Neoplasm

Question 1

What are FOUR environmental risk factors for malignant transformation?

Answer 1

• UV light
• smoking
• alcohol
• HPV

Question 2

What are FIVE architectural features of epithelial atypia (ie. dysplasia)?

Answer 2

• Drop shaped rete pegs
• Single-cell keratinisation (dyskeratosis)
• Superficial mitotic figures
• Loss of polarity of basal cells
• Irregular stratification

Question 3

What are TWO cytological features of epithelial atypia (ie. dysplasia)?

Answer 3

• Nuclear pleomorphism
• Cellular pleomorphism
  (pleomorphism = abnormal size/shape)

Question 4

What is carcinoma in situ?

Answer 4

Severe epithelial dysplasia but not past the basement membrane

Question 5

Oral submucous fibrosis:

• Clinical features
• Cause
• Consequence

Answer 5

• Submucosal striated whitening (limited mouth opening in severe cases)
• Tobacco chewing cause
• Also cancer risk

Question 6

True or false: There is no cancer risk in Syphilis.

Answer 6

False, there is a very high cancer risk in tertiary syphilis.

Question 7

Leukoplakia:

• Clinical appearance
• Cause
• Types
• Consequence

Answer 7

• A fixed white patch/plaque that cannot be characterised clinically/pathologically as any other disease.
• Obscure: trauma/alcohol/food/infections/tobacco
• Homogenous and speckled
• Speckled has malignancy risk

Question 8

True or false: Erythroplakia has a cancer risk.

Answer 8

True

Question 9

Why can’t acute hyperplastic candidiasis be termed candidal leukoplakia while chronic hyperplastic candidiasis can?

Answer 9

In chronic, the white lesion is fixed (not easily scraped off).

Question 10

Lichen planus:

• Clinical appearance
• Common onset
• Histology
• Management

Answer 10

• Often bilateral, either striated (painless) or atrophic/erosive (painful)
• > 40yo
• Striated (hyperkeratosis, saw-tooth rete pegs), atrophic/erosive (thinning of epithelial layer), both have lots of T-cell involvement causing the destruction (apoptosis of basal keratinocytes)
• Corticosteroids (topical/systemic), CHX for pain

Question 11

What is the common clinical appearance of gingival lichen planus? What else might you use to differentiate it from other gingival redness?

Answer 11

• Atrophic mostly with straited on interdental papillae

- Lichen planus on the rest of the mouth may be present (or you could just take a biopsy)

Question 12

True or false: Lichen planus and chronic candidiasis do not have a cancer risk.

Answer 12

False, although cancer risk for them is low.

Question 13

What is ONE example topical corticosteroid with instructions for treatment of lichen planus.

Answer 13

Betamethasone dipropionate (Diprosone) 0.05% ointment
- Apply tid after meals for a max of 6 weeks.

Question 14

What are THREE risk factors for SCC?

Answer 14

• Smoking (main)
• Alcohol (main - may potentiate smoking risk factor by making mucosa more accessible via atrophy)
• HPV type 16 or 18 (SCC less mutations so easier to treat)

Question 15

SCC clinical appearance?

Answer 15

Quite variable.
Red, speckled or white patches.
Can be raised nodule or non-healing ulcer with raised borders.

Question 16

What does it mean when a lesion is less differentiated?

Answer 16

Growth rate is more out of control and differentiation cannot keep up.

Question 17

What is the grading system for SCC degree of differentiation? What is an example feature?

Answer 17

Grade 1 (Well differentiated) - (moderate) - (poorly) -  Grade 4 (Anaplasia - similar to poorly)
Example: Are there prickle cells and keratin formed?

Question 18

Tumour location in the oral cavity can determine risk of spread. How so?

Answer 18

The more posterior the tumour is, the greater chance of spread (more vascularity and lymphatics)

Question 19

Describe the TNM staging system.

Answer 19

T = size (T1, T2 2-4cm diameter, T3, T4 >4cm and invading local structures)
N = condition of regional lymph nodes (N0, N1 ipsilateral, N2 contra/bilateral, N3 fixed)
M = metastases (M0, M1)

Stage 1 = T1, N0, M0
Stage 2 = T2, N0, M0
Stage 3 = T3, N0, M0 or N1 with any T
Stage 4 = N2/N3 with any T or M1 with any T/N

Stage 1/2 = >50% 5yr survival
Stage 3 = 15-20%
Stage 4 = <5%

Question 20

What are THREE dentally relevant side effects of radiotherapy? Which is generally a long term side effect?

Answer 20

• Mucositis
• Xerostomia (caries, candida, taste - long term)
• Osteoradionecrosis

Question 21

What are the suffixes for benign and malignant lesions?

Answer 21

“oma” = benign (e.g. osteoma)

“carcinoma” (epithelial) or “sarcoma” (mesenchymal) = malignant (e.g. osteosarcoma)

Question 22

Give examples of benign and malignant fibrous tumours and one fact for each.

Answer 22

Benign
- Solitary fibrous tumour (collagenous)
- Myxoma (myxoid stroma = non-collagenous, lots of ground substance)
Malignant
- Fibrosarcoma (most common malignant mesenchymal tumour in oral/oropharynx with many pts <20yo - painless growth)

Question 23

Name benign and malignant tumours for:

• Fat
• Muscle
• Endothelium
• Nerve

Answer 23

• Fat (lipoma, liposarcoma)
• Muscle (leiomyoma, leiosarcoma, rhabdomyosarcoma)
• Endothelium (angioma, angiosarcoma)
• Nerve (schwannoma, neurofibroma - both benign)

Question 24

Do malignant peripheral nerve sheath tumours appear radioopaque or radiolucent?

Answer 24

Radiolucent

Question 25

Granular cell tumour and granular cell epulis: - Clinical appearance - Location - Histology

Answer 25

Granular cell tumour (found on the tongue) Granular cell epulis (on newborns alveolar ridge) Both - Painless smooth swellings (benign) - Histology: cells with granular cytoplasm

Question 26

What is a lymphoma and where would we find non-hodgkin lymphoma vs. hodgkin lymphoma?

Answer 26

``` Lymphoma = tumour of the lymphoid cells Non-hodgkin = palate, gingiva, tongue Hodgkin = Waldeyer's ring (palatine tonsil), rarely oral cavity ```

Question 27

Metastatic tumours generally present as radioopaque or radiolucent?

Answer 27

Radiolucent