy brain function


Signs = weakness, dizziness, seizure


Vitamin C Deficiency

scurvy


Ascorbic acid is necessary for the proper synthesis of collagen



gingival swelling with sponataneous hemorrhage, ulceration, tooth mobility, severe perio


Vitamin C Deficiency

Vitamin C Deficiency

Vitamin D Deficiency

Rickets= infancy
Osteomalacia = adults
Weak, fragile bone structure


Vitamin E Deficiency

A-tocopherol is a fat-soluble vitamin


Liver disease


antioxidant

Vitamin K Deficiency

Clotting factor


Coagulopathy


Oral = increased gingival bleeding




Wide variety of green vegetables

Peutz-Jehger's Syndrome

Peutz-Jeghers Syndrome

Peutz-Jeghers Syndrome

LKB1 gene
-- Encodes for serine/threonine
kinase


Peutz-Jeghers Syndrome

Peutz-Jeghers Syndrome

Polyposis

Peutz-Jeghers Syndrome

Addison’s


(more wide)

Addison’s


(more wide)

Tetracycline pigmentation

Tetracycline pigmentation

hypocalcification of the skeletal structures


 

hypocalcification of the skeletal structures


hypophosphatasia


(Deficiency of tissue-nonspecific alkaline phosphatase)



very linear ulcerations of the mandibular vestibule

very linear ulcerations of the mandibular vestibule

Crohn’s Disease

Crohn’s Disease


(very linear ulcerations of the mandibular vestibule)

Cobblestone appearance of the mucosa, and deep granulomatous-appearing ulcers



Crohn’s Disease

Nonnecrotizing granulomatous inflammation of submucosal CT 


 

Nonnecrotizing granulomatous inflammation of submucosal CT


Crohn’s Disease

Crohn’s Disease treatment

-Sulfa type of drug (sulfasalazine)
-Metronidazole used if no response with sulfasalazine therapy


snailtrack

snailtrack

Pyostomatitis Vegetans


(Crohn’s & Ulcerative colitis)

Pyostomatitis Vegetans


(snailtrack)

before and after dialysis

before and after dialysis

Uremic Stomatitis

Uremic Stomatitis

Uremic Stomatitis

no eye lashes


no eye brows


no sweat glands


Males >>>>> females


can not regulate temperature

Ectodermal Dysplasia

Ectodermal Dysplasia

Ectodermal Dysplasia

Ectodermal Dysplasia

Ectodermal Dysplasia


oral presentation

Oligodontia -- Diminished number of teeth
Hypodontia -- Diminished numberof teeth
Anodontia -- No teeth develop
Microdontia -- Small tooth size
Conical crowns

Ectodermal Dysplasia

Tuberous Sclerosis

Ungual or periungual fibromas

Ungual or periungual fibromas

Tuberous Sclerosis

Tuberous Sclerosis

shagreen patches


Cardiac rhabdomyoma


Disruption of the tumor suppressor activit


hypopigmentation called ash-leaf spot




Tuberous Sclerosis

Multiple, randomly distributed enamel pits

Gingival fibromas 

Bone “cysts” (actually fibrous proliferations)


 

Multiple, randomly distributed enamel pits
Gingival fibromas
Bone “cysts” (actually fibrous proliferations)


Tuberous Sclerosis

Multiple Hamartoma Syndrome Cowden’s Syndrome

Multiple, irregular fibroepithelial papules involve the tongue and alveolar ridge mucos


 

Multiple, irregular fibroepithelial papules involve the tongue and alveolar ridge mucos


Multiple Hamartoma Syndrome Cowden’s Syndrome

Cowden’s Syndrome

-Most common Lipid Reticuloendotheliosis


-Lack glucocerebrosidase


-Accumulation of glucosylceramide

Gaucher Disease

-type of Lipid Reticuloendotheliosis


-Deficiency of acid sphingomyelinase


-Accumulation of sphyngomyelin

Neimann-Pick Disease

-type of Lipid Reticuloendotheliosis


-Lack of b-hexosaminidase A
-Accumulation of a ganglioside


Tay-Sachs Disease

What is the second most common cyst, is derived from degenerated stellate reticulum?

Dentigerous cyst

Which lesion is associated with rosette structures (zellballen), hamartomas, young females, is located in the anterior maxilla, and is derived from reduced enamel epithelium?

Adenamatoid Odontogenic Tumor (AOT)

Which lesion has a ground glass appearance and a mutation in GNAS 1 gene?

Fibrous Displasia of the bone


Which lesions are multilocular and have scalloped borders in the radiolucency?

Central Giant Cell Granuloma and traumatic bone cyst

Which lesion derives from malignant neoplasm of neuroectodermal cells, is associated with young white males, and has moth eaten borders?

Ewing sarcoma

Which lesion resembles a Cementoblastoma but is not attached to the root?


Osteoblastoma

Which lesion is very painful but relieved with aspirin?

Osteoid Osteoma

Which lesion is not relieved by aspirin?

Osteoblastoma

Which lesion looks similar to mandibular tori?

Osteoma

Starry sky appearance

Burkitts lymphoma


Eosinophilic Ghost Cells are characteristic of what kind of cyst?

Calcifying Odont Cyst

Mutation of PATCH gene is assoc with what syndrome?

Gorlin Syndrome

Reed-Sternberg Cells can be found in what kind of lymphoma?

Hodgkin Lymphoma

Most common inherited disorder

Thalassemia

hair on end skull (2 diseases)

Thalassemia


Sickle cell anemia