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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''''' | '''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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===Microscopic=== | ===Microscopic=== | ||
:See ''[[candidiasis]]''. | :See ''[[candidiasis]]''. | ||
==Hairy leukoplakia== | |||
===General=== | |||
Features:<ref name=Ref_PBoD777>{{Ref PBoD|777}}</ref> | |||
*Oral lesion. | |||
**Often on [[tongue]]. | |||
*Caused by [[EBV]].<ref name=pmid2169222>{{Cite journal | last1 = Kanitakis | first1 = J. | last2 = Zambruno | first2 = G. | last3 = Marchand | first3 = C. | last4 = Perret-Liaudet | first4 = P. | last5 = Hermier | first5 = C. | last6 = Thivolet | first6 = J. | title = [Oral hairy leukoplakia in AIDS. Histologic and ultrastructural study of 8 cases]. | journal = Ann Dermatol Venereol | volume = 117 | issue = 5 | pages = 345-53 | month = | year = 1990 | doi = | PMID = 2169222 }}</ref> | |||
**May be seen in the context of a [[HIV]]-infection.<ref>{{Cite journal | last1 = Itin | first1 = PH. | last2 = Lautenschlager | first2 = S. | title = Viral lesions of the mouth in HIV-infected patients. | journal = Dermatology | volume = 194 | issue = 1 | pages = 1-7 | month = | year = 1997 | doi = | PMID = 9031782 }}</ref> | |||
===Gross=== | |||
*White confluent patches (icing sugar) - usu. tongue. | |||
DDx: | |||
*See ''[[leukoplakia]]''. | |||
Images: | |||
*[http://hardinmd.lib.uiowa.edu/cdc/6061.html Hairy leukoplakia (uiowa.edu)]. | |||
===Microscopic=== | |||
Features:<ref>URL: [http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia].</ref> | |||
*Hyperkeratosis (thicker stratum corneum).<ref>URL: [http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis].</ref> | |||
*Acanthosis (thicker stratum spinosum).<ref>URL: [http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis].</ref> | |||
*"Balloon cells" in upper stratum spinosum - perinuclear clearing. | |||
==Oral condyloma== | |||
===General=== | |||
*Benign. | |||
*Sexually transmitted.<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref> | |||
*Typically seen in young adults. | |||
===Gross=== | |||
*Polypoid projection with a broad base. | |||
*Usually palate or labia.<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref> | |||
===Microscopic=== | |||
Features: | |||
*Broad papillary projections with rounded contours. | |||
*No hyperkeratosis. | |||
DDx:<ref name=Ref_HaNP246>{{Ref HaNP|246}}</ref> | |||
*[[Squamous papilloma]] - thinner papillary projections, often branch. | |||
*[[Verruca vulgaris]] - church spire-like projections, hyperkeratosis and parakeratosis. | |||
*Squamous cell carcinoma. | |||
Image: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020353/figure/f4-cln_65p1383/ Condyloma acuminatum (nih.gov)].<ref name=pmid21340231>{{Cite journal | last1 = Reis | first1 = HL. | last2 = Ferreira | first2 = DC. | last3 = Forattini | first3 = AG. | last4 = Souza | first4 = PG. | last5 = Curvelo | first5 = JA. | last6 = Passos | first6 = MR. | title = Genital and oral human papillomavirus infection in a patient from the group of women who have sex with women. | journal = Clinics (Sao Paulo) | volume = 65 | issue = 12 | pages = 1383-5 | month = | year = 2010 | doi = | PMID = 21340231 | PMC = 3020353 }}</ref> | |||
===Sign out=== | |||
<pre> | |||
LESION, PALATE, EXCISION: | |||
- ORAL CONDYLOMA. | |||
</pre> | |||
=Oral neoplasms= | =Oral neoplasms= | ||
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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> | ||
{{Main|Oral fibroma}} | |||
=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]]. | ||
