Pathology Midterm 2

  1. What is neoplasia?
    The unregulated formation and growth of new tissue- uncontrolled proliferation.
  2. What is a neoplasm?
    TUMOR- mass of cells that have undergone uncontrolled growth.
  3. What is hyperplasia?
    • Overgrowth of tissue in response to stimuli
    • *Stops when the stimuli is removed
  4. What is dysplasia?
    Disordered growth
  5. What is metastasis?
    Transport of neoplastic cells to parts of the body remote from the tumor
  6. What are the two types of malignant neoplasms?
    1. Carcinoma- cancers of epithelial orgin (squamous/basal cell carcinoma)

    2. Sarcoma- cancers of connective tissue orgin (osteosarcoma/fibrosarcoma)
  7. (Squamous Epithelium Tumors)
    • Benign, exophytic or sessile- core fibrous CT
    • MC: soft palate/tongue
    • White b/c surface keratin

    (resembles: warts)
  8. (Squamous Epithelium Tumors)
    • Generic clinical term- white patch, cannot be rubbed off (b/c hyperkeratosis)
    • PREMALIGNANCY (can show epithelial displasia) *always biopsy
    • 16%= squamous cell carcinoma (malignant)
    • MC: floor of mouth, ventral/lateral tongue
  9. (Squamous Epithelium Tumors)
    • Generic clinical term- red, premalignant speckled leukoplakia (red and white)
    • *Much less common than leukoplakia 60:1, more likely to be dysplasia, squamous cell carcinoma
  10. (Squamous Epithelium Tumors)
    Epithelial dysplasia
    • Histological diagnosis
    • Premalignant
    • Histologically: 
    • -abnormal maturation
    • -hyperplasia of basal cells
    • -disorganization of layers
    • -hyperchromatic nuclei
    • -increased mitotic figures
    • -no invasion through the basement membrane
  11. Carcinoma in situ vs Squamous cell cancer
    Carcinoma in situ: severe dysplasia involving full thickness of epithelium

    Squamous cell cancer: all histological characteristics plus invasion through basement membrane
  12. (Squamous Epithelium Tumors)
    Squamous Cell Carcinoma
    (Epidermoid Carcinoma)
    • Most common malignancy in oral cavity
    • -usually metastasizes to lymph nodes
    • -invasion through basement membrane; keratin pearls (keratin seen in the cells within the tumor)
    • MC: floor of the mouth, ventrolateral tongue, soft palate
    • Assoc. w/ solar/actinic cheilitis
    • Males > 40 --tobacco/alcohol increases risk
  13. What does TNM stand for?
    • T: tumor, what is the size of the primary tumor?
    • N: nodes, which lymph node involvement?
    • M: metastasis, how far has the tumor spread?
    • ***Any pt with metastasis = stage IV***
  14. (Squamous Epithelium Tumors)
    Verrucous Carcinoma
    • A squamous cell carcinoma w/ better prognosis due to slow growth
    • -Exophytic/pebbly
    • -No invasion of basement membrane (rare to metastasize, well differenciated)
  15. (Squamous Epithelium Tumors)
    Basal Cell Carcinoma
    • NOT in oral cavity
    • Raised pearly boarders w/ visible capillary network surrounding a central depressed, crusted area
    • -sun ☀ exposure, ulcer like
    • -rare to metastasize
  16. (Salivary Gland Tumors)
    Pleomorphic Adenoma
    • Most common salivary gland tumor
    • 90% benign -- CAN undergo malignant transformation
    • -CT and ep
    • -Painless, slow enlarging
    • MC: palate
  17. (Salivary Gland Tumors)
    Monomorphic Adenoma
    • -Benign
    • -Epithelium only
    • MC: upper lip
    • -Warthin's Tumor
  18. Papillary Cystadenoma Lymphomatosum
    (Warthin's Tumor)
    • -Special kind of monomorphic adenoma
    • -Epithelial and lymphoid tissue
    • -Benign
  19. (Salivary Gland Tumors)
    Adenoid Cystic Carcinoma
    • Malignant
    • -infiltrates, pain, slow growing
    • -CAN have distant metastasis years later
    • MC: parotid gland (extraoral), palate (intraoral)
  20. (Salivary Gland Tumors)
    Mucoepidermoid Carcinoma
    • Malignant
    • Most common malignant salivary tumor in children
    • -mucous and epithelial cells
    • -slow enlarging
    • -uni/mulilocular, radiolucent, invasive
    • MC: parotid, palate, in bone
    • -low grade tumor 5 year survival: 92%
    • -high grade tumor 5 year survival: 49%
  21. Are most odontogenic tumors benign or malignant?
  22. (Odontogenic Tumors)
    • -Benign, unencapsulated
    • -Bone expansion, painless, slow growing
    • -Locally aggressive
    • -Ameloblast ep cells surrounding stellate reticulum
    • -uni/multilocular, soap bubble
    • -80% mand (ramus/molar areas)
    • -Max (molar areas)
  23. (Odontogenic Tumors)
    Calcifying Epithelial Odontogenic Cyst
    (Pindborg Tumor)
    • -Benign, unique sheets of multi-sided ep cells with calcifications
    • -Remnants of the enamel organ
    • -Uni/multi
    • -Mand > 
    • -premolar/molar
    • -Many assoc w/ impacted teeth

