Week 4

Question 1

Can Leukoplakia be definitively Diagnosed via a biopsy?

Answer 1

NO, the Pathologist will simply say that it is a high probability, but the diagnosis can only be made by the clinician.

Question 2

What is the most important about CLINICAL characteristics while LOOKING at the lesion for leukoplakia?

Answer 2

The margins are EXTREMELY well defined.

-No feathering, very distinct change from normal to “white”

Question 3

Two broad categories for Leukoplakia?

How do you decide between them?

Answer 3

Homogenous and NON-Homogenous

The clinical look of the lesion.

Question 4

Frictional keratosis has what clinical appearance that would NOT make it Leukoplakia?

Answer 4

Feathered margins! Not well defined.

Question 5

Clinical look of homogenous Leukoplakia? (3)

Answer 5

1. Smooth
2. Cracked Mud
3. Slightly opaque

Question 6

Clinical look of NON-homogenous Leukoplakia? (3)

Answer 6

1. Rough
2. Very Opaque
3. Ragged margins

Question 7

Differential for Leukoplakia? (5)

Answer 7

1. Frictional Keratosis
2. Lichen Planus
3. SLE
4. Candida
5. Hairy Leukoplakia (HHV-4)

Question 8

Most to least common location of Leukoplakia? (3/5)

1. Most common
2. (2)
3. (2)

Answer 8

1. Vestibule (most common)
2. Palate, Lip
3. Tongue, FOM

Question 9

Most common sites positive for malignancy? (5)

Answer 9

1. FOM
2. Tongue
3. lip
4. Palate
5. Vestibule

Question 10

Is the severity of Leukoplakia (malignant transformation) worse for those with risk factors (smoking) or without?

Answer 10

It is more often that when a Leukoplakia presents, that if there is not a risk factor, it is MORE likely to be malignant!

Question 11

Proliferative Verrucous Leukoplakia.
-Who?
-

Answer 11

60-70 Y.o. Women (women over 40)

Question 12

Proliferative Verrucous Leukoplakia

-Clinical presentation?

Answer 12

1. Multiple NON-homogenous white plaques

2. Recurring plaques

Question 13

Proliferative Verrucous Leukoplakia

-Malignancy rates

Answer 13

80-100% Transformation to Cancer

Question 14

Fraction of the Epithelium that is dysplastic to Term as Mild, moderate, severe, and In Situ?

Answer 14

Mild-33%
Mod-50%
Sev-66%
In Situ- 100%

Question 15

Most white lesions have this descriptive characteristic (morphology)?

Answer 15

Most white lesions are PLAQUES

Question 16

4 Reasons the lesions appear white

Answer 16

1. Less vascularity
2. Hyperplasia
3. Thickened keratin
4. Edema

Question 17

White lesion examples

that CAN be wiped off

Answer 17

1. Pseudomembranous candidiasis
2. Burns
3. Sloughing traumatic lesions
4. Na+ Lauryl Sulfate Rxn

Question 18

First two concerns when a white lesion is found?

Answer 18

1. How long?

2. Can I scrape it off the surface?

Question 19

Leukoedema

-What is pathognomonic for Leukoedema

Answer 19

Disappears when stretched

Question 20

Leukoedema

• Pain?
• Race?
• Bilateral?

Answer 20

Pain: Painless
Race: African Americans
Bilateral: Yes, bilateral lesions

Question 21

Leukoedema HISTOPATHOLOGY (2)

• Nuclei/Cytoplasm
• Layer of _________ Edema

Answer 21

• Nuclei are Pyknotic (small, bold, purple)

- Spinous Layer has INTRAcellular swelling

Question 22

Leukoedema treatment?

Answer 22

NONE

Question 23

White Sponge Nevus

• Pain
• Age
• Bilateral?

Answer 23

Pain-NONE
Age-PrePubertal
Bilateral-YES

Question 24

White Sponge Nevus

• Other involved locations(4)
• 1 Location specifically NOT involved

Answer 24

1. Eso NOT involving the EYES
2. Anus
3. Vagina
4. Vulva

Question 25

White Sponge Nevus | -Where do you find the oral lesions?

Answer 25

ANYWHERE!!!!

Question 26

White Sponge Nevus Histopathology(2) -Perinuclear -The epithelium is ortho or Para?

Answer 26

Perinuclear eosinophilic condensation of Cytoplasm ***of the Prickle cells Parakeratosis (should be ortho)

Question 27

White Sponge Nevus treatment?

Answer 27

None

Question 28

Hereditary Benign Intraepithelial Dyskeratosis - Age - Race? * HBID/Witkop's disease

Answer 28

- Age is BABY | - Race is Triracial, white, Native American and African American

Question 29

Hereditary Benign Intraepithelial Dyskeratosis | -Lesion locations (2)

Answer 29

Oral (anywhere) | Eyes

Question 30

Hereditary Benign Intraepithelial Dyskeratosis | -Location of oral lesions

Answer 30

ANYWHERE!

Question 31

Hereditary Benign Intraepithelial Dyskeratosis | -Histopath(3)

Answer 31

Hyperplasia Intracellular edema (with acanthosis) Big ass Keratinocytes

Question 32

Hereditary Benign Intraepithelial Dyskeratosis treatment?

Answer 32

NONE | *Refer to Ophthalmologist

Question 33

Reactive lesions List them (6)

Answer 33

1. Frictional Hyperkeratosis 2. Tobacco Keratosis 3. Nicotine Stomatitis 4. Hairy Leukoplakia 5. Hairy Tongue 6. Sloughing from Na+ Lauryl Sulfate

Question 34

Frictional Hyperkeratosis | -Cause?

Answer 34

Traumatic, repetitive movements

Question 35

Frictional Hyperkeratosis | -Location

Answer 35

Found near occlusal table (buccal, Labial, and Lingual)

Question 36

Frictional Hyperkeratosis | -Histopath (2)

Answer 36

Hyperkeratosis (like a callus) | LOW inflammation

Question 37

Frictional Hyperkeratosis | -Treatment

Answer 37

Fix frictional problem

Question 38

$$$$$$$ latin term for Cheek biting (2)

Answer 38

Morsicatio buccarum/Lingulum/Labiorum | -Or frictional keratosis