Benign epithelial Tumors

Question 1

Origin and epidemiology:Squamous Cell Papilloma

Answer 1

Surface squamous epithelium.
* Epidemiology: 3% of oral lesions.

Question 2

Squamous Cell Papilloma - Etiology هل هو معدي؟ والعمر

Answer 2

Etiology: Human papilloma viruses (HPV-6 and HPV-11) detected in 50% of cases.
* Contagiousness: Does not seem to be contagious. غير معدي
العقد ال 4 وال 5

Question 3

Squamous Cell Papilloma - Age and Occurrence

Answer 3

• Age: Any age, but more common in the fourth and fifth decades.
• Occurrence: Usually solitary, but multiple lesions are common in immunosuppressed patients.

Question 4

Squamous Cell Papilloma - Clinical Features
شكل
لون
حجم
الم ?

Answer 4

Exophytic papilliferous growth (نمو حلمي زي الحلمه )with numerous finger-like projections (cauliflower-like (قرنبيط)or wart-like appearance(عين سمكه ).
* Color: Normal pink to white or red.
* Pedunculated( ذات عنق ) or sessile(بروز بدون عنق ارقبه ).
* Location: Palate, tongue, lips, buccal mucosa.
* Size: Few millimeters to 3 cm.
* Painless

Question 5

Different diagnosis Squamous Cell Papilloma - Resemblance

Answer 5

Clinically resembles the (common wart )or (verruca vulgaris) (عين السمكه )(caused by HPV-4 and 40).
* Autoinoculation:(تلقيح ذاتي ) May cause papilloma-like lesions intraorally through finger sucking. وضع الاصبع ف الفم وانتقال العدوي

Question 6

Squamous Cell Papilloma - Prognosis

Answer 6

Recurrence is rare in oral lesions, and prognosis is generally good (unlike laryngeal lesions).

Question 7

Squamous Cell Papilloma - Histological Features

Answer 7

Exophytic finger-like projections of stratified squamous epithelium (acanthosis) covered by keratinized surface (may show hyperkeratosis).
* Koilocytes (HPV-altered epithelial cells with perinuclear clear spaces and nuclear pyknosis) piknotic
There is a clear cytoplasm around the shrunk nuclei.

Question 8

Diseases with Multiple Papillomas (Differential Diagnosis)

Answer 8

Cowden’s syndrome
Verruca vulgaris(wart ,vagabond)
Heck’s disease

Question 9

Term: Cowden Syndrome
Or multiple hammarTom syndrome
Etiology

Answer 9

Autosomal dominant inherited condition.حاله وراثية سائده

benign overgrowths called
hamartomas
حاله وراثيه بتجيب benign في كل الجسم تقريبا في اعضاء كتيره
Cowden syndrome is usually caused by mutations (changes)
in the PTEN gene.

Question 10

شكلها Heck’s Disease (Focal Epithelial Hyperplasia)

Answer 10

characterized by multiple white
to pinkish papules that occur
diffusely in the oral cavity.
It shows ‘cobblestone’اهم
appearance clinically.

Question 11

Heck’s disease
العمر
الاسباب

Answer 11

More common in children (3 to 18
years).
 Malnutrition, poor hygiene and low social
condition as well as genetic background also play
an important role.
 HPV-13, 32.
 Not contagious

Question 12

Keratoacanthoma (SeIf-Healing
Carcinoma; Pseudocarcinoma) Eteology

Answer 12

HPV-9,11,13
Sun damage
In immunosuppressed patients.
Chemical carcinogens (pitch and tar).
Trauma
Genetic factors; may associate xeroderma
pigmentosa

Question 13

Keratoacanthoma (SeIf-Healing
Carcinoma; Pseudocarcinoma)
Sex
Age
Site
شكله من بره

Answer 13

Men/women= 2:1
 Age: 50 — 70 years.
 Site: sun-exposed skin
and outer border of the
lip. less common in
darker skinned!!!
individuals.
 Originates in the
pilosebaceous glands.
جمب الغدد الدهنية اللي جمب الشعر مينفعش يبقي داخل الفم
nodule, dome-shaped with
central depression (umbilicated) plugged with keratin.

Question 14

Keratoacanthoma (SeIf-Healing
Carcinoma; Pseudocarcinoma)
Pine?

Answer 14

Painful but non-tender
 Usually solitary.
 The central keratin plug is yellowish,

Question 15

The clinical course of keratoacanthoma can be
divided into three phases :

Answer 15

I- Growth phase:
rapidly enlarging nodule, reaching its full size (1:2 cms) within 6 weeks.
 II- Stationary (ثابت)phase:
Then lesion stabilizes for 6
weeks.
 III- Involution phase(التلف): Spontaneous regression within scar.
6 - 12 months,

Question 16

Keratoacanthoma - Treatment & Prognosis

Answer 16

Only large lesions need surgical excision to avoid
scarring.

Question 17

Keratoacanthoma - Histological Features

Answer 17

Downward proliferating hyperplastic
squamous epithelium covered by thin
layer of abnormal keratin (parakeratin)
with central depression (crater).الفوهه ملينا كراتين
فرط من النسيج وحصله downwar الي الاسفل
‏ may look like invasion karate team
Epithelium Iceland result cutting
As result cutting misdiagnosis
the squamous cell carcinoma?

Acute angle (or “buttress”) is formed between the overlying epithelium and the lesion.

Question 18

Differential
Diagnosi keratoacanthoma

Answer 18

 Squamous cell carcinoma
 Verrucous carcinoma
 Keratoacanthoma is commonly associated with syndromes such as Muir-Torre
syndrome,
Ferguson-Smith syndrome,
xeroderma pigmentosum, and incontinentia
pigmenti.احفظهم كده وخلاص