  24. (Odontogenic Tumors)
    Adenomatoid Odontogenic Tumor
    • -Benign, does not recur
    • -Duct-like structures, fibrous CT capsule
    • -70% females under 20, ant max
    • -asymptomatic
    • -well defined RL w/ impacted tooth
  25. (Odontogenic Tumors)
    Calcifying Odontogenic Cyst
    • -Nonaggressive
    • -Radiographic ghost cells (keratin w/ lost nuclei), uni/multi
    • -May resemble ameloblastoma
    • -Males under 40
  26. (Odontogenic Tumors)
    Odontogenic Myoxoma
    • -Benign, unencapsulated
    • -Derived from ectomesenchyme, originates from PDL and pulp
    • -10-30 years
    • -Root resorption and displacement, multi, RL w/ poor margins
  27. (Odontogenic Tumors)
    Central and Ossifying Fibromas
    • -Benign, fibrous CT calcifications
    • -Female 30's and 40's
    • -Well defined, RL
  28. (Odontogenic Tumors)
    Benign Cementoblastoma
    • Cementum tumor
    • Lesion fused to root, tooth may be vital
    • -Well defined RO w/ resorbed apex and RL halo
    • -premolar, molar mand
    • -Younger than 25
    • -Pain
  29. (Odontogenic Tumors)
    Ameloblastic Fibroma
    • -Benign, unencapsulated
    • -Younger than 20
    • -Mandibular premolars
    • -RL may be assoc w/ unerupted tooth
  30. (Odontogenic Tumors)
    • Most common odontogenic tumor
    • -Mature enamel, dentin, cementum, pulp
    • -Females younger than 20
    • -Asymptomatic, found in routine radiographs
  31. What are the two types of odontomas?
    1. Compound: resembles small teeth (cluster of calcified material); ant max

    2. Complex: Masses of tissue NOT resembling a tooth; post mand
  32. (Odontogenic Tumors)
    Peripheral Ossifying Fibroma
    • Well defined sessile/pedunculated/exophytic mass on attatched gingiva
    • -Develops from submucosal CT or PDL
    • -Surface may be ulcerated
  33. (Tumors of Soft Tissue)
    • Most common soft tissue tumor of the body
    • -Benign, adipose cells, yellow
    • -Soft/palpable
    • -Rare recurrence
    • -Around 50 years old

    ***Lipsarcoma: rare in oral cavity, can recur***
  34. (Tumors of Soft Tissue)
    • -Benign, solitary nerve tissue neoplasm
    • MC: Tongue
    • *Neurofibromatosis
  35. What is neurofibromatosis?
    Von Recklinghausen's Disease: multiple neurofibromas
  36. (Tumors of Soft Tissue)
    • -Proliferation of Schwann cells
    • -Nerve pushed aside as tumor grows, slow growing
    • -20-50 years of age
  37. (Tumors of Soft Tissue)
    Granular Cell Tumor
    • -Large cells w/ granular cytoplasm
    • -Tongue, painless
  38. (Tumors of Muscle)
    Rhabdomyoma and sarcoma
    Rhabdomyoma- benign, striated

    • Rhabdosarcoma- malignant, striated, rapid, destructive
    • Most common malignant soft tissue tumor in children
  39. (Vascular Tumors)
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Pathology Midterm 2