***[[Blue nevus]]. | ***[[Blue nevus]]. | ||
***[[Malignant melanoma]]. | ***[[Malignant melanoma]] - classically hard palate.<ref name=pmid22956033/> | ||
==Melanotic macule== | |||
===General=== | |||
*Benign. | |||
*Clinically apparent lesion. | |||
===Gross=== | |||
*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: | |||
*[http://ocw.tufts.edu/Content/51/lecturenotes/551831/552087 Melanotic macule - labia (tufts.edu)]. | |||
===Microscopic=== | |||
Features - either or both of the following:<ref name=pmid289929/> | |||
#Pigmented basal cell layer. | |||
#Pigment incontinence - (dermal) macrophages with pigment (melanin). | |||
DDx: | |||
*Focal melanosis - ''not'' clinically apparent, i.e. history does not say ''pigmented lesion''. | |||
Image: | |||
*[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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*[http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1077501-1654.jpg Basal melanosis (medscape.com)]. | *[http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1077501-1654.jpg Basal melanosis (medscape.com)]. | ||
==See also | ==Intramucosal melanocytic nevus== | ||
*Abbreviated ''IMN''. | |||
*[[AKA]] ''intramucosal melanocytic nevus''. | |||
===General=== | |||
*Most common oral nevus.<ref>URL: [http://emedicine.medscape.com/article/1079272-overview http://emedicine.medscape.com/article/1079272-overview]. Accessed on: 10 December 2012.</ref> | |||
**Second most common is the [[blue nevus]]. | |||
*Essentially an ''[[intradermal melanocytic nevus]]''. | |||
===Microscopic=== | |||
Features: | |||
*Symmetrical lesion. | |||
*"Matures" with depth | |||
**Less cellular with depth | |||
**Less nuclear atypia with depth. | |||
**Smaller cells with depth. | |||
**Smaller nests with depth. | |||
**Rare mitoses (superficial). | |||
***No deep mitoses. | |||
*No destruction of surrounding structures. | |||
*No [[nucleoli]]. | |||
===Sign out=== | |||
<pre> | |||
PALATE LESION, PUNCH BIOPSY: | |||
- INTRAMUCOSAL MELANOCYTIC NEVUS. | |||
</pre> | |||
==Amalgam tattoo== | |||
===General=== | |||
*Benign and common. | |||
*Material from a dental filling.<ref name=Ref_HaNP215>{{Ref HaNP|215}}</ref> | |||
*May be confused with a [[melanocytic lesion]]. | |||
===Gross=== | |||
*Pigmented lesion. | |||
Image: | |||
*[http://www.surgical-dentistry.info/AmalgamTattoo.html Amalgam tattoo (surgical-dentistry.info)]. | |||
===Microscopic=== | |||
Features:<ref name=Ref_HaNP216>{{Ref HaNP|216}}</ref> | |||
*Fine powdery black material in the subepithelial tissue - '''key feature'''. | |||
**May be clumped. | |||
**Found between collagen fibres. | |||
*+/-Foreign body-type [[giant cells]] - uncommon. | |||
DDx: | |||
*[[Melanocytic lesions]]. | |||
*Other [[pigmented material]]. | |||
====Images==== | |||
<gallery> | |||
File:Amalgam_tattoo-1.jpg | Amalgam tattoo. (WC/Bernhard138) | |||
File:Amalgam_tattoo-2.jpg | Amalgam tattoo. (WC/Bernhard138) | |||
File:Amalgam_tattoo-3.jpg | Amalgam tattoo. (WC/Bernhard138) | |||
</gallery> | |||
www: | |||
*[http://dermatlas.med.jhmi.edu/image/amalgam_tattoo_1_090401 Amalgam tattoo (jhmi.edu)]. | |||
===Sign out=== | |||
<pre> | |||
MOUTH, BIOPSY: | |||
- AMALGAM TATTOO. | |||
- SQUAMOUS MUCOSA WITH PARAKERATOSIS. | |||
- SUBEPITHELIAL CALCIFICATIONS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=See also= | |||
*[[Head and neck cytopathology]]. | *[[Head and neck cytopathology]]. | ||
*[[Odontogenic tumours and cysts]]. | *[[Odontogenic tumours and cysts]]. | ||
*[[Tongue]]. | |||
*[[Tonsil]]. | |||
=References= | |||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Head and neck pathology]] | [[Category:Head and neck pathology]] |
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