Pseudoepitheliomatous hyperplasia

# Which among the following shows pseudoepitheliomatous hyperplasia?
a) Squamous cell carcinoma
b) Basal cell carcinoma
c) Verrucous carcinoma
d) Granular cell myoblastoma

The correct answer is D. Granular cell myoblastoma.

Granular cell myoblastoma is a benign tumor of muscle tissue origin, most commonly involving tongue. The epithelium exhibits pseudoepitheliomatous hyperplasia because of which it is confused with epidermoid carcinoma.

NOTE:
Pseudoepitheliomatous hyperplasia is also seen in:
• Granular cell myoblastoma
• Blastomycosis
• Papillary hyperplasia
• DLE (Discoid lupus erythematosus)


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High rate of Cancer

# Increased incidence of carcinoma is observed with:
a) Homogenous leukoplakia
b) Verrucous leukoplakia
c) Nodular leukoplakia
d) None of the above

The correct answer is C. Nodular Leukoplakia.

Clinically, Leukoplakia is of three types:
A. Homogenous
B. Speckled or Nodular
C. Proliferative verrucous leukoplakia (PVL)

A. Homogenous
• Appears as translucent white, raised area. • It is non-palpable i.e., same as surrounding mucous membrane.
• Differential diagnosis is hyperplastic lichen planus.

B. Speckled or Nodular 
• Raised from surface with red and white areas.
• Mostly seen at the angle of mouth and commissures of lips in chronic smokers.
• Indurations, fissuring and ulcer formation is seen
• The epithelial dysplasia is more common and has more tendency for malignancy.

C. Proliferative verrucous leukoplakia (PVL) 
• First described by Hansen and is associated with a high risk of progression to squamous cell carcinoma.
• May be associated with human papilloma virus (HPV)
• Seen as white papilliferous or cauliflower like growth
• Commonly seen in the region, where the quid is kept for long time
• No fixity is seen
• Differential diagnosis is verrucous carcinoma.


Note:
The forms of leukoplakia according to CURRENT classifications are:
1) Homogeneous: 
Lesions that are uniformly white.
a) Smooth
b) Furrowed (Fissured)
c) Ulcerated

2) Nonhomogeneous nodulospeckled: Lesion with well demarcated raised white areas, interspersed with reddened areas. It is applicable to both color (mixed red and white lesion -erythroleukoplakia) and texture (exophytic, papillary or verrucous).

Proliferative verrucous leukoplakia is a term used to describe a clinically aggressive form or oral leukoplakia with a strong potential for malignant transformation.


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Elephantiasis neuromatosa

# Elephantiasis neuromatosa is a feature of:
a) Von Recklinghausen's disease
b) Neurilemmoma
c) Paraganglioma
d) Multiple endocrine neoplasia syndrome

The correct answer is A. Von Recklinghausen's disease.

Two distinct variants of Elephant man syndrome or von Recklinghausen's neurofibromatosis are known. Type 1 which is often associated with oral lesions and neurofibromatosis 2 (bilateral acoustic neurofibromatosis) is less common and is less frequently associated with obvious peripheral neurofibromatosis or oral lesions.

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Flush Terminal Plane

# If a flush terminal plane is present in the deciduous dentition then the molars will erupt:
a) Initially in class I occlusion
b) Initially in class II occlusion
c) Initially in class III occlusion
d) End to end

The correct answer is D. End to End

Baume's classification of primary molars

Flush terminal plane : 
• The distal surface of upper and lower second deciduous molars are in one vertical plane.
• The permanent molars will erupt in a flush or end on relationship.

Mesial Step:
• The distal surface of lower second deciduous molar is more mesial to that of upper second deciduous molar.
• Mesial step- (normal mesial step of < 2mm, which is more common)- The permanent molars will erupt in Angle's class-I occlusion
• Exaggerated Mesial step of >2 mm- The permanent molars will erupt in Angle's classIII occlusion

Distal Step:
• The distal surface of lower second deciduous molar is distal to that of upper second deciduous molar.
• The permanent molars may erupt in Angle's class-II occlusion.

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Cephalocaudal gradient of Growth

# Growth trends show that in most patients
a) maxilla and mandible grow in unison
b) maxilla grows more rapidly
c) mandible grows at a faster rate than the middle third of the face
d) no such conclusion could be made

The correct answer is: C. mandible grows at a faster rate than the middle third of the face.

The concept of "Cephalo-caudal gradient of growth" says that there is an axis of increased growth extending from the head towards the feet i.e., structures, which are far from brain grow more compared to other parts. When the facial growth pattern is viewed against the perspective of cephalocaudal gradient, it is not surprising that the mandible, being farther away from the brain tends to grow more and later than the maxilla, which is close to brain.

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Primary displacement vs Secondary displacement

# The movement of bone in response to its own growth is termed as:
a) Rotation
b) Secondary displacement
c) Primary displacement
d) Differentiation

The correct answer is C. Primary displacement.

Types of Bone Growth:
Drift: 
Combinations of deposition and resorption occurring in different bones of skull resulting in growth movement towards depositary surface.

Displacement:
• It is the movement of whole bone as a unit.
• In primary displacement, the bone is displaced as a result of its own growth.
• In secondary displacement, the bone gets displaced as a result of growth and enlargement of adjacent bone.

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Histopathological feature of basal cell carcinoma

# Characteristic histopathological feature of basal cell carcinoma is:
a) Nuclear palisading
b) Keratin pearls
c) Psammoma bodies
d) Foam cells

The correct answer is A. Nuclear palisading.

• In nodular basal cell carcinoma, the tumor cells typically have large, hyperchromatic, oval nuclei with little cytoplasm and nests of tumor cells show peripheral cell palisading.

• Keratin pearls are found in squamous cell carcinoma, while Psammoma bodies are concentric lamellated structures found in papillary thyroid carcinoma, meningioma, papillary serous cystadenocarcinoma of the ovary.

• Foam cells are found in verruciform xanthoma.

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