AGD Oral Pathology and Diagnosis 3 — Questions and Answers
Question 1: A 35-year-old woman presents with painful oral ulcers, skin blistering, and a positive Nikolsky sign. Direct immunofluorescence shows intercellular IgG deposits in a 'chicken-wire' pattern. What is the diagnosis?
- Mucous membrane pemphigoid
- Pemphigus vulgaris (Correct answer)
- Bullous pemphigoid
- Linear IgA disease
Correct answer: Pemphigus vulgaris
Pemphigus vulgaris features intraepithelial acantholysis with intercellular IgG and C3 deposits in a chicken-wire pattern on direct immunofluorescence and a positive Nikolsky sign.
Question 2: Which of the following describes the radiographic appearance of a periapical cemento-osseous dysplasia in its mature stage?
- Well-defined radiolucency at the root apex
- Mixed radiolucent-radiopaque lesion with a radiolucent rim (Correct answer)
- Diffuse radiopacity replacing normal bone pattern
- Multilocular radiolucency with soap bubble appearance
Correct answer: Mixed radiolucent-radiopaque lesion with a radiolucent rim
Mature cemento-osseous dysplasia appears as a predominantly radiopaque mass with a thin radiolucent rim, distinguishing it from condensing osteitis or hypercementosis.
Question 3: A patient presents with lip swelling, facial nerve palsy, and fissured tongue. This triad is diagnostic of which condition?
- Crohn's disease
- Sarcoidosis
- Melkersson-Rosenthal syndrome (Correct answer)
- Orofacial granulomatosis
Correct answer: Melkersson-Rosenthal syndrome
Melkersson-Rosenthal syndrome is characterized by the classic triad of recurrent orofacial edema, relapsing facial nerve paralysis, and lingua plicata (fissured tongue).
Question 4: Histologically, which feature differentiates a traumatic (solitary) bone cyst from other jaw cysts?
- Presence of cholesterol clefts and hemosiderin
- Absence of an epithelial lining with thin fibrous connective tissue wall (Correct answer)
- Orthokeratinized stratified squamous epithelial lining
- Presence of mucous cells and ciliated columnar epithelium
Correct answer: Absence of an epithelial lining with thin fibrous connective tissue wall
Traumatic bone cysts lack an epithelial lining; the cavity is empty or contains scant serosanguineous fluid with a thin fibrous connective tissue wall.
Question 5: Which of the following salivary gland neoplasms is characterized histologically by cribriform 'Swiss cheese' spaces filled with basophilic mucoid material and perineural invasion?
- Pleomorphic adenoma
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma (Correct answer)
- Polymorphous adenocarcinoma
Correct answer: Adenoid cystic carcinoma
Adenoid cystic carcinoma is known for its cribriform pattern with pseudocysts containing basophilic glycosaminoglycans, high rate of perineural invasion, and propensity for late distant metastasis.
Question 6: A biopsy of a painless, soft, fluctuant swelling on the lateral border of the tongue in a 6-year-old reveals a cyst lined by stratified squamous or pseudostratified ciliated columnar epithelium with lymphoid tissue in the wall. What is the diagnosis?
- Dermoid cyst
- Lymphoepithelial cyst (Correct answer)
- Thyroglossal duct cyst
- Epidermoid cyst
Correct answer: Lymphoepithelial cyst
Oral lymphoepithelial cysts are lined by squamous or respiratory epithelium surrounded by dense lymphoid tissue, and are commonly found on the floor of mouth, posterior lateral tongue, or soft palate.
Question 7: Which condition is characterized by multiple hamartomatous polyps of the GI tract, perioral and mucocutaneous melanotic macules, and an increased risk of GI malignancy?
- Gardner syndrome
- Cowden syndrome
- Peutz-Jeghers syndrome (Correct answer)
- Birt-Hogg-Dubé syndrome
Correct answer: Peutz-Jeghers syndrome
Peutz-Jeghers syndrome is caused by STK11 gene mutations and features hamartomatous GI polyps, melanotic macules on lips and oral mucosa, and elevated cancer risk at multiple sites.
AGD Oral Pathology and Diagnosis 3
A 35-year-old woman presents with painful oral ulcers, skin blistering, and a positive Nikolsky sign.
Direct immunofluorescence shows intercellular IgG deposits in a 'chicken-wire' pattern.
What is the diagnosis?