Hyperplastic, Neoplastic and Related Disorders of Oral Mucosa

LAB Dr. Rima Safadi

Leaf Fibroma

Giant cell fibroma

Multinucleated fibroblasts Tongue dorsum

Denture irritation hyperplasia

Hyperplastic epithelium Hyperplastic fibrous tissue

Papillary palatal hyperplasia

Psuedoepitheiomatous hyperplasia

13 year old female



This 13 year-old yearfemale is referred for evaluation of an asymptomatic, 1 x 1.5 asymptomatic, mm mass in the right buccal mucosa in the premolar area at the level of the occlusal plane. The patient plane. wears full orthodontic appliances. She appliances. believes that the lesion was present before she started the orthodontic treatment one year ago.

Courtesy of Dr. Hellstein, UIowa

Differential Diagnosis


List
1 2 3 4 5

Hyperplastic epithelium

Granular cells

Diagnosis??

Granular Cell Tumor



Microscopic features
Pseudoepitheliomatou s hyperplasia of overlying stratified squamous epithelium Large cells with granular, eosinophilic cytoplasm


Granules: lysosomes

Pseudo Epitheliomatous Hyperplasia

PEH

Patient: 17 year old female

Chief Complaint: NonNon-tender swelling of the left posterior buccal mucosa of 2 months duration.

What is your Clinical Diagnosis and Management?

Clinical Differential Diagnosis of Localized Soft Tissue Enlargements with a normal mucosa: mucosa: Benign mesenchymal tumors (irritation fibroma, schwannoma, neurofibroma, lipoma) Benign salivary gland tumors Low grade salivary adenocarcinomas

Management in this case: Excisional biopsy.

Irritation fibroma
 Histopathology

Hypocellular fibrous tissue

Patient:19-year-old male Patient:19-yearChief Complaint: Referred by Internal Medicine to evaluate for possible odontogenic cause of right submandibular swelling.

Hodgkins lymphoma

lymphocytes

Reed Sternberg cell

Histopathologic Findings Hodgkins lymphoma

26 year old woman

26 year old woman



Clinical Findings: A diffuse, compressible, nonnontender, purple surface lesion is present on the left soft palate.

What is your Clinical Diagnosis and Management?

Differential Diagnosis of Intravascular Blood Lesions Lesions Surface Lesions: Hemangioma Varix Kaposis sarcoma

Clinical Diagnosis: Hemangioma Management: No treatment

Kaposi Sarcoma

Cellular hemangioma

Endothelial cells

AVM
Thick walled

Thin walled vein

Sublingual varicosities

Sturge Weber Syndrome

Hereditary hemorrhagic telangiectasia

 

AD Multiple dilated malformed capillaries

Skin and mucous membranes and organs

Nose bleeding

Patient: 10 year old male

Chief Complaint: History of a tongue lesion since the patient was 6 months of age. The lesion is currently asymptomatic and slowly enlarging.

A diffuse,

compressible, nontender enlargement is present in the anterior dorsum of the tongue. No thrill or bruit evident.

Lymphangioma

Lymphatic fluid

Cystic Hygroma


Early in development of lymphatic changes

Large fluctuant swelling  10 cm in diameter  May extend to base of the tongue and floor of the mouth


Hemangioma

Patient: 18 year old female

Third recurrence of non tender gingival swelling.

What is your Clinical Diagnosis and Management?

Epulides
 Types:

Fibrous epulis, chronic hyperplastic gingivitis pyogenic granuloma Peripheral giant cell granuloma Peripheral ossifying fibroma Peripheral odontogenic fibroma

Management: Excisional biopsy.

Peripheral giant cell granuloma

Peripheral ossifying fibroma

Bone formation

Cellular fibrous stroma

Pyogenic granuloma
Vascular spaces

Clinical findings
Area is firm but movable, somewhat pedunculated and located about 5mm from Stensons duct. It is of unknown duration and nonpainful to palpation.

Schwannoma

Capsule

Schwannoma

Schwannoma
 Microscopic

features:

Rows of cells with palisading nuclei S-100 stain is positive (neural origin) No neurites (nerve fibers) passing through

Neurofibroma

Neurofibroma

Neurofibroma

Wavy spindeled cells

Neurofibromatosis
CafCaf-au lait spots Other findings: axillary freckeling Malignant transformation In 5-15% of cases 5-

Traumatic neuroma

Nerve bundels

Lipoma

liposarcoma

Lipoblasts with pleomorphic nuclei

Ulcerative enlargement of the hard palate

NonNon-Hodgkin's lymphoma

Starry Sky pattern in Burkitt`s lymphoma

are not neoplastic  Small closely packed malignant cells
 Macrophages

Aggressive fibromatosis

Fibrosarcoma

Lethal midline granuloma Tcell lymphoma