Revision as of 09:24, 30 July 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]

Pseudomembranous (thrush).
Erythematous.
Hyperplastic.

Microscopic

See candidiasis.

Hairy leukoplakia

General

Features:^[1]

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

Gross

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

DDx:

See leukoplakia.

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:

Condyloma acuminatum (nih.gov).^[8]

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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]

Multiple oral fibromas may be seen in Cowden disease.^[12]^[13]
Histologically similar to fibrous papule.^[14]

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]

Diffuse & bilateral:
- Peutz-Jeghers syndrome.
- Addison's disease.
- Drug-induced.
- Smoker's melanosis.
Focal:
- Vascular lesions.
- Amalgam tattoo.
- Melanocytic lesions.

Melanotic macule

General

Benign.

Microscopic

Features:

Pigmented basal cells.

Image:

Melanotic macuole - labia (tufts.edu).

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:

Basal melanosis (medscape.com).

Intramucosal melanocytic nevus

Abbreviated IMN.
AKA intramucosal melanocytic nevus.

General

Most common oral nevus.^[16]
- 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.

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PALATE LESION, PUNCH BIOPSY:
- INTRAMUCOSAL MELANOCYTIC NEVUS.

Amalgam tattoo

General

Benign and common.
Material from a dental filling.^[17]
May be confused with a melanocytic lesion.

Gross

Pigmented lesion.

Image:

Amalgam tattoo (surgical-dentistry.info).

Microscopic

Features:^[18]

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

Amalgam tattoo. (WC/Bernhard138)
Amalgam tattoo. (WC/Bernhard138)
Amalgam tattoo. (WC/Bernhard138)

www:

Amalgam tattoo (jhmi.edu).

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

References

↑ ^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.
↑ 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.
↑ Itin, PH.; Lautenschlager, S. (1997). "Viral lesions of the mouth in HIV-infected patients.". Dermatology 194 (1): 1-7. PMID 9031782.
↑ URL: http://www.pathologyoutlines.com/oralcavity.html#hairyleukoplakia.
↑ URL: http://www.emedicine.com/asp/dictionary.asp?keyword=hyperkeratosis.
↑ URL: http://www.emedicine.com/asp/dictionary.asp?keyword=acanthosis.
↑ ^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.
↑ 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/.
↑ 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.
↑ URL: http://emedicine.medscape.com/article/1080948-overview#aw2aab6b3. Accessed on: 20 August 2012.
↑ ^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.
↑ 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.
↑ Oliveira, MA.; Medina, JB.; Xavier, FC.; Magalhães, M.; Ortega, KL. (2010). "Cowden syndrome.". Dermatol Online J 16 (1): 7. PMID 20137749.
↑ ^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.
↑ ^15.0 ^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.
↑ URL: http://emedicine.medscape.com/article/1079272-overview. Accessed on: 10 December 2012.
↑ Ref NaNP|215
↑ Template:Ref NaNP

[Ref_PBoD777-1] 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.

[pmid2169222-2] 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.

[Ref_HaNP246-7] 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.

[pmid21340231-8] 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/.

[Ref_Sternberg5_775-9] 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.

[Ref_HaNP240-11] 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.

[pmid16878060-12] 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.

[pmid20137749-13] Oliveira, MA.; Medina, JB.; Xavier, FC.; Magalhães, M.; Ortega, KL. (2010). "Cowden syndrome.". Dermatol Online J 16 (1): 7. PMID 20137749.

[pmid20421776-14] 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.

[pmid15530266-15] 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] URL: http://emedicine.medscape.com/article/1079272-overview. Accessed on: 10 December 2012.

[Ref_NaNP215-17] Ref NaNP|215

[Ref_NaNP216-18] Template:Ref NaNP

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@@ Line 108: / Line 108: @@
 **Amalgam tattoo.
 **[[Melanocytic lesions]].
-***Melanotic [[macule]].
+***[[Melanotic macule]].
 ***[[Blue nevus]].
 ***[[Malignant melanoma]].
+==Melanotic macule==
+===General===
+*Benign.
+===Microscopic===
+Features:
+*Pigmented basal cells.
+Image:
+*[http://ocw.tufts.edu/Content/51/lecturenotes/551831/552086 Melanotic macuole - labia (tufts.edu)].
 ==Smoker's melanosis==

Difference between revisions of "Oral pathology"

Revision as of 09:24, 30 July 2013

Odontogenic tumours and cysts

Oral infections

Oral candidiasis

General

Microscopic

Hairy leukoplakia

General

Gross

Microscopic

Oral condyloma

General

Gross

Microscopic

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Oral neoplasms

Peripheral fibroma

General

Microscopic

Sign out

Pigmented lesions of the oral cavity

Melanotic macule

General

Microscopic

Smoker's melanosis

General

Gross

Microscopic

Intramucosal melanocytic nevus

General

Microscopic

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Amalgam tattoo

General

Gross

Microscopic

Images

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See also

References

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