Oral Pathology

Front 1

Neoplasm vs hyperplasia

Back 1

Neoplasm: abnormal proliferation of cells that are relatively free of growth control (autonomous growth, its growth persists even after cessation of evoking stimulus

Hyperplasia: Increased number of cells but this is a controlled proliferation and abates when the inciting stimulus abates

Front 2

Ddx of red lesions on gums

Back 2

- Pyogenic granuloma

- Peripheral giant cell granuloma

- Peripheral ossifying fibroma

- Inflamed fibroepithelial polyp

- Hemangioma

- Parulis

Front 3

Ddx of 3 week ulcer on side of tongue (>3wks implies long-term ulcer)

Back 3

• Trauma: persistent trauma
• Infection: bacterial - syphilis, TB; deep fungal- histoplasmosis, blastomycosis
• Neoplastic: oral cancer (SSC)
• Degenerative: RAU, TUGSE (traumatic ulcerative granuloma with stromal eosinophilia)
• Necrotizing Sialometaplasia

Front 4

Kaposi Sarcoma: HHV-8

Back 4

• Angiosarcoma that occurs in patients with HIV/AIDS
• Macular or nodular, single or multiple
• Predilection for palate, gingiva and skin
• Also seen in old men from Mediterranean basin, and extremities of blacks in Africa
• Ddx: hemangioma, erythroplakia, melanoma and pyogenic granuloma
• Tx: possibly surgery, chemotherapy or low dose radiation (or a combo)

Front 5

Hairy leukoplakia

Back 5

• White patches of the lateral borders of the tongue that have a tendency for vertical linear folds found in latent stages of HIV-infected patients.
  
• Thickened epithelium contains an upper zone of clear cells (Kilobytes)
• Most contain: EBV (causative agent)
• Is it premalignant? -> NO!

Front 6

Primary or Recurrent Herpes look the same histologically? T or F

Back 6

TRUE:

• Ballooning degeneration of individual keratinocytes that lose contact with adjacent cells resulting in pacantholysis
• Viral inclusions are evident
• Degenerating fused and multinucleate edematous epithelial cells can be seen

Front 7

Leukoplakia risk factors:

Back 7

• Hx of oral cancers
• Appearance of lesion: Homogeneous vs non homogeneous, vs erythroplakia
• Site: ventrolateral tongue, floor of mouth, soft palate complex
• Size: incr. risk with larger size (<2cm, 2-4cm, >4cm); Incr # of sites incr. risk
• Others: increased duration, female, non-smokers (genetics)

Front 8

Management of leukoplakia

Back 8

• Eliminate cause (2-4wks no change) -> biopsy
• Complete excision if SEVERE or CIS
• Mild/moderate -???

Front 9

Key histologic features of lichen planus

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• Liquefactive degeneration of basal cells
  
• Well defined band of lymphocytes (T-cells) hugging the BM
• Hyperparakratosis or hyperorthokeratosis
• "Saw toothed" rete ridges

Front 10

Blue-black lesion in buccal vestibule for 6 yrs: what do you do?

Back 10

• Take a history of the lesion
  
• Look for an aetiology
• Ddx: drugs, heavy metals, nevus, melanoma, amalgam tattoo

Front 11

Bilateral lacey lesion and red inflammed gingiva: where do you take the biopsy? do you need to biopsy?

Back 11

• Take a history and look for aetiology
  
• Biopsy the worst looking area and involve some normal tissue
• If you're unsure of the diagnosis clinically then biopsy

Front 12

Pathology report of "CMV infection" what do you do next?

Back 12

• CMV is usually manifests itself in the immunocompromised (HIV/AIDS), organ transplant individuals. Can get a sever ulcer, CMV sialadenitis and mono-like symptoms
• Refer to GP and talk to patient about having immune system checked, if they don't already know about it.

