Difference between revisions of "Oral pathology"

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===Gross===
===Gross===
*Polypoid projection.
*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|426}}</ref>


Revision as of 12:56, 5 April 2013

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.

Odontogenic tumours and cysts

Main article: 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.

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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.[8]
  • AKA oral fibroma.[9][10]

General

  • Most common oral cavity tumour.[10]
  • Female predominance (female:male = 2:1), usually 30-50 years old.[10]

Microscopic

Features:[13]

  • 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.[10]

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TONGUE LESION, BIOPSY:
- FIBROMA.

Pigmented lesions of the oral cavity

A brief DDx of pigmented lesions:[14]

Smoker's melanosis

General

  • Benign.
  • Seen in ~20% of smokers.[14]
  • Presence of find (smoking) dose-dependent, i.e. longer heavier smokers are more likely to have it.

Gross

  • Typically labial gingvia or buccal mucosa.[14]

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.

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. ↑ 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.
  9. ↑ URL: http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3. Accessed on: 20 August 2012.
  10. ↑ 10.0 10.1 10.2 10.3 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.
  11. ↑ 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.
  12. ↑ Oliveira, MA.; Medina, JB.; Xavier, FC.; Magalhães, M.; Ortega, KL. (2010). "Cowden syndrome.". Dermatol Online J 16 (1): 7. PMID 20137749.
  13. ↑ 13.0 13.1 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.
  14. ↑ 14.0 14.1 14.2 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.
  15. ↑ URL: http://emedicine.medscape.com/article/1079272-overview. Accessed on: 10 December 2012.
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