Difference between revisions of "Oral pathology"

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Oral pathology (view source)

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'''Oral pathology''' is a domain of dentistry.  In the context of [[anatomical pathology]], it can be lumped with [[head and neck pathology]].  '''''Oral lesions''''' redirects here.
'''Oral pathology''' is a domain of dentistry.  In the context of [[anatomical pathology]], it can be lumped with [[head and neck pathology]].  '''''Oral lesions''''' and '''''oral cavity''''' redirect here.
 
=Normal=
==Normal oral mucosa==
:''Buccal mucosa'' redirect here.
===Microscopic===
*Non-keratinized squamous mucosa.
*No pigmentation.
*No inflammation.
 
=Reactive=
==Benign leukoplakia==
{{Main|Leukoplakia}}
===General===
*Very common finding.
*Biopsied as it may be malignant.
 
===Microscopic===
Features:
*Hyperkeratosis.
*Parakeratosis.
*No nuclear atypia.
*No pigmentation.
*No significant inflammation.
 
DDx:
*Dysplasia.
*[[Squamous cell carcinoma of the head and neck|Squamous cell carcinoma]].
*[[Benign alveolar ridge keratosis]].
 
===Sign out===
<pre>
BUCCAL MUCOSA, RIGHT, BIOPSY:
- SQUAMOUS MUCOSA WITH A COMPACT KERATIN LAYER AND PARAKERATOSIS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show a squamous mucosa with a layer of compact keratin, parakeratosis, and
focal hypergranulosis. There is no inflammation at the interface. Epidermal intercellular
bridges are easily seen. There is no significant nuclear atypia. Mitoses are not evident.
 
==Oral contact mucositis==
===General===
*Inflammatory reaction of irritative agent, e.g. cinnamon-flavoured chewing gum.<ref name=pmid19862397 >{{Cite journal  | last1 = Siqueira | first1 = AS. | last2 = Santos | first2 = CC. | last3 = Cristino | first3 = MR. | last4 = Silva | first4 = DC. | last5 = Pinheiro | first5 = Md. | last6 = Pinheiro | first6 = JJ. | title = Intraoral contact mucositis induced by cinnamon-flavored chewing gum--a case report. | journal = Quintessence Int | volume = 40 | issue = 9 | pages = 719-21 | month = Oct | year = 2009 | doi =  | PMID = 19862397 }}</ref>
*Similar to [[contact dermatitis]].<ref name=pmid2234878/>
 
Note:
*''Oral mucositis'' be seen in the context of radiation treatment.<ref name=pmid21537592>{{Cite journal  | last1 = Lino | first1 = MD. | last2 = Carvalho | first2 = FB. | last3 = Oliveira | first3 = LR. | last4 = Magalhães | first4 = EB. | last5 = Pinheiro | first5 = AL. | last6 = Ramalho | first6 = LM. | title = Laser phototherapy as a treatment for radiotherapy-induced oral mucositis. | journal = Braz Dent J | volume = 22 | issue = 2 | pages = 162-5 | month =  | year = 2011 | doi =  | PMID = 21537592 }}</ref>
 
===Microscopic===
Features:
*+/-Ulceration.<ref name=pmid2234878>{{Cite journal  | last1 = Hay | first1 = KD. | last2 = Greig | first2 = DE. | title = Propolis allergy: a cause of oral mucositis with ulceration. | journal = Oral Surg Oral Med Oral Pathol | volume = 70 | issue = 5 | pages = 584-6 | month = Nov | year = 1990 | doi =  | PMID = 2234878 }}</ref>
 
Image:
*[http://lupusimages.com/browser/detail/2488/histopathology-hyperparakeratosis-with-interface-mucositis Interface mucositis with parakeratosis in lupus (lupusimages.com)].


=Odontogenic tumours and cysts=
=Odontogenic tumours and cysts=
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Images:
Images:
*[http://bestpractice.bmj.com/best-practice/monograph/621/resources/image/bp/6.html Hairy leukoplakia (bestpractise.bmj.com)].
*[http://hardinmd.lib.uiowa.edu/cdc/6061.html Hairy leukoplakia (uiowa.edu)].
*[http://hardinmd.lib.uiowa.edu/cdc/6061.html Hairy leukoplakia (uiowa.edu)].


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===General===
===General===
*Benign.
*Benign.
*Sexually transmitted.<ref name=Ref_HaNP246>{{Ref HaNP|426}}</ref>
*Sexually transmitted.<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref>
*Typically seen in young adults.
*Typically seen in young adults.


