Oral pathology

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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 and oral cavity redirect here.

Odontogenic tumours and cysts

Oral infections

Oral candidiasis

General

  • Due to candida - a fungus.
  • May be associated with immunodeficiency, e.g. AIDS, organ transplant/immunosuppression.

Forms:[1]

  1. Pseudomembranous (thrush).
  2. Erythematous.
  3. Hyperplastic.

Microscopic

See candidiasis.

Hairy leukoplakia

General

Features:[1]

  • Oral lesion.
  • Caused by EBV.[2]
    • May be seen in the context of a HIV-infection.[3]

Gross

  • White confluent patches (icing sugar) - usu. tongue.

DDx:

Images:

Microscopic

Features:[4]

  • Hyperkeratosis (thicker stratum corneum).[5]
  • Acanthosis (thicker stratum spinosum).[6]
  • "Balloon cells" in upper stratum spinosum - perinuclear clearing.

Oral condyloma

General

  • Benign.
  • Sexually transmitted.[7]
  • Typically seen in young adults.

Gross

  • Polypoid projection with a broad base.
  • Usually palate or labia.[7]

Microscopic

Features:

  • Broad papillary projections with rounded contours.
  • No hyperkeratosis.

DDx:[7]

  • Squamous papilloma - thinner papillary projections, often branch.
  • Verruca vulgaris - church spire-like projections, hyperkeratosis and parakeratosis.
  • Squamous cell carcinoma.

Image:

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LESION, PALATE, EXCISION:
- ORAL CONDYLOMA.

Oral neoplasms

Peripheral fibroma

  • AKA focal fibrous hyperplasia, AKA peripheral ossifying fibroma, AKA fibroid epulis (old term), AKA fibroepithelial polyp.[9]
  • AKA oral fibroma.[10][11]

General

  • Most common oral cavity tumour.[11]
  • Female predominance (female:male = 2:1), usually 30-50 years old.[11]

Microscopic

Features:[14]

  • 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.[11]

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TONGUE LESION, BIOPSY:
- FIBROMA.

Pigmented lesions of the oral cavity

A brief DDx of pigmented lesions:[15]

Melanotic macule

General

  • Benign.
  • Clinically apparent lesion.

Gross

  • Flat pigmented lesion less than 10 mm in size (macule).
  • Usually solitary.[17]

Image:

Microscopic

Features - either or both of the following:[17]

  1. Pigmented basal cell layer.
  2. Pigment incontinence - (dermal) macrophages with pigment (melanin).

DDx:

  • Focal melanosis - not clinically apparent, i.e. history does not say pigmented lesion.

Image:

Stains

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LESION, BUCCAL MUCOSA (LEFT), BIOPSY:
- MELANOTIC MACUOLE.
- NEGATIVE FOR DYSPLASIA.
- NEGATIVE FOR MALIGNANCY.

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

General

  • Benign.
  • Seen in ~20% of smokers.[15]
  • Presence of find (smoking) dose-dependent, i.e. longer heavier smokers are more likely to have it.

Gross

  • Typically labial gingvia or buccal mucosa.[15]

Microscopic

Features:

  • Basal melanosis.
  • +/-Melanin incontinence.

Image:

Intramucosal melanocytic nevus

  • Abbreviated IMN.
  • AKA intramucosal melanocytic nevus.

General

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.

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PALATE LESION, PUNCH BIOPSY:
- INTRAMUCOSAL MELANOCYTIC NEVUS.

Amalgam tattoo

General

Gross

  • Pigmented lesion.

Image:

Microscopic

Features:[20]

  • Fine powdery black material in the subepithelial tissue - key feature.
    • May be clumped.
    • Found between collagen fibres.
  • +/-Foreign body-type giant cells - uncommon.

DDx:

Images

www:

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MOUTH, BIOPSY:
- AMALGAM TATTOO.
- SQUAMOUS MUCOSA WITH PARAKERATOSIS.
- SUBEPITHELIAL CALCIFICATIONS.
- NEGATIVE FOR MALIGNANCY.

See also

References

  1. 1.0 1.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 777. ISBN 0-7216-0187-1.
  2. Kanitakis, J.; Zambruno, G.; Marchand, C.; Perret-Liaudet, P.; Hermier, C.; Thivolet, J. (1990). "[Oral hairy leukoplakia in AIDS. Histologic and ultrastructural study of 8 cases].". Ann Dermatol Venereol 117 (5): 345-53. PMID 2169222.
  3. Itin, PH.; Lautenschlager, S. (1997). "Viral lesions of the mouth in HIV-infected patients.". Dermatology 194 (1): 1-7. PMID 9031782.
  4. URL: http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia.
  5. URL: http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis.
  6. URL: http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis.
  7. 7.0 7.1 7.2 Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 426. ISBN 978-0443069604.
  8. Reis, HL.; Ferreira, DC.; Forattini, AG.; Souza, PG.; Curvelo, JA.; Passos, MR. (2010). "Genital and oral human papillomavirus infection in a patient from the group of women who have sex with women.". Clinics (Sao Paulo) 65 (12): 1383-5. PMC 3020353. PMID 21340231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020353/.
  9. Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 775. ISBN 978-0781779425.
  10. URL: http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3. Accessed on: 20 August 2012.
  11. 11.0 11.1 11.2 11.3 Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 240. ISBN 978-0443069604.
  12. Segura Saint-Gerons, R.; Ceballos Salobreña, A.; Toro Rojas, M.; Gándara Rey, JM. (Aug 2006). "Oral manifestations of Cowden's disease. Presentation of a clinical case.". Med Oral Patol Oral Cir Bucal 11 (5): E421-4. PMID 16878060.
  13. Oliveira, MA.; Medina, JB.; Xavier, FC.; Magalhães, M.; Ortega, KL. (2010). "Cowden syndrome.". Dermatol Online J 16 (1): 7. PMID 20137749.
  14. 14.0 14.1 Fernandez-Flores, A. (Jul 2010). "Solitary oral fibromas of the tongue show similar morphologic features to fibrous papule of the face: a study of 31 cases.". Am J Dermatopathol 32 (5): 442-7. doi:10.1097/DAD.0b013e3181c47142. PMID 20421776.
  15. 15.0 15.1 15.2 Kauzman, A.; Pavone, M.; Blanas, N.; Bradley, G. (Nov 2004). "Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations.". J Can Dent Assoc 70 (10): 682-3. PMID 15530266.
  16. 16.0 16.1 Beck-Mannagetta, J.; Hutarew, G. (Sep 2012). "[Pigmented lesions of the oral mucosa].". Hautarzt 63 (9): 704-9. doi:10.1007/s00105-012-2351-x. PMID 22956033.
  17. 17.0 17.1 Buchner, A.; Hansen, LS. (Sep 1979). "Melanotic macule of the oral mucosa. A clinicopathologic study of 105 cases.". Oral Surg Oral Med Oral Pathol 48 (3): 244-9. PMID 289929.
  18. URL: http://emedicine.medscape.com/article/1079272-overview. Accessed on: 10 December 2012.
  19. Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 215. ISBN 978-0443069604.
  20. Thompson, Lester D. R. (2006). Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 216. ISBN 978-0443069604.