Front 13

Ddx of white non-movable lesion on lateral border of tongue:

Back 13

- Lichen planus

- Hairy leukoplakia

- Friction hyperkeratosis

- etc

Front 14

Ddx of lichen planus

Back 14

• lichenoid reaction
• discoid lupus erythematous
• Lichenoid mucositis (LM): this condition likely reflects an immune response that either mimics that of true OLP, or one that is stimulated by a number of external antigens, principally drugs
• Chronic Graft vs Host disease: This condition arises in patients who have received a bone marrow transplant

Front 15

List 2 causes of xerostomia - Meds, rad and why

Back 15

Medications:

• tobacco, alcohol, caffeine
• Anti-hypertensives: Bblockers, ACEi, furosemide
• Antipsychotics: D2blockade, also blocks histamine, catecholamies, acetylcholine and 5-HT
• Antidepressants: TCAs, SSRIs
• Anti-histamines: older ones
• Urinary drugs: block parasympathetics
• Others: include atropine, benzos, cannabis, ecstasy, retinoids, anti-HIV

Radiation induced pathology:

• >5000 cGy causes permanent salivary gland damage such that acing tissue is replaced with fibrous storm, change in duct epithelium, fatty degeneration, vascular changes

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Back 16

Pemphigus vulgaris

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Pemphigus vulgaris

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Mucous membrane pemphigoid

Front 19

Back 19

Minor aphthous ulcer

Front 20

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Major aphthous ulcer

Front 21

Back 21

Erythema multiforme

Front 22

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Lupus erythematosus

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Squamous cell carcinoma, floor of mouth

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Squamous cell carcinoma, gingiva

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Hyperkeratosis, edentulous ridge

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Hyperkeratosis, snuff dipper's mouth

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Nicotine stomatitis

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Idiopathic leukoplakia

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Hairy leukoplakia

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Geographic tongue

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Lichen planus

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Lichen planus

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Candidiasis

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Gingival cyst

Front 35

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Vascular malformation

Front 36

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Pyogenic granuloma

Front 37

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Peripheral giant cell granuloma

Front 38

Back 38

Median rhomboid glossitis (hyperplastic candidiasis)

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geographic tongue

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vitamin B deficiency

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Smoking associated melanosis

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Melanotic macule

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Blue nevus

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Melanoma

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Amalgam tattoo

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Papillary hyperplasia

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Papilloma

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Condyloma latum

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Verrucous carcinoma

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Focal epithelial hyperplasia

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Pyogenic granuloma

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Peripheral ossifying fibroma

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exostosis

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Mucous retention cyst (ranula)

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Lymphoepithelial cyst, lingual frenum

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Focal fibrous hyperplasia

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Mucus extravasation phenomenon (mucocele), mandibular vestibule

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Mucocele

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Focal fibrous hyperplasia

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Mucosal neuromas of multiple endocrine neoplasia syndrome type III

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Mucocele

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Pleomorphic adenoma

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Lymphoma

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Periapical cyst associated with a carious tooth

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Dentigerous cyst

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Lateral root cyst

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KCOT

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Nasopalatine canal cyst

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Traumatic bone cyst

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Static bone cyst

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Ameloblastoma

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Adenomatoid odontogenic tumor

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Odontogenic myxoma

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Periapical cementoosseous dysplasia

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Odontoma

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Ameloblastic fibroodontoma

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Ossifying fibroma

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Osteoblastoma

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Central giant cell granuloma

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Hemangioma

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Focal sclerosing osteitis

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Ranula

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Necrotizing sialometaplasia

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Fibrous dysplasia

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Florid cemento-osseous dysplasia

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Focal cemento-osseous dysplasia

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Periapical cemento-osseous dysplasia

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Focal cemento-osseous dysplasia

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Ossifying fibroma

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Cementoblastoma

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Paget's disease

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Odontogenic myxoma

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Ameloblastic fibro-odontoma

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Ameloblastic fibroma

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Squamous Odontogenic Tumor

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Calcifying epithelial odontogenic tumor

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Calcifying epithelial odontogenic tumor

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Adenomatoid odontogenic tumor

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Calcifying odontogenic cyst (gorlin's cyst)

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Calcifying odontogenic cyst (gorlin's cyst)

shows ghost cells

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Glandular odontogenic cyst (GOC)

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Glandular odontogenic cyst (GOC)

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Glandular odontogenic cyst (GOC)

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Calcifying epithelial odontogenic tumor (CEOT)

- Pindborg Tumor

- "driven snow pattern"

Front 105

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Calcifying epithelial odontogenic tumor (CEOT)

- Pindborg tumor

- Sheets of epithelial tumor cells

- Pools of eosinophilic amyloid deposits

- focal calcification

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Calcifying epithelial odontogenic tumor (CEOT)

- Pindborg tumor

- Liesegang ring calcifications