===Gross===
===Gross===
*Polypoid projection with a broad base.
*Polypoid projection with a broad base.
*Usually palate or labia.<ref name=Ref_HaNP246>{{Ref HaNP|426}}</ref>
*Usually palate or labia.<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref>


===Microscopic===
===Microscopic===
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*No hyperkeratosis.
*No hyperkeratosis.


DDx:<ref name=Ref_HaNP246>{{Ref HaNP|426}}</ref>
DDx:<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref>
*[[Squamous papilloma]] - thinner papillary projections, often branch.
*[[Squamous papilloma]] - thinner papillary projections, often branch.
*[[Verruca vulgaris]] - church spire-like projections, hyperkeratosis and parakeratosis.
*[[Verruca vulgaris]] - church spire-like projections, hyperkeratosis and parakeratosis.
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*[[AKA]] ''focal fibrous hyperplasia'', [[AKA]] ''peripheral ossifying fibroma, [[AKA]] ''fibroid epulis'' (old term), [[AKA]] ''fibroepithelial polyp''.<ref name=Ref_Sternberg5_775>{{Ref Sternberg5|775}}</ref>
*[[AKA]] ''focal fibrous hyperplasia'', [[AKA]] ''peripheral ossifying fibroma, [[AKA]] ''fibroid epulis'' (old term), [[AKA]] ''fibroepithelial polyp''.<ref name=Ref_Sternberg5_775>{{Ref Sternberg5|775}}</ref>
*[[AKA]] ''oral fibroma''.<ref>URL: [http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3 http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3]. Accessed on: 20 August 2012.</ref><ref name=Ref_HaNP240>{{Ref HaNP|240}}</ref>
*[[AKA]] ''oral fibroma''.<ref>URL: [http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3 http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3]. Accessed on: 20 August 2012.</ref><ref name=Ref_HaNP240>{{Ref HaNP|240}}</ref>
===General===
{{Main|Oral fibroma}}
*Most common oral cavity tumour.<ref name=Ref_HaNP240>{{Ref HaNP|240}}</ref>
*Female predominance (female:male = 2:1), usually 30-50 years old.<ref name=Ref_HaNP240>{{Ref HaNP|240}}</ref>
 
*Multiple oral fibromas may be seen in [[Cowden disease]].<ref name=pmid16878060>{{Cite journal  | last1 = Segura Saint-Gerons | first1 = R. | last2 = Ceballos Salobreña | first2 = A. | last3 = Toro Rojas | first3 = M. | last4 = Gándara Rey | first4 = JM. | title = Oral manifestations of Cowden's disease. Presentation of a clinical case. | journal = Med Oral Patol Oral Cir Bucal | volume = 11 | issue = 5 | pages = E421-4 | month = Aug | year = 2006 | doi =  | PMID = 16878060 }}</ref><ref name=pmid20137749>{{Cite journal  | last1 = Oliveira | first1 = MA. | last2 = Medina | first2 = JB. | last3 = Xavier | first3 = FC. | last4 = Magalhães | first4 = M. | last5 = Ortega | first5 = KL. | title = Cowden syndrome. | journal = Dermatol Online J | volume = 16 | issue = 1 | pages = 7 | month =  | year = 2010 | doi =  | PMID = 20137749 | URL = http://dermatology.cdlib.org/1601/case_reports/cowden/ortega.html }}</ref>
*Histologically similar to [[fibrous papule]].<ref name=pmid20421776>{{Cite journal  | last1 = Fernandez-Flores | first1 = A. | title = Solitary oral fibromas of the tongue show similar morphologic features to fibrous papule of the face: a study of 31 cases. | journal = Am J Dermatopathol | volume = 32 | issue = 5 | pages = 442-7 | month = Jul | year = 2010 | doi = 10.1097/DAD.0b013e3181c47142 | PMID = 20421776 }}</ref>
 
===Microscopic===
Features:<ref name=pmid20421776/>
*Fibrous stroma - '''key feature'''.
**"Very pink" at low power.
*+/-Collagen bundles, may be prominent.
*Prominent (dilated) vessels.
*Overlying (squamous) mucosa benign (flat).
**+/-Hyperkeratosis +/-focal ulceration.<ref name=Ref_HaNP240>{{Ref HaNP|240}}</ref>
 
===Sign out===
<pre>
TONGUE LESION, BIOPSY:
- FIBROMA.
</pre>


=Pigmented lesions of the oral cavity=
=Pigmented lesions of the oral cavity=
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**[[Peutz-Jeghers syndrome]].
**[[Peutz-Jeghers syndrome]].
**[[Addison's disease]].
**[[Addison's disease]].
**Drug-induced.
**Drug-induced - typically [[OCP]] or tetracycline, usu. has an irregular distribution.<ref name=pmid22956033>{{Cite journal  | last1 = Beck-Mannagetta | first1 = J. | last2 = Hutarew | first2 = G. | title = [Pigmented lesions of the oral mucosa]. | journal = Hautarzt | volume = 63 | issue = 9 | pages = 704-9 | month = Sep | year = 2012 | doi = 10.1007/s00105-012-2351-x | PMID = 22956033 }}</ref>
**Smoker's melanosis.
**[[Smoker's melanosis]].
*Focal:
*Focal:
**Vascular lesions.
**Vascular lesions.
**Amalgam tattoo.
**[[Amalgam tattoo]].
**[[Melanocytic lesions]].
**[[Melanocytic lesions]].
***[[Melanotic macule]].
***[[Melanotic macule]].
***[[Blue nevus]].
***[[Blue nevus]].
***[[Malignant melanoma]].
***[[Malignant melanoma]] - classically hard palate.<ref name=pmid22956033/>


==Melanotic macule==
==Melanotic macule==
===General===
===General===
*Benign.
*Benign.
*Clinically apparent lesion.


===Gross===
===Gross===
*Flat pigmented lesion less than 10 mm in size ([[macule]]).
*Flat pigmented lesion less than 10 mm in size ([[macule]]).
*Usually solitary.<ref name=pmid289929>{{Cite journal  | last1 = Buchner | first1 = A. | last2 = Hansen | first2 = LS. | title = Melanotic macule of the oral mucosa. A clinicopathologic study of 105 cases. | journal = Oral Surg Oral Med Oral Pathol | volume = 48 | issue = 3 | pages = 244-9 | month = Sep | year = 1979 | doi =  | PMID = 289929 }}</ref>


Image:
Image:
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===Microscopic===
===Microscopic===
Features:
Features - either or both of the following:<ref name=pmid289929/>
*Pigmented basal cells.
#Pigmented basal cell layer.
*Pigment incontinence - (dermal) macrophages with pigment (melanin).
#Pigment incontinence - (dermal) macrophages with pigment (melanin).
 
DDx:
*Focal melanosis - ''not'' clinically apparent, i.e. history does not say ''pigmented lesion''.


Image:
Image:
*[http://ocw.tufts.edu/Content/51/lecturenotes/551831/552086 Melanotic macule - labia (tufts.edu)].
*[http://ocw.tufts.edu/Content/51/lecturenotes/551831/552086 Melanotic macule - labia (tufts.edu)].
===Stains===
*[[Fontana-Masson stain]] +ve.
*[[Prussian blue stain]] -ve.
===Sign out===
<pre>
LESION, BUCCAL MUCOSA (LEFT), BIOPSY:
- MELANOTIC MACUOLE.
- NEGATIVE FOR DYSPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Micro====
The sections show a non-keratinized squamous mucosa. The squamous epithelium has no
significant pathology and does not have noticeable pigmentation. The subepithelial tissue
has pigmented macrophages (melanophages) and is otherwise unremarkable.
A Fontana-Masson stain marks the pigment (confirming it is melanin).  A Prussian blue
stain is negative.


==Smoker's melanosis==
==Smoker's melanosis==
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===General===
===General===
*Benign and common.
*Benign and common.
*Material from a dental filling.<ref name=Ref_NaNP215>Ref NaNP|215</ref>
*Material from a dental filling.<ref name=Ref_HaNP215>{{Ref HaNP|215}}</ref>
*May be confused with a [[melanocytic lesion]].
*May be confused with a [[melanocytic lesion]].


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*[http://www.surgical-dentistry.info/AmalgamTattoo.html Amalgam tattoo (surgical-dentistry.info)].
*[http://www.surgical-dentistry.info/AmalgamTattoo.html Amalgam tattoo (surgical-dentistry.info)].
===Microscopic===
===Microscopic===
Features:<ref name=Ref_NaNP216>{{Ref NaNP|216}}</ref>
Features:<ref name=Ref_HaNP216>{{Ref HaNP|216}}</ref>
*Fine powdery black material in the subepithelial tissue - '''key feature'''.
*Fine powdery black material in the subepithelial tissue - '''key feature'''.
**May be clumped.
**May be clumped.
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*[[Head and neck cytopathology]].
*[[Head and neck cytopathology]].
*[[Odontogenic tumours and cysts]].
*[[Odontogenic tumours and cysts]].
*[[Tongue]].
*[[Tonsil]].


=References=
=References=
Michael
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